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Risk of Colorectal Polyps in Patients with Gastric Adenomas
Abstracts
T1411 Risk Analyses for Sigmoidoscopy As a Screening Tool Based On the Incidence of Proximal Colorectal Carcinomas in a General Hospital Sanna Mulder, Rob J. Ouwendijk, Monique E. Van Leerdam, Ernst J. Kuipers
T1413 Narrow Band Imaging: Is the Observation of Vascular Pattern in Neoplastic Colonic Lesions By Using Magnifying Colonoscopy Useful Method Or Not? Shoichi Saito, Masahiro Ikegami, Hiroshi Arakawa, Hisao Tajiri, Osamu Tsuruta
Introduction: Sigmoidoscopy screening for colorectal cancer (CRC) has been suggested. Colonoscopy may be more effective in CRC prevention, however colonoscopy requires more endoscopy facilities, has a higher risk of complications and is more expensive. Aim: To determine the risk for advanced proximal neoplasia and to identify subgroups in which screening sigmoidoscopy might suffice using retrospective colonoscopy data from a single general hospital. Methods: A database search using the Endobase datasystem was performed on all patients who underwent lower endoscopy between 1997 and October 2005 in a single general hospital. All patients diagnosed with CRC were included. Demographical data were collected as well as data concerning tumor characteristics, i.e. location, stage. Variables including age (!65 or O65 years of age), sex, and distal findings were used for risk analyses. Results: In total, 794 patients were diagnosed with CRC (M/F 416/378, mean age 70 yrs, range 27-95 yr). The CRC was localized in 67% of the patients in the distal colon and in 33% proximal of the descending colon. In 7 patients the location of the CRC was not further specified.In the group under 65 years of age, in total 258 patients were diagnosed with CRC (149 M, 109 F). In 65/ 258 (25%) patients the CRC was localized in the proximal colon, without significant difference between men and women. A synchronous distal neoplasia was found in 21 of these 65 patients (12 M, 9 F). In 17% (44/258) only a proximal CRC was found, which would have been missed by screening sigmoidoscopy. In the group over 65 years of age, 536 patients were diagnosed with CRC (267 M, 269 F). In 198/536 (37%) patients the CRC was localized in the proximal colon, significantly more women had a proximal CRC (75 M, 123 F, p ! 0.01). A synchronous distal neoplasia was found in 44 of these 198 patients (22 M, 22 F). In 29% (154/536) only a proximal CRC was found, which is significantly more compared to those under 65 yrs of age (p ! 0.01). There was a significant difference regarding the overall prevalence of proximal neoplasia between the age-group under and over 65 years (p ! 0.01). Conclusions: The proportion of CRC that is located in the proximal colon changes with age. In elderly, proximal CRC is proportionally more common, and more often occurs without distal marker lesions. In patients above 65 yrs of age significantly more proximally localized CRC would have been missed by screening sigmoidoscopy. When considering CRC screening sigmoidoscopy screening will suffice in the age-group below 65 yrs of age. Given these data, in men and women above 65 yrs of age colonoscopy might be the preferred screening method.
Introduction: Today, observation of pit pattern by using magnifying colonoscopy has been established as a useful method for determining depth of invasion of colon cancer in Japan. However, all information is not in the least brought by observation of pit pattern. The aim of this study is whether to observe the vascular pattern is playing the helpful role. Methods: 96 colorectal lesions were excised by endoscopically or surgically were examined in this study. These all lesions were carefully observed with magnifying colonoscopy using Narrow-Band Imaging (NBI) system. We classified neoplastic lesions into three groups macroscopically and analyzed: 1) Protruded type (Is, Isp, Ip), 2) Superficial type (IIa, IIc, IIa+IIc), 3) Lateral Spreading Tumor (LST). And vascular pattern was divided into three types: Type A was fine network pattern, which is observed the dilated capillary vessels in the tumor. Type B was cork screw type, which was marked cangestive capillary vessels like cork screw. Type C was the shaped of the vessels were disappeard . The level of submucosal invasion is assessed as sm1 or sm2-3 according to the relative classification. Results: Protruded type was 30 lesions (mean size; 18.2 mm), Superficial type was 30 lesions (12.3 mm) and LSTwas 36 lesions (28.5 mm). Table 1 and 2 are shown as below. Conclusions: Our data suggested that there was no significant the difference of accuracy between vascular pattern and pit pattern with findings by using the magnifying endoscopy. Therefore, the observation of vascular pattern by using the magnifying endoscopy with NBI systems is proved to be useful method for diagnosis of infiltration in early colon cancer to decide the method of therapy. Table 1. Relationship between depth of invasion and vascular pattern Protruded Type (n:30) Type A (n:18) m, 83.3% sm1 sm2- 16.7% 3
Protruded Type (n:30) Type B (n:10)
Protruded Type (n:30) Type C (n:2)
Superficial Type (n:30) Type A (n:19)
Superficial Type (n:30) Type B (n:6)
Superficial Type (n:30) Type C (n:5)
LST LST LST (n:36) (n:36) (n:36)
40.0%
0%
100%
33.3%
0%
100%
40.0% 0%
60.0%
100%
0%
66.7%
100%
0%
60.0% 100%
Type Type Type C B A (n:29) (n:5) (n:2)
Table 2. Comparison of the accuracy between pit pattern and vascular pattern Vascular pattern Pit pattern
T1412 Risk of Colorectal Polyps in Patients with Gastric Adenomas Min Hyung Kim, Hee Jung Son, Dong Kyung Chang, Jun Haeng Lee, Poong-Lyul Rhee, Jae J. Kim, Jong Chul Rhee Background: The risk of gastroduodenal polyps is increased in diverse colonic polyposis syndromes. However, it is uncertain whether patients with gastric adenomas are at greater risk for colorectal polyps. The aim of study, therefore, was to determine the association between gastric adenomas and colorectal polyps. Methods: 41 patients with gastric adenomas (adenoma group) and 105 patiets without gastric adenoma (controls group), seen from January 2001 to May 2005, were enrolled. All patients had undergone esophagogastroduodenoscopy (EGD) and colonoscopy. Age, risk factor of colonic neoplasia (smoking, alcohol and family history), endoscopic (number, size, location), and histopathologic findings were evaluated. Results: Twenty-five patients of 41 adenoma group (61%) had associated with colorectal polyps, whereas 41 patients of 105 control group had associated with colorectal polyps (39%, p Z 0.02). 54 colorectal polyps in adenoma group and 62 colorectal polyps in controls were diagnosed by colonoscopy. However, there was no significant difference in the risk of colorectal adenoma (40/54, 74.1% of adenoma group; 48/62, 77.4% of controls). Two of 54 colorectal polyps in adenoma group contain high grade-dysplasia (3.7%). The mean size of the colorectal polyps was greater in adenoma group (0.5 G 0.2 cm) than controls (0.4 G 0.2 cm, p Z 0.01). 53.7% of colorectal polyps in adenoma group (29/54) were located in the proximal colon (from cecum to transverse colon) and 64.5% in controls (40/62) were found in the distal colon (from descending colon to rectum, p Z 0.04). Conclusions: Patients with gastric adenomas had a higher risk of colorectal polyps than general population. Therefore surveillance colonoscopy might be required in this group.
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Sensitivity
Specificity
Accuracy
98.3% 85.5%
80.0% 95.7%
92.2% 98.1%
T1414 Survival Stratification Pattern of Colorectal Carcinoma with CEA MMP-2 and p27kip1 Expression Jin Gu The prognosis varies greatly in colorectal caner (CRC) patients, even in the same stage. We examined the correlation between the expression of a reportedly wide range of biomarkers (MMP-2, CEA, p27kip1, b-catenin, CDC25B, Mucin-1, VEGF-D, c-erbB-2/neu, TGF-a and C-met) and clinicopathological features in CRC patients in order to identify a panel of biomarkers predictive of CRC prognosis. The expressions of these ten individual biomarkers in 127 CRC were analyzed by immunohistochemistry method. Univariate and multivariate analysis were done to analyze these biomarkers expression with the disease free survival time in CRC. Among markers studied, high expression of MMP-2, CEA and low expression of p27kip1 are significantly related to poor prognosis in univariate analysis. The expression of MMP-2, CEA, p27kip1, TNM staging, and differentiation are independent prognostic factors for survival by Cox regression analysis. The coexpression pattern of MMP-2, CEA and p27kip1 MCP has significant prognostic value in all patients. Cox regression reveals that coexpression pattern of MMP-2, p27kip1 and CEA, TNM stage and differentiation are independent prognostic factors in CRC. Though prognosis in patients with CRC is difficult to predict, the results of this study provide further evidence that the combination of biomarkers of MMP-2, CEA and p27kip1, or MCP, is more informative than any single tumor biomarker alone for the survival stratification of CRC. MCP may be a useful marker for clinical management and may provide multiple targets for therapeuticintervention.
Volume 63, No. 5 : 2006 GASTROINTESTINAL ENDOSCOPY AB217
T1411 Risk Analyses for Sigmoidoscopy As a Screening Tool Based On the Incidence of Proximal Colorectal Carcinomas in a General Hospital Sanna Mulder, Rob J. Ouwendijk, Monique E. Van Leerdam, Ernst J. Kuipers
T1413 Narrow Band Imaging: Is the Observation of Vascular Pattern in Neoplastic Colonic Lesions By Using Magnifying Colonoscopy Useful Method Or Not? Shoichi Saito, Masahiro Ikegami, Hiroshi Arakawa, Hisao Tajiri, Osamu Tsuruta
Introduction: Sigmoidoscopy screening for colorectal cancer (CRC) has been suggested. Colonoscopy may be more effective in CRC prevention, however colonoscopy requires more endoscopy facilities, has a higher risk of complications and is more expensive. Aim: To determine the risk for advanced proximal neoplasia and to identify subgroups in which screening sigmoidoscopy might suffice using retrospective colonoscopy data from a single general hospital. Methods: A database search using the Endobase datasystem was performed on all patients who underwent lower endoscopy between 1997 and October 2005 in a single general hospital. All patients diagnosed with CRC were included. Demographical data were collected as well as data concerning tumor characteristics, i.e. location, stage. Variables including age (!65 or O65 years of age), sex, and distal findings were used for risk analyses. Results: In total, 794 patients were diagnosed with CRC (M/F 416/378, mean age 70 yrs, range 27-95 yr). The CRC was localized in 67% of the patients in the distal colon and in 33% proximal of the descending colon. In 7 patients the location of the CRC was not further specified.In the group under 65 years of age, in total 258 patients were diagnosed with CRC (149 M, 109 F). In 65/ 258 (25%) patients the CRC was localized in the proximal colon, without significant difference between men and women. A synchronous distal neoplasia was found in 21 of these 65 patients (12 M, 9 F). In 17% (44/258) only a proximal CRC was found, which would have been missed by screening sigmoidoscopy. In the group over 65 years of age, 536 patients were diagnosed with CRC (267 M, 269 F). In 198/536 (37%) patients the CRC was localized in the proximal colon, significantly more women had a proximal CRC (75 M, 123 F, p ! 0.01). A synchronous distal neoplasia was found in 44 of these 198 patients (22 M, 22 F). In 29% (154/536) only a proximal CRC was found, which is significantly more compared to those under 65 yrs of age (p ! 0.01). There was a significant difference regarding the overall prevalence of proximal neoplasia between the age-group under and over 65 years (p ! 0.01). Conclusions: The proportion of CRC that is located in the proximal colon changes with age. In elderly, proximal CRC is proportionally more common, and more often occurs without distal marker lesions. In patients above 65 yrs of age significantly more proximally localized CRC would have been missed by screening sigmoidoscopy. When considering CRC screening sigmoidoscopy screening will suffice in the age-group below 65 yrs of age. Given these data, in men and women above 65 yrs of age colonoscopy might be the preferred screening method.
Introduction: Today, observation of pit pattern by using magnifying colonoscopy has been established as a useful method for determining depth of invasion of colon cancer in Japan. However, all information is not in the least brought by observation of pit pattern. The aim of this study is whether to observe the vascular pattern is playing the helpful role. Methods: 96 colorectal lesions were excised by endoscopically or surgically were examined in this study. These all lesions were carefully observed with magnifying colonoscopy using Narrow-Band Imaging (NBI) system. We classified neoplastic lesions into three groups macroscopically and analyzed: 1) Protruded type (Is, Isp, Ip), 2) Superficial type (IIa, IIc, IIa+IIc), 3) Lateral Spreading Tumor (LST). And vascular pattern was divided into three types: Type A was fine network pattern, which is observed the dilated capillary vessels in the tumor. Type B was cork screw type, which was marked cangestive capillary vessels like cork screw. Type C was the shaped of the vessels were disappeard . The level of submucosal invasion is assessed as sm1 or sm2-3 according to the relative classification. Results: Protruded type was 30 lesions (mean size; 18.2 mm), Superficial type was 30 lesions (12.3 mm) and LSTwas 36 lesions (28.5 mm). Table 1 and 2 are shown as below. Conclusions: Our data suggested that there was no significant the difference of accuracy between vascular pattern and pit pattern with findings by using the magnifying endoscopy. Therefore, the observation of vascular pattern by using the magnifying endoscopy with NBI systems is proved to be useful method for diagnosis of infiltration in early colon cancer to decide the method of therapy. Table 1. Relationship between depth of invasion and vascular pattern Protruded Type (n:30) Type A (n:18) m, 83.3% sm1 sm2- 16.7% 3
Protruded Type (n:30) Type B (n:10)
Protruded Type (n:30) Type C (n:2)
Superficial Type (n:30) Type A (n:19)
Superficial Type (n:30) Type B (n:6)
Superficial Type (n:30) Type C (n:5)
LST LST LST (n:36) (n:36) (n:36)
40.0%
0%
100%
33.3%
0%
100%
40.0% 0%
60.0%
100%
0%
66.7%
100%
0%
60.0% 100%
Type Type Type C B A (n:29) (n:5) (n:2)
Table 2. Comparison of the accuracy between pit pattern and vascular pattern Vascular pattern Pit pattern
T1412 Risk of Colorectal Polyps in Patients with Gastric Adenomas Min Hyung Kim, Hee Jung Son, Dong Kyung Chang, Jun Haeng Lee, Poong-Lyul Rhee, Jae J. Kim, Jong Chul Rhee Background: The risk of gastroduodenal polyps is increased in diverse colonic polyposis syndromes. However, it is uncertain whether patients with gastric adenomas are at greater risk for colorectal polyps. The aim of study, therefore, was to determine the association between gastric adenomas and colorectal polyps. Methods: 41 patients with gastric adenomas (adenoma group) and 105 patiets without gastric adenoma (controls group), seen from January 2001 to May 2005, were enrolled. All patients had undergone esophagogastroduodenoscopy (EGD) and colonoscopy. Age, risk factor of colonic neoplasia (smoking, alcohol and family history), endoscopic (number, size, location), and histopathologic findings were evaluated. Results: Twenty-five patients of 41 adenoma group (61%) had associated with colorectal polyps, whereas 41 patients of 105 control group had associated with colorectal polyps (39%, p Z 0.02). 54 colorectal polyps in adenoma group and 62 colorectal polyps in controls were diagnosed by colonoscopy. However, there was no significant difference in the risk of colorectal adenoma (40/54, 74.1% of adenoma group; 48/62, 77.4% of controls). Two of 54 colorectal polyps in adenoma group contain high grade-dysplasia (3.7%). The mean size of the colorectal polyps was greater in adenoma group (0.5 G 0.2 cm) than controls (0.4 G 0.2 cm, p Z 0.01). 53.7% of colorectal polyps in adenoma group (29/54) were located in the proximal colon (from cecum to transverse colon) and 64.5% in controls (40/62) were found in the distal colon (from descending colon to rectum, p Z 0.04). Conclusions: Patients with gastric adenomas had a higher risk of colorectal polyps than general population. Therefore surveillance colonoscopy might be required in this group.
www.giejournal.org
Sensitivity
Specificity
Accuracy
98.3% 85.5%
80.0% 95.7%
92.2% 98.1%
T1414 Survival Stratification Pattern of Colorectal Carcinoma with CEA MMP-2 and p27kip1 Expression Jin Gu The prognosis varies greatly in colorectal caner (CRC) patients, even in the same stage. We examined the correlation between the expression of a reportedly wide range of biomarkers (MMP-2, CEA, p27kip1, b-catenin, CDC25B, Mucin-1, VEGF-D, c-erbB-2/neu, TGF-a and C-met) and clinicopathological features in CRC patients in order to identify a panel of biomarkers predictive of CRC prognosis. The expressions of these ten individual biomarkers in 127 CRC were analyzed by immunohistochemistry method. Univariate and multivariate analysis were done to analyze these biomarkers expression with the disease free survival time in CRC. Among markers studied, high expression of MMP-2, CEA and low expression of p27kip1 are significantly related to poor prognosis in univariate analysis. The expression of MMP-2, CEA, p27kip1, TNM staging, and differentiation are independent prognostic factors for survival by Cox regression analysis. The coexpression pattern of MMP-2, CEA and p27kip1 MCP has significant prognostic value in all patients. Cox regression reveals that coexpression pattern of MMP-2, p27kip1 and CEA, TNM stage and differentiation are independent prognostic factors in CRC. Though prognosis in patients with CRC is difficult to predict, the results of this study provide further evidence that the combination of biomarkers of MMP-2, CEA and p27kip1, or MCP, is more informative than any single tumor biomarker alone for the survival stratification of CRC. MCP may be a useful marker for clinical management and may provide multiple targets for therapeuticintervention.
Volume 63, No. 5 : 2006 GASTROINTESTINAL ENDOSCOPY AB217