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1.
Gut ; 69(2): 201-223, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31776230

RESUMO

These consensus guidelines were jointly commissioned by the British Society of Gastroenterology (BSG), the Association of Coloproctology of Great Britain and Ireland (ACPGBI) and Public Health England (PHE). They provide an evidence-based framework for the use of surveillance colonoscopy and non-colonoscopic colorectal imaging in people aged 18 years and over. They are the first guidelines that take into account the introduction of national bowel cancer screening. For the first time, they also incorporate surveillance of patients following resection of either adenomatous or serrated polyps and also post-colorectal cancer resection. They are primarily aimed at healthcare professionals, and aim to address:Which patients should commence surveillance post-polypectomy and post-cancer resection?What is the appropriate surveillance interval?When can surveillance be stopped? two or more premalignant polyps including at least one advanced colorectal polyp (defined as a serrated polyp of at least 10 mm in size or containing any grade of dysplasia, or an adenoma of at least 10 mm in size or containing high-grade dysplasia); or five or more premalignant polyps The Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument provided a methodological framework for the guidelines. The BSG's guideline development process was used, which is National Institute for Health and Care Excellence (NICE) compliant.two or more premalignant polyps including at least one advanced colorectal polyp (defined as a serrated polyp of at least 10 mm in size or containing any grade of dysplasia, or an adenoma of at least 10 mm in size or containing high-grade dysplasia); or five or more premalignant polyps The key recommendations are that the high-risk criteria for future colorectal cancer (CRC) following polypectomy comprise either:two or more premalignant polyps including at least one advanced colorectal polyp (defined as a serrated polyp of at least 10 mm in size or containing any grade of dysplasia, or an adenoma of at least 10 mm in size or containing high-grade dysplasia); or five or more premalignant polyps This cohort should undergo a one-off surveillance colonoscopy at 3 years. Post-CRC resection patients should undergo a 1 year clearance colonoscopy, then a surveillance colonoscopy after 3 more years.


Assuntos
Pólipos do Colo/cirurgia , Neoplasias Colorretais/cirurgia , Vigilância da População/métodos , Colonoscopia/normas , Medicina Baseada em Evidências/métodos , Humanos , Assistência de Longa Duração/métodos , Assistência de Longa Duração/normas , Recidiva Local de Neoplasia/diagnóstico , Seleção de Pacientes , Período Pós-Operatório
5.
Gastrointest Endosc ; 91(1): 203-204, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31865990
6.
Arq Gastroenterol ; 56(4): 399-404, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31800736

RESUMO

BACKGROUND: Colorectal cancer (CRC) is one of the leading causes of cancer worldwide. Early diagnostic methods using serum biomarkers are required. The study of omics, most recently lipidomics, has the purpose of analyzing lipids for a better understanding of human lipidoma. The evolution of mass spectrometry methods, such as MALDI-MS technology, has enabled the detection and identification of a wide variety of lipids with great potential to open new avenues for predictive and preventive medicine. OBJECTIVE: To determine the lipid profile of patients with colorectal cancer and polyps. METHODS: Patients with stage I-III CRC, adenomatous polyps and individuals with normal colonoscopy were selected. All patients underwent peripheral blood collection for lipid extraction. The samples were analyzed by MALDI-MS technique for lipid identification. STATISTICAL ANALYSIS: Univariate and multivariate (principal component analysis [PCA] and discriminant analysis by partial least squares [PLS-DA]) analyses workflows were applied to the dataset, using MetaboAnalyst 3.0 software. The ions were identified according to the class of lipids using the online database Lipid Maps (http://www.lipidmaps.org). RESULTS: We included 88 individuals, 40 with CRC, 12 with polyps and 32 controls. Boxplot analysis showed eight VIP ions in the three groups. Differences were observed between the cancer and control groups, as well as between cancer and polyp, but not between polyps and control. The polyketide (810.1) was the lipid represented in cancer and overrepresented in polyp and control. Among the patients with CRC we observed differences between lipids with lymph node invasion (N1-2) compared to those without lymph node invasion (N). CONCLUSION: Possible lipid biomarkers were identified among cancer patients compared to control and polyp groups. The polyketide lipid (810.1) was the best biomarker to differentiate the cancer group from control and polyp. We found no difference between the biomarkers in the polyp group in relation to the control.


Assuntos
Pólipos do Colo/diagnóstico , Neoplasias Colorretais/diagnóstico , Lipídeos/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/sangue , Estudos de Casos e Controles , Pólipos do Colo/sangue , Colonoscopia , Neoplasias Colorretais/sangue , Detecção Precoce de Câncer , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias
7.
Anticancer Res ; 39(12): 6419-6430, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31810906

RESUMO

BACKGROUND/AIM: Colon interposition counts among the most common techniques for reconstruction after esophagectomy. Availability of data on metachronous mucosal pathologies is weak. The aim of this review was to identify all reports on the development of metachronous adenoma and adenocarcinoma in colon interposition after esophagectomy in adulthood. MATERIALS AND METHODS: A comprehensive search was conducted in MEDLINE/PubMed, Science Direct, Cochrane Library, Bayerische Staatsbibliothek München. All studies reporting on patients who received colon interposition as substitute after esophagectomy in adulthood for benign and malignant reasons were included. RESULTS: Five retrospective studies were included, reporting on 1016 patients. Therein, no interval lesion was identified. One further study, which formally must be excluded for a misfit to inclusion criteria reports on three interval carcinomas within 365 patients. Because these lesions were the only ones found within a cohort analysis, results were supplementary reported in this review. Additionally, 31 case reports including 32 patients with benign (n=7) or malignant (n=25) findings were analyzed. Median age was 63.5 years (interval carcinoma) and 69 years (benign lesion). Benign and malignant lesions were diagnosed after a median of 8.5 years. CONCLUSION: Due to the rareness of respective cohort studies, the frequency of metachronous lesions cannot be calculated accurately. The estimated rate of interval carcinoma is 0-0.22%. Life-long endoscopic surveillance of patients with colon interposition is recommended.


Assuntos
Adenocarcinoma/epidemiologia , Neoplasias do Colo/epidemiologia , Pólipos do Colo/epidemiologia , Neoplasias Esofágicas/cirurgia , Segunda Neoplasia Primária/epidemiologia , Adulto , Idoso , Detecção Precoce de Câncer , Esofagectomia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo
8.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 44(10): 1169-1173, 2019 Oct 28.
Artigo em Chinês | MEDLINE | ID: mdl-31857512

RESUMO

OBJECTIVE: To discuss the treatment strategy for outpatient diminutive colorectal polyps.
 Methods: Diminutive colonic polyps (≤5 mm in size) patients detected at the initial screening colonoscopy between January 2012 to December 2014 at outpatient endoscopy center of the Second Xiangya Hospital were retrospectively studied. The linear growth rate of the natural history cases without polypectomy (Group A, n=31) and the recurrence rate after polypectomy (Group B, n=212) were analyzed. Then the adenoma detection rate, the incidence of advanced adenoma and cancer were compared between the 2 groups.
 Results: Patients were followed up for 1.5-57.6 months. In the Group A, 61.2% patients' linear diameter remained stable and 19.4% patients were progressed. The growth rate in 12.1-24.0 months were the highest (25.0%). In the Group B, overall recurrence rate was 16% after polypectomy in the Group B. The highest recurrence rate for the first follow-up was 12.1-24.0 months, accounting for 14.3%. The adenoma detection rates in the Group A and the Group B were 38.7% and 54.2%, respectively. In the Group A, 3.2% of patients naturally progressed to advanced adenoma, and 1.4% of patients in the Group B relapsed into advanced adenoma. No cancerous patients were found in either group.
 Conclusion: Outpatient diminutive colorectal polyps can be temporarily unremoved for colonoscopy screening. It is advisable to perform colonoscopy within 12-24 months.


Assuntos
Pólipos do Colo , Colonoscopia , Neoplasias Colorretais , Humanos , Recidiva Local de Neoplasia , Pacientes Ambulatoriais , Estudos Retrospectivos
10.
Zhonghua Yu Fang Yi Xue Za Zhi ; 53(11): 1162-1165, 2019 Nov 06.
Artigo em Chinês | MEDLINE | ID: mdl-31683406

RESUMO

This study analyzed the distribution of high-risk population, the compliance and detected lesions of colorectal cancer screening from the Cancer Screening Program in urban areas of Kunming,Yunnan Province from 2014 to 2017. A total of 127 960 residents were included,of which 14 791 (11.70%) cases were diagnosed with high risk of colorectal cancer by the National Cancer Center High Risk Population Assessment System. A total of 3 484 cases completed colonoscopy clinical screening and the rate of participation was 23.55%. The screening results showed that 592 positive cases were detected, and the positive rate was 17.17%. The detection rates of polyps,adenomas,advanced adenomas,precancerous lesions and colorectal cancer were 16.27%,13.12%,7.18%,7.63% and 0.26%, with 567, 457, 250, 266 and 9 cases, respectively.


Assuntos
Adenoma/diagnóstico , Pólipos do Colo/epidemiologia , Colonoscopia/métodos , Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer , Lesões Pré-Cancerosas/diagnóstico , Adenoma/epidemiologia , Adenoma/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Pólipos do Colo/etiologia , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/patologia , Estudos Transversais , Feminino , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Lesões Pré-Cancerosas/epidemiologia , Lesões Pré-Cancerosas/patologia , Fatores de Risco , Adulto Jovem
11.
Arq Gastroenterol ; 56(3): 276-279, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31633725

RESUMO

BACKGROUND: Endoscopic mucosal resection is one of the most frequent therapeutic alternatives for large colorectal lateral spreading tumors. There are few data on the prevalence of synchronous lesions on these patients. OBJECTIVE: To describe the prevalence of synchronous colorectal lesions in patients referred for endoscopic mucosal resection of lateral spreading tumors >20 mm. METHODS: We reviewed the endoscopic database of our Department and identified adult patients who were referred for the resection of a colorectal lateral spreading tumor >20 mm and had a diagnostic colonoscopy performed up to six months before. The proportion of patients with at least one synchronous lesion was estimated. The following features were compared between patients with and without synchronous lesions: age, gender, bowel preparation quality and cecal intubation on index colonoscopy and therapeutic colonoscopy, serrated adenoma as index lesion. RESULTS: From December 2016 to November 2017, we identified 70 patients who fulfilled inclusion criteria. Median size of lesions was 25 mm (20-45). Eighty percent were located in the right colon and 35.71% were serrated adenomas. Synchronous lesion rate was 38.57%. Bowel preparation quality was similar in both groups when comparing both index and therapeutic colonoscopies. Patients with synchronous lesions had a higher proportion of serrated adenoma as index lesion than patients without synchronous lesions [51.85% vs 25.58%, OR 3.13 (1.13-8.68), P=0.03]. CONCLUSION: We found a high prevalence of synchronous lesions among patients with a large colorectal lateral spreading tumor. This risk seems to be increased if index lesions are serrated adenomas.


Assuntos
Adenoma/cirurgia , Colonoscopia/métodos , Neoplasias Colorretais/cirurgia , Ressecção Endoscópica de Mucosa/métodos , Adenoma/patologia , Adulto , Idoso , Pólipos do Colo/cirurgia , Neoplasias Colorretais/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
15.
Rev Med Suisse ; 15(660): 1483-1487, 2019 Aug 28.
Artigo em Francês | MEDLINE | ID: mdl-31496171

RESUMO

Colonic polyps are very common in the general population. Some polyps present a cancerization risk and their screening and management by endoscopy reduce the risk of colorectal cancer. Other polyps do not need specific follow-up. There are different types of polyps whose classification has been updated over the last ten years. Serrated polyps now intersect hyperplastic polyps, sessile serrated adenomas and traditional serrated adenomas. Current recommendations are to resect and histologically analyze each colonic polyp to define a personalized endoscopic surveillance strategy. Some colonic polyposis syndromes require management in a specialized center.


Assuntos
Pólipos do Colo , Adenoma/patologia , Pólipos do Colo/patologia , Pólipos do Colo/cirurgia , Humanos
18.
J Med Life ; 12(2): 133-139, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31406514

RESUMO

Colon cancer is the most commonly diagnosed gastrointestinal cancers in developed countries with varied incidence and the onset age of disease worldwide. Overall, 161 participants who were under patronage of a local relief foundation and referred to the endoscopy ward of Razi Hospital affiliated to the Guilan University of Medical Sciences. These patients have been aged more than 50 or more than 40 years with history of colorectal cancer in their first-degree family were enrolled from March 2016-March 2017. Demographic information were collected. Colonoscopy was performed and histopathological evaluation of observed lesions and polyps was done. Most of participants were female (113 individuals, 70.2%) and aged 50-60 years (83 individuals, 51.6%). Seventy-four (46%) had certain lesions. Most of colonoscopy findings were observed in the ascending colon in which depressed polyps and diverticulum were most frequent. However, rectum showed the most histological findings. All polyps of descending and ascending colons were neoplastic, while most of rectal polyps were non-neoplastic. Male patients, who were aged more than 60 years and smokers had significant higher percentage of both lesions and polyps in their colon (p<0.05). Moreover, significant positive association was detected between exposure to harmful industries and having polyps (p=0.01). We found male gender, higher age, smoking, and exposure to harmful industries as important risk factors for having colorectal lesions, which must be confirmed in further studies.


Assuntos
Neoplasias do Colo/epidemiologia , Lesões Pré-Cancerosas/epidemiologia , Colo/patologia , Neoplasias do Colo/diagnóstico por imagem , Neoplasias do Colo/microbiologia , Neoplasias do Colo/patologia , Pólipos do Colo/patologia , Colonoscopia , Feminino , Infecções por Helicobacter/microbiologia , Helicobacter pylori/fisiologia , Humanos , Incidência , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Lesões Pré-Cancerosas/diagnóstico por imagem , Prevalência , Análise de Regressão , Fatores de Risco
19.
Gastroenterology ; 157(5): 1222-1232.e4, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31419435

RESUMO

BACKGROUND AND AIMS: In patients who have undergone surgery for colorectal cancer (CRC), 3% have recurrence of (metachronous) CRC. We investigated whether tumor seeding during colonoscopy (iatrogenic implantation of tumor cells in damaged mucosa) increases risk for metachronous CRC. METHODS: In a proof of principle study, we collected data from the Dutch National Pathology Registry for patients with a diagnosis of CRC from 2013 through 2015, with a second diagnosis of CRC within 6 months to 3.5 years after surgery. We reviewed pathology reports to identify likely metachronous CRC (histologically proven adenocarcinoma located elsewhere in the colon or rectum from the surgical anastomosis). For 22 patients fulfilling the inclusion criteria, we ascribed the most likely etiology to tumor seeding when endoscopic manipulations, such as biopsies or polypectomy, occurred at the location where the metachronous tumor was subsequently detected, after endoscopic manipulation of the primary tumor. We collected clinical data from patients and compared molecular profiles of the primary and metachronous colorectal tumors using next-generation sequencing. We then examined the source of seeded tumor. We tested whether tumor cells stay behind in the working channel of the endoscope after biopsies of colorectal tumors, and whether these cells maintain viability in organoid cultures. RESULTS: In total, tumor seeding was suspected as the most likely etiology of metachronous CRC in 5 patients. Tumor tissues were available from 3 patients. An identical molecular signature was observed in the primary and metachronous colorectal tumors from all 3 patients. In 5 control cases with a different etiology of metachronous CRC, the molecular signature of the primary and metachronous tumor were completely different. Based on review of 2147 patient records, we estimated the risk of tumor seeding during colonoscopy to be 0.3%-0.6%. We demonstrated that the working channel of the colonoscope becomes contaminated with viable tumor cells during biopsy collection. Subsequent instruments introduced through this working channel also became contaminated. These cells were shown to maintain their proliferative potential. CONCLUSIONS: In an analysis of primary and secondary tumors from patients with metachronous CRC, we found that primary tumor cells might be seeded in a new location after biopsy of the primary tumor. Although our study does not eliminate other possibilities of transmission, our findings and experiments support the hypothesis that tumor seeding can occur during colonoscopy via the working channel of the endoscope. The possibility of iatrogenic seeding seems low. However, our findings compel awareness on this potentially preventable cause of metachronous CRC.


Assuntos
Pólipos Adenomatosos/cirurgia , Pólipos do Colo/cirurgia , Colonoscopia/efeitos adversos , Neoplasias Colorretais/cirurgia , Inoculação de Neoplasia , Segunda Neoplasia Primária/patologia , Pólipos Adenomatosos/genética , Pólipos Adenomatosos/patologia , Idoso , Biomarcadores Tumorais/genética , Pólipos do Colo/genética , Pólipos do Colo/patologia , Colonoscópios , Colonoscopia/instrumentação , Neoplasias Colorretais/genética , Neoplasias Colorretais/patologia , Contaminação de Equipamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Segunda Neoplasia Primária/genética , Estudo de Prova de Conceito , Estudos Prospectivos , Sistema de Registros , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Carga Tumoral , Células Tumorais Cultivadas
20.
J Cancer Res Clin Oncol ; 145(10): 2423-2432, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31456088

RESUMO

PURPOSE: The mortality of colorectal cancer ranked fifth in China according to cancer statistics in 2015. Cancer screening had been repeatedly proved to play a vital role in decreasing the incidence and mortality of colorectal cancer, but the existing screening methods could not meet the requirements. So it is of urgent need to develop a non-invasive, convenient and accurate screening method. METHODS: In this study, stool samples were collected from 102 colorectal cancer, 20 colorectal adenoma, 6 hyperplastic polyps patients and 105 normal controls, and stool DNA was extracted for detection of methylation (BMP3, NDRG4, SDC2 and SFRP2) and KRAS mutations. Meanwhile, hemoglobin in stool samples was detected by immunoassays. Then, the logistic regression model used for classification was built with these biomarkers, and a ROC curve was drawn to evaluate the performance of each biomarker and the panel of them. Meanwhile, conventional serum biomarkers were detected for the comparison of positive rate in colorectal cancer between serum biomarkers and stool DNA biomarkers. RESULTS: As a result, a classification model built with methylation of SDC2 and SFRP2, KRAS mutations and hemoglobin showed a sensitivity of 91.4% for colorectal cancer and 60% for adenoma with the specificity of 86.1%. Compared with it, most of the conventional serum biomarkers showed a sensitivity of less than 20% for colorectal cancer which was significantly lower than stool DNA biomarkers. CONCLUSIONS: A novel panel comprised of stool DNA biomarkers was of much higher sensitivity and specificity in early screening of colorectal neoplasms than conventional serum biomarkers.


Assuntos
Biomarcadores Tumorais , Neoplasias Colorretais/genética , DNA de Neoplasias , Fezes/química , Adenoma/diagnóstico , Adenoma/genética , China/epidemiologia , Pólipos do Colo/diagnóstico , Pólipos do Colo/genética , Colonoscopia , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/epidemiologia , Metilação de DNA , Detecção Precoce de Câncer , Feminino , Humanos , Masculino , Programas de Rastreamento , Mutação , Estadiamento de Neoplasias , Proteínas Proto-Oncogênicas p21(ras)/genética , Curva ROC , Sensibilidade e Especificidade
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