Changes of fecal short-chain fatty acid and bile acid levels in patients with colon cancer / 中华临床营养杂志

Objective To investigate the changes of fecal short-chain fatty acids (SCFA) and bile acid levels in patients with colon cancer.Methods Totally 189 patients with colon cancer (CC group),201 patients with adenomatous polyp (AP group),and 512 healthy patients (control group) who were confirmed by endoscopy were included in this study.The fecal SCFA and bile acid levels were measured by enzyme linked immunosorbent assay.Results The total bile acids,primary bile acids,and secondary bile acids were not significantly different among these three groups (P ＞ 0.05).The chenodeoxycholate level in the CC group [0.338 (0.101,0.416) mg/g] was significandy higher than that in AP group [0.241 (0.108,0.375) mg/g] and control group [0.248 (0.110,0.371) mg/g] (P=0.025,P=0.023),but was not significantly different between the AP groupand the control group (P ＞ 0.05).The deoxycholic acid level in CC group [0.375 (0.136,0.503) mg/g] and AP group [0.369 (0.113,0.494) mg/g] were significandy higher than that in control group [0.277 (0.115,0.412) mg/g] (P=0.026,P=0.024),and the difference between CC group and AP group was not statistically significant (P ＞ 0.05).The level of lithocholic acid in CC group [0.386 (0.147,0.507) mg/g] was significantly higher than those in the AP group [0.103 (0.012,0.238) mg/g] and control group [0.239 (0.081,0.405) rng/g] (P=0.011,P=0.027); also,its level in AP group was significantly lower than that in the control group (P =0.022).The levels of total short-chain fatty acids,acetic acid,propionic acid,and isovaleric acid were not significantly different among the control group,AP group,and CC group (P＞0.05).The levels of butyrate [0.105 (0.059,0.198) mg/g,0.090 (0.050,0.183) mg/g],isobutyl acid [0.036 (0.024,0.046) mg/g,0.025 (0.020,0.034) mg/g] in CC group and AP group were significantly higher than in the control group [0.081 (0.051,0.107) mg/g,0.021 (0.016,0.029) mg/g] (butyrate:P=0.026,P=0021; isobutyl acid:P=0.025,P=0.019),and the difference between CC group and AP group was statistically significant (butyrate:P =0.031; isobutyl acid:P =0.024).Conclusions Fetal chenodeoxycholic acid,lithocholic acid,butyric acid,and isobutyric acid may play a role in the developmem of colon cancer,while deoxycholic acid may also be implicated in both colon cancer and colon adenomas.No association is found between other SCFA and bile acids and colorectal cancer/adenoma.

Uso de endoloop no comercial en el tratamiento de neoplasias pediculadas de colon / Non-factory endoloop in management of colonic pedunculated neoplasms

Introducción: las neoplasias pediculadas del colon comprenden lesiones epiteliales y no epiteliales, dependiendo de su crecimiento pueden presentar un pedículo largo y grueso. El tratamiento endoscópico de estas lesiones representa un reto para el endoscopista, por lo que se han descrito diversas técnicas para minimizar las complicaciones. Objetivo: evaluar el uso de un endoloop de fabricación no comercial en el tratamiento endoscópico de las neoplasias pediculadas del colon. Pacientes y métodos: entre enero y abril de 2012 se escogieron pacientes sometidos a colonoscopia de rutina que presentaron neoplasias con pedículos grandes y largos para realizar resección endoscópica previa ligadura de la base con endoloop de fabricación no comercial (elaborado con asa de polipectomía y lazo de nylon con nudo corredizo). Se evaluó tiempo del procedimiento, tipo de neoplasia, ubicación, complicaciones inmediatas y tardías. Resultados: se seleccionaron 4 pacientes de un total de 110 sometidos a colonoscopia de rutina (3,6 %), media de edad: 53,25 años, todos del sexo masculino, el tipo de neoplasia más frecuente: pólipo adenomatoso pediculado, la ubicación más frecuente fue colon sigmoides, se realizó resección completa de las lesiones, no se encontraron complicaciones inmediatas ni tardías. Conclusión: el endoloop de fabricación no comercial es una herramienta útil para el control de la base en lesiones neoplásicas con pedículos grandes y largos, incluso en aquellas de tipo no epitelial.

Introduction: Pedunculated colonic neoplasms include epithelial and non-epithelial lesions, depending on their growth may to have a large and long pedicle. Management of this lesions represent a challenge for the endoscopist, due this, many techniques have been described to minimize complications. Objective: This trial aims to evaluate the use of a non-factory endoloop in the endoscopic treatment of pedunculated neoplasms of the colon. Methods: Between January and April 2012 patients undergoing routine colonoscopy who had tumors with large and long pedicle were selected to perform endoscopic resection after base ligation with non-factory endoloop (made Cook Medical AcuSnare G22629 detachable standard oval and nylon loop with roeder's knot). Procedure time was evaluated, tumor type, location, immediate and late complications. Results: 4 patients were selected from a total of 110 undergoing routine colonoscopy (3.6 %), the mean age was 53.25 years, all males, the most common type of tumor was pedunculated adenomatous polyp, the most common location was the sigmoid colon, complete resection of the lesion was performed, there was no immediate or late complications. Conclusion: non-factory endoloop is a useful tool for the base control of neoplasm with large and long pedicle, including those non-epithelial.

Incidence and Multiplicities of Adenomatous Polyps in TNM Stage I Colorectal Cancer in Korea

PURPOSE: In recent years, the incidence of early-stage colorectal cancer (CRC) has markedly increased in the population within the Republic of Korea. The aim of this study was to evaluate the clinicopathologic features of adenomatous polyps in TNM stage I CRC patients and in the general population. METHODS: Between March 2003 and September 2009, 168 patients with stage I CRC were enrolled in this study. In addition, the records of 4,315 members of the general population without CRC, as determined by colonoscopy during a health check-up, were reviewed. RESULTS: Of the 168 patients with stage I CRC, 68 (40.5%) had coexisting colorectal adenomatous polyps and of the 4,315 members of the general population, 1,112 (26.0%) had coexisting adenomatous polyps (P = 0.006). The prevalences of adenomatous polyp multiplicity in early CRC and in the general population were 32% and 15%, respectively (P = 0.023). Patients with coexisting adenomatous polyps had a higher frequency of tubulovillous or villous adenomas than members of the general population with polyps (7.5% vs. 2.0%, P = 0.037). Furthermore, a subgroup analysis showed that the occurrence (44% vs. 34%, P = 0.006) and the multiplicity (32% vs. 15%, P = 0.023) of adenomatous polyps were greater for T2 than T1 cancer. CONCLUSION: The prevalence and the multiplicity of adenomatous polyps in TNM stage I CRC is higher than it is in the general population. The findings of this study suggest that depth of invasion of early stage CRC affects the prevalence and the number of adenomatous polyps in the remaining colon and rectum.

Dietary Intake of Calcium and Distal Colorectal Adenomatous Polyps in Korean Adults / 가정의학회지

BACKGROUND: Colorectal cancer is fourth in prevalence of carcinoma and fourth most cause of death from malignant neoplasm, which has been increasing in Korea. In this study, we tried to investigate the association of dietary intake of calcium and distal colorectal adenomatous polyps known as precursors of colorectal cancer. METHODS: A total of 2,456 subjects who visited a health promotion center in one university hospital in Seoul, Korea, from June 2003 to June 2006 underwent sigmoidoscopy and completed a 24-hour dietary recall. RESULTS: Among the selected 2,408 subjects, the prevalence of distal colorectal adenoma found in sigmoidoscopy was 12.54%. After adjusting for age and total serum cholesterol by multiple logistic regression, the odds ratio of the male subjects who had the highest quintile of dietary intake of calcium was 0.512 (95% CI: 0.305-0.859; P = 0.011) compared with the lowest. CONCLUSION: In male subjects with the highest quintile of dietary calcium density was associated with a low risk of distal colorectal adenomatous polyps.

Adult Sigmoido-recto-anal Intussusception by a Sigmoid Colon Adenoma

Although rectal procidentia is not an uncommon disease, presentation of more proximal segments of the large bowel through the anus is extremely rare. A case with sigmoido-recto-anal prolapse secondary to a large adenoma of the sigmoid colon is reported herein. A 28-yr-old man with an anal prolapsing mass was admitted to our hospital. Preoperative CT scan showed a sigmoid-recto-anal prolapse. An emergency operation was decided upon because the prolapsed segment was irreducible and because its viability was questionable. After a manual reduction of the mass, an anterior resection was performed under general anesthesia. The pathologic diagnosis of the resected specimen was a large villo-tubular adenoma.

Clinical Characteristics and Risk Factors of Colon Polyps in Gyeongju and Pohang Area / 대한소화기학회지

BACKGROUND/AIMS: The purposes of this study were to investigate various environmental factors for colon polyps and to analyze locoregional clinical characteristics of colon polyps in Gyeongju and Pohang area. METHODS: From October 2005 to September 2006, patients who underwent colonoscopy were analyzed based on their ages, genders, body mass indices (BMI), dietary habits, smoking behaviors, accompaying diseases, and medications as risk factors for the occurrence of colon polyps. Then clinical manifestations, gross appearances and pathologic findings of polyps were investigated. RESULTS: Among 253 patients enrolled, a total of 296 colon polyps were found in 108 patients. The incidence of colon polyps in more than 50-year old patients was 3.2-fold greater compared to less than 50-year old patients. Smoking habits were also significantly associated with the occurence of colon polyps. Among adenomatous polyps, tubulovillous type and moderate to severe dysplasia were frequently observed as the size increased, yet the location of polyps was not significantly associated. CONCLUSIONS: Older age and smoking habit increase the risk of colon polyps. Rectal polyps have less chance to be adenomatous type. The larger the polyp grows, the more likely it to be tubulovillous and dysplastic.

Prospective Comparing the Efficacy of CT Colonography and Colonoscopy for Detecting Colorectal Adenomatous Polyp in Asymptomatic Adults / 대한소화기내시경학회지

BACKGROUND/AIMS: The purpose of this study is to evaluate the efficacy of CT colonography (CTC) in comparison with colonoscopy for the detection of colorectal adenomatous polyp in asymptomatic adults. METHODS: A total 208 asymptomatic adults underwent successive CTC and colonoscopy, on the same day. RESULTS: On the analysis of adenomatous polyps per subject, the sensitivity of CTC was 90% (9/10) in case of polyps > or =10 mm in size, and 67.7% (21/31) in case of polyps > or =6 mm in size. Those values of colonoscopy were 100% and 93.5%, respectively. The per-patient specificity of CTC was 98.0% (194/198) in case of polyps > or =10 mm in size and 88.1% (156/177) in case of polyps > or =6 mm in size. CTC missed 4 (3 flat adenomas and, 1 sessile adenoma) out of 17 adenomatous polyps > or =10 mm in size in 2 subjects. CONCLUSIONS: In asymptomatic adults, the sensitivity of CTC for detecting adenomatous polyps was lower than that of colonoscopy, particularly for the small lesions below 10 mm in size, and also for the flat adenomas > or = 10 mm in size. However, CTC showed a high sensitivity and specificity for detecting the subjects with clinically important colorectal adenomatous polyps > or = 10 mm in size. These results suggest that CTC has potential as a screening method for colorectal neoplasm.

Analysis of the characteristics of endoscopic and histopathological features of colorectal serrated adenomas / 中华消化内镜杂志

Objective To explore the endoscopic and histopathological features of serrated adenomas (SAs).Methods The data of patients with colorectal polyps diagnosed in the Digestive Endoscopy Center at Nanfang Hospital from January 2002 to July 2005 were reviewed and the detection rate, endoscopic appearances, pit patterns and histopathological features of SAs were analyzed.Results In 1928(16.21%) out of 11 894 patients undergoing colonscopy 2811 polyps were found.Among them 61 patients with 71 polyps were found,with a detection rate of 0.51%.The SAs,larger than hyperplastic polyps obviously,were found in patients 39.44% with diameter (larger than 1 cm).The incidence of pedunculated polyps in SAs (26.76%) was higher than that in hyperplastic polyps(13.25%),but less than in adenomatous polyps (43.95%).The pit patterns of SAs, were typeⅢ pit pattern (41.67%) and type Ⅳ pit pattern (18.33%), this result was similar to adenomatous polyps.The incidences of moderate and severe dysplasia of SAs were higher than those of tubular adenomas but lower than villous adenomas.The canceration rate of SA was 2.82%.Conclusion The endoscopic appearances,these of pit patterns and histopathological features of SAs,were different from hyperplastic polyps essentially, but similar to neoplastic polyps with potential malignancy,which should be emphasized in clinical practice.

Analysis of Surgical Outcome of Gastric Adenomatous Polyp

PURPOSE: Adenomatous polyps in the stomach are rather uncommon, however are related to a malignant transformation. So, in such cases it is important to predict cancer risk and to select an appropriate surgical method. The aim of this study is to examine clinicopathologic factor for predicting malignancy and determine appropriate surgical management of gastric adenomatous polyps. METHODS: A total 41 patients who underwent surgery from 1996 to 1999 for gastric adenomatous polyps at the Department of Surgery, Seoul National University Hospital were included this study. All patients had undergone preoperative endoscopic biopsy and histology was confirmed. Authors analyzed the clinicopathologic factors associated with malignancy and the outcome of surgical treatment. RESULTS: Of the 41 patients, 17 patients had an adenomatous polyp alone, 24 patients had an adenomatous polyp associated with malignancy. The location, number, size and morphology of the polyp were not associated with malignancy. Only cellular atypism in the preoperative biopsy was significantly associated with malignancy. 31 patients underwent subtotal gastrectomy whereas 10 patients wedge resection. All lymph nodes resected in patients with adenocarcinoma were negative. Recurrence of polyp or adenocarcinoma had not occurred in any patients after follow-up of mean 22 months. CONCLUSION: Cellular atypism detected in preoperative histology was associated with malignancy in gastric adenomatous polyp. Lymph node metastasis was negative in patients with malignancy. Our findings support the wedge resection withsafe margin as being appropriate in surgical management of gastric adenomatous polyps.

A Case of Early Gastric Remnant Cancer Treated by Endoscopic Mucosal Resection / 대한소화기내시경학회지

Patients who have undergone partial gastric resection are at an increased risk for the development of cancer and polyps in the gastric remnant, and this risk increases with time following gastrectomy. The prevalence of polypoid change at 15~20 years after surgery is approximately 10%, about four or five times higher as compared to nonoperated one. Hyperplastic polyps are encountered more frequently than adenomatous polyps. Surgical treatment for gastric remnant cancer has been regarded as standard method, but it was reported that endoscopic mucosal resection of early gastric remnant cancer could be performed under strict indication, as the incidence of lymph node metastasis was very low. Recently one adenomatous polyp with focally carcinoma in situ in the gastric remnant was removed by endoscopic mucosal resection in male patient who had undergone Billroth II gastrojejunostomy for gastric ulcer disease 12 years earlier.

Telomerase Activity of Normal Mucosa, Adenomatous Polyp and Cancer of the Colon

PURPOSE: Progressive shortening of telomeres, specialized chromosomal structures that have a function in chromosomal protection, positioning and replication, has been linked to cell senescence and aging. Telomeres are usually replicated by telomerase, the activation of which is essential for cells to overcome cellular senescence; and thus, indefinite proliferation/immortality and malignant progression are associated with telomere activity. However, little is known about the telomerase activity in adenomatous polyp and colorectal cancer. METHODS: To determine whether malignant progression depends on the activation of telomerase or not, we analyzed the telomerase activity in the mucosa of normal colon, adenomatous polyp and colorectal cancer by telomeric repeat amplification protocol (TRAP) assay and enzyme-linked immunosorbent assay (ELISA). RESULTS: Except for one case in which there was severe inflammation, telomerase activity was not detected in any case of histologically normal colonic mucosa. In contrast, enzyme activity was detected in 58.3% (7/12), 75% (15/20) of adenomatous polyps and colorectal carcinomas, respectively. Of these cases of adernomatous polyps, telomerase activity was positive in 40% (2/5) of tubular type, 66.7% (4/6) of villotubular type and 100% (1/1) of villous type; however, the difference in telomerase activity between tubular and villotubular types was not significant. Of these 20 cases of carcinomas, telomerase activity was positive in 100% (2/2) of well differentiated, 71.4% (10/14) of moderately differentiated and 75% (3/4) of poorly differentiated histologies. Taking into consideration the Dukes' classification, there was no significant difference in telomerase activity among stages A, B and C, except for D. CONCLUSION: These results indicate that telomerase activation in colorectal cancer may well correlate with malignant progression. The detection of telomerase activity may serve as a useful auxiliary tool for the diagnosis of colorectal cancer; nevertheless, the histological type of adenomatouspolyps, the histological differentiation and the stage of cancer may not correlate with telomerase activity.

Clinical Significance of Hyperplastic Polyps in the Distal Colon

To determine whether hyperplastic polyps found in the distal colon are associated with proximal adenomas, and to judge whether patients with distal hyperplastic polyps found during sigmoidoscopy might benefit from full colonoscopy. METHODS: We retrospectively analyzed 2333 consecutive patients who were examined with colonoscopy between January 1991 and December 1994. RESULTS: 247 of 2333 patients (10.6%) had one or more colonic polyps. The prevalence of adenomatous polyps alone was 72.5%, hyperplastic polyps 22.7%, and both 0.52%. The proportion of patients with distal hyperplastic polyps and proximal adenomatous polyps (4.4%) was not significantly different from the proportion of those without distal hyperplastic polyps (1.6%). Patients with distal adenomatous polyps, on the other hand, were significantly more likely to have proximal adenomatous polyps than those without distal adenomatous polyps. CONCLUSIONS: Distal hyperplastic polyps are not strong predictors of risk for proximal adenomatous polyps. Based on the results of this study, we do not believe that finding a hyperplastic polyp during sigmoidoscopy justifies doing a full colonoscopy to search for proximal adenomatous polpys.

Association of serum lipids and glucose with the risk of colorectal adenomatous polyp in men: a case-control study in Korea

Previous studies on life style for colorectal cancer risk suggest that serum lipids and glucose might be related to adenomatous polyps as well as to colorectal carcinogenesis. This case-control study was conducted to investigate the associations between serum lipids, blood glucose, and other factors and the risk of colorectal adenomatous polyp. Male cases with colorectal adenomatous polyp, histologically confirmed by colonoscopy (n=134), and the same number of male controls matched by age for men were selected in hospitals in Seoul, Korea between January 1997 and October 1998. Serum lipids and glucose levels were tested after the subjects had fasted for at least 12 hr. Conditional logistic regression showed that there was a significant trend of increasing adenomatous polyp risk with the rise in serum cholesterol level (Ptrend=0.07). Increasing trend for the risk with triglyceride was also seen (Ptrend=0.01). HDL-cholesterol and LDL-cholesterol had increasing trends for the risk, which were not significant. In particular, it was noted that higher fasting blood glucose level reduced the adenomatous polyp risk for men (Ptrend=0.001). This study concluded that both serum cholesterol and triglyceride were positively related to the increased risk for colorectal adenomatous polyp in Korea. Findings on an inverse relationship between serum glucose and the risk should be pursued in further studies.