Evaluating the Minimal Specimens From Endoscopic Ultrasound-Guided Fine-Needle Aspiration in Pancreatic Masses.

Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has become one of the most useful diagnostic modalities for the diagnosis of pancreatic mass. The aim of this study was to investigate the role of analyzing the minimal specimens obtained by EUS-FNA for the diagnosis of solid masses of pancreas.This study consisted of retrospective and prospective analyses. The retrospective study was performed on 116 patients who underwent EUS-FNA of solid masses for cytological smear, histological analysis, and combined analysis including immunohistochemical (IHC) staining. In the prospective study, 79 patients were enrolled to evaluate the quality and accuracy of EUS-FNA histological analysis and feasibility of IHC staining.The final diagnoses of all patients included pancreatic cancer (n = 126), nonpancreatic cancer (n = 21), other neoplasm (n = 27), and benign lesions (n = 21). In our retrospective study, the combined analysis was more sensitive than cytological analysis alone (P < 0.01). The overall sensitivity of cytology, histology, and combined analysis was 69.8%, 67.2%, and 81.8%, respectively. In the prospective analysis, 64.2% of all punctures were helpful for determining the diagnosis and 40.7% provided sufficient tissue for IHC staining. Histological analysis was helpful for diagnosis in 74.7% of patients. IHC staining was necessary for a definite diagnosis in 11.4% of patients, especially in the cases of nonmalignant pancreatic mass.Histological analysis and IHC study of EUS-FNA specimens was useful for the accurate diagnosis of pancreatic and peripancreatic lesions. Combined analysis showed significantly higher sensitivity than cytology alone because IHC staining was helpful for a diagnosis in some patients.

Corrosive esophagitis caused by ingestion of picosulfate.

Corrosive esophagitis is characterized by caustic injury due to the ingestion of chemical agents, mainly alkaline substances such as detergents. Esophageal bleeding, perforation, or stricture can be worsened by high-degree corrosive esophagitis. Picosulfate is a commonly used laxative frequently administered for bowel preparation before colonoscopy or colon surgery. Picosulfate powder should be completely dissolved in water before ingestion because the powder itself may cause chemical burning of the esophagus and stomach. Here, we report a case of corrosive esophagitis due to the ingestion of picosulfate powder that was not completely dissolved in water.

Clinicopathological factors of multiple lateral margin involvement after endoscopic submucosal dissection for early gastric cancer.

BACKGROUND AND STUDY AIMS: In some ESD specimens of EGC, tumors involve multiple lateral margins. However, the factors related to the number of lateral margins involved are unclear. We evaluated the factors related to the multiplicity of lateral margin involvement in specimens of ESD for EGC. PATIENTS AND METHODS: The study included 1,358 patients treated with ESD for EGC between March 2004 and September 2011 at a single tertiary hospital. Of those, 71 patients (5.2%) were found to have lateral margin-positive specimens. The demographic, endoscopic, and pathological features between the single lateral margin-positive lesions (SLM+ group) and the multiple lateral margin-positive lesions (MLM+ group) were compared retrospectively. RESULTS: Single lateral margin involvement was noted in 43 lesions (60.6%), and multiple lateral margin involvement was seen in 28 lesions (39.4%). Extremely well-differentiated adenocarcinoma (EWDA) and histological heterogeneity were more common in the MLM+ group (p = 0.043 and p = 0.070, respectively). In multivariate analysis, EWDA was the only significant risk factor for multiple lateral margin involvement (OR 4.453 [1.011-19.624, 95% CI], p = 0.048). Surgery was performed in 65% (46/71) of the patients as an additional treatment for positive lateral margin, while 20% (14/71) of the patients underwent an additional ESD. After additional treatment, residual tumors were observed in 65% (39/60) of the specimens. There was no local recurrence among the patients treated with either type of additional treatment. CONCLUSIONS: In ESD for EGC, multiple lateral margin involvement was related to the histological characteristics of the tumor, such as extremely well-differentiated adenocarcinoma and histological heterogeneity.

Oncogenic Role of BOLL in Colorectal Cancer.

BACKGROUND: Boule-like RNA-binding protein (BOLL protein) is the progenitor of the Deleted in Azoospermia (DAZ) gene family. To date, previous studies have focused on the reproductive function of BOLL. While we were identifying new DNA methylation biomarkers for colorectal cancer (CRC), we found that BOLL protein was overexpressed in CRC. AIM: The aim of this study was to determine the role of BOLL in CRC by epigenetic and functional studies in vivo and in vitro. METHODS: BOLL promoter methylation and expression were determined by MethyLight, RT-PCR, Western blot, and immunohistochemistry. The functional role of BOLL in CRC was evaluated by cell proliferation, colony formation, migration and invasion, cell cycle status, and tumor growth in a xenograft model. RESULTS: BOLL promoter methylation was enhanced in CRC tissues compared with normal colorectal tissues [97/124 (78 %) vs. 2/124 (2 %)]. However, the mean immunoreactivity score of CRC tissues and paired adjacent normal tissues was 8.15 ± 0.18 (SD) and 3.35 ± 0.19 (SD), respectively (p < 0.01). No significant association was observed between immunoreactivity score and clinicopathological parameters, including age, gender, tumor size, tumor differentiation, and tumor node metastasis stage. Expression of BOLL in CRC cell lines significantly enhanced cell proliferation (p < 0.01), colony formation (p < 0.01), and migration (p < 0.01). In BOLL-expressing cells, the percentage of cells in S-phase of the cell cycle was significantly increased. Tumor volume in BOLL xenografted mice was significantly enhanced after subcutaneous implantation (p < 0.01). CONCLUSIONS: Our study demonstrated an oncogenic role of BOLL in CRC despite tumor-specific promoter hypermethylation.

Is a second-look endoscopy necessary after endoscopic submucosal dissection for gastric neoplasm?

BACKGROUND/AIMS: Second-look endoscopy is performed to check for the possibility of post-endoscopic submucosal dissection (ESD) bleeding and to perform prophylactic hemostasis in most hospitals; however, there is little evidence about the efficacy of second-look endoscopy. We investigated whether second-look endoscopy after ESD is useful in the prevention of post-ESD bleeding. METHODS: A total of 550 lesions with gastric epithelial neoplasms in 502 patients (372 men and 130 women) were treated with ESD between August 18, 2009 and August 18, 2010. After the exclusion of three lesions of post-ESD bleeding within 24 hours, 547 lesions (335 early gastric cancers and 212 gastric adenomas) were included for the final analysis. RESULTS: The occurrence rate of delayed post-ESD bleeding was not significantly differ-ent between the second-look group and the no second-look group (1% vs 2.5%, p>0.05). The only predictor of delayed bleeding was tumor size, regardless of second-look endoscopy after ESD (22.8±9.87 vs 15.1±10.47, p<0.05). There was no difference between the prophylactic hemostasis and nonprophylactic hemostasis groups, including the occurrence rate of delayed bleeding. In the second-look group with prophylactic hemostasis, the hospital stay was more prolonged than in the second-look group without prophylactic hemostasis, but there was no significant difference (p=0.08). CONCLUSIONS: Second-look endoscopy to prevent delayed bleeding after ESD provides no significant medical benefits.

The role of the CpG island methylator phenotype on survival outcome in colon cancer.

BACKGROUND/AIMS: CpG island methylator phenotype (CIMP)- high colorectal cancers (CRCs) have distinct clinicopathologi-cal features from their CIMP-low/negative CRC counterparts. However, controversy exists regarding the prognosis of CRC according to the CIMP status. Therefore, this study examined the prognosis of Korean patients with colon cancer according to the CIMP status. METHODS: Among a previous cohort pop-ulation with CRC, a total of 154 patients with colon cancer who had available tissue for DNA extraction were included in the study. CIMP-high was defined as ≥3/5 methylated mark-ers using the five-marker panel (CACNA1G, IGF2, NEUROG1, RUNX3, and SOCS1). RESULTS: CIMP-high and CIMP-low/neg-ative cancers were observed in 27 patients (17.5%) and 127 patients (82.5%), respectively. Multivariate analysis adjust-ing for age, gender, tumor location, tumor stage and CIMP and microsatellite instability (MSI) statuses indicated that CIMP-high colon cancers were associated with a significant increase in colon cancer-specific mortality (hazard ratio [HR], 3.23; 95% confidence interval [CI], 1.20 to 8.69; p=0.02). In microsatellite stable cancers, CIMP-high cancer had a poor survival outcome compared to CIMP-low/negative cancer (HR, 2.91; 95% CI, 1.02 to 8.27; p=0.04). CONCLUSIONS: Re-gardless of the MSI status, CIMP-high cancers had poor sur-vival outcomes in Korean patients. (Gut Liver, 2015;9202-207).

Endoscopic resection for undifferentiated early gastric cancer: focusing on histologic discrepancies between forceps biopsy-based and endoscopic resection specimen-based diagnosis.

BACKGROUND: Before endoscopic resection (ER), a considerable number of undifferentiated early gastric cancer (UD-EGC) cases were initially diagnosed as atypical glands, dysplasia, or differentiated EGC (D-EGC) based on forceps biopsy specimens. As UD-EGC carries a high risk of resection margin involvement, identifying the predictive factors for UD-EGC cases with histologic discrepancy (HD) is of clinical importance. AIMS: To investigate the outcomes of ER for UD-EGC and to identify the predictive factors for UD-EGC with HD. METHODS: Among 2,194 EGC lesions treated by ER, 59 lesions were finally diagnosed as UD-EGC and 50 UD-EGC cases showed HD. The demographic and endoscopic characteristics were compared between D-EGC and UD-EGC with HD, and the predictive factors for the latter were investigated among cases of forceps biopsy-based diagnosis of atypical glands, dysplasia, or D-EGC. RESULTS: UD-EGC showed significantly higher rate of lateral margin involvement compared to D-EGC (18.6 vs. 3.4%). Among the UD-EGC cases meeting the expanded criteria and not involving additional surgery, no local or extragastric tumor recurrence was observed during the median follow-up of 27.5 months. Multivariate analysis demonstrated that age (≤60 years), female gender, gastric body, flat or depressed type, and tumor size (>2 cm) were independent predictive factors for UD-EGC with HD among cases of forceps biopsy-based diagnosis of atypical glands, dysplasia, or D-EGC. CONCLUSIONS: For lesions with predictive factors for UD-EGC with HD, a circumferential mapping biopsy before ER or wide marking during ER could be considered to avoid the potential risk of incomplete resection.

Paradoxical reaction to midazolam in patients undergoing endoscopy under sedation: Incidence, risk factors and the effect of flumazenil.

BACKGROUND: The incidence, risk factors and management strategy of paradoxical reaction to midazolam during endoscopy are yet to be clarified. METHODS: This single center prospective study included 4140 adult patients (2263 males, mean age of 57.7 ± 12.6) undergoing endoscopy under sedation with midazolam and pethidine between September 2011 and December 2011. The characteristics of patients with and without paradoxical reaction were compared. For patients who experienced paradoxical reaction and received flumazenil, their endoscopic images were reviewed to assess whether European Society of Gastrointestinal Endoscopy guidelines were met as quality indicator of endoscopy. RESULTS: The incidence of paradoxical reaction was 1.4%. In multivariate analyses, male gender, unsuccessful sedation in previous endoscopy, upper endoscopy, higher dose of midazolam, and lower dose of pethidine were identified as independent risk factors for paradoxical reaction. Despite paradoxical reaction, endoscopic procedures were successfully completed in 93.3% of cases when flumazenil was administered. The rates of meeting quality indicator of endoscopy were 92.3% in patients receiving flumazenil for paradoxical reaction and 97.6% in patients without paradoxical reaction. CONCLUSIONS: For patients with risk factors for paradoxical reaction, active use of pethidine with a dose reduction of midazolam might be helpful to prevent the occurrence of paradoxical reaction. Administration of flumazenil might be positively considered in cases of paradoxical reaction.

The Loop-Tip Wire for Selective Cannulation during ERCP in Patients with Billroth II Anastomosis: A Preliminary Feasibility Study.

BACKGROUND/AIMS: Selective cannulation of common bile duct remains technically challenging in patients with Billroth II anastomosis due to an altered anatomy. We aimed to determine the feasibility of performing wire-assisted cannulation using a loop-tip wire during ERCP in patients with Billroth II anastomosis. METHODOLOGY: We retrospectively analyzed a database of nine patients with Billroth II anastomosis who underwent ERCP using a loop-tip wire from January 2009 to July 2013 in the Hallym University Sacred Heart Hospital. Clinical characteristics and procedure-associated clinical outcomes were analyzed. RESULTS: The mean age of the patients was 73.7 years, and the male/female ratio was 2:1. The success rate of selective biliary cannulation was 77.8%. The mean cannulation time was 3.6 minutes (range, 1-9 minutes). Two patients who had failed in selective cannulation underwent infundibulotomy using a needle-knife papillotome, but one of the two patients had failed in biliary stone removal and finally underwent surgery. Six patients underwent endoscopic sphincterotomy. Complete clearance of bile duct stones was achieved in seven patients in one session. There was one case of mild post-ERCP pancreatitis (11.1%). CONCLUSIONS: The loop-tip wire can be an alternative instrument for wire-assisted selective cannulation in patients with Billroth II anastomosis.

Alginate hydrogel as a potential alternative to hyaluronic acid as submucosal injection material.

BACKGROUND: Sodium alginate is currently used in medical products, including drugs and cosmetic materials. It can also be used as a submucosal injection material due to its excellent water retention ability. Alginate with a high water retention ability is called alginate hydrogel (AH). The aim of this study was to investigate the usefulness of AH as a submucosal injection material. METHODS: To investigate the optimal viscosity of AH as a submucosal injection material, we observed the changes in submucosal height from the initial submucosal height in the stomachs of six miniature pigs for each injection material tested (0.3 % AH, 0.5 % hyaluronic acid, glycerol). All submucosal heights were compared serially over time (3, 5, 10, 20, and 30 min). Both immediate and 1-week delayed tissue reactions were investigated endoscopically in the same living pigs. Histological analyses were performed after the animals had been sacrificed. RESULTS: In a preliminary study, we determined that 0.3 % sodium alginate mixed with BaCl2 (400 µl) was the optimal viscosity of AH as an injection material. Our comparison of submucosal height changes over time showed that there was a significant decrease in submucosal height just 3 min following the injection of hyaluronic acid and glycerol, but that following the injection of AH a significant decrease in submucosal height was observed only after 10 min (p < 0.05). The histological analyses revealed that there were mild capillary dilations with congestion and mild fibrotic changes with some lymphocytic infiltration at the AH injection site. CONCLUSION: Alginate hydrogel demonstrated long-lasting maintenance of submucosal elevation, safety, and cost-effectiveness in a pig model, which makes it a potential alternative to hyaluronic acid.

The feasibility and safety of the endoscopic submucosal dissection of superficial gastric neoplastic lesions in patients with compensated liver cirrhosis: a retrospective study.

BACKGROUND/AIMS: When undergoing endoscopic submucosal dissection (ESD), patients with liver cirrhosis (LC) may suffer from a high risk of bleeding, bacteremia and tissue vulnerability. There have been few reports evaluating the efficacy and safety of ESD in patients with LC. METHODS: From January 2004 to March 2010, 23 patients with LC (cirrhosis group) underwent ESD for superficial gastric neoplastic lesions. The number of patients with a liver function in the Child-Pugh classes A and B were 20 and 3, respectively. The clinical outcomes and complications were compared with 69 patients without LC (control group) that were matched for age and sex. RESULTS: The en bloc resection, R0 resection and en bloc plus R0 resection rates of the cirrhosis group were 82.6%, 91.3%, and 82.6%, respectively, and did not show significant differences from the rates of the control group. No local recurrence was found in either group during the follow-up period. The procedure length of time (41.0 vs 39.0 minutes), rate of bleeding (4.3% vs 7.2%) and rate of perforation (0.0% vs 1.4%) in the cirrhosis group were also comparable to the results from the control group. CONCLUSIONS: ESD was safely performed in patients with LC, and satisfactory outcomes were achieved with high en bloc and R0 resection rates for superficial gastric neoplastic lesions.

Clinical usefulness of microsatellite instability test in Korean young patients with high-risk features associated with adenoma.

The aim of this study was to determine the correlation between microsatellite instability (MSI) and young age in patients with advanced colorectal adenomas. We retrospectively analyzed young patients (≤ 40 years of age) with advanced adenomas (n=84) between January 1996 and December 2006. We randomly selected the control group as patients ≥ 50 years of age with advanced adenomas (n=84) during the same time period. Of these patients, the MSI test and MLH1 immunohistochemistry were performed in the available tissue samples from patients with advanced adenomas. The number of patients who had the two tests was 52 in the young group and 49 in the old group. The monomorphic nature of the BAT26 panel for MSI analysis was used without comparison of normal tissue. MSI was detected in three young patients (n=52) and none of the old patients (n=49). There was no statistical difference between the two groups (P=0.243). All three young patients with MSI had a strong family history of colorectal cancer. MSI analysis was not a useful method of screening for HNPCC in young patients with advanced colorectal adenoma, at least in cases without a family history of colorectal cancer.

Endoscopic findings in mantle cell lymphoma with gastrointestinal tract involvement.

BACKGROUND AND AIMS: Mantle cell lymphoma (MCL) of the gastrointestinal (GI) tract is a rare disease with a poor prognosis. The aim of this study was to determine clinical and endoscopic characteristics of patients with GI MCL. METHODS: Clinical features of 19 patients with GI MCL were reviewed along with the endoscopic findings on 27 anatomical lesions. RESULTS: The initial presenting symptoms were abdominal pain (n = 7, 36.8%), GI tract bleeding (n = 5, 26.3%), dyspnea (n = 2, 10.5%), indigestion (n = 1, 5.3%), diarrhea (n = 1, 5.3%), cervical lymphadenopathy (n = 1, 5.3%), tonsilar mass (n = 1, 5.3%), and no symptoms (n = 1, 5.3%). On endoscopy, in 19 patients with 27 lesions, the anatomic locations of the lesions were: stomach, n = 2 (10.5%); stomach and colon, n = 7 (36.8%); terminal ileum and colon, n = 1 (5.3%); colon, n = 9 (47.4%). There was 1 fungating case (3.7%), 4 ulcerative cases (14.8%), 9 infiltrative cases (33.3%), and 13 polypoid cases (48.1%). CONCLUSIONS: The endoscopic findings in GI MCL are variable, with common presenting manifestations of abdominal pain and GI bleeding.

Endoscopy-based decision is sufficient for predicting completeness in lateral resection margin in colon endoscopic submucosal dissection.

BACKGROUND AND AIMS: Our aim was to investigate the incidence of tumor recurrence in cases in which there was a discrepancy in the diagnosis of complete resection by pathologists and colonoscopists, especially in the lateral resection margin. METHODS: We reviewed 245 patients with colorectal tumors that were treated by endoscopic submucosal dissection (ESD) between March 2006 and June 2011. We evaluated the recurrence rate in cases judged as pathologically incomplete resection despite endoscopically complete resection. RESULTS: Of the 24 cases with tumor cells on the lateral resection margin, the histologies of the colorectal tumors were found to be tubular adenoma (TA) with low-grade dysplasia (n = 19), TA with high-grade dysplasia (n = 3) and differentiated adenocarcinoma (n = 2). No tumor recurrence was observed in 22 patients after ESD. Four patients did not receive surveillance colonoscopy. The median tumor size was 28 mm (12-35) and the median follow-up period was 19 months (5-42). CONCLUSIONS: This retrospective analysis was limited by a short follow-up period. However, surveillance colonoscopy could be attempted without additional ESD in those cases in which incomplete resection on the lateral margin was judged pathologically, if endoscopic complete resection was grossly achieved.

Endoscopic submucosal dissection of early gastric cancer.

Gastric cancer is the most common cancer worldwide. The proportion of early gastric cancer (EGC) cases at diagnosis has increased because of the use of mass screening endoscopy in older adults. Endoscopic mucosal resection has become the standard treatment for EGC in cases with standard indications because of its low risk of lymph node metastasis. A new endoscopic method, endoscopic submucosal dissection, has recently become available. This method allows en bloc resection without limitation of the size of the lesion. The goal of this article is to review the history and methods of endoscopic treatment with EGC, the conventional and extended indications, the therapeutic outcomes, and the complication rates.

Efficacy of Bispectral Index Monitoring for Midazolam and Meperidine Induced Sedation during Endoscopic Submucosal Dissection: A Prospective, Randomized Controlled Study.

BACKGROUND/AIMS: Propofol induced sedation with bispectral index (BIS) monitoring has been reported to lead to higher satisfaction in patients and endoscopists during endoscopic submucosal dissection (ESD) procedures. There are no data, however, regarding the efficacy of midazolam and meperidine (M/M) induced sedation with BIS monitoring during ESD. The purpose of this study was to evaluate whether M/M induced sedation with BIS monitoring could improve satisfaction and reduce the dose of M/M required during ESD. METHODS: Between September 2009 and January 2010, 56 patients were prospectively enrolled and randomly assigned to a BIS group (n=28) and a non-BIS group (n=28). Patient and endoscopist satisfaction scores were assessed using the visual analog scale (0 to 100) following the ESD. RESULTS: The mean satisfaction scores did not significantly differ between the BIS and non-BIS groups (92.3±16.3 vs 93.3±15.5, p=0.53) or endoscopists (83.1±15.4 vs 80.0±16.7, p=0.52). Although the mean meperidine dose did not differ (62.5±27.6 vs 51.0±17.3, p=0.18) between the two groups, the mean dose of midazolam in the non-BIS group was lower than in the BIS group (6.8±2.0 vs 5.4±2.1, p=0.01). CONCLUSIONS: BIS monitoring during ESD did not increase the satisfaction of endoscopists or patients and did not lead to an M/M dose reduction. These results demonstrate that BIS monitoring provides no additional benefit to M/M induced sedation during ESD.

Cytomegalovirus colitis in patients without inflammatory bowel disease: a single center study.

OBJECTIVE: Cytomegalovirus (CMV) aggravates preexisting inflammatory bowel disease (IBD), and there are numerous reports of CMV colitis in IBD patients. However, little attention has been paid to CMV colitis in non-IBD patients. The aim was to determine the clinical manifestations, endoscopic appearance, and clinical course of CMV colitis in non-IBD patients. MATERIAL AND METHODS: We reviewed medical records of patients diagnosed with CMV colitis based on immunohistochemical studies of biopsy specimens or surgical specimens between 1998 and 2009. RESULTS: The medical records of 43 patients were reviewed. Subjects included individuals with AIDS, and those undergoing chemotherapy, steroid therapy, or transplantation, as well as individuals with other co-morbidities and individuals with no previous illnesses. Frequent symptoms were non-bloody diarrhea, abdominal pain, fever, and hematochezia. Macroscopically normal rectosigmoid mucosa was observed in eight of 21 patients who underwent full-length colonoscopy. Endoscopic findings were varied, and included macroscopically normal (n = 2), colitis alone (n = 12), ulcer alone (n = 5), and ulcer with colitis (n = 22). The ulcer margin was well-circumscribed in 12 of 21 patients. Thirty-six patients were administered antiviral agents and two patients died. All patients who were not treated with an antiviral agent recovered spontaneously while waiting for their biopsy results. CONCLUSIONS: Colonoscopy is preferred to sigmoidoscopy for diagnosis of CMV colitis. Antiviral therapy should not be mandatory for a subset of patients with CMV colitis.

Adenoma incidence after resection of sporadic colorectal cancer with microsatellite instability.

BACKGROUND AND OBJECTIVES: Microsatellite instability (MSI) tumors that develop via the mismatch repair (MMR) gene pathway show rapid growth. It is unknown if patients with sporadic colorectal cancer (CRC) with MSI would benefit from a shorter interval between colonoscopies. The purpose of this study is to determine if there is a difference in adenoma incidence based on the presence of MSI in patients with sporadic CRC. METHODS: We retrospectively reviewed the incidence of a recurring adenoma at the 1- and 3-year surveillance colonoscopies in 426 patients who had sporadic CRC after surgery RESULTS: The number of high MSI (MSI-H), low MSI (MSI-L), and microsatellite stable (MSS) tumors were 38 (9%), 27 (6%), and 361 (85%), respectively. After 1 year, the incidence of adenoma (13% vs. 16% for MSI-L + MSS vs. MSI-H, P = 0.61) or advanced adenoma (3% vs. 8% for MSI-L + MSS vs. MSI-H, P = 0.14) did not differ based on MSI status. The incidence of adenoma or advanced adenoma also did not differ based on MSI status at the 3-year surveillance colonoscopy. CONCLUSIONS: Our study does not show recommendations for a shorter interval for subsequent colonoscopies in patients with sporadic CRC with MSI-H. Further studies on a large scale are needed.

Clinical usefulness of glycosylated hemoglobin as a predictor of adenomatous polyps in the colorectum of middle-aged males.

OBJECTIVE: We investigated the clinical usefulness of HbA1c in screening an average-risk group <50 years of age who need colonoscopy for colorectal cancer (CRC) screening. METHODS: Eight hundred nineteen asymptomatic males who underwent colonoscopy for CRC screening with blood chemistries between January 2006 and December 2006 were enrolled. The ages of the subjects ranged from 40 to 59. RESULTS: Subjects in their 50 s had significantly more adenomatous polyps than subjects in their 40 s (32.7% vs. 26.0%, p < 0.05). The incidence of adenomatous polyp increased with increasing quartiles of HbA1C as follows: first quartile (19.9%, HbA1c 4.0-5.0), second quartile (27.8%, HbA1c 5.1-5.3), third quartile (32.7%, HbA1c 5.4-5.5), and fourth quartile (34.9%, HbA1c = 5.6-8.8)(p = 0.008). When combining quartile of HbA1c and age (40 s vs. 50 s) according to HbA1C levels, the odds ratio for adenomatous polyp in subjects in their 40 s with HbA1c <5.4% was significantly lower than that in subjects in their 50 s. However, the odds ratio for adenomatous polyp in subjects in their 40 s with HbA1c > or =5.4% was similar to that in subjects in their 50 s with average risk for CRC. CONCLUSIONS: An elevated HbA1c may be useful as a clinical predictor of adenomatous polyps in male subjects <50 years of age who have average risk for CRC.