Detection rate of colorectal cancer by routine colonoscopy is comparable in patients aged 45-49 and 50-54 years.

OBJECTIVES: Colorectal carcinoma remains one of the most common malignancies worldwide. Colonoscopy screening is most effective for early detection and tumour prevention and is currently recommended in Europe for adults aged over 50 years. However, given that an increasing proportion of patients are diagnosed before the age of 50, we set out to determine the detection rate of colorectal carcinoma in patients younger than 50 years and to determine the best threshold for starting colonoscopy screening. METHODS: Single-centre, retrospective cohort study of all colonoscopies performed, regardless of indication, in our department at a tertiary Swiss university hospital in patients aged ≥18 and <60 years between 2016 and 2021. Colorectal cancer detection rate was calculated per 5-year age group and analysed separately by sex. RESULTS: The current analysis included 2846 colonoscopies performed for any indication. Colorectal carcinoma was found in 5/366 (1.4%) patients aged 45-49 years (3/210 or 1.4% of males and 2/156 or 1.3% of females) and in 9/819 (1.1%) patients aged 50-54 years (5/495 or 1.0% of males and 4/324 or 1.2% of females). Adenomas with high-grade dysplasia were found in 5/366 (1.4%) patients aged 45-49 years and in 11/819 (1.3%) aged 50-54 years; by sex, in 4/210 or 1.9% of males and 1/156 or 0.6% of females aged 45-49 years, and in 6/495 or 1.2% of males and 5/324 or 1.5% of females aged 50-54 years. Detection of adenoma with low-grade dysplasia increased from 14.6% (21/144) at age <30 years to 41% (150/366) at 45-49 years and 43.5% (356/819) at 50-54 years. A similar increasing trend was also seen if we analysed these groups by sex. CONCLUSIONS: The detection rate of colorectal carcinoma, but also adenomas, in our patients aged 45-49 years was similar to that in patients aged over 50, in both sexes. Thus our data are in line with the assumption that lowering the screening age to 45 years might be reasonable from a medical point of view for achieving a reduction in disease-specific mortality by improved screening strategies.

Integrative plasma and fecal metabolomics identify functional metabolites in adenoma-colorectal cancer progression and as early diagnostic biomarkers.

Changes in plasma and fecal metabolomes in colorectal cancer (CRC) progression (normal-adenoma-CRC) remain unclear. Here, plasma and fecal samples were collected from four independent cohorts of 1,251 individuals (422 CRC, 399 colorectal adenoma [CRA], and 430 normal controls [NC]). By metabolomic profiling, signature plasma and fecal metabolites with consistent shift across NC, CRA, and CRC are identified, including CRC-enriched oleic acid and CRC-depleted allocholic acid. Oleic acid exhibits pro-tumorigenic effects in CRC cells, patient-derived organoids, and two murine CRC models, whereas allocholic acid has opposing effects. By integrative analysis, we found that oleic acid or allocholic acid directly binds to α-enolase or farnesoid X receptor-1 in CRC cells, respectively, to modulate cancer-associated pathways. Clinically, we establish a panel of 17 plasma metabolites that accurately diagnoses CRC in a discovery and three validation cohorts (AUC = 0.848-0.987). Overall, we characterize metabolite signatures, mechanistic significance, and diagnostic potential of plasma and fecal metabolomes in CRC.

Early detection of multiple endocrine neoplasia type 1: A case report.

BACKGROUND: Multiple endocrine neoplasias (MENs) are a group of hereditary diseases involving multiple endocrine glands, and their prevalence is low. MEN type 1 (MEN1) has diverse clinical manifestations, mainly involving the parathyroid glands, gastrointestinal tract, pancreas and pituitary gland, making it easy to miss the clinical diagnosis. CASE SUMMARY: We present the case of a patient in whom MEN1 was detected early. A middle-aged male with recurrent abdominal pain and diarrhea was admitted to the hospital. Blood tests at admission revealed hypercalcemia and hypophosphatemia, and emission computed tomography of the parathyroid glands revealed a hyperfunctioning parathyroid lesion. Gastroscopy findings suggested a duodenal bulge and ulceration. Ultrasound endoscopy revealed a hypoechoic lesion in the duodenal bulb. Further blood tests revealed elevated levels of serum gastrin. Surgery was performed, and pathological analysis of the surgical specimens revealed a parathyroid adenoma after parathyroidectomy and a neuroendocrine tumor after duodenal bulbectomy. The time from onset to the definitive diagnosis of MEN1 was only approximately 1 year. CONCLUSION: For patients who present with gastrointestinal symptoms accompanied by hypercalcemia and hypophosphatemia, clinicians need to be alert to the possibility of MEN1.

A rare association of pheochromocytoma, paraganglioma, and pituitary adenoma (3PA): A case report and literature review.

RATIONALE: 3P association (3PA) is a rare condition with co-occurrence of pituitary adenoma and pheochromocytoma/paraganglioma. There have been less than a hundred documented cases of 3PA, which can be sporadic or related to genetic mutations. The present case report describes the first Iranian patient with 3PA and a 90th case of 3PA in the available literature. PATIENT CONCERNS AND INTERVENTIONS: A 36-year-old Caucasian male was admitted with headache and sudden increase in blood pressure. An abdominal CT scan revealed a retroperitoneal mass posterior to the inferior vena cava, later removed and diagnosed as a pheochromocytoma. Four years later, he noticed occasional mild headaches and a painless mass on the right side of his neck. The ultrasonography evaluations suggested a carotid body tumor, which was surgically removed. About a month after his second surgery, the severity of the patient's headaches worsened, and he developed right homonymous hemianopia. A brain MRI showed a mass in favor of macroadenoma, craniopharyngioma, or meningioma, and elevated prolactin level led to the diagnosis of macroprolactinoma. DIAGNOSES: Based on the provided history, this patient was diagnosed with 3PA, and a genetic study identified a positive succinate-dehydrogenase-complex subunit b mutation, possibly linked to his family history of carotid body tumor. OUTCOMES: He has remained symptom-free during his visits every 3 months. LESSONS: The number of cases diagnosed with 3PA worldwide is increasing. Using clinical and genetic assessments, we can timely diagnose and adequately monitor individuals with or at risk of 3PA.

Acute Gastropathy Associated with Bowel Preparation for Colonoscopy.

Background/Aims: Utilization of low-volume preparation agents is crucial to improve patient willingness to undergo repeat colonoscopies. However, gastric safety data on preparation agents are limited. This study evaluated the acute gastropathy associated with bowel preparation agents. Methods: This retrospective study enrolled healthy subjects who underwent both esophagogastroduodenoscopy and colonoscopy screening. Baseline patient characteristics, bowel preparation success, acute gastropathy, and polyp and adenoma detection rates were evaluated for 1 L polyethylene glycol with ascorbic acid (1 L PEG/Asc) and oral sulfate tablet (OST) groups. Results: Comparison of the OST group (n=2,463) with the 1 L PEG/Asc group (n=2,060) revealed that the rates of successful cleansing and high-quality cleansing were similar between the two groups. Polyp and adenoma detection rates were significantly higher in the OST group than in the 1 L PEG/Asc group (p<0.001 and p=0.013), while the incidence of acute gastric mucosal lesion-like blood stain/clot, erosions at greater curvature side of antrum/body, multiple erosions, and overlying mucosal erythema or edema were all significantly higher in the OST group than in the 1 L PEG/Asc group (all p<0.001). Additionally, high and indeterminate probability scores of preparation agent-induced gastropathy (p=0.001) and mean Lanza scores were significantly higher in the OST group than in the 1 L PEG/Asc group (1.3 vs. 0.4, p<0.001). Conclusions: Compared with 1 L PEG/Asc, OSTs were significantly associated with acute gastropathy during bowel preparation, thus requiring careful consideration from physicians for the simultaneous screening of EGD and colonoscopy.

The value of FPR, FAR, CAR, CPR in the auxiliary diagnosis of colon cancer.

Chronic malnutrition, abnormal blood clotting, and systemic inflammation contribute to the occurrence and progression of colon cancer. This study aimed to assess the diagnostic utility of the 100fibrinogen-to-prealbumin ratio (FPR), 100fibrinogen-to-albumin ratio (FAR), 100C-reactive protein-to-albumin ratio (CAR), and 100C-reactive protein-to-prealbumin ratio (CPR) in aiding the diagnosis of colon cancer. A total of 129 patients with colon cancer were enrolled between April 2015 and August 2022. While 129 patients with colon adenoma were selected as the control group. The serum levels of FAR, FPR, CAR, CPR, CEA, and CA125 in the colon cancer group were significantly higher than those in the colon adenoma group (P < .05). In Logistic regression analysis, high FAR and high FPR were identified as independent risk factors for colon cancer. Receiver operating characteristic (ROC) curve analysis results showed that Among the combined measures, FAR, FPR, CAR, and CPR had the highest diagnostic efficacy in distinguishing colon cancer from colon adenomas (AUC = 0.886, Sen = 80.62%, Spe = 81.40%). Thus, FAR, FPR, CAR, and CPR may serve as valuable biomarkers for the diagnosis of colon cancer, and the combined detection of FAR, FPR, CAR, and CPR can enhance the diagnostic efficiency for both colon cancer and colon adenoma.

EVALUATION OF QUALITY INDICATORS OF SCREENING COLONOSCOPY PERFORMED IN A PRIVATE QUARTERNARY HOSPITAL IN BRAZIL.

BACKGROUND: Colorectal cancer is the third most common type of cancer in Brazil, despite the availability of screening methods that reduce its risk. Colonoscopy is the only screening method that also allows therapeutic procedures. The proper screening through colonoscopy is linked to the quality of the exam, which can be evaluated according to quality criteria recommended by various institutions. Among the factors, the most used is the Adenoma Detection Rate, which should be at least 25% for general population. AIMS: To evaluate the quality of the screening colonoscopies performed in a quarternary private Brazilian hospital. METHODS: This is a retrospective study evaluating the quality indicators of colonoscopies performed at a private center since its inauguration. Only asymptomatic patients aged over 45 years who underwent screening colonoscopy were included. The primary outcome was the Adenoma Detection Rate, and secondary outcomes included polyps detection rate and safety profile. Subanalyses evaluated the correlation of endoscopic findings with gender and age and the evolution of detection rates over the years. RESULTS: A total of 2,144 patients were include with a mean age of 60.54 years-old. Polyps were diagnosed in 68.6% of the procedures. Adenoma detection rate was 46.8%, with an increasing rate over the years, mainly in males. A low rate of adverse events was reported in 0.23% of the cases, with no need for surgical intervention and no deaths. CONCLUSIONS: This study shows that high quality screening colonoscopy is possible when performed by experienced endoscopists and trained nurses, under an adequate infrastructure.

Endoscopist's Satisfaction with the Insertion Phase of Colonoscopy Is a Potential Quality Indicator for Colorectal Polyp Detection: A Propensity Score Matching Study.

Quality indicators during the insertion phase of colonoscopy require exploration. Unsatisfactory insertion experiences cause endoscopist psychophysiological fatigue and affect the quality of their inspection. This comparative study used propensity score matching (PSM) to determine whether endoscopist satisfaction during scope insertion was related to polyp detection rate (PDR). Patients who underwent colonoscopy screening between April 2019 and December 2022 were enrolled in this study. The endoscopist satisfaction score (high and low) during the insertion phase in each examination was recorded based on the level of fatigue and presence of paradoxical scope movement. All examinations were classified into 2 groups: a high and a low satisfaction score group. After PSM with potential confounding factors related to polyp detection (endoscopist, insertion and withdrawal time, and sedative agent use), the PDR and adenoma detection rate (ADR) were compared. Overall, 4142 patients (average age, 54.1 years old; 54.4% male) underwent colonoscopies performed by twelve experienced endoscopists. Analysis using a logistic regression model revealed that a high satisfaction score during the insertion phase was an independent predictor of polyp detection (P < .001, odds ratio 1.79, 95% CI 1.41-2.33), whereas insertion time was not. After PSM, 513 patients from both groups were eligible for comparison. Polyp detection rate and ADR were significantly higher in the high-satisfaction group than in the low-satisfaction group (49.5% vs. 36.6%, P < .001; 35.1% vs. 27.1%, P = .007). The endoscopists' level of satisfaction with the insertion phase was shown to be a potential predictor of PDR in screening colonoscopy.

MicroRNA-193a-3p as a Valuable Biomarker for Discriminating between Colorectal Cancer and Colorectal Adenoma Patients.

Specific markers for colorectal cancer (CRC), preceded by colorectal adenoma (pre-CRC), are lacking. This study aimed to investigate whether microRNAs (miR-19a-3p, miR-92a-3p, miR-193a-3p, and miR-210-3p) from tissues and exosomes are potential CRC biomarkers and compare them to existing biomarkers, namely carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 19-9. MiRNA was isolated in the samples of 52 CRC and 76 pre-CRC patients. Expression levels were analyzed by RT-qPCR. When comparing pre-CRC and CRC tissue expression levels, only miR-193a-3p showed statistically significant result (p < 0.0001). When comparing the tissues and exosomes of CRC samples, a statistically significant difference was found for miR-193a-3p (p < 0.0001), miR-19a-3p (p < 0.0001), miR-92a-3p (p = 0.0212), and miR-210-3p (p < 0.0001). A receiver-operating characteristic (ROC) curve and area under the ROC curve (AUC) were used to evaluate the diagnostic value of CEA, CA 19-9, and miRNAs. CEA and CA 19-9 had good diagnostic values (AUCs of 0.798 and 0.668). The diagnostic value only of miR-193a-3p was highlighted (AUC = 0.725). The final logistic regression model, in which we put a combination of CEA concentration and the miR-193a-3p expression level in tissues, showed that using these two markers can distinguish CRC and pre-CRC in 71.3% of cases (AUC = 0.823). MiR-193a-3p from tissues could be a potential CRC biomarker.

Middle Ear Neuroendocrine Tumor: Case Report of a Tympanic Adenoma.

Middle ear neuroendocrine tumors (MeNETs) are an exceptionally rare occurrence. These benign tumors stem from the tympanic mucosa and can easily be misinterpreted by the clinician and the pathologist. Clinical characteristics, otoscopic findings and medical imaging in these cases are non-specific. We present a case of a 60-year-old male patient with bilateral hearing loss following recent coronavirus disease 2019 disease. Diagnostic work-up revealed a soft tissue neoplasm of the left middle ear. Surgical resection of the tumor mass with implantation of a partial ossicular replacement prosthesis (PORP) was the main modality of treatment. Middle ear neuroendocrine tumors was confirmed through positive immunohistochemistry for neuroendocrine tumor markers. Follow-up magnetic resonance imaging 12 months after the surgery reported no tumor recurrence or significant residual disease with a stable PORP. Our report highlights challenges in diagnosing and treating these rare tumors, while emphasizing surgical resection pitfalls and resulting improvement of quality of life of the patient. We recommend a through followup of patients with unclear soft tissue masses in the middle ear to obtain a definitive diagnosis.

Improving colorectal cancer screening programs.

In this editorial we comment on the article by Agatsuma et al published in the World Journal of Gastroenterology. They suggest policies for more effective colorectal screening. Screening is the main policy that has led to lower mortality rates in later years among the population that was eligible for screening. Colonoscopy is the gold standard tool for screening and has preventive effects by removing precancerous or early malignant polyps. However, colonoscopy is an invasive process, and fecal tests such as the current hemoglobin immunodetection were developed, followed by endoscopy, as the general tool for population screening, avoiding logistical and economic problems. Even so, participation and adherence rates are low. Different screening options are being developed with the idea that if people could choose between the ones that best suit them, participation in population-based screening programs would increase. Blood tests, such as a recent one that detects cell-free DNA shed by tumors called circulating tumor DNA, showed a similar accuracy rate to stool tests for cancer, but were less sensitive for advanced precancerous lesions. At the time when the crosstalk between the immune system and cancer was being established as a new hallmark of cancer, novel immune system-related biomarkers and information on patients' immune parameters, such as cell counts of different immune populations, were studied for the early detection of colorectal cancer, since they could be effective in asymptomatic people, appearing earlier in the adenoma-carcinoma development compared to the presence of fecal blood. sCD26, for example, detected 80.37% of advanced adenomas. To reach as many eligible people as possible, starting at an earlier age than current programs, the direction could be to apply tests based on blood, urine or salivary fluid to samples taken during routine visits to the primary health system.

Pancreatitis with Intraabdominal Venous Thrombosis as an Initial Presentation of Parathyroid Adenoma: A Rare Clinical Presentation.

BACKGROUND Benign parathyroid adenoma is a cause of hypercalcemia, which can lead to acute pancreatitis. Patients with acute pancreatitis are at risk for venous thrombosis. This report describes a 34-year-old woman with hypercalcemia due to parathyroid adenoma and acute pancreatitis associated with splenic vein and superior mesenteric vein thrombosis. CASE REPORT A previously healthy 34-year-old woman presented with severe epigastric pain that radiated to the back, associated with vomiting. Her abdominal examination was soft and lax, with epigastric and left upper quadrant tenderness. Pancreatitis with splenic and superior mesenteric veins thrombosis was diagnosed. The diagnosis was confirmed by an elevated serum lipase level and contrast-enhanced computed tomography (CT) of abdomen. Her serum calcium level was elevated. However, further workup revealed elevated parathyroid hormone (PTH) levels and radiological imaging showed parathyroid adenoma. She was diagnosed with hypercalcemia-induced pancreatitis secondary to hyperparathyroidism with intraabdominal venous thrombosis. The patient was initially treated conservatively, and later underwent parathyroidectomy after her condition was stabilized. The patient is currently in good condition, after a 2-year follow-up period. CONCLUSIONS Acute pancreatitis and thrombosis secondary to primary hyperparathyroidism (PHPT) are rare, but can lead to potentially fatal complications, especially in patients without symptoms of PHPT. This report highlights the importance of recognizing that hypercalcemia associated with parathyroid adenoma can result in acute pancreatitis, leading to hypercoagulable states and inflammation of adjacent vessels, including the splenic and mesenteric veins. To the best of our knowledge, this is second case report of acute pancreatitis with intraabdominal venous thrombosis secondary to PHPT.

An artificial intelligence-assisted system versus white light endoscopy alone for adenoma detection in individuals with Lynch syndrome (TIMELY): an international, multicentre, randomised controlled trial.

BACKGROUND: Computer-aided detection (CADe) systems for colonoscopy have been shown to increase small polyp detection during colonoscopy in the general population. People with Lynch syndrome represent an ideal target population for CADe-assisted colonoscopy because adenomas, the primary cancer precursor lesions, are characterised by their small size and higher likelihood of showing advanced histology. We aimed to evaluate the performance of CADe-assisted colonoscopy in detecting adenomas in individuals with Lynch syndrome. METHODS: TIMELY was an international, multicentre, parallel, randomised controlled trial done in 11 academic centres and six community centres in Belgium, Germany, Italy, and Spain. We enrolled individuals aged 18 years or older with pathogenic or likely pathogenic MLH1, MSH2, MSH6, or EPCAM variants. Participants were consecutively randomly assigned (1:1) to either CADe (GI Genius) assisted white light endoscopy (WLE) or WLE alone. A centre-stratified randomisation sequence was generated through a computer-generated system with a separate randomisation list for each centre according to block-permuted randomisation (block size 26 patients per centre). Allocation was automatically provided by the online AEG-REDCap database. Participants were masked to the random assignment but endoscopists were not. The primary outcome was the mean number of adenomas per colonoscopy, calculated by dividing the total number of adenomas detected by the total number of colonoscopies and assessed in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, NCT04909671. FINDINGS: Between Sept 13, 2021, and April 6, 2023, 456 participants were screened for eligibility, 430 of whom were randomly assigned to receive CADe-assisted colonoscopy (n=214) or WLE (n=216). 256 (60%) participants were female and 174 (40%) were male. In the intention-to-treat analysis, the mean number of adenomas per colonoscopy was 0·64 (SD 1·57) in the CADe group and 0·64 (1·17) in the WLE group (adjusted rate ratio 1·03 [95% CI 0·72-1·47); p=0·87). No adverse events were reported during the trial. INTERPRETATION: In this multicentre international trial, CADe did not improve the detection of adenomas in individuals with Lynch syndrome. High-quality procedures and thorough inspection and exposure of the colonic mucosa remain the cornerstone in surveillance of Lynch syndrome. FUNDING: Spanish Gastroenterology Association, Spanish Society of Digestive Endoscopy, European Society of Gastrointestinal Endoscopy, Societat Catalana de Digestologia, Instituto Carlos III, Beca de la Marato de TV3 2020. Co-funded by the European Union.

[Alveolar adenoma of the lung]. / Al'veolyarnaya adenoma legkogo.

Alveolar adenoma of the lung is a rare benign tumor first described in 1986. This article presents an observation of alveolar adenoma in a 72-year-old woman. Morphological and immunohistochemical methods of tumor diagnostics, issues of differential diagnosis are analyzed. The necessity of complex examination, including radiation methods, morphologic examination and immunohistochemical diagnostics to exclude other more dangerous diseases is shown.

ENDOANGEL improves detection of missed colorectal adenomas in second colonoscopy: A retrospective study.

The ENDOANGEL (EN) computer-assisted detection technique has emerged as a promising tool for enhancing the detection rate of colorectal adenomas during colonoscopies. However, its efficacy in identifying missed adenomas during subsequent colonoscopies remains unclear. Thus, we herein aimed to compare the adenoma miss rate (AMR) between EN-assisted and standard colonoscopies. Data from patients who underwent a second colonoscopy (EN-assisted or standard) within 6 months between September 2022 and May 2023 were analyzed. The EN-assisted group exhibited a significantly higher AMR (24.3% vs 11.9%, P = .005) than the standard group. After adjusting for potential confounders, multivariable analysis revealed that the EN-assisted group had a better ability to detect missed adenomas than the standard group (odds ratio = 2.89; 95% confidence interval = 1.14-7.80, P = .029). These findings suggest that EN-assisted colonoscopy represents a valuable advancement in improving AMR compared with standard colonoscopy. The integration of EN-assisted colonoscopy into routine clinical practice may offer significant benefits to patients requiring hospital resection of lesions following adenoma detection during their first colonoscopy.

G-EYE Improves Polyp, Adenoma, and Serrated Polyp Detection Rates in Colonoscopy: A Systematic Review and Meta-analysis.

BACKGROUND: Colonoscopy is the gold-standard test to decrease mortality from colorectal cancer (CRC). G-EYE is an inflated balloon on the bending section of the scope with the ability to flatten the folds to improve the adenoma detection rate (ADR). We performed this meta-analysis to evaluate the efficacy of G-EYE in improving ADR and other quality indicators of colonoscopy. METHODS: A literature search was performed through March 21, 2023, on databases including Embase, Medline, Cochrane Central Register of Controlled Trials, Web of Science Core Collection, KCI-Korean Journal Index, and Global Index Medicus. Core concepts of G-EYE, colonoscopy, ADR, polyp detection rate (PDR), serrated polyp detection rate (SPDR), and withdrawal time were searched. Statistical analysis was performed with OpenMeta[Analyst]. The odds ratio (OR) for the proportional variable and mean difference for the continuous variable along with 95% CI was used with a P-value <0.05 considered statistically significant. We used the DerSimonian-Laird method and random effects model for pooling data. RESULTS: The search strategy yielded a total of 143 articles. Three studies with 3868 total colonoscopies were finalized. The pooled ADR, PDR, and SPDR showed statistical improvement with G-EYE (OR: 1.744, 95% CI: 1.534-1.984, P<0.001; OR: 1.766, 95% CI: 1.547-2.015, P<0.001; and OR: 1.603, 95% CI: 1.176-2.185, P=0.003). The withdrawal time was also noted to be higher in the G-EYE group (mean difference: 0.114, CI: 0.041-0.186, P=0.002). CONCLUSIONS: This meta-analysis suggests that G-EYE can improve ADR, PDR, and SPDR. Further studies are needed to evaluate the effect of G-EYE on interval CRC and mortality rate.