RESUMEN
BACKGROUND: Cold resection of colorectal lesions is widely performed because of its safety and effectiveness; however, it remains uncertain whether adding submucosal injection could improve the efficacy and safety. We aimed to compare cold endoscopic mucosal resection (C-EMR) versus cold snare polypectomy (CSP) for colorectal lesions. METHODS: We performed a systematic review of randomized controlled trials (RCTs) identified from PubMed, Cochrane Library, and Embase. The primary outcome was complete resection. Secondary outcomes were procedure time, en bloc resection, and adverse events (AEs). Prespecified subgroup analyses based on the size and morphology of the polyps were performed. The random-effects model was used to calculate the pooled risk ratio (RR) and mean difference, with corresponding 95%CIs, for dichotomous and continuous variables, respectively. Heterogeneity was assessed using the Cochran Q test and I 2 statistics. RESULTS: 7 RCTs were included, comprising 1556 patients, with 2287 polyps analyzed. C-EMR and CSP had similar risk ratios for complete resection (RR 1.02, 95%CI 0.98-1.07), en bloc resection (RR 1.08, 95%CI 0.82-1.41), and AEs (RR 0.74, 95%CI 0.41-1.32). C-EMR had a longer procedure time (mean difference 42.1 seconds, 95%CI 14.5-69.7 seconds). In stratified subgroup analyses, the risk was not statistically different between C-EMR and CSP for complete resection in polyps<10 mm or ≥10 mm, or for complete resection, en bloc resection, and AEs in the two groups among nonpedunculated polyps. CONCLUSIONS: The findings of this meta-analysis suggest that C-EMR has similar efficacy and safety to CSP, but significantly increases the procedure time. PROSPERO: CRD42023439605.
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Pólipos del Colon , Resección Endoscópica de la Mucosa , Ensayos Clínicos Controlados Aleatorios como Asunto , Humanos , Resección Endoscópica de la Mucosa/métodos , Resección Endoscópica de la Mucosa/efectos adversos , Pólipos del Colon/cirugía , Pólipos del Colon/patología , Tempo Operativo , Neoplasias Colorrectales/cirugía , Neoplasias Colorrectales/patología , Colonoscopía/métodos , Criocirugía/métodos , Criocirugía/efectos adversos , Resultado del TratamientoRESUMEN
BACKGROUND: Polypectomy is an important treatment option for preventing colorectal cancer. Incomplete polyp resection (IPR) is re-cognized as a risk factor for interval cancer. OBJECTIVE: The primary objective was to evaluate the complete polyp resection (CPR) rate for cold snare polypectomy (CSP) in small non-pedunculated polyps and, secondarily, specimen retrieval and complication rates. METHODS: We prospectively evaluated 479 polyps <10 mm removed by CSP in 276 patients by an inexperienced endoscopist. RESULTS: A total of 476 polyps (99.4%) were resected en bloc. A negative margin (classified as CPR) was observed in 435 polyps (90.8%). An unclear or positive margin (classified as IPR) was observed in 43 cases (9.0%) and 1 case (0.2%), respectively, for an overall IPR rate of 9.2% (44/479). The IPR rate was 12.2% in the first half of cases and 5.9% in the second half (P=0.02). Dividing into tertiles, the IPR rate was 15.0% in the first tertile, 6.9% in the second tertile, and 5.7% in the third tertile (P=0.01). Dividing into quartiles, the IPR rate was 15.8% in the first quartile and 5.9% in the fourth quartile (P=0.03). The IPR rate was 6.3% for type 0-IIa lesions and 14.1% for type 0-Is lesions (P=0.01). For serrated and adenomatous lesions, the IPR rate was 9.2%. Specimen retrieval failed in 3.6% of cases. Immediate bleeding (>30 s) occurred in 1 case (0.2%), treated with argon plasma coagulation. No delayed bleeding or perforation occurred. CONCLUSION: CSP is a safe technique that provides good results for the resection of small non-pedunculated polyps, with a short learning curve.
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Pólipos Adenomatosos , Pólipos del Colon , Neoplasias Colorrectales , Humanos , Pólipos del Colon/cirugía , Pólipos del Colon/patología , Colonoscopía/métodos , Factores de Riesgo , Pólipos Adenomatosos/cirugía , Pólipos Adenomatosos/patología , Neoplasias Colorrectales/cirugía , Neoplasias Colorrectales/patologíaRESUMEN
INTRODUCTION: colonoscopy is the best method for detecting polyps, with a reduction in colorectal cancer mortality of 29% and reaching 47% for distal tumors. However, it fails to demonstrate a significant reduction in proximal colon cancer mortality, and is the most common segment with interval neoplasm. The present study aimed to evaluate the impact on detection of polyps of a second sequential evaluation of cecum and ascending colon, with or without the use of indigo carmine chromoendoscopy. METHODS: prospective, non-randomized clinical trial. Patients were divided into two groups. The first (G1) underwent a routine colonoscopy, followed by a second endoscopy assessment of ascending colon and cecum. The second group (G2) underwent a routine colonoscopy, followed by a second assessment of the ascending colon and cecum with indigo carmine chromoendoscopy. RESULTS: In total, 203 patients were analyzed, 101 in the G1 and 102 in the G2. Newer polyps were identified in both groups after the second assessment with a significantly higher number of polyps detected in the patients in the G2 (p=0.0001). The number of patients who had at least one polyp in the two endoscopic assessments was significantly higher in the G2 (53 or 52% vs 27 or 26.7%, p=0.0002). In the second endoscopic assessment, the number of polyps found was also significantly higher in the G2 (50 or 76.9%) compared to the G1 (15 or 23.1%), p<0.0001. CONCLUSIONS: the second assessment with dye-based chromoendoscopy increases the detection of polyps in the ascending colon and cecum.
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Adenoma , Pólipos del Colon , Humanos , Colon Ascendente/patología , Pólipos del Colon/diagnóstico , Pólipos del Colon/patología , Carmin de Índigo , Estudios Prospectivos , Adenoma/diagnóstico , Adenoma/patología , Colonoscopía , Ciego/patologíaRESUMEN
BACKGROUND/AIMS: Digital chromoendoscopy has proven to be useful in the histological prediction of premalignant lesions in the colon. The aim of the study was to describe the diagnostic performance of Narrow-Band Imaging International Colorectal Endoscopic Classification in the histological differentiation of colonic lesions, applied by expert endoscopists and trainees. MATERIALS AND METHODS: Cross-sectional study that includes high-definition endoscopic images and histopathological reports of 94 patients over 50 years. Images were evaluated and classified as Narrow-Band Imaging International Colorectal Endoscopic 1, 2, or 3 by 2 experts and 2 trainee endoscopists, all of them blinded to histological results. Diagnostic accuracy for each Narrow-Band Imaging International Colorectal Endoscopic category was calculated for trainees and expert endoscopists. Intra-observer agreement was evaluated by means of Cohen's kappa coefficient; meanwhile, inter-observer agreement was calculated by means of Fleiss' kappa. RESULTS: Evaluations performed by expert and trainee endoscopists showed a performance for Narrow-Band Imaging International Colorectal Endoscopic category 1: sensitivity 62%, specificity 85%, area under receiver operator characteristic 0.73; Narrow-Band Imaging International Colorectal Endoscopic category 2: sensitivity 61%, specificity 73%, area under receiver operator characteristic 0.66; and Narrow-Band Imaging International Colorectal Endoscopic category 3: sensitivity 88%, specificity 91%, area under receiver operator characteristic 0.86. The total agreement of the evaluations was 72.5%, with an inter-observer variability of K 0.60 (95% CI 0.52-0.74). When the diagnostic performance for non-dysplastic lesions and dysplastic lesions (Narrow-Band Imaging International Colorectal Endoscopic 1 vs 2 and 3) was compared, we observed an increase in sensitivity for differentiated adenomas (Narrow-Band Imaging International Colorectal Endoscopic 2). CONCLUSION: Narrow-Band Imaging International Colorectal Endoscopic Classification applied in the histological prediction of static images of colonic lesions has a good diagnostic performance for Narrow-Band Imaging International Colorectal Endoscopic category 3, as well as an acceptable performance for Narrow-Band Imaging International Colorectal Endoscopic category 1, with a moderate agreement among observers.
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Pólipos del Colon , Neoplasias Colorrectales , Humanos , Colonoscopía/métodos , Estudios Transversales , Pólipos del Colon/diagnóstico por imagen , Pólipos del Colon/patología , Imagen de Banda Estrecha/métodos , Neoplasias Colorrectales/diagnóstico por imagen , Neoplasias Colorrectales/patologíaRESUMEN
BACKGROUND: Colorectal cancer is among the most common malignancies worldwide. Colonoscopy is the examination of choice for the prevention of CRC because of its great diagnostic and, especially, therapeutic capacity in relation to adenomatous lesions. AIMS: This study aimed to analyze the prevalence, macroscopic, and histological characteristics of polypoid rectal lesions resected through endoscopic techniques and assess whether endoscopic therapy is safe and efficient for treating lesions located in the rectum. METHODS: This is a retrospective observational study with an analysis of the medical records of all patients undergoing resection of rectal polyps. RESULTS: A total of 123 patients with rectal lesions were evaluated, with 59 men and 64 women of mean age 56 years. All patients underwent endoscopic resection: 70% with polypectomy and 30% with wide mucosectomy. Complete colonoscopy with removal of the entire rectal lesion occurred in 91%, while in 5% the preparation was inadequate and poor clinical conditions were an impeditive factor, and in 4% surgical treatment was indicated because there was an infiltrative lesion with central ulceration. Histological evaluation showed adenomas in 3.25%, hyperplasia in 7.32%, and hamartoma in 0.81%; low-grade dysplasia was identified in 34.96%, high-grade dysplasia in 51.22%, and adenocarcinoma in 1.63%, while one case (0.81%) was classified as erosion. CONCLUSIONS: Polyps in the rectum are common and were found in 37% of these colonoscopies. Adenomas with dysplasia were the most common form of Colorectal cancer . Therapeutic colonoscopy proved to be a safe and efficient method for the complete treatment of rectal lesions.
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Adenoma , Pólipos del Colon , Neoplasias Colorrectales , Neoplasias del Recto , Masculino , Humanos , Femenino , Persona de Mediana Edad , Recto/cirugía , Pólipos del Colon/diagnóstico , Pólipos del Colon/patología , Pólipos del Colon/cirugía , Colonoscopía/métodos , Neoplasias del Recto/cirugía , Adenoma/diagnóstico , Neoplasias Colorrectales/patologíaRESUMEN
OBJECTIVE: Studies addressing small and diminutive polyps and their potential of harboring advanced histologic features (AH) are scarce in Hispanics. We aimed to determine the prevalence of AH in a cohort of Hispanics. METHODS: A retrospective review of medical records of patients who had a colonoscopy from 2005 through 2010. The data collected included demographics, indications, history (personal/family) of colon cancer and/or polyps, and polyp histology. Polyps with high-grade dysplasia, prominent villous component, adenocarcinoma or serrated were classified as having AH. RESULTS: The population comprised 1884 patients, and 3835 polyps were evaluated; 63.3% were diminutive (1-5 mm), 22.7% small (6-9 mm), and 13.9% large (≥10 mm). The prevalence of AH for small and diminutive polyps were 4.9% and 1.1%, respectively. Of the polyps with AH, 11.9% were diminutive and 19.6% small. Small polyps were 5.04 times more likely to harbor AH than were diminutive polyps. Distal rather than proximal polyps were more likely to harbor AH. Furthermore, AH was >7 times more common in small (6-9 mm) polyps identified during diagnostic or surveillance colonoscopies compared to screening colonoscopies. CONCLUSION: The prevalence of AH was significantly associated with size, location (distal), and procedure indication. Although diminutive polyps (<6 mm) were less likely to harbor AH, the risk for non-Hispanics was higher than previously reported. The "resect and discard" strategy for polyps ≤ 1 cm should be used with caution in ethnically diverse cohorts, as the risk for AH may be higher in Hispanics than in non-Hispanic Whites.
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Adenoma , Neoplasias del Colon , Pólipos del Colon , Neoplasias Colorrectales , Humanos , Pólipos del Colon/epidemiología , Pólipos del Colon/diagnóstico , Pólipos del Colon/patología , Prevalencia , Adenoma/epidemiología , Adenoma/patología , Colonoscopía/métodos , Neoplasias del Colon/epidemiología , Neoplasias del Colon/patología , Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/epidemiologíaRESUMEN
BACKGROUND: There are lesions that are still being missed in colonoscopy. Many of those could be superficially elevated serrated lesions or depressed ones. AIMS: The aim of this study was to compare the histopathological characteristics of these lesions and their risks for submucosal carcinoma. METHODS: This is a retrospective, cross-sectional, and observational study comparing 217 superficially elevated serrated lesions larger than 5 mm resected by colonoscopies (G1) with 558 depressed lesions (G2). RESULTS: In G1, 217 lesions were found in 12,653 (1.7%) colonoscopies; in G2, 558 lesions were found in 36,174 (1.5%) colonoscopies. In G1, 63.4% were women and in G2, there was no gender predominance. The average size of G1 was 16.2 mm and G2 was 9.2 mm (p<0.001). G1 predominated on the proximal colon and G2 on the distal and rectum (p<0.001). In G1, there were 214 (98.6%) low-grade intramucosal neoplasia and 3 (1.4%) high-grade intramucosal neoplasia. Excluding 126 hyperplastic polyps and considering 91 sessile serrated adenomas in G1, we observed 88 (96.7%) low-grade intramucosal neoplasia and 3 (3.3%) high-grade intramucosal neoplasia; in G2, we observed 417 (74.7%) low-grade intramucosal neoplasia, 113 (20.3%) high-grade intramucosal neoplasia, and 28 (5.0%) submucosal adenocarcinomas (p<0.001). CONCLUSION: Depressed lesions significantly had more high-grade intramucosal neoplasia and more invasive carcinomas in the submucosal layer than superficially elevated serrated lesions and more than superficially elevated sessile serrated adenomas.
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Adenoma , Carcinoma , Pólipos del Colon , Neoplasias Colorrectales , Humanos , Femenino , Masculino , Pólipos del Colon/patología , Estudios Retrospectivos , Estudios Transversales , Neoplasias Colorrectales/patología , ColonoscopíaRESUMEN
Colonoscopy screening is an effective method to prevent colon cancer through the detection of polyps on which colon cancer develops in a higher percentage; however, the detection of these lesions varies in the different segments of the colon and the detection rate of them in the right colon is usually lower. OBJECTIVE: The objective of this study is to evaluate whether double endoscopic revision of the right colon during colonoscopy is a mechanism to improve its performance in terms of polyp detection rate (TDP) and adenoma detection rate (ADR). MATERIALS AND METHODS: Systematic review and meta-analysis of the literature including randomized clinical trials that evaluated repeat right-sight examination by colonoscopy compared to standard view to improve detection of polyps and adenomas. The protocol for this decision was published in PROSPERO under the code CRD42022356509. RESULTS: Five studies involving 2729 participants were included. Polyp detection was reported in 585/1197 patients (48.87%) after the second review, compared with 537/1206 (44.52%) of patients who received a single examination (p< 0.05), for a combined RR of 1.09 (95% CI: 0.97-1.23) (I2 was 44%). Detection of adenomas was reported in 830/1513 patients (54.75%) after the second review, compared with 779/1509 (51.62%) of patients who received a single examination (p < 0.05), for a combined RR of 1.06 (95% CI: 1.00-1.13) (I2 was 0%). CONCLUSION: Second examination of the right colon by colonoscopy may have a modest improvement in the detection of polyps and adenomas.
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Adenoma , Neoplasias del Colon , Pólipos del Colon , Humanos , Pólipos del Colon/diagnóstico , Pólipos del Colon/patología , Colonoscopía , Neoplasias del Colon/diagnóstico , Neoplasias del Colon/patología , Adenoma/diagnóstico , Adenoma/patologíaRESUMEN
BACKGROUND: Most colorectal cancers (CRC) arise from precursor lesions. This study aimed to characterize the mutation profile of colorectal cancer precursor lesions in a Brazilian population. METHODS: In total, 90 formalin-fixed paraffin-embedded colorectal precursor lesions, including 67 adenomas, 7 sessile serrated lesions, and 16 hyperplastic polyps, were analyzed by next-generation sequencing using a panel of 50 oncogenes and tumor suppressor genes. The genetic ancestry of the patients was estimated. RESULTS: Somatic driver mutations were identified in 66.7% of cases, including alterations in APC (32.2%), TP53 (20.0%), KRAS (18.9%), BRAF (13.3%) and EGFR (7.8%). Adenomas displayed a higher number of mutations, mainly in APC, compared to serrated polyps (73.1% vs. 47.8%, p = 0.026). Advanced adenomas had a significantly higher frequency of mutation in KRAS and a high overall mutation rate than early adenomas (92.9% vs. 59%, p = 0.006). A high degree of ancestry admixture was observed in the population studied, with a predominance of European components (mean of 73%) followed by African (mean of 11.3%). No association between genetic ancestry and type of lesions was found. The mutation profile of Brazilian colorectal precursor lesions exhibits alteration in APC, KRAS, TP53, and BRAF at different frequencies according to lesion type. CONCLUSIONS: These results bestow the knowledge of CRC's biologic history and support the potential of these biomarkers for precursor lesions detection in CRC screening of the Brazilian population.
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Adenoma , Pólipos del Colon , Neoplasias Colorrectales , Adenoma/genética , Adenoma/patología , Pólipos del Colon/genética , Pólipos del Colon/patología , Neoplasias Colorrectales/genética , Neoplasias Colorrectales/patología , Humanos , Mutación , Proteínas Proto-Oncogénicas B-raf/genética , Proteínas Proto-Oncogénicas p21(ras)/genéticaRESUMEN
The serrated pathway of carcinogenesis has been the subject of intense investigation over the past 2 decades, but many gaps in our understanding still need to be resolved. Serrated polyp precursors include hyperplastic polyps, sessile serrated polyps, and traditional serrated adenomas. These are considered discrete entities, but there is emerging molecular data to suggest that they may be more closely related to each other than currently believed. The recent US Multi-Society Task Force surveillance guidelines for patients with serrated polyps are admittedly based on low quality evidence. In this brief review, we discuss the limitations in endoscopic detection and pathologic interpretation of serrated polyps and the implications of these diagnostic difficulties on risk prediction and postpolypectomy surveillance recommendations.
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Adenocarcinoma/patología , Pólipos Adenomatosos/patología , Transformación Celular Neoplásica/patología , Pólipos del Colon/patología , Neoplasias Colorrectales/patología , Adenocarcinoma/cirugía , Pólipos Adenomatosos/cirugía , Animales , Biopsia , Colectomía , Pólipos del Colon/cirugía , Colonoscopía , Neoplasias Colorrectales/cirugía , Progresión de la Enfermedad , Humanos , Hiperplasia , Valor Predictivo de las PruebasRESUMEN
BACKGROUND: Since 2012, a new technique for resection of large polyps has been described, the underwater endoscopic mucosal resection (UEMR). Some advantages that emerge from it is the needless of injection in submucosal layer and a greater chance of complete capture of the polyp. OBJECTIVE: There are few studies of UEMR in Brazil. The aim of this study is to evaluate the safety and efficacy of this technique in one Brazilian center. METHODS: This case series was conducted from February to December of 2020. Colorectal polyps greater than 9 mm without features of deep submucosal invasion were resected using UEMR. RESULTS: Twenty-four large polyps were resected with the UEMR approach from 24 patients. The mean size of the polys was 19 mm, ranging from 12 to 35 mm. All lesions were successful resected and 66% (16/24) were resected en bloc. In histologic analyses, most of them were adenomas (70.8%) and only one had deep submucosal invasion. There were no cases of acute complications, such perforation or acute bleeding. CONCLUSION: The UEMR is a safe and feasible procedure. With the emerging data on the procedure, it seems to be a wonderful tool in preventing colorectal cancer and its applicability and scope should be encourage to surpass reference centers.
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Pólipos del Colon , Neoplasias Colorrectales , Resección Endoscópica de la Mucosa , Instituciones de Atención Ambulatoria , Brasil , Pólipos del Colon/patología , Pólipos del Colon/cirugía , Colonoscopía , Neoplasias Colorrectales/patología , Neoplasias Colorrectales/cirugía , Humanos , Mucosa Intestinal/patología , Mucosa Intestinal/cirugíaRESUMEN
ABSTRACT BACKGROUND: Since 2012, a new technique for resection of large polyps has been described, the underwater endoscopic mucosal resection (UEMR). Some advantages that emerge from it is the needless of injection in submucosal layer and a greater chance of complete capture of the polyp. OBJECTIVE: There are few studies of UEMR in Brazil. The aim of this study is to evaluate the safety and efficacy of this technique in one Brazilian center. METHODS: This case series was conducted from February to December of 2020. Colorectal polyps greater than 9 mm without features of deep submucosal invasion were resected using UEMR. RESULTS: Twenty-four large polyps were resected with the UEMR approach from 24 patients. The mean size of the polys was 19 mm, ranging from 12 to 35 mm. All lesions were successful resected and 66% (16/24) were resected en bloc. In histologic analyses, most of them were adenomas (70.8%) and only one had deep submucosal invasion. There were no cases of acute complications, such perforation or acute bleeding. CONCLUSION: The UEMR is a safe and feasible procedure. With the emerging data on the procedure, it seems to be a wonderful tool in preventing colorectal cancer and its applicability and scope should be encourage to surpass reference centers.
RESUMO CONTEXTO: Desde 2012, uma nova técnica para ressecção de pólipos grandes tem sido descrita, a ressecção da mucosa endoscópica sob imersão d'água (REMS). Algumas vantagens que surgem desta técnica são evitar a injeção na camada submucosa e a maior chance de captura completa do pólipo. Objetivo - Há poucos estudos com REMS no Brasil. Nosso objetivo é avaliar a segurança e a eficácia da técnica em um centro brasileiro. MÉTODOS: Esta série de casos foi conduzida de fevereiro a dezembro de 2020. Pólipos colorretais maiores que 9 mm sem sinais endoscópicos de invasão de submucosa foram ressecados utilizando RMES. RESULTADOS: Vinte e quatro pólipos foram ressecados com RMES em 24 pacientes diferentes. O tamanho médio dos pólipos era de 19 mm, variando de 12 a 35 mm. Todas as lesões foram ressecadas e 66% (16/24) foram ressecadas em monobloco. Na análise histológica, a maioria era adenoma (70.8%) e apenas uma havia invasão profunda da submucosa. CONCLUSÃO: O uso de REMS é um procedimento seguro e factível. Com o aumento de dados relativos ao procedimento, esta parece ser uma excelente ferramenta na prevenção do câncer colorretal e sua aplicabilidade deve ser encorajada para fora dos centros de referência.
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Humanos , Neoplasias Colorrectales/cirugía , Neoplasias Colorrectales/patología , Pólipos del Colon/cirugía , Pólipos del Colon/patología , Resección Endoscópica de la Mucosa , Brasil , Colonoscopía , Atención Ambulatoria , Mucosa Intestinal , Mucosa Intestinal/cirugíaRESUMEN
"Serrated polyps" is the term used for epithelial lesions of the colon and rectum that have a "sawtooth" pattern on the polyp's surface and crypt epithelium. The so-called serrated pathway describes the progression of sessile serrated adenomas and traditional serrated adenomas to colorectal cancer. Said pathway is well recognized as an alternative mechanism of carcinogenesis and accounts for 15-30% of the cases of colorectal cancer. It also explains a large number of the cases of interval colorectal cancer. Thus, due to their usually aggressive and uncertain behavior, serrated polyps are of the utmost importance in colorectal cancer screening. Our aim was to review the history, current nomenclature, pathophysiology, morphology, treatment, and surveillance of serrated polyps.
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Adenoma , Pólipos del Colon , Neoplasias Colorrectales , Adenoma/patología , Pólipos del Colon/patología , Neoplasias Colorrectales/diagnóstico , Humanos , Recto/patologíaRESUMEN
Colorectal cancer (CRC) is one of the most frequent worldwide. Approximately one third of cases originate from the serrated pathway of carcinogenesis, with colonic sessile serrated lesions (SSL) being the main cause of interval CRC. OBJECTIVE: To evaluate the clinical, endoscopic, histological characteristics and endoscopic management of colonic LSS. MATERIALS AND METHODS: Observational, descriptive, retrospective study from July 2017 to June 2019 in the gastroenterology service of the Guillermo Almenara Irigoyen National Hospital, Lima - Peru. The characteristics of 79 LSS were evaluated, the chi-square statistic was used to analyze the association of clinical and endoscopic variables with the presence of dysplasia; and the size of the lesion with the type of endoscopic resection. RESULTS: In 74 patients, 79 SSL were found, 67 (84.8%) with dysplasia (44 high-grade and 23 low-grade). Average age of 52 years and 44 (59.4%) were males. The location in the right colon (OR=5.09, 95% CI 1.38â"18.7, p=0.009), the size >10 mm (OR=6.13, 95% CI 1.50â"24,94, p=0.014) and the âÅblurred edgesâ (OR=5.08, 95% CI 1.17-21.98, p=0.019), are significantly related to the presence of dysplasia. SSL smaller than 20 mm showed statistical association with bloc resection (OR=69.3, 95% CI 7.35-653.9, p <0.001) with respect to the piecemeal resection. CONCLUSIONS: The finding of SSL during colonoscopies is frequent. The location, size and finding of blurred edges are related to the presence of dysplasia. Mucosal endoscopic resection was a safe and effective technique.
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Pólipos del Colon/patología , Pólipos del Colon/cirugía , Colonoscopía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Perú , Estudios RetrospectivosRESUMEN
Resumen Introducción: los pólipos del colon son los tumores más comunes del tracto gastrointestinal. Se presentan relativamente frecuentes en niños. El método eficaz para su diagnóstico es la colonoscopia que permite su tratamiento mediante la polipectomía. Objetivo: determinar las características clínicas, endoscópicas e histológicas de los pólipos colorrectales, diagnosticados en niños atendidos en el Hospital Pediátrico Provincial "Eliseo Noel Caamaño", de la ciudad de Matanzas. Materiales y métodos: se realizó un estudio descriptivo, retrospectivo en niños diagnosticados con pólipos colorrectales y atendidos en el hospital. En el período comprendido del 2010 al 2018. Se estudiaron 141 pacientes menores de 18 años, con diagnóstico de pólipos por colonoscopia confirmado en el estudio histológico. Se excluyeron los pacientes con diagnósticos diferentes a pólipos y aquellos que no se pudieron estudiar histológicamente. Resultados: se observó mayor frecuencia de pacientes con pólipos en las edades entre 1 y 10 años (37,6 %), del sexo masculino (57,4 %). Los síntomas más frecuentes fueron el sangramiento digestivo bajo, (96,3 %) y prolapso de masa T por el recto, (27 %). Los pólipos estudiados se localizaron con mayor frecuencia en rectosigmoide (73, 4 %), predominando los pólipos únicos (78 %), pediculados (56,2 %), de 1-2 cm de tamaño (53,2 %). Histológicamente predominaron los pólipos juveniles, (62,1 %) seguidos de los inflamatorios (33 %). Conclusiones: los pólipos fueron más frecuentes en las edades de 1 y 10 años y en el sexo masculino. Se demostró la importancia de la colonoscopia en el diagnóstico precoz de estas lesiones (AU).
ABSTRACT Introduction: colon polyps are the most common tumors of the gastrointestinal tract. They are found relatively frequently in children. The efficacious method for their treatment is the colonoscopy, allowing their treatment through polypectomy. Objective: to determine the histological, endoscopic and clinical characteristics of colorectal polyps diagnosed in children who attended the Pediatric Provincial Hospital "Eliseo Noel Caamaño", of Matanzas. Materials and methods: a retrospective, descriptive study was carried out in children diagnosed with colorectal polyps in the hospital in the period from 2010 to 2018. 141 patients under 18 years-old were studied, all with diagnosis of polyps by colonoscopy confirmed in the histological study. The patients with different diagnosis but polyps were excluded, and also those who could not be histologically studied. Results: the highest frequency of patients with polyps was found in ages between 1 and 10 years (37,6 %), and the male sex (57.4 %). The most frequent symptoms were low digestive bleeding (96.3 %) and Mass T prolapse through the rectum (27 %). The studied polyps were more frequently located in the rectosigmoid (73.4 %). The single polyps predominated (78 %)m and the pedunculated ones (56.2 %) of 1-2 cm size (53.2 %). Histologically predominated young polyps (62.1 %), followed by the inflammatory ones (33 %). Conclusions: polyps were more frequent at the ages from 1 to 10 years and in the male sex. The authors showed the importance of colonoscopy in the precocious diagnosis of these lesions (AU).
Asunto(s)
Humanos , Masculino , Femenino , Niño , Niño , Pólipos del Colon/epidemiología , Pacientes , Signos y Síntomas , Terapéutica/métodos , Pólipos del Colon/diagnóstico , Pólipos del Colon/patología , Pólipos del Colon/terapia , Colonoscopía/métodosRESUMEN
RESUMEN El cáncer colorrectal (CCR) es uno de los más frecuentes a nivel mundial. Aproximadamente un tercio de los casos se originan por la vía serrada de carcinogénesis, siendo las lesiones serradas sésiles (LSS) de colon, una las principales responsables del CCR de intervalo. Objetivo: Evaluar las características clínicas, endoscópicas, histológicas y el manejo endoscópico de las LSS de colon. Materiales y métodos: Estudio observacional, descriptivo, retrospectivo de julio del 2017 a junio del 2019 en el servicio de gastroenterología del Hospital Nacional Guillermo Almenara Irigoyen, Lima - Perú. Se evaluó las características de 79 LSS, se utilizó el estadístico chi-cuadrado para analizar la asociación de variables clínicas y endoscópicas con la presencia de displasia; y el tamaño de la lesión con el tipo de resección endoscópica. Resultados: En 74 pacientes se halló 79 LSS, 67 (84,8%) con displasia (44 de alto grado y 23 de bajo grado). Edad media de 52 años y 44 (59,4%) fueron varones. La localización en colon derecho (OR=5,09, IC 95% 1,38-18,7, p= 0,009), el tamaño >10 mm (OR=6,13/IC 95%/1,50-24,94/ p=0,014) y los "bordes borrosos" (OR=5,08, IC 95% 1,17-21,98, p=0,019), se relacionan de manera significativa con la presencia de displasia. Las LSS menores a 20 mm mostraron asociación estadística con la resección en bloque (OR=69,3, IC 95% 7,35-653,9, p<0,001) respecto a la piecemeal. Conclusiones: El hallazgo de LSS durante colonoscopías es frecuente. La localización, el tamaño y el hallazgo de bordes borrosos se relacionan con la presencia de displasia. La resección endoscópica mucosa fue una técnica segura y efectiva.
ABSTRACT Colorectal cancer (CRC) is one of the most frequent worldwide. Approximately one third of cases originate from the serrated pathway of carcinogenesis, with colonic sessile serrated lesions (SSL) being the main cause of interval CRC. Objective: To evaluate the clinical, endoscopic, histological characteristics and endoscopic management of colonic LSS. Materials and methods: Observational, descriptive, retrospective study from July 2017 to June 2019 in the gastroenterology service of the Guillermo Almenara Irigoyen National Hospital, Lima - Peru. The characteristics of 79 LSS were evaluated, the chi-square statistic was used to analyze the association of clinical and endoscopic variables with the presence of dysplasia; and the size of the lesion with the type of endoscopic resection. Results: In 74 patients, 79 SSL were found, 67 (84.8%) with dysplasia (44 high-grade and 23 low-grade). Average age of 52 years and 44 (59.4%) were males. The location in the right colon (OR=5.09, 95% CI 1.38-18.7, p=0.009), the size >10 mm (OR=6.13, 95% CI 1.50-24,94, p=0.014) and the "blurred edges" (OR=5.08, 95% CI 1.17-21.98, p=0.019), are significantly related to the presence of dysplasia. SSL smaller than 20 mm showed statistical association with bloc resection (OR=69.3, 95% CI 7.35-653.9, p <0.001) with respect to the piecemeal resection. Conclusions: The finding of SSL during colonoscopies is frequent. The location, size and finding of blurred edges are related to the presence of dysplasia. Mucosal endoscopic resection was a safe and effective technique.
Asunto(s)
Femenino , Humanos , Masculino , Persona de Mediana Edad , Pólipos del Colon/cirugía , Pólipos del Colon/patología , Colonoscopía , Perú , Estudios RetrospectivosRESUMEN
BACKGROUND AND AIM: There is no consensus whether a colonoscopy should be recommended for patients under 50 years of age who present with both anal bleeding and benign anal diseases. The aim of this study is to evaluate the effectiveness of colonoscopy to detect neoplastic lesions in this specific group of patients. METHODS: A prospective study analyzing the results of colonoscopies performed in patients younger than 50 years of age who reported a rectal bleeding and also had a diagnosis of benign anal disease at first clinical visit. RESULTS: One hundred and eighty-seven consecutive patients were prospectively included in this study. In 35 patients (18.7%), adenomatous polyps were diagnosed. Thirty-seven percent of those lesions (13 cases) were further classified as either advanced adenomas or serrated adenomas. The prevalence of adenomas was 14.6% among patients under the age of 40 and 20% among those between 40 and 50 years of age. Thirty-one percent of the adenomas (11 cases) were located in the right colon, without any other concomitant lesion in the distal colon. In addition, an unsuspected case of sigmoid carcinoma was diagnosed. CONCLUSION: The performance of colonoscopy in young patients with benign anal diseases and hematochezia resulted in a high rate of detection of neoplastic lesions. The method might be considered as a valid strategy of investigation in this frequent clinical situation.
Asunto(s)
Pólipos Adenomatosos/patología , Enfermedades del Ano/patología , Pólipos del Colon/patología , Colonoscopía , Neoplasias Colorrectales/patología , Hemorragia Gastrointestinal/epidemiología , Pólipos Adenomatosos/epidemiología , Adulto , Factores de Edad , Enfermedades del Ano/epidemiología , Brasil/epidemiología , Toma de Decisiones Clínicas , Pólipos del Colon/epidemiología , Neoplasias Colorrectales/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Selección de Paciente , Valor Predictivo de las Pruebas , Prevalencia , Estudios Prospectivos , Medición de Riesgo , Factores de RiesgoRESUMEN
BACKGROUND: Colorectal cancer is one of the most prevalent pathologies. Its prognosis is linked to the early detection and treatment. Currently diagnosis is performed by histological analysis from polyp biopsies, followed by morphological classification. Kudo's pit pattern classification is frequently used for the differentiation of neoplastic colorectal lesions using hematoxylin-eosin stained samples. Few articles have reported this classification with image software processing, using exogenous markers over the samples. The processing of autofluorescence images is an alternative that could allow the characterization of the pits from the crypts of Lieberkühn, bypassing staining techniques. OBJECTIVE: Processing and analysis of widefield autofluorescence microscopy images obtained by fresh colon tissue samples from a murine model of colorectal cancer in order to quantify and characterize the pits morphology by measuring morphology parameters and shape descriptors. METHODS: Adult male BALB/cCmedc strain mice (n=27), ranging from 20 to 30 g, were randomly assigned to four and five groups of treated and control animals. Colon samples were collected at day zero and at fourth, eighth, sixteenth and twentieth weeks after treatmentwith azoxymethane. Two-dimensional (2D) segmentation, quantification and morphological characterization of pits by image processing applied using macro programming from FIJI. RESULTS: Type I is the pit morphology prevailing between 53 and 81% in control group weeks. III-L and III-S types were detected in reduced percentages. Between the 33 and 56% of type I was stated as the prevailing morphology for the 4th, 8th and 20th weeks of treated groups, followed by III-L type. For the 16th week, the 39% of the pits was characterized as III-L type, followed by type I. Further, pattern types as IV, III-S and II were also found mainly in that order for almost all of the treated weeks. CONCLUSION: These preliminaries outcomes could be considered an advance in two-dimensional pit characterization as the whole image processing, comparing to the conventional procedure, takes a few seconds to quantify and characterize non-pathological colon pits as well as to estimate early pathological stages of colorectal cancer.
Asunto(s)
Pólipos del Colon/diagnóstico por imagen , Neoplasias Colorrectales/diagnóstico por imagen , Microscopía Fluorescente , Animales , Pólipos del Colon/patología , Neoplasias Colorrectales/patología , Modelos Animales de Enfermedad , Masculino , Ratones , Ratones Endogámicos BALB CRESUMEN
ABSTRACT BACKGROUND: Colorectal cancer is one of the most prevalent pathologies. Its prognosis is linked to the early detection and treatment. Currently diagnosis is performed by histological analysis from polyp biopsies, followed by morphological classification. Kudo's pit pattern classification is frequently used for the differentiation of neoplastic colorectal lesions using hematoxylin-eosin stained samples. Few articles have reported this classification with image software processing, using exogenous markers over the samples. The processing of autofluorescence images is an alternative that could allow the characterization of the pits from the crypts of Lieberkühn, bypassing staining techniques. OBJECTIVE: Processing and analysis of widefield autofluorescence microscopy images obtained by fresh colon tissue samples from a murine model of colorectal cancer in order to quantify and characterize the pits morphology by measuring morphology parameters and shape descriptors. METHODS: Adult male BALB/cCmedc strain mice (n=27), ranging from 20 to 30 g, were randomly assigned to four and five groups of treated and control animals. Colon samples were collected at day zero and at fourth, eighth, sixteenth and twentieth weeks after treatmentwith azoxymethane. Two-dimensional (2D) segmentation, quantification and morphological characterization of pits by image processing applied using macro programming from FIJI. RESULTS: Type I is the pit morphology prevailing between 53 and 81% in control group weeks. III-L and III-S types were detected in reduced percentages. Between the 33 and 56% of type I was stated as the prevailing morphology for the 4th, 8th and 20th weeks of treated groups, followed by III-L type. For the 16th week, the 39% of the pits was characterized as III-L type, followed by type I. Further, pattern types as IV, III-S and II were also found mainly in that order for almost all of the treated weeks. CONCLUSION: These preliminaries outcomes could be considered an advance in two-dimensional pit characterization as the whole image processing, comparing to the conventional procedure, takes a few seconds to quantify and characterize non-pathological colon pits as well as to estimate early pathological stages of colorectal cancer.
RESUMO CONTEXTO: O câncer colorretal é uma das patologias mais prevalentes. Seu prognóstico é ligado à detenção e ao tratamento precoces. Atualmente o diagnóstico é realizado por análise histológica de biópsias de pólipo, seguida de classificação morfológica. A classificação de padrões de Kudo é frequentemente utilizada para a diferenciação de lesões colorretais neoplásicas usando amostras coradas por hematoxilina-eosina. Poucos artigos relatam esta classificação com utilização de processamento por software de imagem, utilizando marcadores exógenos sobre as amostras. O processamento de imagens de autofluorescência é uma alternativa que pode permitir a caracterização do padrão das criptas de Lieberkühn, contornando técnicas de coloração. OBJETIVO: Analisar, quantificar e caracterizar a morfologia do padrão das criptas medindo os parâmetros morfológicos e descritores de forma, através do processamento e análise de imagens de microscopia de autofluorescência de campo de Widefield obtidas em amostras de tecido de cólon fresco a partir de um modelo murino de câncer colorretal. MÉTODOS: Camundongos machos adultos BALB/cCmedc (n=27), variando de 20 a 30 g, foram distribuídos aleatoriamente em quatro e cinco grupos de animais tratados e de controle. As amostras de cólon foram coletadas no dia zero e na 4ª, 8ª, 16ª e 20ª semanas após o tratamento com azoxometano. Segmentação bidimensional (2D), quantificação e caracterização morfológica do padrão das criptas por processamento de imagem aplicados utilizando programação macro de FIJI. RESULTADOS: O tipo I é a morfologia da cripta prevalente entre 53% e 81% semanas do grupo controle. Os tipos III-L e III-S foram detectados em porcentagens reduzidas. A morfologia do tipo I entre os 33% e 56% foi constatada como a predominante para as 4ª, 8ª e 20ª semanas de grupos tratados, seguidos pelo tipo III-L. Para a 16ª semana, os 39% dos padrões das criptas foram caracterizados como tipo III-L, seguidos pelo tipo I. Além disso, os tipos de padrão como IV, III-S e II também foram encontrados principalmente nessa ordem para quase todas as semanas tratadas. CONCLUSÃO: Estes resultados preliminares podem ser considerados um avanço na caracterização bidimensional da cripta como um processamento integral da imagem, comparando-se ao procedimento convencional; demora-se alguns segundos a mais para quantificar e caracterizar pontos não-patológicos, bem como para estimar estágios patológicos precoces do câncer colorretal.