Fig 1 - uploaded by Vipin Gupta
Content may be subject to copyright.
Source publication
Serrated polyps are considered precursor lesions that account for 15% to 30% of colorectal cancers, and they are overrepresented as a cause of interval cancers. They are difficult to detect and resect comprehensively; however, recent data suggest that high definition endoscopy, chromoendoscopy (via spray catheter, pump or orally), narrow band imagi...
Contexts in source publication
Context 1
... detection of non-adenomatous (serrated) lesions suggested significantly improved detection with either first or second generation "Bright" NBI. 22 With increasing use of NBI, the Workgroup on Serrated Polyps and Polyposis (WASP)-has described classification (also called WASP) for distinguishing between hyperplastic and adenomatous/serrated polyps (Fig. 1). 23 In WASP classification , criterion like "dark spots inside crypt" are more reliable than criterion "irregular shape." Also, it does not incorporate a commonly used criterion in practice, "mucus ...
Context 2
... detection of non-adenomatous (serrated) lesions suggested significantly improved detection with either first or second generation "Bright" NBI. 22 With increasing use of NBI, the Workgroup on Serrated Polyps and Polyposis (WASP)-has described classification (also called WASP) for distinguishing between hyperplastic and adenomatous/serrated polyps (Fig. 1). 23 In WASP classification , criterion like "dark spots inside crypt" are more reliable than criterion "irregular shape." Also, it does not incorporate a commonly used criterion in practice, "mucus ...
Similar publications
Narrow band imaging in Crohns ileatis
Citations
... This is especially relevant for the adenoma dwell time, the time from the appearance of an adenoma until its transition to preclinical CRC. ii) The serrated adenoma pathway, which may account for up to 30% of CRC [90] and may be particularly relevant in the right colon, is not explicitly considered by our model. However, our model has implemented carcinoma directly developing from normal mucosa with a rightcolonic preference that at least indirectly accounts for the serrated adenoma path. ...
Colonoscopy-based screening provides protection against colorectal cancer (CRC), but the optimal starting age and time intervals of screening colonoscopies are unknown. We aimed to determine an optimal screening schedule for the US population and its dependencies on the objective of screening (life years gained or incidence, mortality, or cost reduction) and the setting in which screening is performed. We used our established open-source microsimulation model CMOST to calculate optimized colonoscopy schedules with one, two, three or four screening colonoscopies between 20 and 90 years of age. A single screening colonoscopy was most effective in reducing life years lost from CRC when performed at 55 years of age. Two, three and four screening colonoscopy schedules saved a maximum number of life years when performed between 49–64 years; 44–69 years; and 40–72 years; respectively. However, for maximum incidence and mortality reduction, screening colonoscopies needed to be scheduled 4–8 years later in life. The optimum was also influenced by adenoma detection efficiency with lower values for these parameters favoring a later starting age of screening. Low adherence to screening consistently favored a later start and an earlier end of screening. In a personalized approach, optimal screening would start earlier for high-risk patients and later for low-risk individuals. In conclusion, our microsimulation-based approach supports colonoscopy screening schedule between 45 and 75 years of age but the precise timing depends on the objective of screening, as well as assumptions regarding individual CRC risk, efficiency of adenoma detection during colonoscopy and adherence to screening.
... 10 Patients with SPS should undergo surveillance every 1e2 years once the colon is cleared of larger lesions, and their first-degree relatives should undergo screening every 5 years starting at age 40. 11 The European Hereditary Tumour Group and the European Society of Coloproctology recently produced joint consensus guidelines for the management of Lynch syndrome. 12 These guidelines recommend surveillance with biennial colonoscopy starting from age 25 years for MLH1 and MSH2 mutation carriers and from age 35 years for individuals with MSH6 and PMS2 mutations, with the option of considering 5-yearly colonoscopy in PMS2 mutation carriers. ...
The majority of solid organ malignancies occur sporadically, with approximately 10% of these cancers linked to hereditary cancer syndromes (HCSs). HCSs are caused by gene mutations that result in an increased susceptibility to cancer development and are often inherited in an autosomal dominant pattern (50% risk of transmission to offspring). Individuals carrying these cancer-predisposing genes have different lifetime cancer risks, depending on the gene pene-trance. High penetrance genes convey close to 100% lifetime risk of developing cancer. In contrast, moderate penetrance genes elevate cancer risk to a lesser degree but still significantly enough to be of medical concern. Surgical oncologists play a pivotal role in recognizing these hereditary predispositions through patient family histories and understanding genetic testing eligibility criteria. Genetic counselling and testing are essential, aiding in identifying these risks and guiding tailored investigations and treatments. This article will provide an overview of the current knowledge of HCSs for the main solid tumour subtypes, discuss treatment recommendations, surveillance and prevention in affected individuals.
... CRC develops from two types of precancerous neoplasia: adenomatous polyps and sessile serrated lesions [8]. Polyps that are at higher risk of turning malignant include advanced adenomas (adenomas with a diameter of 1 cm or greater and/or villous features and/or high-grade dysplasia) [8] and advanced serrated lesions (sessile serrated lesions with a diameter of 1 cm or greater and/or with dysplasia, or all traditional serrated adenomas) [9]. Such larger lesions are also more likely to bleed [10][11][12]. ...
Background. Iron deficiency (ID) is a common micronutrient deficiency and the leading cause of anemia worldwide. ID can be caused by chronic occult blood loss from colorectal neoplasia including colorectal cancer (CRC) and advanced precancerous colorectal lesions. Current guidelines recommend colonoscopy in both men and postmenopausal women presenting with ID anemia (IDA). However, there is controversy on the investigation of patients presenting with a lower risk of CRC including younger women with ID and those with nonanemic ID (NAID). There is a need for a triaging tool to identify which ID patients may benefit from colonoscopy. The fecal immunochemical test (FIT) is sensitive for CRC screening in an asymptomatic population, but its role in ID patients is unclear. The aim of this study is to conduct a systematic review to determine the diagnostic accuracy of FIT for detecting CRC and advanced precancerous neoplasia in individuals presenting with ID with or without anemia. Methods and Analysis. This protocol conforms with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols and Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy. A comprehensive search of the MEDLINE, Embase, and Web of Science databases will be undertaken for studies published after 2010 which involve patients with ID, who completed a FIT in the 6 months prior to colonoscopy, with FIT sensitivity and specificity calculated against the reference standard colonoscopy. The search will be limited to studies conducted after 2010 to reduce variability in colonoscopy quality. Risk of bias assessment will be conducted using the Quality Assessment of Diagnostic Accuracy Studies version 2. FIT sensitivity and specificity will be the primary measure of diagnostic accuracy, and data will be analysed using a random effects meta-analysis. Discussion. This review and meta-analysis will be the first to systematically explore the value of the FIT as a triaging tool for patients with ID. This trial is registered with CRD42022367162.
... In our study, almost 40% of serrated polyps were detected in the proximal colon; however, all polyps were hyperplasic unlike other stud- ies where an important proportion of proximal serrated polyps were SSA/Ps and TSAs [30,33,34]. We think this finding could be associated with less experience in the identification of serrated polyps by non-gastrointestinal pathologist and with endoscopist experience in the resection of serrated polyp as was reported in other reports [30,[34][35][36][37]. Studies focused on serrated polyp detection including endoscopy resection technique and histopathological interpretation are necessary to determine factor associated with SDR and the role as a quality metric in a CRC screening program. ...
Background:
The benefit of colorectal cancer screening in reducing cancer risk and related death is unclear. There are quality measure indicators and multiple factors that affect the performance of a successful colonoscopy. The main objective of our study was to identify if there is a difference in polyp detection rate (PDR) and adenoma detection rate (ADR) according to colonoscopy indication and which factors might be associated.
Methods:
We conducted a retrospective review of all colonoscopies performed between January 2018 and January 2019, in a tertiary endoscopic center. All patients ≥ 50 years old scheduled for a nonurgent colonoscopy and screening colonoscopy were included. We stratified the total number of colonoscopies into two categories according to the indication: screening vs. non-screening, and then calculated PDR, ADR and serrated polyp detection rate (SDR). We also performed logistic regression model to identify factors associated with detecting polyps and adenomatous polyps.
Results:
A total of 1,129 and 365 colonoscopies were performed in the non-screening and screening group, respectively. In comparison with the screening group, PDR and ADR were lower for the non-screening group (33% vs. 25%; P = 0.005 and 17% vs. 13%; P = 0.005). SDR was non-significantly lower in the non-screening group when compared with the screening group (11% vs. 9%; P = 0.53 and 22% vs. 13%; P = 0.007).
Conclusion:
In conclusion, this observational study reported differences in PDR and ADR depending on screening and non-screening indication. These differences could be related to factors related to the endoscopist, time slot allotted for colonoscopy, population background, and external factors.
... Multiple polyps in children who underwent a polypectomy colonoscopy were 20% to 50% [7,8], polyps near the sigmoid colon were 10%-50% [9,10] and 3%-15% in the right colon [11,12]. Many juvenile polyps in children, particularly with JPS, are at risk of developing adenomatous changes or even carcinomas in 26%-47% polyp's cases [13,14]. ...
Background and Aim: Polyps of the gastrointestinal tract (GI) are apparent protrusions from the mucosal surface. The majority of polyps is asymptomatic and goes unnoticed; however in symptomatic situations, the most common clinical manifestations include abdominal discomfort, and rectal prolapse, intestinal blockage, and GI bleeding. The present study intended to assess the colorectal polyps characteristics based on clinical, pathological, and endoscopy in children and adolescents. Patients and Methods: This retrospective study was conducted on 78 children and adolescents (<18 years) with colorectal polyps in Gastroenterology Department of DHQ Teaching Hospital and Mufti Mahmood Memorial Hospital, Dera Ismail Khan from January 2020 to September 2022. Participants were assessed for various clinical variables such as age, gender, colonoscopy-related signs and symptoms, polyp identification, symptom’s onset age, duration between colonic polyp’s endoscopic diagnosis and symptoms onset, and intestinal polyps family history. Polyp’s characteristics involved: frequency, histology, morphological type, and distribution. SPSS version 26 was used for data analysis. Results: The overall mean age was 8.6±2.4 years with an age range 3 to 18 years. Of the total 78 colonic polyps, there were 48 (61.5%) male and 30 (38.5%) females. The most prevalent symptom was rectal bleeding present in 94.6% (n=74) cases with 13.8±16 months. Juvenile was the prevalent polyps found in 76.9% (n=60), out of which 96.7% (n=58) were in left colon. The prevalence of Solitary polyps, multiple polyps, familial adenomatous polyposis, and Peutz-Jeghers syndrome (PJS) was 10.3% (n=8), 6.4% (n=5), 3.8% (n=3), and 2.6% (n=2) respectively. Polyposis syndrome cases were more likely to have old age, diarrhea, anemia, and abdominal pain. Peutz-Jeghers syndrome majority patients experienced intestinal partial blockage with acute episodes, abdominal pain, and emergency laparotomy, resulting in increased morbidity. Conclusion: The present study found that clinical signs of polyposis syndrome include anemia, diarrhea, abdominal pain, polypectomy history, and older age at presentation. Despite the fact that the most commonly diagnosed kind of polyp was juvenile colonic polyps, the current investigation recognized a substantial number of polyposis syndromes children, which are related with individual’s higher rate of morbidity. Keywords: Colonic polyps, Clinical features, Endoscopic characteristics, Colonoscopy
... 5 TSA locates in distal colon with BRAF or KRAS mutation, which is thought to develop into BRAF/KRAS-mutant serrated CRC with MSS. 6 Of note, some case studies revealed that lesions arising from serrated pathway showed accelerated carcinogenesis, with reports of rapid transformation from SSL to invasive CRC within several months, 7,8 although there was no definite evidence, 9 and contradictory opinions existed. 10 Furthermore, SSL is easily missed during colonoscopy examination due to its flat appearance. As such, SSLs have become a major cause of interval CRCs after a negative colonoscopy. ...
Background and aims
Approximately one-third of colorectal cancers develop from serrated lesions (SLs), including hyperplastic polyp (HP), sessile serrated lesion (SSL), traditional serrated adenoma (TSA), and SSL with dysplasia (SSLD) through the serrated neoplasia pathway, which progresses faster than the conventional adenoma-carcinoma pathway. We sought to depict the currently unclarified molecular and immune alterations by the single-cell landscape in SLs.
Methods
We performed single-cell RNA sequencing of 16 SLs (including four proximal HPs, five SSLs, two SSLDs, and five TSAs) versus three normal colonic tissues.
Results
A total of 60,568 high-quality cells were obtained. Two distinct epithelial clusters with redox imbalance in SLs were observed, along with upregulation of tumor-promoting SerpinB6 that regulated ROS level. Epithelial clusters of SSL and TSA showed distinct molecular features: SSL-specific epithelium manifested overexpressed proliferative markers with Notch pathway activation, while TSA-specific epithelium showed Paneth cell metaplasia with aberrant lysozyme expression. As for immune contexture, enhanced cytotoxic activity of CD8+ T cells was observed in SLs; it was mainly attributable to increased proportion of CD103+CD8+ tissue-resident memory T cells, which might be regulated by retinoic acid metabolism. Microenvironment of SLs was generally immune-activated, while some immunosuppressive cells (regulatory T cells, anti-inflammatory macrophages, MDK+IgA+ plasma cells, MMP11-secreting PDGFRA+ fibroblasts) also emerged at early stage and further accumulated in SSLD.
Conclusion
Epithelial, immune, and stromal components in the serrated pathway undergo fundamental alterations. Future molecular subtypes of SLs and potential immune therapy might be developed.
... However, a recent study by Dipasquale et al. 9 reported that right colonic polyps were significantly larger than left colonic polyps. 15 We also identified this finding. The underlying cause of this difference in polyp size according to location should be elucidated. ...
Background/aims:
A full colonoscopy is currently required in children and adolescents with colorectal polyps, because of their potential of neoplastic transformation and complications such as intussusception. We aimed to analyze the associations of polyp characteristics in children and adolescents with colorectal polyps. Based on these findings, we also aimed to reevaluate the necessity of conducting a full colonoscopy.
Methods:
Pediatric patients <18 years of age who had undergone a colonoscopic polypectomy and those with <5 colorectal polyps were included in this multicenter, retrospective study. Baseline clinicodemographics, colonoscopic and histologic findings were investigated.
Results:
A total of 91 patients were included. Multivariate logistic regression analysis showed that polyp size was the only factor associated with the presence of any polyps located proximal to the splenic flexure (odds ratio [OR], 2.25; 95% confidence interval [CI], 1.28 to 4.28; p=0.007). Furthermore, polyp location proximal to the splenic flexure and sessile morphology were associated with the presence of any adenomatous polyp (OR, 8.51; 95% CI, 1.43 to 68.65; p=0.023; OR, 18.41; 95% CI, 3.45 to 173.81; p=0.002, respectively).
Conclusions:
In children and adolescents presenting with <5 colorectal polyps, polyp size and the presence of any adenomatous polyp were positively associated with polyp location proximal to the splenic flexure. This finding supports the necessity of a full colonoscopic exam in pediatric patients with colorectal polyps for the detection of polyps before the occurrence of complications such as intussusception or neoplastic transformation.
... Second, using the NICE or JNET classification, the sessile serrated polyps, which are considered as precursors of 15% to 30% of colorectal cancers, are difficult to distinguish from hyperplastic polyps. 10,11 Thus, I would like to know whether the authors have data on this issue. If AIPHP can discriminate between serrated and hyperplastic polyps, it would be a significant differentiating advantage compared to other systems. ...
Background:
Serrated polyps are considered the precursor lesions of colorectal cancer through the serrated pathway. In the present study, we aimed to evaluate and discuss the clinical and endoscopic characteristics and management of serrated polyps.
Methods:
The data of 220 cases with serrated polyps between September 2018 and November 2021 in Shenzhen People's Hospital were retrospectively analyzed.
Results:
Of all these cases, 32 were hyperplastic polyps, 36 were traditional serrated adenomas, 126 were sessile serrated lesions, 25 were SSLs with dysplasia, and one was an unclassified serrated adenoma. Although most patients were males aged ≥50 years and most serrated polyps were located in the distal colon and rectum with a size of 6-10 mm and the shape of type 0-Is, there was no significant difference (P > 0.05). Serrated polyps of ≤5 mm in size and type 0-IIa were mostly removed by cold biopsy forceps. Cold snare polypectomy was primarily used for those of 6-10 mm in size. Endoscopic mucosal resection was used for those of 6-20 mm, and endoscopic submucosal dissection was used for those of ≥20 mm (P < 0.05). All complications occurred in SSL patients with or without dysplasia (P < 0.05).
Conclusions:
Clinical and endoscopic characteristics were beneficial for distinguishing and diagnosing serrated polyps. In addition, management options were crucial to prevent recurrence and progression. However, the detection rate of serrated polyps was relatively low. Therefore, prospective multicenter studies with large samples are necessary to better assess colorectal serrated polyps.
