Colorectal cancer: comparative analysis between two series of patients separated by more than three decades

Abstract Aim This study characterizes Colorectal Cancer (CRC) incidence in the University Hospital Ramon and Cajal, Madrid, and analyzes variations over time. It establishes risk groups, aiming to discover whether diagnosis can be determined in less advanced stages of disease. Method Evolutionary epidemiological study of genetic and environmental factors contributing to the development of CRC in this district that enables the comparison of two cohorts of patients separated by 37 years: G1 (patients of current group) and G2 (patients of historical group). The main risk variables gleaned retrospectively were analyzed and the statistical association between cohorts was determined. Results The mean age of patients increased significantly from 64 to 71 along with the incidence of ascending colon cancer. G1 scored higher than G2 for: the incidence of colon cancer in men, detection of adenomatous polyps (48.1%), percentage of resectability with curative intent (80.4%), and Dukes A stage (34.1%) (p < 0.001). Conclusion Biological aspects of CRC have been compared against its profile three decades earlier. We can confirm the existence of concrete changes in the manifestation and staging at the time of diagnosis or following earlier treatment. (AU)

Detección automática de pólipos colorrectales con técnicas de inteligencia artificial / Artificial intelligence techniques for the automatic detection of colorectal polyps

Resumen El cáncer colorrectal (CCR) es uno de los tumores malignos con mayor prevalencia en Colombia y el mundo. Estas neoplasias se originan en lesiones adenomatosas o pólipos que deben resecarse para prevenir la enfermedad, lo cual se puede realizar con una colonoscopia. Se ha reportado que durante una colonoscopia se detectan pólipos en el 40 % de los hombres y en el 30 % de las mujeres (hiperplásicos, adenomatosos, serrados, entre otros), y, en promedio, un 25 % de pólipos adenomatosos (principal indicador de calidad en colonoscopia). Sin embargo, estas lesiones no son fáciles de observar por la multiplicidad de puntos ciegos en el colon y por el error humano asociado con el examen. Diferentes investigaciones han reportado que alrededor del 25 % de pólipos colorrectales no son detectados o se pasan por alto durante la colonoscopia y, como consecuencia, el paciente puede tener un cáncer de intervalo. Estas cifras muestran la necesidad de contar con un segundo observador (sistema de inteligencia artificial) que reduzca al mínimo la posibilidad de no detectar estos pólipos y, de este modo, sea posible prevenir al máximo el cáncer de colon. Objetivo: crear un método computacional para la detección automática de pólipos colorrectales usando inteligencia artificial en videos grabados de procedimientos reales de colonoscopia. Metodología: se usaron bases de datos públicas con pólipos colorrectales y una colección de datos construida en un Hospital Universitario. Inicialmente, se normalizan todos los cuadros de los videos para disminuir la alta variabilidad entre bases de datos. Posteriormente, la tarea de detección de pólipos se hace con un método de aprendizaje profundo usando una red neuronal convolucional. Esta red se inicia con pesos aprendidos en millones de imágenes naturales de la base de datos ImageNet. Los pesos de la red se actualizan usando imágenes de colonoscopia, siguiendo la técnica de ajuste fino. Finalmente, la detección de pólipos se realiza asignando a cada cuadro una probabilidad de contener un pólipo y determinando el umbral que define cuando el pólipo se encuentra presente en un cuadro. Resultados: este enfoque fue entrenado y evaluado con 1875 casos recopilados de 5 bases de datos públicas y de la construida en el hospital universitario, que suman aproximadamente 123 046 cuadros. Los resultados obtenidos se compararon con las marcaciones de diferentes expertos en colonoscopia y se obtuvo 0,77 de exactitud, 0,89 de sensibilidad, 0,71 de especificidad y una curva ROC (receiver operating characteristic) de 0,87. Conclusión: este método logra detectar pólipos de manera sobresaliente, superando la alta variabilidad dada por los distintos tipos de lesiones, condiciones diferentes de la luz del colon (asas, pliegues o retracciones) con una sensibilidad muy alta, comparada con un gastroenterólogo experimentado, lo que podría hacer que se disminuya el error humano, el cual es uno de los principales factores que hacen que no se detecte o se escapen los pólipos durante un examen de colonoscopia.

Abstract Colorectal cancer (CRC) is one of the most prevalent malignant tumors worldwide. These neoplasms originate from adenomatous lesions or polyps that must be resected to prevent the development of the disease, and that can be done through a colonoscopy. Polyps are reported during colonoscopy in 40% of men and 30% of women (hyperplastic, adenomatous, serrated, among others), and, on average 25% are adenomatous polyps (the main indicator of quality in colonoscopy). However, these lesions are not easy to visualize because of the multiplicity of blind spots in the colon and human errors associated with the performance of the procedure. Several research works have reported that about 25% of colorectal polyps are overlooked or undetected during colonoscopy, and as a result, the patient may have interval cancer. These figures show the need for a second observer (artificial intelligence system) to reduce the possibility of not detecting polyps and prevent colon cancer as much as possible. Objective: To create a computational method for the automatic detection of colorectal polyps using artificial intelligence using recorded videos of colonoscopy procedures. Methodology: Public databases of colorectal polyps and a data collection constructed in a university hospital were used. Initially, all the frames in the videos were normalized to reduce the high variability between databases. Subsequently, polyps were detected using a deep learning method with a convolutional neural network. This network starts with weights learned from millions of natural images taken from the ImageNET database. Network weights are updated using colonoscopy images, following the fine-tuning technique. Finally, polyps are detected by assigning each box a probability of polyp presence and determining the threshold that defines when the polyp is present in a box. Results: This approach was trained and evaluated with 1 875 cases collected from 5 public databases and the one built in the university hospital, which total approximately 123 046 frames. The results obtained were compared with the markings of different experts in colonoscopy, obtaining 0.77 accuracy, 0.89 sensitivity, 0.71 specificity, and a receiver operating characteristic curve of 0.87. Conclusion: This method detected polyps in an outstanding way, overcoming the high variability caused by the types of lesions and bowel lumen condition (loops, folds or retractions) and obtaining a very high sensitivity compared with an experienced gastroenterologist. This may help reduce the incidence of human error, as it is one of the main factors that cause polyps to not be detected or overlooked during a colonoscopy.

Circulating level of 25(OH)D3 with risk factors of asymptomatic adenoma and proximal non-adenoma colorectal polyps / Níveis circulantes de 25(OH)D3 com fatores de risco de adenoma assintomático e pólipos colorretais proximais sem adenoma

ABSTRACT Background: An inverse association between circulating vitamin D and adenoma risk hasbeen reported, but less is known about proximal inflammatory-hyperplastic polyps.Purpose: To investigate circulating 25(OH)D3and risk factors of proximal inflammatory-hyperplastic and adenoma colorectal polyps.Methods: From January 2017 to June 2019, consecutive asymptomatic average-risk partic-ipants undergoing initial screening colonoscopy. Questionnaires provided information oncolorectal polyp risk factors, and plasma samples were assayed for 25-Hydroxyvitamin-D ­25(OH)D3. The colorectal polyps were assessed, and medical history and demographic datawere obtained from each patient.Results: Of the 220 asymptomatic subjects, the prevalence of proximal inflammatory-hyperplastic polyps and adenoma polyps were 16.8%; 18.1% and 22.2%, respectively.Multivariate analysis revealed that low vitamin D (25(OH)D3< 18 ng/mL, OR = 3.94; 95%CI: 1.81­9.51) and current/former smoking (OR = 6.85; 95% CI: 2.98­15.70), high bodymass index (BMI > 24, OR = 5.32, 95% CI: 2.62­4.71) were independent predictors forproximal inflammatory-hyperplastic colorectal polyps (non-adenoma). Low vitamin D(25(OH)D3< 18 ng/mL, OR = 7.75; 95% CI: 3.19­18.80) and current/former smoking (OR = 3.75;95% CI: 1.30­10.81), age over 60 years old (OR = 2.38, 95% CI: 1.02­5.57), were independentpredictors for adenoma colorectal polyps.Conclusion: Low vitamin D and smoking are common risk factors for both adenomatous andproximal inflammatory hyperplastic polyps. Old age and BMI are additional risk factors forthe development of adenomatous and non-adenomatous colorectal polyps.

RESUMO Background: An inverse association between circulating vitamin D and adenoma risk hasbeen reported, but less is known about proximal inflammatory-hyperplastic polyps.Purpose: To investigate circulating 25(OH)D3and risk factors of proximal inflammatory-hyperplastic and adenoma colorectal polyps.Methods: From January 2017 to June 2019, consecutive asymptomatic average-risk partic-ipants undergoing initial screening colonoscopy. Questionnaires provided information oncolorectal polyp risk factors, and plasma samples were assayed for 25-Hydroxyvitamin-D ­25(OH)D3. The colorectal polyps were assessed, and medical history and demographic datawere obtained from each patient.Results: Of the 220 asymptomatic subjects, the prevalence of proximal inflammatory-hyperplastic polyps and adenoma polyps were 16.8%; 18.1% and 22.2%, respectively.Multivariate analysis revealed that low vitamin D (25(OH)D3< 18 ng/mL, OR = 3.94; 95%CI: 1.81­9.51) and current/former smoking (OR = 6.85; 95% CI: 2.98­15.70), high bodymass index (BMI > 24, OR = 5.32, 95% CI: 2.62­4.71) were independent predictors forproximal inflammatory-hyperplastic colorectal polyps (non-adenoma). Low vitamin D(25(OH)D3< 18 ng/mL, OR = 7.75; 95% CI: 3.19­18.80) and current/former smoking (OR = 3.75;95% CI: 1.30­10.81), age over 60 years old (OR = 2.38, 95% CI: 1.02­5.57), were independentpredictors for adenoma colorectal polyps.Conclusion: Low vitamin D and smoking are common risk factors for both adenomatous andproximal inflammatory hyperplastic polyps. Old age and BMI are additional risk factors forthe development of adenomatous and non-adenomatous colorectal polyps.

Are obesity and adenoma development associated as colorectal cancer precursors? / Obesidade e desenvolvimento de adenoma estão associados como precursores do câncer colorretal?

ABSTRACT Background: One of the most important concerns on health is the increased rates of obesity in population and the speed in which this number is increasing. This number translates a serious public health problem, since it also increases the risk of several other diseases associated with obesity resulting in significant morbidity and mortality. Among them, it seems to be connected to several neoplasms, such as colorectal carcinoma. Aim: To evaluate the impact of obesity as a risk factor for colorectal carcinoma through the detection of adenoma, and to discuss the mechanisms that could establish a link between obesity and neoplasm. Methods: Patients who underwent colonoscopy were included. Personal and anthropometric data, clinical history, and results of the tests were analyzed in order to verify the correlation of BMI and the presence of adenomatous polyps. Results: A total of 142 patients were studied, which a mean age of 62 years. Of the patients, 74 (52.1%) were men and 68 (47.9%) were. Obesity was identified in 16.2% of the patients. Polyps were found in 61 (42.9%), mostly smaller than 1 cm. Obese individuals were 1.56 times more likely to present colorectal adenoma than patients with normal weight. Conclusion: This study, although showing the greater presence of colorectal adenomas in obese individuals, did not show a significant difference in the occurrence of pre-malignant lesions.

RESUMO Racional: Uma das grandes preocupações no âmbito da saúde é o crescente índice de obesidade na população e a velocidade com que esse número vem aumentando. Ele constitui grave problema de saúde pública, uma vez que aumenta também o risco de inúmeras doenças associadas à obesidade e que resultam em morbimortalidade significativa, como o câncer colorretal. Objetivo: Avaliar o impacto da obesidade como fator de risco para câncer colorretal, através da detecção de adenomas colorretais, e discutir os mecanismos que podem estabelecer uma ligação entre esta neoplasia e a obesidade. Métodos: Foram incluídos pacientes submetidos à colonoscopia. Dados pessoais e antropométricos, antecedentes clínicos e laudos dos exames foram analisados, a fim de verificar a correlação do IMC e a presença de pólipos adenomatosos. Resultados: Foram estudados 142 pacientes, 74 (52,1%) homens e 68 (47,9%) mulheres, com média de 62 anos. A obesidade foi identificada em 16,2% dos pacientes. Pólipos foram encontrados em 61 (42,9%), sendo em sua maioria menores do que 1 cm. Obesos tiveram probabilidade 1,56 vez maior de apresentar adenoma colorretal que pacientes com peso normal. Conclusão: Este estudo, apesar de mostrar a maior presença de adenomas colorretais em indivíduos obesos, não mostrou diferença estatisticamente significativa na ocorrência de lesões pré-malignas.

Prevalencia y características histológicas de los pólipos diminutos del recto y del sigmoides en una población colombiana / Prevalence and histological characteristics of tiny rectal and sigmoid polyps in a Colombian population

Resumen Introducción: el cáncer de colon y recto (CCR) se origina a partir de pólipos adenomatosos y serrados. Por tanto, se recomienda que todos los pólipos colónicos sean resecados y enviados a patología. Sin embargo, en los pólipos diminutos (<5 mm) del recto y del sigmoides existe controversia sobre esta conducta, razón por la cual se ha planteado la estrategia de resecar y descartar o dejar in situ, a partir de la utilización de endoscopios avanzados (con una imagen de banda angosta [Narrow Band Imaging, NBI] u otras), y se logre concordancia con la histopatología, superior al 90 %. En nuestro medio, no hay estudios prospectivos con luz blanca sobre la prevalencia y las características histológicas de estos pólipos en el recto y el sigmoides. Por esta razón, se desarrolló este trabajo. Materiales y métodos: estudio de prevalencia analítica, prospectivo. Se incluyeron las colonoscopias de tamización realizadas en la Unidad de Gastroenterología de la Clínica Fundadores de Bogotá, entre enero y julio de 2018. Resultados: se incluyeron 719 pacientes. La prevalencia de pólipos diminutos en el recto y el sigmoides fue del 27 % (intervalo de confianza [IC], 95 %: 23,7-30,2 %). El 50 % eran pólipos adenomatosos, mientras que en 8 casos se presentó una displasia de alto grado (DAG). Entre los pólipos diminutos, 3 fueron tumores neuroendocrinos. No hubo cáncer en ninguna de las lesiones. Conclusiones: la mitad de los pólipos diminutos encontrados fueron adenomatosos y 8 (0,83 %) tuvieron DAG. Recomendamos resecar todos los pólipos diminutos hasta que los estudios locales realizados con NBI u otra tecnología demostrasen la capacidad para discriminar en más del 90 % los pólipos hiperplásicos (dejarlos in situ) o adenomatosos (resecarlos).

Abstract Introduction: Because colorectal cancer (CRC) originates from adenomatous and serrated polyps, it is recommended that all colonic polyps be resected and sent to pathology. However, there is controversy over this recommendation in the case of rectal and sigmoid polyps measuring less than 5 mm. Strategies using advanced NBI endoscopes to either "resect and discard" or leave "in situ" have been proposed. Concordance with histopathology of over 90% has been achieved. No prospective studies of the prevalence and histological characteristics of these rectal and sigmoid polyps had been done with white light in this country, so we undertook this study. Materials and methods: This is an analytical and prospective prevalence study. Screening colonoscopies performed in the gastroenterology unit of Clínica Fundadores in Bogotá between January and July 2018 were included. Results: Seven hundred nineteen patients were included. The prevalence of tiny polyps in the rectum and sigmoid colon was 27% (95% CI: 23.7 to 30.2%). Fifty percent were adenomatous, but eight cases had high grade dysplasia. Among the tiny polyps, three were neuroendocrine tumors. There was no cancer in any of the lesions. Conclusions: Half of the tiny polyps found were adenomatous, and eight (0.83%) had high grade dysplasia. We recommend resecting all tiny polyps until local studies conducted with NBI or other technology demonstrate the ability to discriminate between the more than 90% hyperplastic polyps (leaving them in situ) and adenomatous polyps (resect them).

Prevalencia de tipos histológicos de pólipos gástricos en pacientes adultos de un hospital público de Lima-Perú, en el periodo 2007 al 2016 / Prevalence of histological types of gastric polyps in adult patients from a public hospital in Lima-Peru (2007 - 2016)

Objetivos: Determinar la prevalencia de pólipos gástricos detectados mediante endoscopía digestiva alta, en pacientes mayores de 18 años del Hospital Cayetano Heredia, en el periodo 2007-2016. Materiales y métodos: Estudio retrospectivo de corte transversal, realizado con datos de biopsias gástricas de pacientes sometidos a endoscopía digestiva alta entre enero de 2007 y julio de 2016. Se evaluó cambios histológicos asociados, datos demográficos y características endoscópicas, las cuales fueron sometidas a análisis estadístico mediante STATA v14.2. Resultados: En una población de 16 552 endoscopías realizadas, se encontró 407 biopsias compatibles con pólipos gástricos, lo cual da una prevalencia de 2,5%. Los pólipos gástricos fueron más frecuentes en mujeres (62,38%). La mediana de edad fue de 61 años (52-71 años). El tipo histológico más frecuente fue el pólipo glandular fúndico (PGF) (44,85%), seguido de pólipo hiperplásico (38,48%) y adenomatoso (15,23%). La localización más frecuente fue en fondo/cuerpo (48,65%, p=0,001) Se detectó la presencia de Helicobacter pylori (Hp) en el 30,6% de las biopsias compatibles con pólipos. Conclusión: La prevalencia de pólipos gástricos es similar con otras regiones del mundo; los PGF e hiperplásicos son los más frecuentes. Los pólipos adenomatosos estuvieron en mayor relación a cambios como metaplasia y displasia.

Objectives: Establish the prevalence of gastric polyps detected by upper gastrointestinal endoscopy in patients older than 18 years old during the period from 2007 - 2016 in Cayetano Heredia Hospital. Materials and methods: Retrospective cross- sectional study, performed with data from the gastric biopsies reports of patients that have undergone upper gastrointestinal endoscopy between January 2007 and July 2016. Demographic data, endoscopic characteristics of the polyps and associated histological changes of the surrounding gastric mucosa were evaluated, which were subjected to statistical analysis using STATA v14.2. Results: In a population of 16 552 endoscopies, 407 gastric polyps biopsies were found. These results give a prevalence of 2.5% .Gastric polyps were detected predominantly in women (62.38%). The median age was 61 years (52-71 years). The most frequent histological type was the fundic gland polyp (FGP) (44.85%), followed by the hyperplastic (38.48%) and adenomatous (15.23%) polyp. The most frequent location was in the fundus / corpus (48.65%, p = 0.001). The presence of Hp was detected in 30.6% of the biopsies with polyps. Conclusion: The prevalence of gastric polyps is similar to other regions of the world; PGF and hyperplastic are the most frequent. Adenomatous polyps showed a greater relationship with and metaplasia and dysplasia.

Pólipos de glândulas fúndicas: a histologia pode ser utilizada para prever uso de inibidores de bomba de próton? / Gastric fundic gland polyps: can histology be useful to predict proton pump inhibitors use?

ABSTRACT BACKGROUND: Fundic gland polyps allegedly increased in frequency in recent decades, and had attracted great attention due to possible association with prolonged proton pump inhibitor therapy. Prolonged use of this drug could cause parietal cell hyperplasia, obstruction of glandular lumen and cystic dilation of the gland. OBJECTIVE: This study aims to analyze clinical and pathological features of fundic gland polyps in patients with and without proton pump inhibitor therapy in a selected population from Brazil. METHODS: It was selected a sample of 101 Brazilian patients (78 females and 23 males), from a five years retrospective search of the files from a private pathology laboratory. The patients had an average age of 57 years and we included patients with a histological diagnosis of fundic gland polyp. The clinical data were obtained from their files and all histological slides were reviewed and examined with hematoxylin and eosin (HE) and Giemsa. RESULTS: Information about the use or non-use of proton pump inhibitors (PPI) was obtained in 84 patient files. In 17 cases we could not determine if PPI were used or not. Among those in which the information was available, a positive history of anti-acid therapy was observed in 63 (75.0%) patients. Parietal cell hypertrophy/hyperplasia and parietal cell protrusions were detected in most slides. Histological findings were identical in PPI users and PPI negative patients. Helicobacter pylori infection was detected in just two samples. Epithelial dysplasia or adenocarcinoma were not observed in our cases. Histopathological analysis of fundic gland polyps could not distinguish between PPI and non-PPI related cases. Parietal cell cytoplasmic protrusions, an alleged marker of prolonged acid suppression therapy, was detected in both groups. CONCLUSION: Histological features could not discriminate anti-acid therapy related fundic glands polyps in our patients.

RESUMO CONTEXTO: Os pólipos das glândulas fúndicas do estômago supostamente aumentaram em frequência nas últimas décadas e atraíram grande atenção devido à possível associação com a terapia prolongada com inibidores da bomba de prótons. O uso prolongado deste fármaco pode causar hiperplasia das células parietais, obstrução do lúmen glandular e dilatação cística da glândula. OBJETIVO: Este estudo tem como objetivo analisar os aspectos clínicos e patológicos dos pólipos das glândulas fúndicas em pacientes com e sem terapia com inibidores da bomba de prótons em uma população selecionada do Brasil. MÉTODOS: Foi selecionada uma amostra de 101 pacientes brasileiros (78 do sexo feminino e 23 do sexo masculino), a partir de uma pesquisa retrospectiva de cinco anos dos arquivos de um laboratório privado de patologia. Os pacientes tinham uma idade média de 57 anos e foram incluídos pacientes com diagnóstico histológico de pólipo das glândulas fúndicas. Os dados clínicos foram obtidos a partir de seus prontuários e todas as lâminas histológicas foram revisadas e examinadas com hematoxilina e eosina (HE) e Giemsa. RESULTADOS: Informações sobre o uso ou não uso de inibidores da bomba de próton (IBP) foram obtidas em 84 prontuários de pacientes. Em 17 casos, não foi possível determinar se o IBP foi usado ou não. Entre aqueles em que a informação estava disponível, observou-se uma história positiva de terapia com IBP em 63 (75,0%) pacientes. A hipertrofia das células parietais/hiperplasia e protrusões das células parietais foram detectadas na maioria das lâminas. Os achados histológicos foram idênticos em usuários de IBP e pacientes não usuários. A infecção por Helicobacter pylori foi detectada em apenas duas amostras. A displasia epitelial ou o adenocarcinoma não foram observados em nossos casos. A análise histopatológica dos pólipos das glândulas fúndicas não pôde distinguir entre os casos IBP e não relacionados ao IBP. As protuberâncias citoplasmáticas das células parietais, um suposto marcador de terapia prolongada de supressão de ácido, foram detectadas em ambos os grupos. CONCLUSÃO: Características histológicas não podem discriminar os pólipos das glândulas fúndicas relacionados à terapia anti-secretora em nossos pacientes.

Doenças imunomediadas em pacientes com doença celíaca e em seus familiares: um estudo comparativo entre idade e sexo / Immune mediated diseases in patients with celiac disease and their relatives: a comparative study of age and sex

ABSTRACT BACKGROUND: Up to 15% of other immune-mediated diseases (IMDs) can occur in patients with CD throughout their lives and are associated with multiple factors, including sex and sex hormone levels. Moreover, sex is associated with differences in clinical presentation, onset, progression, and outcomes of disorders. OBJECTIVE: To investigate the prevalence of IMDs at diagnosis in patients with celiac disease (CD) and their first-degree relatives and to compare the findings between female and male patients of different age. METHODS: A retrospective study including Brazilian patients with CD who visited the same doctor during January 2012 to January 2017 was performed. Demographic and medical history data were collected through self-administered questionnaires and medical charts of the patients. In total, 213 patients were examined at diagnosis: 52 males (mean age, 40.0 years) and 161 females (mean age, 41.4 years). The patients were divided into two groups according to sex and age. RESULTS: IMDs were observed in 60.2% of the female (97/161) and 42.3% of the male patients (22/52; P=0.22). However, the frequency of IMDs was significantly higher in females aged 51-60 years than in males with same age (P=0.0002). Dermatitis herpetiformis (DH) was significantly more prevalent in males (P=0.02), whereas atopy was more prevalent in females (P=0.02). IMDs observed in first-degree relatives were similar to those observed in patients (70.9%; P<0.001), with a higher number observed in female relatives. CONCLUSION: The frequency of IMDs in CD patients was similar in all age groups and both sexes, except women diagnosed with CD after 51 years of age presented with an increased frequency of IMDs compared with males. Dermatitis herpetiformis was more prevalent in males, whereas atopy was more prevalent in females. No difference was observed in the type of IMDs between the first-degree relatives of both sexes.

RESUMO CONTEXTO: Até 15% das outras doenças imunomediadas (DIMs) podem ocorrer em pacientes com doença celíaca ao longo de suas vidas e estão associados a múltiplos fatores, incluindo sexo e níveis de hormônios sexuais. Além disso, o sexo está associado a diferenças na apresentação, início, progressão e desfecho das doenças. OBJETIVO: Investigar a prevalência de DIMs ao diagnóstico de doença celíaca e em seus familiares de primeiro grau e comparar os resultados entre sexo feminino e masculino em diferentes idades. MÉTODOS: Estudo retrospectivo incluindo pacientes brasileiros com diagnóstico de doença celíaca que realizaram acompanhamento com o mesmo médico no período de janeiro 2012 a janeiro de 2017. Dados demográficos e histórico médico foram coletados através de um questionário auto administrado e prontuários médicos dos pacientes envolvidos. No total, 213 pacientes eram portadores de doença celíaca, dos quais 52 do sexo masculino (idade média 40,0 anos) e 161 do sexo feminino (idade média 41,4 anos). Os pacientes foram divididos em dois grupos de acordo com o sexo e idade. RESULTADOS: DIMs foram observadas em 60,2% das pacientes femininas (97/161) e 42,4% dos pacientes masculinos (22/52; P=0,22). Entretanto, a frequência de DIMs foi significantemente maior em pacientes do sexo feminino com idade entre 51-60 anos que em pacientes masculinos da mesma idade (P=0,0002). Dermatite herpetiforme apresentou maior prevalência no sexo masculino (P=0,02), enquanto atopia obteve maior prevalência nas pacientes do sexo feminino (P=0,02). DIMs observadas em familiares de primeiro grau foram similares as encontradas nos pacientes (70,9%; P<0,001), com um maior número observado em familiares femininos. CONCLUSÃO: A frequência de DIMs em pacientes com doença celíaca foi similar nos grupos etários e ambos sexos, exceto as mulheres com diagnóstico de doença celíaca após a idade de 51 anos, as quais apresentaram um aumento na frequência de DIMs em comparação com os pacientes do sexo masculino. Dermatite herpetiforme apresentou maior prevalência em pacientes do sexo masculino, enquanto que atopia foi mais prevalente no sexo feminino. Em relação ao sexo, não foi observada diferença no tipo de DIMs observada entre os familiares de primeiro grau.

Manifestaciones maxilofaciales en una familia chilena con adenomatosis poliposa familiar / Maxillofacial manifestations in a Chilean family with familial adenomatous polyposis

RESUMEN: La Poliposis Adenomatosa Familiar (PAF) es un síndrome hereditario autosómico dominante causado por la mutación del gen APC. En su forma clásica se desarrollan más de 100 pólipos adenomatosos intestinales que progresan a cáncer colorrectal en casi el 100% de los casos no tratados. Dentro de las manifestaciones extracolónicas de PAF, se encuentran las maxilofaciales, como: osteomas y alteraciones dentales, que pueden preceder por años al desarrollo de poliposis colónica. A pesar de que en Chile hay estudios de PAF y cáncer de colon, son escasos los reportes de manifestaciones maxilofaciales en estos pacientes. En la familia en estudio se encontró manifestaciones descritas previamente como: odontoma, osteomas y malformaciones de incisivos; adicionalmente tags mucosos que no se han asociado previamente al síndrome.

ABSTRACT: Familial adenomatous polyposis (FAP) is an autosomal dominant hereditary syndrome caused by the mutation of the APC gene. In its classic form, more than 100 intestinal adenomatous polyps progress to colorectal cancer in almost 100% of cases if they are not treated. Within the extracolonic manifestations of FAP are the maxillofacial, such as: osteomas and dental alterations, which may precede the development of colonic polyposis. Although studies of colonic adenomatous polyposis and colon cancer exist in Chile, there are few reports of maxillofacial manifestations in these patients. In the family under study, previously described manifestations were found, such as: odontoma, osteomas and dental malformations; mucosal tags were also observed, with no previous association with the syndrom.

Pólipos gástricos: experiencia en el hospital Daniel Alcides Carrión - Callao 2014-2016 / Gastric polyps: experience in Daniel Alcides Carrion Hospital 2014-2016

Objetivos: El propósito de este estudio fue determinar la prevalencia y las características endoscópicas e histopatológicas de los distintos tipos de pólipos gástricos en el Hospital Daniel Alcides Carrión entre los años 2014-2016. Materiales y métodos: Se revisó 7559 reportes endoscópicos, donde se encontró 148 pólipos gástricos y se consignó datos de edad, sexo, localización, número de lesiones, tamaño, y aspectos macroscópicos y microscópicos de la lesión. Resultados: La prevalencia de pólipos gástricos fue 1,9%; el 74,3% de estos se presentaron en mujeres donde la edad promedio fue de 61,5 años. El 59,46% de los pólipos gástricos fueron únicos, la mayoría localizándose en el antro y cuerpo del estómago. El 74,29% de pólipos fueron menores de 1 cm en diámetro y el 83,64% tenían un aspecto macroscópico sésil. Con respecto al tipo histológico, se encontró que la mayoría de los pólipos gástricos en esta población son hiperplásicos (76,4%), seguidos por los de glándulas fúndicas (17,5%) y la minoría fueron adenomas (6,1%). Cabe resaltar que los pólipos múltiples fueron en su gran mayoría de tipo de glándulas fúndicas mientras que en los demás tipos histológicos predominó el pólipo único. Conclusión: La prevalencia de pólipos de glándulas fúndicas ha aumentado, mientras los otros tipos de pólipos han mantenido su prevalencia esperada.

Objective: The purpose of this study was to determine the prevalence of the different types of gastric polyps in the Daniel Alcides Carrión Hospital between the years of 2014 and 2016, and also define the endoscopic and histopathological characteristics of the lesions. Materials and methods: 7559 endoscopic reports were reviewed, in which 148 gastric polyps were found. The patients' age and sex as well as the localization, number, size and macroscopic and microscopic aspects of the polyps were recorded. Results: The prevalence of gastric polyps was 1.9%; 74.3% of these were found in women with an average age of 61.5 years. 59.4% of the gastric polyps found were singular, and the majority were located on the body and antrum of the stomach. 74.29% of the polyps were less than 1 cm in diameter and 83.64% of these were sessile when seen macroscopically. According to the histological type, it was found that the majority of gastric polyps were hyperplasic (76.4%), followed by fundic gland polyps (17.5%) and gastric adenomas (6.1%). It was also found that multiple gastric polyps were associated with fundic gland polyps while singular polyps were most likely hyperplastic or adenomas. Conclusion: The prevalence of fundic gland polyps has increased, while the other types of polyps have maintained their estimated prevalence.

Concordância entre diferentes patologistas no diagnóstico anatomopatológico de uma série de 128 pólipos gástricos / Agreement between different pathologists in histopathologic diagnosis of 128 gastric polyps

ABSTRACT BACKGROUND - Gastric polyps are elevated mucosal lesions. Most of them are less than 1 cm and when larger than 2 cm, has a high malignancy probability. The histopathological types are mainly fundic gland polyps, hyperplastic polyps and adenomatous polyps. OBJECTIVE - To evaluate the agreement between three different pathologists in the histopathological diagnosis of 128 biopsied gastric polyps in Digestive Endoscopy Unit from Walter Cantídeo University Hospital, between May 2010 to May 2012. METHODS - To describe the intensity of agreement between observers, we use kappa index that is based on the number of concordant measures between them. RESULTS - There was substantial agreement in the diagnosis of adenoma (kappa=0.799, CI: 0.899-0.698) and fundic glands (kappa=0.655, CI: 0.755-0.555). Regarding to hyperplastic polyps (kappa=0.415, CI: 0.515-0.315) and inflammatory (kappa=0.401, CI: 0.501-0.301), we obtained a moderate agreement. Regarding the presence of Helicobacter pylori in biopsy of the polyp, there was a low agreement (kappa=0.219, CI: 0.319-0.119). CONCLUSION - It is clear that the agreement between pathologists depends on the histological type of the biopsied polyp and this agreement is more substantial in adenoma, or fundic gland polyps.

RESUMO CONTEXTO - Os pólipos gástricos são lesões elevadas da mucosa. A maioria são menores que 1 cm (60%-82%) e quando maiores do que 2 cm, tem alta probabilidade de malignidade. Os tipos histopatológicos são principalmente pólipos de glândulas fúndicas, pólipos hiperplásicos e pólipos adenomatosos. OBJETIVO - Avaliar a concordância entre três diferentes patologistas no diagnóstico histopatológico de 128 pólipos gástricos biopsiados na Unidade de Endoscopia Digestiva do Hospital Universitário Walter Cantídeo no período de maio de 2010 a maio de 2012. MÉTODOS - Para descrevermos a intensidade de concordância entre os avaliadores, utilizamos o índice kappa que é baseado no número de medidas concordantes entre eles. RESULTADOS - Houve uma substancial concordância no diagnóstico de adenoma (kappa=0,799, IC: 0,899-0,698) e glândulas fúndicas (kappa=0,655, IC: 0,755-0,555). Em relação aos pólipos hiperplásicos (kappa=0,415, IC: 0,515-0,315) e inflamatórios (kappa=0,401, IC: 0,501-0,301), obtivemos uma concordância moderada. Em relação à presença do Helicobacter pylori na biópsia do pólipo, houve uma baixa concordância (kappa=0,219, IC: 0,319-0,119). CONCLUSÃO - Em vista do que foi observado, torna-se claro que a concordância entre observadores depende do tipo histológico do pólipo biopsiado, sendo essa mais alcançada no diagnóstico de adenoma e pólipos de glândulas fúndicas.

Epidemiological aspects of endoscopic resections of colorectal polyps in patients at an endoscopy training center in the Santos region, Brasil / Aspectos epidemiológicos de las resecciones endoscópicas de los pólipos colo-rectales en un centro de entrenamiento de endoscopía en la región de Santos, Brasil

Introduction: Colorectal polyps are structures that project from the surface of the mucosal layer of the large intestine. They are classified as neoplastic or non-neoplastic. Early detection of pre-neoplastic lesions is important for preventing colorectal cancer. These can be resected so as to decrease the morbidity and mortality rates. Colonoscopy is the gold-standard procedure for diagnosing and resecting precursor lesions. Objective: To evaluate the epidemiological, endoscopic and histological aspects of endoscopic resection of lesions of the colon and rectum at a training center. Materials and method: A search was conducted in the database of our institution covering the period from January 2011 to July 2014. Cases that underwent endoscopic resection of polyps and/or colorectal lesions were selection. The following variables were defined: general data on the patients (age, gender and indication from the examination) and data on the polypoid lesion (number, histological type and topographic distribution). Results: 678 lesions were identified in 456 examinations. Regarding sex, 242 (53.1%) were female and 214 (46.9%) were male. The mean age was 64.54 years, with extremes of 5 and 94 years. The most frequent locations were the rectum (21%) and sigmoid (20%). Histologically, 34.7% were hyperplastic polyps and 58.9% were adenomatous polyps, of which 74.1% were tubular, 10.6% tubulovillous, 2% villous and 13% indeterminate; and 1.7% were adenocarcinomas. In 65.4% of the cases, the examination showed that only one polyps was present, while 34.6% had two or more lesions. Conclusion: In our clinic, with a mean of 250 examinations/month, the parameters evaluated were compatible with the results reported in the literature.

Introducción: Los pólipos colorrectales son estructuras que se proyectan en la superficie de la capa mucosa del intestino grueso. Son clasificados en neoplásicos y no neoplásicos. La detección precoz de lesiones preneoplásicas es relevante en la prevención del cáncer colorrectal. Pueden ser resecados y reducir los índices de morbimortalidad. La colonoscopia es el patrón de oro para el diagnóstico y resección de lesiones precursoras. Objetivo: Evaluar aspectos epidemiológicos, endoscópicos e histológicos relacionados a las resecciones endoscópicas de lesiones de colon y recto en un centro de entrenamiento. Matariales y métodos: Fue realizada una búsqueda en la base de datos de nuestra institución durante el período de enero de 2011 a julio de 2014. Se seleccionaron aquellos sometidos a las resecciones endoscópicas de pólipos y/o lesiones colorrectales. Las siguientes variables fueron definidas: datos generales de los pacientes (edad género e indicación del examen) y datos de la lesión polipoidea (número, tipo histológico, distribución topográfica). Resultados: Fueron identificadas 678 lesiones en 456 exámenes. Con relación al sexo, 242 (53,1 %) eran del género femenino y 214 (46,9 %) masculino. El promedio de edad fue de 64,54 años, con extremos de 5 y 94 años. La ubicación más frecuente fue en el recto (21 %) y sigmoide (20 %). Histológicamente, 34,7% eran pólipos hiperplásicos y 58,9% adenomatosos, siendo 74,1% tubulares, 10,6% tubulovellosos, 2% vellosos y 13% indeterminados y, 1,7% correspondieron a adenocarcinomas. En el 65,4% de los casos existía solamente un pólipo al hacer el examen, 34,6% presentaban dos o más lesiones. Conclusión: En nuestro trabajo, con un promedio de 250 exámenes/mes, los parámetros evaluados fueron compatibles a los resultados encontrados en la literatura.

Fecal occult blood test and flexible rectosigmoidoscopy: tools for the screening of colorectal neoplasms in asymptomatic patients / Teste de sangue oculto nas fezes e retossigmoidoscopia flexível: instrumentos para o rastreamento de neoplasias colorretais em pacientes assintomáticos

PURPOSE: To assess the feasibility and effectiveness of the fecal occult blood test (FOBT) and flexible rectosigmoidoscopy (RSS), as tools used in the CRC screening, in asymptomatic patients, from 50 years of age. METHODS: The study is transversal and presents a sample of 102 individuals. The FOBT used was the guaiaco, FECA-CULT(r) method, held at a single time, in feces collected from a complete evacuation. Individuals, who presented the positive FOBT, were sent to colonoscopy complement, although this is not primary variable examined in this study. All subjects underwent to flexible RSS, after bowel preparation, using a solution of sodium phosphate monobasic monohydrate and dibasic sodium phosphate heptahydrate. RESULTS: Individuals showed minimum age of 50 years and maximum 82 years, 61.6 years average and standard deviation +8.1. Of the 102 individuals, 42 (41%) belong to the males, whereas 60 (58.8%) female. The FOBT presented 10 positive cases (9.8%) (IC 95%: 4.8-17.3%) and 92 negative cases (90.2%) (IC 95%; 82.7-95.2%). The FOBT was effective at 2.9% and presented false-positive result in 6.9%. The result of the FBOT association with flexible RSS showed that 70% of neoplastic polyps showed no bleeding. Its sensitivity was 30% (IC 95%: 0.00-63.40%), the value of the relative risk was 3.94 (IC 95%: 1.20-12.89) and 5.20 valued odds ratio (IC 95%: -23.15 to 1.21). The specificity was 92.40% (IC 95%: 86.43-98.35%). The flexible RSS detected 15 polyps, among which, after histopathological study, 10 were neoplastic, being 09 adenomatous polyps (60%) and 01 malignity (6.7%) (IC 95%: 0.20-31.90%) and 05 non-neoplastic polyps (33.3%), and 03 inflammatory polyps (20%) (IC 95%: 4.3-48.1%) and 02 hyperplastic polyps (13.3%) (IC 95%: 1.7-40.5%). Neoplastic polyps were present in 60% of individuals over 60 years of age. Among the adenomatous polyps, the adenomatous polyp tubular prevalence is 53.33%. Among the 102 individuals, flexible RSS detected 09 adenomatous polyps (8.82%) and 01 (0.98%) malignity polyp. CONCLUSION: The tools FOBT and flexible RSS presented feasibility and, when associated demonstrated statistical significance in detecting polyps in general and important clinical significance on the detection of adenomatous polyps and colorectal cancer. (AU)

OBJETIVO: Avaliar a viabilidade e eficácia do teste de sangue oculto nas fezes (TSOF) e retossigmoidoscopia (RSS) flexível, como instrumentos utilizados na triagem do CCR, em pacientes assintomáticos a partir dos 50 anos. MÉTODOS: Esse é um estudo transversal e apresenta uma amostra de 102 indivíduos. O TSOF utilizado foi o método do guaiaco FECA-CULT(r), realizado em uma única vez, em fezes coletadas de uma evacuação completa. Indivíduos com TSOF positivo foram encaminhados para o complemento de colonoscopia, embora essa não seja a variável primária examinada neste estudo. Todos os pacientes foram submetidos a uma RSS flexível, após a preparação do intestino com o uso de uma solução de fosfato de sódio monobásico mono-hidratado e de fosfato de sódio dibásico hepta-hidratado. RESULTADOS: Os participantes tinham idade mínima de 50 anos e máxima de 82 anos (média ± desvio padrão, 61,6 ± 8,1 anos). Dos 102 pacientes, 42 (41%) eram homens, enquanto 60 (58,8%) eram mulheres. O TSOF revelou 10 casos positivos (9,8%) (IC 95%: 4,8-17,3%) e 92 casos negativos (90,2%) (IC 95%; 82,7-95,2%). O TSOF foi eficaz em 2,9% e apresentou resultado falso-positivo em 6,9%. O resultado da associação de TSOF com RSS flexível demonstrou que 70% dos pólipos neoplásicos não exibiam qualquer sangramento. Sua sensibilidade foi de 30% (IC 95%: 0,00-63,40%), com risco relativo de 3,94 (IC 95%: 1,20-12,89) e razão de sensibilidade (odds ratio) de 5,20 (IC 95%: 1,21-23,15). A especificidade da associação foi de 92,40% (IC 95%: 86,43-98,35%). A RSS flexível detectou 15 pólipos, tendo sido contatado que, depois do estudo histopatológico, 10 eram neoplásicos: 9 pólipos adenomatosos (60%) e 1 malignidade (6,7%) (IC 95%: 0,20-31,90%). Além disso, a RSS flexível detectou 5 pólipos não neoplásicos (33,3%): 3 pólipos inflamatórios (20%) (IC 95%: 4,3-48,1%) e 2 pólipos hiperplásicos (13,3%) (IC 95%: 1,7% -40,5%). Os pólipos neoplásicos estavam presentes em 60% dos pacientes com mais de 60 anos de idade. Entre os pólipos adenomatosos, houve prevalência tubular de pólipos adenomatosos em 53,33%. Entre os 102 indivíduos, a RSS flexível detectou 9 pólipos adenomatosos (8,82%) e 1 (0,98%) pólipo maligno. CONCLUSÃO: Foi constatada a viabilidade dos instrumentos TSOF e RSS flexível; quando associados, demonstraram significância estatística na detecção de pólipos em geral e importante significado clínico para a detecção de pólipos adenomatosos e do câncer colorretal. (AU)

Ressecção endoscópica de tumor polipoide da junção retossigmoidiana / Endoscopic resection of a polypoid tumor on the rectosigmoid junction

Os adenomas são classificados histologicamente conforme a participação do componente tubular e viloso na sua constituição, e também conforme o seu grau de displasia, que pode ser de baixo ou de alto grau. De acordo com o National Polyp Study, os fatores mais importantes relacionados aos adenomas com displasia de alto grau são o tamanho = 1 cm, idade avançada e a presença de componente viloso. Portanto, a identificação dos fatores de risco para os adenomas com displasia de alto grau pode contribuir de maneira significativa para o tratamento e seguimento dos pacientes com pólipos adenomatosos. A maioria (2/3) dos pólipos é assintomática, sobretudo os < 1,0 cm, podendo, eventualmente, ocorrer sintomas nos pólipos > 1,0 cm. A detecção e a remoção dos adenomas rompem a sequência patogênica, eliminando a progressão para a malignidade.

La colonoscopia en la pesquisa de cáncer colorrectal / Colorectal cancer screening with colonoscopy

El cáncer colorrectal representa una de las primeras causas de muerte por cáncer en todo el mundo y también en la Argentina. En los últimos años la pesquisa de cáncer de colon ha cobrado gran importancia y se ha postulado a la colonoscopia como el patrón de oro. En esta revisión resumimos las evidencias de este método poniendolo en contexto con las complicaciones y desventajas.

Colorectal cancer is one of the leading causes of cancer death worldwide and also in Argentina. In the past few years colorectal cancer screening has become more popular and colonoscopy has been postulated as the gold standard. In this review we analyzed the evidence supporting this method in contrast with its complications and disadvantages.

Rol e importancia del médico-endoscopista en la detección de pólipos adenomatosos durante la colonoscopía en el Hospital Nacional PNP Luis N. Sáenz. Enero a Julio 2011 / Role and importance of the physician- endoscopist in the detection of adenomatous polyps during colonoscopy in the National Hospital of PNP, Luis N. Saenz. January to July 2011

Objetivo: Determinar el rol e importancia de la calidad del médico endocopista en la detección de pólipos adenomatosos durante la colonoscopía en el Hospital Nacional PNP Luis N. Sáenz (año 2011). Material y Métodos: Estudio de diseño retrospectivo y metodología observacional, analítico y descriptivo en pacientes con indicación de colonoscopía, en el Servicio de Gastroenterología del Hospital Nacional PNP Luis N. Sáenz (año 2011). Resultados: En 610 colonoscopias la edad promedio de los pacientes fue de 62.4+/-7.1 años, con mayor frecuencia de edad =>de 50 años (66.70 por ciento) y predominancia femenina (59 por ciento). La indicación más frecuente para colonoscopía fue: despistaje (47.55 por ciento), estreñimiento (18.70 por ciento), dolor abdominal (10.15 por ciento). El rango para la detección de al menos un pólipo fue de 13.45 a 19.65 por ciento en los endoscopistas participantes. En los pacientes =>50 años el rango fue de 21.15-38.45 por ciento (p=0.001). Existió diferencia significativa (p=0.04) entre los endoscopistas con mayor y menor tasa de detección de pólipos adenomas. La edad avanzada y el género masculino fueron poderes predictores de adenomas. La indicación para la colonoscopía no se encontró diferencias significativas entre las categorías (p=0.290). Conclusiones: La calidad en la técnica de exploración del colón por parte del endoscopista en nuestro hospital, puede ser más importante que conocidos predictores de adenomas, como edad, género e indicación para el examen. Nuestros resultados apoyan el papel principal de esta medida, en la mejora continua de la calidad de detección del cáncer colorrectal.

Objective: To determine the role and importance of physician quality endocospist in detecting adenomatous polyps during colonoscopy in the National Hospital PNP Luis N. Saenz (2011). Material and Methods: Study design and methodology retrospective observational, analytical and descriptive in patients requiring colonoscopy in the Gastroenterology Service of the National Hospital PNP Luis N. Saenz (2011). Results: In 610 colonoscopies average age of patients was 62.4+/-7.1 years, most often age =>50 years (66.70 per cent) and female predominance (59 per cent). The most common Indication for colonoscopy was: screening (47.55 per cent), constipation (18.70 per cent), and abdominal pain (10.15 per cent). The range for the detection of at least one polyp was from 13.45 to 19.65 per cent in the endoscopist participants. In patients =>50 years, the range was 21.15-38.45 per cent (p=0.001). Significant difference (p=0.04) between the highest and lowest endoscopists polyp detection rate adenomas. Older age and male gender were predictors of adenomas powers. The indication for colonoscopy was not found significant differences between categories (p=0.290). Conclusions: The quality of the scanning technique of the colon by the endoscopist at our hospital may be more important than adenomas known predictors such as age, gender and indication for the examination. Our results support the role of this measure in the continuous improvement of the quality of colorectal cancer screening.

Caracterización clínica, endoscópica e histológica de lesiones elevadas diminutas del colon / Clinical, endoscopic and histological characterization of raised diminutive colon lesions

Introducción: las lesiones elevadas diminutas del colon son de gran interés por su frecuente aparición en los procederes endoscópicos y su asociación con lesiones adenomatosas. Objetivo: caracterizar clínica, endoscópica e histológicamente este tipo de lesiones. Métodos: se hizo un estudio observacional, descriptivo y transversal en el Instituto de Gastroenterología desde enero 2007 a junio 2009. La muestra quedó constituida por 249 lesiones elevadas y diminutas del colon que se encontraron en 193 pacientes de 18 años y más, a los que se les realizó colonoscopia y se les tomó muestra de las lesiones para biopsia. Resultados: Predominó la edad entre los 50 y 69 años, el sexo femenino y el color de la piel blanca. La mayoría de los pacientes se mantenían asintomáticos y la enfermedad del colon que más se asoció fueron los pólipos. La localización más frecuente fue en sigmoides y recto, con un predominio de las lesiones con tamaño £ 2 mm y entre 4 y 5 mm. La mayoría de las lesiones fueron no neoplásicas y todos los adenomas que se encontraron fueron tubulares, la displasia de bajo grado resultó la más frecuentemente observada

Introduction: raised diminutive colon lesions are of great interest due to their frequent appearance in endoscopic procedures and their association with adenomatous lesions. Objective: carry out a clinical, endoscopic and histological characterization of this type of lesions. Methods: an observational descriptive cross-sectional study was conducted at the Institute of Gastroenterology from January 2007 to June 2009. The sample consisted of 249 raised diminutive colon lesions found in 193 patients aged 18 and over. These patients underwent colonoscopy and biopsies were taken from their lesions. Results: there was a prevalence of the 50-69 age group, female sex and white skin color. Most patients were asymptomatic and the colon disease most commonly associated was polyps. The most common locations were the sigmoid colon and the rectum, with a prevalence of £ 2 mm and > 4-5 mm lesions. Most lesions were non-neoplastic and all adenomas were tubular. Low-grade dysplasia was the most common

Pólipos colorectales: actualización en el diagnóstico / Colorectal polyps: update in the diagnosis

El diagnóstico histológico de los pólipos colorrectales determina la conducta que tomará el médico especialista con el paciente. Con la aparición de nuevos pólipos en los últimos años, la clasificación histológica se ha tornado más compleja y amplia. Nuestro objetivo es actualizar los conceptos en el diagnóstico histológico de pólipos de colon de una manera clara y de fácil comprensión, especialmente para gastroenterólogos y patólogos.

Histological diagnosis determines the clinical behavior of colorectal polyps. Recently new types of polyps have been described and the classification has become wider and more complex. Our aim is update the current concepts in the knowledge of colorectal polyps.