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This article discusses the diagnostic difficulties associated with epithelial misplacement in Peutz-Jeghers polyps, a rare autosomal dominant gastrointestinal polyposis syndrome. The polyps are characterized by well-organized arborising muscular fibers lined by normal or hyperplastic mucosa. Epithelial misplacement, particularly in the small intestine, can mimic well-differentiated adenocarcinoma, leading to misdiagnosis. The article explores the use of immunohistochemical markers in differentiating non-neoplastic epithelium from neoplastic epithelium and emphasizes the importance of accurate diagnosis to prevent over-treatment. [Extracted from the article]

Introduction: Over the last few years, there has been an increase in the prevalence of Blastocystis spp. in colorectal cancer (CRC) patients. Moreover, various in vitro and in vivo studies have highlighted that intestinal colonisation of Blastocystis spp. has an influence on host immune responses leading to cellular apoptosis and membrane permeability. It has been suggested that Blastocystis spp. is an important risk factor for the worsening of CRC. Aim: To present evidence concerning the association between CRC and Blastocystis spp. Material and methods: A review of the literature was performed by searching Science Direct, PubMed, Scopus and Google Scholar databases up to December, 2023. Results and discussion: Out of all in vitro and in vivo studies selected for this review, the majority of them have confirmed a significantly higher prevalence of Blastocystis spp. in colorectal cancer patients in comparison to the control groups. Several in vitro human colorectal carcinoma cell line studies have shown significant cytopathic and immunological effects of Blastocystis spp. Additionally, in vivo experimental animal model studies have shown that Blastocystis spp. infection significantly contributed to large intestinal polyp (colorectal adenoma) formation and the progression of colorectal carcinogenesis. Conclusions: These studies strongly support suggestions that Blastocystis spp. could be an important factor to existing CRC development by influencing the host immune response and increasing oxidative damage. [ABSTRACT FROM AUTHOR]

Gardner's syndrome has been recognized as a hereditary affliction that is autosomal in nature. This disorder is known to exhibit characteristics of familial adenomatous polyposis, of which it is also considered a variation. The features of this syndrome include the gradual development of osteomas and epidermoid cysts, including a characteristic feature that is the noted presence of intestinal polyps, which are generally multiple in number. Additionally, dental anomalies have been observed and recorded in a sizeable ratio of cases encompassing an increased frequency of multiple odontomas that are benign tumors linked to the development of a tooth and tooth agenesis/hypodontia that refers to developmental absence of one or more teeth. The other dental ascertainment includes abnormal morphology of the tooth/teeth as well as the presence of supernumerary teeth and impacted or unerupted teeth. This case report outlines the case of a 59-year-old male patient who had reported to the clinic, and was then diagnosed with Gardner's syndrome post a thorough examination. On radiographic examination, the manifestation of multiple osteomas in the frontal bone was revealed. The presence of a motley of diffused benign lesions of the bone in both the upper and lower jaw as well as the presence of an epidermoid cyst on the scalp was suggestive of an exemplar presentation of Gardner's syndrome. [ABSTRACT FROM AUTHOR]

In various countries worldwide, the incidence of colon cancer-related deaths has been on the rise in recent years. Early detection of symptoms and identification of intestinal polyps are crucial for improving the cure rate of colon cancer patients. Automated computer-aided diagnosis (CAD) has emerged as a solution to the low efficiency of traditional methods relying on manual diagnosis by physicians. Deep learning is the latest direction of CAD development and has shown promise for colonoscopic polyp segmentation. In this paper, we present a multi-level encoder-decoder architecture for polyp segmentation based on the Transformer architecture, termed NA-SegFormer. To improve the performance of existing Transformer-based segmentation algorithms for edge segmentation on colon polyps, we propose a patch merging module with a neighbor attention mechanism based on overlap patch merging. Since colon tract polyps vary greatly in size and different datasets have different sample sizes, we used a unified focal loss to solve the problem of category imbalance in colon tract polyp data. To assess the effectiveness of our proposed method, we utilized video capsule endoscopy and typical colonoscopy polyp datasets, as well as a dataset containing surgical equipment. On the datasets Kvasir-SEG, Kvasir-Instrument and KvasirCapsule-SEG, the Dice score of our proposed model reached 94.30%, 94.59% and 82.73%, with an accuracy of 98.26%, 99.02% and 81.84% respectively. The proposed method achieved inference speed with an Frame-per-second (FPS) of 125.01. The results demonstrated that our suggested model effectively segmented polyps better than several well-known and latest models. In addition, the proposed method has advantages in trade-off between inference speed and accuracy, and it will be of great significance to real-time colonoscopic polyp segmentation. The code is available at https://github.com/promisedong/NAFormer. [ABSTRACT FROM AUTHOR]

Simple Summary: Approximately half of the populations of developed countries contract cancer, with a very high proportion of colorectal cancer among all cancer types. Food choices must be improved to maintain good health. HASPIN inhibitors suppress the proliferation of various cancer cells. In this study, the antitumor effect of ingesting bean sprouts containing the HASPIN inhibitor coumestrol was investigated using a mouse model of familial adenomatous polyposis (ApcMin/+). The results indicated that ingesting a diet including bean sprouts suppressed the development of intestinal polyps, cachexia, and hypogonadism in mice. These findings demonstrated that bean sprouts are a beneficial food for preventing cancer and are expected to be applicable in humans. (1) Background: HASPIN kinase is involved in regulating spindle function and chromosome segregation, as well as phosphorylating histone H3 at Thr3 in mitotic cells. Several HASPIN inhibitors suppress cancer cell proliferation. It was recently reported that coumestrol from bean sprouts inhibits HASPIN, and a cultivation method for bean sprouts containing large amounts of coumestrol has been established. Here, we showed the effects of bean sprout ingestion on intestinal polyp development, cachexia, and hypogonadism in a mouse model of familial adenomatous polyposis (ApcMin/+). (2) Methods: ApcMin/+ mice were randomized into control and treatment groups. Mice in the control group were given the standard diet, while those in the treatment group were given the same standard diet with the addition of 15% bean sprouts. Treatments were commenced at 7 weeks old and analyses were performed at 12 weeks old. (3) Results: ingesting bean sprouts suppressed the development of intestinal polyps, cachexia, and hypogonadism, and also increased serum levels of testosterone in male wild-type and ApcMin/+ mice. (4) Conclusions: ingesting bean sprouts helps prevent cancer and increases serum levels of testosterone in a mouse model. These results are expected to be applicable to humans. [ABSTRACT FROM AUTHOR]

Introduction: Prostate cancer most commonly metastasizes to the bone and lymph nodes. Gastrointestinal metastasis has been noted in the literature but appears to be an exceedingly uncommon phenomenon. Large intestinal involvement in particular has been reported on only a few occasions, and never concomitantly with small intestinal metastatic involvement. Case Report: We report the case of a 69-year-old gentleman with metastatic castrate-resistant prostate cancer with development of gastrointestinal symptomatology with extensive investigation eventually revealing small and large intestinal polyps subsequently confirmed to be representative of metastatic prostate cancer. Conclusion: This case demonstrates the importance of maintaining a wide differential diagnosis in the context of gastrointestinal symptomatology in malignancy. Thorough endoscopic evaluation may be necessary in such cases in order to identify potential metastatic malignancy in otherwise relatively unremarkable appearing polyps. [ABSTRACT FROM AUTHOR]

BACKGROUND: Electronic coloscopy is an invasive procedure and achieving an ideal result can be challenging, leading to low intestinal cleanliness scores and a poor intestinal polyp positive rate. OBJECTIVE: (1) To demonstrate the impact of intensified nursing intervention on electronic colonoscopy. (2) To improve patients' satisfaction with medical services related to intestinal cleanliness during preparation, the accuracy of the intestinal polyp-positive rate, and nursing. METHODS: Our study included 120 patients who underwent electronic coloscopy. These patients were randomly assigned to either the observation group or the control group, with 60 cases in each group. Patients in the control group received conventional nursing intervention, which included face-to-face oral and written instructions. In addition to the conventional intervention, patients in the observation group received intensified guidance interventions, which included instructions via phone, as well as WeChat messages and pictures. RESULTS: The patients in the observation group who received intensified guidance interventions demonstrated better intestinal cleanliness during preparation compared to the control group (P < 0.05). Besides, the accuracy of the intestinal polyp positive rate was higher in the observation group than in the control group (P < 0.05). Finally, regarding patient satisfaction with the nursing service provided by the endoscopy center, the observation group had a higher level of satisfaction than the control group (P < 0.05). CONCLUSION: The intensified guidance interventions provided to patients undergoing electronic colonoscopy resulted in a significant improvement in intestinal cleanliness during preparation, as well as an increase in the accuracy of the intestinal polyp-positive rate and patient satisfaction with our nursing service. Therefore, we believe that these interventions are highly beneficial and should be promoted and applied in clinical settings. [ABSTRACT FROM AUTHOR]

Juvenile polyposis syndrome (JPS) is a rare autosomal dominant disorder characterized by multiple juvenile polyps in the gastrointestinal tract, often associated with mutations in genes such as Smad4 and BMPR1A. This study explores the impact of Smad4 knock-out on the development of intestinal polyps using collaborative cross (CC) mice, a genetically diverse model. Our results reveal a significant increase in intestinal polyps in Smad4 knock-out mice across the entire population, emphasizing the broad influence of Smad4 on polyposis. Sex-specific analyses demonstrate higher polyp counts in knock-out males and females compared to their WT counterparts, with distinct correlation patterns. Line-specific effects highlight the nuanced response to Smad4 knock-out, underscoring the importance of genetic variability. Multimorbidity heat maps offer insights into complex relationships between polyp counts, locations, and sizes. Heritability analysis reveals a significant genetic basis for polyp counts and sizes, while machine learning models, including k-nearest neighbors and linear regression, identify key predictors, enhancing our understanding of juvenile polyposis genetics. Overall, this study provides new information on understanding the intricate genetic interplay in the context of Smad4 knock-out, offering valuable insights that could inform the identification of potential therapeutic targets for juvenile polyposis and related diseases. [ABSTRACT FROM AUTHOR]

Colorectal cancer is a prevalent malignant tumor affecting the digestive tract. Although colonoscopy remains the most effective method for colon examination, it may occasionally fail to detect polyps. In an effort to enhance the detection rate of intestinal polyps during colonoscopy, we propose MAUNet, a polyp segmentation network based on a multi‐scale feature fusion of an Attention U‐shaped network structure. Our model incorporates advanced components, including the Receptive Field Block, Reverse Attention Block, and Residual Refinement Module, mirroring the analytical process performed by medical imaging professionals. We evaluated the performance of MAUNet on five challenging datasets and conducted a comparative analysis against five state‐of‐the‐art models using six evaluation metrics. The experimental results demonstrate that MAUNet achieves varying levels of performance improvement across the five datasets. Particularly on the Kvasir dataset, the Mean Dice and Mean IOU metrics reached 91.6% and 84.3%, respectively, confirming the model's outstanding performance in polyp segmentation. [ABSTRACT FROM AUTHOR]

Colorectal cancer is a common gastrointestinal malignancy. Early screening and segmentation of colorectal polyps are of great clinical significance. Colonoscopy is the most effective method to detect polyps, but some polyps may be missed in the detection process. On this basis, the use of computer‐aided diagnosis technology is particularly important for colorectal polyp segmentation. To improve the detection rate of intestinal polyps under colonoscopy, a polyp segmentation network (MobileRaNet) based on a lightweight model and reverse attention (RA) mechanism was proposed to accurately segment polyps in colonoscopy images. The coordinated attention module is used to improve MobileNetV3 and make it the backbone network (CaNet). Second, a part of the output of the high‐level feature from the backbone network is passed into the parallel axial receptive field module (PA_RFB) to extract the global dependency representation without losing the details. Third, a global map is generated based on this combined feature as the initial boot area of the subsequent components. Finally, the RA module is used to mine the target region and boundary clues to improve the segmentation accuracy. To verify the effectiveness and lightweight performance of the algorithm, five challenging datasets, including CVC‐ColonDB, CVC‐300, and Kvasir, are used in this paper. In six indexes, including MeanDice, MeanIoU, and MAE, compared with seven typical models such as PraNet and TransUnet, accuracy, FLOPs, parameters, and FPS were compared. The experimental results show that the MobileRaNet proposed in this paper has improved the performance of the five datasets to varying degrees, especially the MeanDice and MeanIOU indexes of the Kvasir dataset reach 91.2% and 85.6%, which are, respectively, increased by 1.4% and 1.6% compared with PraNet. Compared with PraNet, FLOPs and parameters decreased by 83.3% and 76.7%, respectively. [ABSTRACT FROM AUTHOR]

Background: Appendiceal orifice lesions are often managed operatively with limited or oncologic resections. The aim is to report the management of appendiceal orifice mucosal neoplasms using advanced endoscopic interventions. Methods: Patients with appendiceal orifice mucosal neoplasms who underwent advanced endoscopic resections between 2011 and 2021 with either endoscopic mucosal resection (EMR), endoscopic mucosal dissection (ESD), hybrid ESD, or combined endoscopic laparoscopic surgery (CELS) were included from a prospectively collected dataset. Patient and lesion details and procedure outcomes are reported. Results: Out of 1005 lesions resected with advanced endoscopic techniques, 41 patients (4%) underwent appendiceal orifice mucosal neoplasm resection, including 39% by hybrid ESD, 34% by ESD, 15% by EMR, and 12% by CELS. The median age was 65, and 54% were male. The median lesion size was 20 mm. The dissection was completed piecemeal in 49% of patients. Post-procedure, one patient had a complication within 30 days and was admitted with post-polypectomy abdominal pain treated with observation for 2 days with no intervention. Pathology revealed 49% sessile-serrated lesions, 24% tubular adenomas, and 15% tubulovillous adenomas. Patients were followed up for a median of 8 (0–48) months. One patient with a sessile-serrated lesion experienced a recurrence after EMR which was re-resected with EMR. Conclusion: Advanced endoscopic interventions for appendiceal orifice mucosal neoplasms can be performed with a low rate of complications and early recurrence. While conventionally lesions at the appendiceal orifice are often treated with surgical resection, advanced endoscopic interventions are an alternative approach with promising results which allow for cecal preservation. [ABSTRACT FROM AUTHOR]

Background: The interrelation between intestinal polyps, metabolic syndrome (MetS), and colorectal cancer (CRC) is a critical area of study. This research focuses on pinpointing potential molecular targets to understand the link between intestinal polyp formation, metabolic irregularities, and CRC progression. Methods: We examined clinical samples from patients with intestinal polyps coexisting with MetS and compared them with samples from patients with standard intestinal polyps. Transcriptome sequencing and public database analysis were employed to identify significant pathways and genes. These targets were then validated through immunohistochemistry (IHC). Following the RNA interference of key target expression, a series of experiments, including the cell counting kit-8 assay, colony formation, wound healing, and Transwell assays, were conducted. Results: Comparative analysis revealed 75 up-regulated and 61 down-regulated differentially expressed genes (DEGs) in the MetS polyp group vs. the control. Kyoto encyclopedia of genes and genomes (KEGG) pathway enrichment suggested these DEGs were primarily associated with cell cycle and mitosis. Integration with comparative toxicogenomics database (CTD) and the cancer genome atlas (TCGA) databases highlighted 44 key CRC-related genes. Protein interaction networks indicated connections of purkinje cell protein 4 (PCP4), olfactomedin 1 (OLFM1), fibronectin 1 (FN1), and transforming growth factor beta 3 (TGF-β3) with the mitogen-activated protein kinase (MAPK) pathway. Tumor correlation studies suggested higher risk associations with FN1, PCP4, and TGF-β3, while OLFM1 was identified as a lower risk gene. Immunohistochemical analysis revealed a decrease in OLFM1 in MetS-associated intestinal polyps. Upon interference with OLFM1 in polyp epithelial cells, there was a significant enhancement in cell proliferation, colony formation, and cell migration and invasion capabilities. Conclusion: Our study highlights a significant decrease in OLFM1 expression in MetS-associated intestinal polyps. And, this reduction in OLFM1 is associated with enhanced cell proliferation, colony formation, and increased cell migration and invasion capabilities. These findings underscore the reduced OLFM1 expression in MetS-associated intestinal polyps may play a crucial role in promoting tumorigenic processes in colorectal pathology. Further research on OLFM1 may provide valuable insights into understanding and targeting MetS-associated intestinal polyps. [ABSTRACT FROM AUTHOR]

Gardner syndrome (GS) is a rare genetic disorder characterized by numerous intestinal colon polyps with various extraintestinal manifestations. Osteomas are a known extracolonic manifestation of GS and can affect the orbit, as seen in our patient, as well as 13 other cases documented in literature. Excision of large orbital osteomas can be successful with a multi-disciplinary approach as presented in this article. Ophthalmologists can even be the first to diagnose GS, usually via the presence of congenital hypertrophy of the retinal pigment epithelium (CHRPE) lesions. Untreated, 100% of colon polyps will transform into cancer, thus it is important to be aware of this rare syndrome with ophthalmic manifestations and screen patients with osteomas for GS. [ABSTRACT FROM AUTHOR]

Juvenile polyps (JPs) are the most common polyps in pediatric patients. We present the case of an 18-year-old male patient with a giant solitary JP resembling solitary rectal ulcer syndrome (SRUS). The presenting history was rectal bleeding and symptoms of obstructed defecation syndrome. Colonoscopy revealed a polypoidal mass at the anorectal junction, with biopsy-confirmed SRUS. The symptoms worsened, and a protruding mass from the anus caused fecal incontinence. Pelvic magnetic resonance imaging showed a huge pedunculated mass occupying the low rectum with local compression of the urinary bladder. Transanal excision of the anal tumor was performed due to bleeding. A histopathological examination showed a JP with high-grade dysplasia. A histological examination to differentiate JPs and SRUS could be challenging based on a superficial forceps biopsy. Therefore, an excision biopsy is usually warranted with the understanding that adenomatous or malignant transformation is found in 5.6% to 12% of all JPs.

Introduction: Conventional adenomatous polyps are dysplastic proliferations that arise from the surface of the mucosa and grow in a top-down fashion. Dysplasia is graded as low-grade and high-grade using a two-tiered grading system. Aim: To grade the dysplasia in conventional adenomatous polyps by applying a novel scoring system. Materials and Methods: This cross-sectional study was conducted in the Department of Pathology, ESIC Medical College and Post Graduate Institute of Medical Science and Research (PGIMSR), Rajajinagar, Bengaluru, Karnataka, India. A total of 46 cases reported as conventional adenomatous polyps were reviewed from January 2020 to June 2022. A cytological grading system was applied, evaluating eight parameters consisting of architectural and cytological features. Each parameter was scored, resulting in a total score ranging from 8 to 24. The final diagnosis was determined based on the histological pattern and the total cytological score. The results were tabulated in an excel sheet and analysed using mean, standard deviation, percentage, and frequency tables. The relationship between the independent variables was evaluated using the Chi-square test. A p-value of less than 0.05 was considered significant. Results: Out of the 46 cases, most presented in the 4th decade of life 12 (32.61%) cases. The mean age of presentation was 54.56±11.91 years (mean±SD) with a male to female ratio of 1.4:1. The most common site was the sigmoid colon 17 (36.96%) cases. There were 26 cases of low-grade dysplasia with a mean score of 9.1 and 20 cases of high-grade dysplasia with a mean score of 15.2. The most common type was tubular adenoma with low-grade dysplasia 24 (52.17%) cases and a mean cytological score of 9. The high-grade dysplasia in tubular adenomas 7 (15.22%) cases, tubulovillous adenomas 11 (23.19%) cases, and villous adenomas 2 (4.35%) cases had mean scores of 13.3, 15.2, and 18, respectively. Conclusion: Dysplasia in adenomatous polyps is an independent risk factor for malignancy. The cytological scoring system helps in accurately diagnosing the grade of dysplasia and simplifies the process. The present study emphasizes the need for objective criteria, paving the way for implementing relevant surveillance and clinical protocols.

Simple Summary: The high incidence and mortality of colorectal cancer (CRC) have influenced society to promote research in this field. Dysbiosis of the intestinal microbiota occurring in CRC has been extensively studied. However, microbial shifts occurring at the initial stages of mucosal alterations are less known. In this work, the fecal microbiota of volunteers diagnosed with intestinal polyps were compared with the microbial compositions of nonpathological control volunteers, thereby focusing on the nature of the hyperplastic polyps or conventional adenomas, as well as on the degree of dysplasia (low grade vs. high grade) in the last ones as indicators of colorectal cancer risk development. The findings provide insights into the microbiota changes occurring at the early stages of intestinal mucosal lesions. This work could set a starting point for further studies focusing on the influence of diet and lifestyle factors on the initial alterations of the intestinal mucosa and for the proposal of strategies for their prevention. Progressive intestinal mucosal damage occurs over years prior to colorectal cancer (CRC) development. The endoscopic screening of polyps and histopathological examination are used clinically to determine the risk and progression of mucosal lesions. We analyzed fecal microbiota compositions using 16S rRNA gene-based metataxonomic analyses and the levels of short-chain fatty acids (SCFAs) using gas chromatography in volunteers undergoing colonoscopy and histopathological analyses to determine the microbiota shifts occurring at the early stages of intestinal mucosa alterations. The results were compared between diagnosis groups (nonpathological controls and polyps), between samples from individuals with hyperplastic polyps or conventional adenomas, and between grades of dysplasia in conventional adenomas. Some microbial taxa from the Bacillota and Euryarchaeota phyla were the most affected when comparing the diagnosis and histopathological groups. Deeper microbiota alterations were found in the conventional adenomas than in the hyperplastic polyps. The Ruminococcus torques group was enriched in both the hyperplastic polyps and conventional adenomas, whereas the family Eggerthellaceae was enriched only in the hyperplastic polyps. The abundance of Prevotellaceae, Oscillospiraceae, Methanobacteriaceae, Streptococcaceae, Christensenellaceae, Erysipelotrichaceae, and Clostridiaceae shifted in conventional adenomas depending on the grade of dysplasia, without affecting the major SCFAs. Our results suggest a reorganization of microbial consortia involved in gut fermentative processes. [ABSTRACT FROM AUTHOR]

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Background: Colorectal cancer (CC) is one of the most important causes of death due to cancer in the world. The association of blood groups with CC in many races has been reported in previous studies. So far, no study has evaluated the relationship between blood group type, tumor location, and polyp type. Objectives: This study aimed at evaluating the association of the ABO blood group and CC, tumor location, and polyp type. Methods: In this case-control study, 802 subjects (401 cases and 401 controls), who underwent surgery at our medical centers between 2014 and 2021, were included. The case group was selected from the hospital records of patients with CC, and the controls were selected from non-cancer patients who were admitted to the same centers for reasons other than cancer. Patients' demographic characteristics and clinical and pathology findings were extracted from the medical profile, and blood group information was extracted from the blood bank. Multivariate logistic regression analysis was used for the predictive variables of CC. Results: The risk of CC inpatients with blood type A was significantly higher than non-A. While the risk of developing CC inpatients with blood type O was significantly lower than non-O O. The risk of developing neoplastic polyps was significantly higher in patients with blood type A compared to non-A. The results of multivariate analysis showed that ABO blood type A(OR Adju: 1.66) and O (OR Adju: 0.78) and neoplastic polyp type (OR Adju: 1.36) were associated with CC. Conclusions: The results of this study showed that ABO blood group type was significantly related to CC and polyp type. [ABSTRACT FROM AUTHOR]

Purpose: Urachal cancer is similar to gastrointestinal adenocarcinoma in histology, and gastroscopy/colonoscopy is often administered during perioperative evaluation. However, gastroscopy and colonoscopy have corresponding disadvantages. This study discusses whether gastroscopy/colonoscopy is truly necessary for patients with urachal cancer. Patients and methods: A total of 166 bladder adenocarcinoma cases diagnosed at Sun Yat-sen University Cancer Center were retrospectively reviewed and divided into two groups (urachal cancer and nonurachal cancer), and perioperative evaluations were retrieved. Results: There were 78 patients with urachal cancer, the median age was 48 years, and 59 were male. Perioperative gastroscopy/colonoscopy revealed 5 intestinal polyps and 1 adenoma during these evaluations, and no primary gastrointestinal cancer was found. Meanwhile, preoperative imaging evaluation did not detect significant gastrointestinal lesions. For 88 patients with nonurachal cancer, including primary bladder adenocarcinoma and metastatic tumors from gastrointestinal cancer, the median age was 56 years, and 64 were male. Preoperative imaging evaluation demonstrated 36 cases of gastrointestinal lesions, and 32 were confirmed by gastroscopy/colonoscopy; the other 4 were negative. Another 4 cases of colon cancer were detected by regular colonoscopy for suspected primary bladder adenocarcinoma. In all, 35 cases of colon cancer and 1 case of gastric cancer were identified by endoscopic examination. The diagnostic consistency of imaging and gastrointestinal endoscopy was favorable (P < 0.001), and the negative predictive value and diagnostic efficiency of imaging were 96.9% and 94.6%, respectively. Conclusions: The vast majority of gastrointestinal cancer cases can be identified by assessment of the patient's clinical symptoms, meticulous physical examination, and imaging evaluation. We recommend that gastroscopy/colonoscopy only be applied to patients with urachal cancer when the above examinations are positive. [ABSTRACT FROM AUTHOR]

Environmental factors such as diet and lifestyle have been shown to influence the development of some intestinal mucosal lesions that may be precursors of colorectal cancer (CRC). The presence of these alterations seems to be associated with misbalanced immunological parameter levels. However, it is still unclear as to which immunological parameters are altered in each phase of CRC development. In this work, we aimed to study the potential relationships of immunological and metabolic parameters with diet in a CRC-related lesion context. Dietary information was obtained using an annual semi-quantitative food-frequency questionnaire (FFQ) from 93 volunteers classified via colonoscopy examination according to the presence of intestinal polyps or adenocarcinoma. Cytokines, chemokines, and adipokines were determined from serum samples. We observed a reduction in adiponectin according to the damage to the mucosa, accompanied by an increase and decrease in C-X-C motif chemokine ligand 10 (CXCL10) and resistin, respectively, in CRC cases. The presence of aberrant crypt foci (ACF) in the polyp group was associated with higher tumor necrosis factor-alpha (TNF-α) concentrations. Vegetables were directly correlated with adiponectin and resistin levels, while the opposite occurred with red meat. A bioactive compound, soluble pectin, showed a negative association with TNF-α. Future dietary strategies could be developed to modulate specific immunological parameters in the context of CRC. [ABSTRACT FROM AUTHOR]

Background: The yield of colonoscopy in cases presenting with lower gastrointestinal bleeding (LGIB) in previously published studies varies according to several factors, including endoscopic skills, histopathological experience, and pattern of colonic pathology in different countries. The local literature is limited to a single small 20-year-old study. Our objective was to provide updated data on the diagnostic yield of colonoscopy in Saudi children with LGIB in Saudi Arabia. Methods: This was a retrospective analysis of pediatric patients (0–14 years of age) who underwent colonoscopy for LGIB at the King Fahad Medical City (KFMC), from 2008 to 2018. LGIB was defined as fresh or dark blood per rectum. Results: During the study period, 175 children underwent colonoscopy for LGIB (99 males, mean age 7.05 ± 3.81 years), which constituted 53.5% of indications for colonoscopy procedures (n = 327) in our center. The terminal ileum was intubated in 81% of the procedures. Overall, inflammatory bowel disease (IBD) was the most commonly identified cause of LGIB (32%) followed by colonic lymphonodular hyperplasia (CLNH) in 17% and juvenile polyp and rectal mucosal prolapse syndrome (RMPS), 11% each. On sub-analysis, cow's milk protein allergy (CMPA) and CLNH were the most common causes in infants and toddlers, 35% each; IBD (26.5%) and polyps (22.4%) in young children (2–6 years), and IBD (36%), CLNH (14.9%) and RMPS (14%) in older children (6–14 years). In comparing the IBD to the non-IBD group, IBD patients were older (mean 8.37 vs. 6.46 years, P = 0.002) and more likely to have diarrhea, weight loss, high erythrocyte sedimentation rate, anemia, and hypoalbuminemia (odds ratio 24, 11, 10.7, 6.5, and 4, respectively). Colonoscopy had a sensitivity of 97%, specificity of 100%, positive predictive value of 100%, negative predictive value of 81.4%, and accuracy of 97% in diagnosing LGIB. Conclusion: Colonoscopy is an effective diagnostic tool in children with LGIB with a high diagnostic yield. Besides IBD, CLNH and RMPS are two other important pathologic entities that need to be considered in a child with LGIB. [ABSTRACT FROM AUTHOR]

Introduction: Conventional adenomatous polyps are dysplastic proliferations that arise from the surface of the mucosa and grow in a top-down fashion. Dysplasia is graded as low-grade and high-grade using a two-tiered grading system. Aim: To grade the dysplasia in conventional adenomatous polyps by applying a novel scoring system. Materials and Methods: This cross-sectional study was conducted in the Department of Pathology, ESIC Medical College and Post Graduate Institute of Medical Science and Research (PGIMSR), Rajajinagar, Bengaluru, Karnataka, India. A total of 46 cases reported as conventional adenomatous polyps were reviewed from January 2020 to June 2022. A cytological grading system was applied, evaluating eight parameters consisting of architectural and cytological features. Each parameter was scored, resulting in a total score ranging from 8 to 24. The final diagnosis was determined based on the histological pattern and the total cytological score. The results were tabulated in an excel sheet and analysed using mean, standard deviation, percentage, and frequency tables. The relationship between the independent variables was evaluated using the Chi-square test. A p-value of less than 0.05 was considered significant. Results: Out of the 46 cases, most presented in the 4th decade of life 12 (32.61%) cases. The mean age of presentation was 54.56±11.91 years (mean±SD) with a male to female ratio of 1.4:1. The most common site was the sigmoid colon 17 (36.96%) cases. There were 26 cases of low-grade dysplasia with a mean score of 9.1 and 20 cases of high-grade dysplasia with a mean score of 15.2. The most common type was tubular adenoma with low-grade dysplasia 24 (52.17%) cases and a mean cytological score of 9. The high-grade dysplasia in tubular adenomas 7 (15.22%) cases, tubulovillous adenomas 11 (23.19%) cases, and villous adenomas 2 (4.35%) cases had mean scores of 13.3, 15.2, and 18, respectively. Conclusion: Dysplasia in adenomatous polyps is an independent risk factor for malignancy. The cytological scoring system helps in accurately diagnosing the grade of dysplasia and simplifies the process. The present study emphasizes the need for objective criteria, paving the way for implementing relevant surveillance and clinical protocols. [ABSTRACT FROM AUTHOR]

Objective To investigate the safety and efficacy of cold snare polypectomy (CSP) versus hot snare polypectomy (HSP) in the treatment of colorectal polyps with a diameter of 10-15 mm. Methods A total of 138 patients who underwent colonoscopy and planned to undergo polypectomy (at least one colorectal polyp with a maximum diameter of 10-15 mm) in Department of Gastroenterology, Laoshan Branch of The Affiliated Hospital of Qingdao University, from June 2022 to February 2023 were randomly divided into CSP group with 76 patients and HSP group with 62 patients. The two groups were compared in terms of the efficacy of polypectomy (complete resection rate and en bloc resection rate) and safety indicators (proportion of patients with intraoperative bleeding, delayed bleeding, intraoperative perforation, delayed perforation, and postoperative reactive serocolitis). Results The HSP had a complete resection rate of 98.4% and an en bloc resection rate of 96.8%, while the CSP group had a complete resection rate of 97.3% and an en bloc resection rate of 98.7%; there were no significant differences in the above efficacy indicators between the two groups (P>0.05). In the CSP group, 2 patients experienced intraoperative bleeding, while there were no patients with delayed bleeding, intraoperative and delayed perforation, or reactive serocolitis, and a total of 82 titanium clips were used in 71 patients; in the HSP group, 1 patient experienced intraoperative bleeding, 2 patients experienced delayed bleeding, and 4 patients developed reactive serocolitis, while there were no patients with intraoperative and delayed perforation, and a total of 72 titanium clips were used in 61 patients. There were no significant differences in the above safety indicators between the two groups (P>0.05). Conclusion CSP is safe and effective in removing colorectal polyps with a diameter of 10-15 mm and is thus re-commended for clinical application.

Juvenile polyposis syndrome (JPS) is a rare autosomal dominant disorder characterized by multiple juvenile polyps in the gastrointestinal tract, often associated with mutations in genes such as Smad4 and BMPR1A. This study explores the impact of Smad4 knock-out on the development of intestinal polyps using collaborative cross (CC) mice, a genetically diverse model. Our results reveal a significant increase in intestinal polyps in Smad4 knock-out mice across the entire population, emphasizing the broad influence of Smad4 on polyposis. Sex-specific analyses demonstrate higher polyp counts in knock-out males and females compared to their WT counterparts, with distinct correlation patterns. Line-specific effects highlight the nuanced response to Smad4 knock-out, underscoring the importance of genetic variability. Multimorbidity heat maps offer insights into complex relationships between polyp counts, locations, and sizes. Heritability analysis reveals a significant genetic basis for polyp counts and sizes, while machine learning models, including k-nearest neighbors and linear regression, identify key predictors, enhancing our understanding of juvenile polyposis genetics. Overall, this study provides new information on understanding the intricate genetic interplay in the context of Smad4 knock-out, offering valuable insights that could inform the identification of potential therapeutic targets for juvenile polyposis and related diseases.

This article discusses a case study of a 5-year-old boy who had an incidentally found abdominal mass during an ultrasound examination. The mass was initially thought to be a right adrenal mass but was later diagnosed as an intestinal polyp. The article emphasizes the importance of ultrasound in diagnosing polyps in children and highlights the distinct ultrasound characteristics of intestinal polyps. It also mentions other conditions that should be considered in the differential diagnosis, such as neuroblastoma, Wilms' tumor, and Burkitt's lymphoma. The article concludes by recommending the use of high-frequency linear transducers for detailed bowel ultrasound examinations. [Extracted from the article]

Multiple polyposes are heterogeneous diseases with different underlying molecular backgrounds, sharing a common symptom: the presence of transforming into cancerous intestinal polyps. Recent reports have indicated biallelic mutations in the NTHL1 gene, which is involved in base excision repair (BER), as predisposing to an elevated risk of colorectal cancer (CRC). We aimed to evaluate the significance of the p.Q82* truncating variant in predisposition to intestinal polyposis by assessing its frequency in polyposis patients. We genotyped 644 Polish patients and 634 control DNA samples using high-resolution melting analysis (HRM) and Sanger sequencing. We found the p.Q82* variant in four polyposis patients; in three, it was homozygous (OR = 6.90, p value = 0.202). Moreover, the p.R92C mutation was detected in one patient. We also looked more closely at the disease course in patients carrying NTHL1 mutations. Two homozygous patients also presented other neoplasia. In the family case, we noticed the earlier presence of polyps in the proband and early hepatoblastoma in his brother. We cannot univocally confirm the relationship of p.Q82* with an increased risk of CRC. However, homozygous p.Q82* was more frequent by 10-fold in patients without other mutations identified, which makes NTHL1 gene screening in this group reasonable. [ABSTRACT FROM AUTHOR]

Cowden syndrome (CS) is a rare disease that was first described in 1963 and later included in the large group of genodermatoses. It is the most common syndrome among the PTEN-associated hamartomatous tumor syndromes (PHTS). CS has an autosomal dominant inheritance pattern, with increased penetrance and variable expressivity, making early diagnosis difficult. Mutations in the PTEN gene (phosphatase and TENsin homolog) are involved in its pathogenesis, involving many organs and systems originating in the three embryonic layers (ectodermum, endodermum, and mesodermum). The consequence is the development of hamartomatous lesions in various organs (brain, intestines, thyroid, oropharyngeal cavity, colon, rectum, etc.). Multiple intestinal polyps are common in patients with CS, being identified in over 95% of patients undergoing colonoscopy. The authors describe the case of a patient who presented the first signs of the disease at 3 ½ years (tonsil polyp) but was diagnosed only at the age of 20 following a colonoscopy that revealed hundreds of intestinal polyps, suggesting further molecular testing. A heterozygous frameshift mutation was identified in the PTEN gene, classified as a potentially pathogenic variant (c.762del.p(Val255*)). The authors present this case to highlight the path taken by the patient from the first symptoms to the diagnosis and to emphasize the clinical aspects of this mutational variant that have still not been identified in other patients with this syndrome. [ABSTRACT FROM AUTHOR]

The management of pediatric Peutz–Jeghers Syndrome (PJS) focuses on the prevention of intussusception complicating small intestinal (SI) polyposis. This hinges on the accurate appraisal of the polyp burden to tailor therapeutic interventions. Video Capsule Endoscopy (VCE) is an established tool to study SI polyps in children, but an in-depth characterization of polyp burden in this population is lacking. Methods: We performed a retrospective longitudinal cross-sectional analysis of VCE studies in pediatric PJS patients at our institution (CMKC) from 2010 to 2020. Demographic, clinical, and VCE findings reported by three reviewers in tandem were accrued. Polyp burden variables were modeled as functions of patient and study characteristics using linear mixed models adjusted for clustering. Results: The cohort included 15 patients. The total small bowel polyp count and largest polyp size clustered under 30 polyps and <20 mm in size. Luminal occlusion correlated closely with the estimated polyp size. Polyp distribution favored proximal (77%) over distal (66%) small bowel involvement. The adjusted largest polyp size was greater in males. Double Balloon Enteroscopy was associated with a decreased polyp burden. Conclusions: The polyp burden in pediatric PJS patients favors the proximal third of the small intestine, with relatively small numbers and a polyp size amenable to resection through enteroscopy. Male gender and older age were related to an increased polyp burden. [ABSTRACT FROM AUTHOR]

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Simple Summary: Recent evidence has emerged highlighting the role of claudins in the development of cancers of gastrointestinal organs. Accordingly, studies have further analyzed the role and expression of claudin in preneoplastic gastrointestinal conditions, including Barrett's esophagus, sessile serrated polyps, inflammatory bowel disease, and others. Several claudins, mainly -1, -2, -3, -4, and -18, have been identified as aberrantly expressed in these conditions. Furthermore, studies have highlighted their prognostic role in patients. Identifying how claudin expression changes in preneoplastic conditions may allow for early diagnosis and treatment. Additionally, it may unlock the door for potential therapeutic molecular targets. Premalignant lesions of the gastrointestinal tract are a group of disorders which act as the harbinger of malignant tumors. They are the ground-zero of neoplastic transformation, and their identification and management offer patients the best opportunity of blocking the progress of cancer. However, diagnoses of some of these conditions are hard to make, and their clinical importance is difficult to assess. Recent reports indicated that several claudin proteins have altered expressions in many cancers, including esophageal, gastric, colon, liver, and pancreatic cancers. The early identification of the aberrant expression of these proteins could lead to the early diagnosis and management of gastrointestinal tumors. Specifically, claudins -1, -2, -3, -4, and -18 are frequently overexpressed in gastrointestinal preneoplastic lesions. These altered expressions have shown clinical value in several tumors, providing diagnostic and prognostic information. In this article, we review the literature on the aberrant expression of claudins in preneoplastic lesions of the gastrointestinal tract. Additionally, we summarize their diagnostic and prognostic implications. [ABSTRACT FROM AUTHOR]

BACKGROUND/AIMS: The global trend of an expanding aged population has increased concerns about complications correlated with gastrointestinal (GI) endoscopy in elderly patients; however, there have been few reports published on this issue. METHODS: In this retrospective, observational cohort study performed between 2012 and 2017, serious complications of esophagogastroduodenoscopy (EGD), colonoscopy, and colonoscopic polypectomy were compared between patients according to age (≥65 years vs 18-64 years). We used the Health Insurance Review and Assessment-National Patient Samples database, previously converted to the standardized Observational Medical Outcomes Partnership-Common Data Model. Serious complications within 30 days of the procedure included both GI complications (bleeding and perforation) and non-GI complications (cerebrovascular accident [CVA], acute myocardial infarction [AMI], congestive heart failure [CHF], and death). RESULTS: A total of 387,647 patients who underwent EGD, 241,094 who underwent colonoscopy, and 89,059 who underwent colonoscopic polypectomy were assessed as part of this investigation. During the study period, endoscopic procedures in the older group steadily increased in number in all endoscopy groups (all p

Peutz-Jeghers type hamartomatous polyp is known to be associated with Peutz-Jeghers syndrome, which shows characteristic multiple hamartomatous polyp involvement in the gastrointestinal tract, combined with mucocutaneous symptom, familial history of Peutz-Jeghers syndrome or STK11/LTB1 mutation. However, some cases showing histologic appearance of the polyps discovered in Peutz-Jeghers syndrome while lacking other diagnostic criteria of the syndrome have been reported, and these are called solitary Peutz-Jeghers type polyps. Herein, we report a case of solitary Peutz-Jeghers type polyp covered with heterotopic epithelium. The patient was 47-year-old female without any mucocutaneous symptoms nor familial history of Peutz-Jeghers syndrome. Microscopic examination revealed Peutz-Jeghers type hamartomatous polyp in duodenum covered with gastric type foveolar epithelium. Considering the definition of hamartomatous polyp, which is, the abnormal overgrowth of the indigenous epithelial component, the histological feature of current case is noteworthy in a point that it shows proliferation of heterotopic component, rather than the indigenous component.

Background: Colonoscopy is considered the most effective screening method for colorectal polyps. However, the longevity and complexity of the procedure makes it less desirable to screen for colorectal polyps in the general population. Therefore, it is essential to identify other independent risk factors. In this study, we explored the link between Hp infection, atrophic gastritis, and colorectal polyps to identify a new potential risk factors of colorectal polyps. Methods: In this study, atrophic gastritis and intestinal polyps were diagnosed by endoscopy and pathology. All the 792 patients in this retrospective study were divided into sub-groups based on the presence of colorectal polyps. The correlation between polyps and atrophic gastritis was analyzed using the chi-square test and Kruskal-Wallis test. The receiver operating characteristic (ROC) curve was used to compare the predictive value for colorectal polyps between Hp infection and atrophic gastritis. Binary logistic regression was utilized to identify independent risk factors for colorectal polyps. Results: Patients with colorectal polyps were primarily male with advanced age, and the number of patients with colorectal polyps had a higher association with smoking, alcohol drinking, and Hp infection than the control group. A positive correlation between the number of colorectal polyps and the severity of atrophic gastritis was observed. ROC analysis showed that atrophic gastritis was a better risk factors for colorectal polyps. Multivariate analysis identified atrophic gastritis as an independent risk factor for colorectal polyps (OR 2.294; 95% CI 1.597–3.296). Conclusions: Atrophic gastritis confirmed could be an independent risk factors for colorectal polyps. [ABSTRACT FROM AUTHOR]

Peutz-Jeghers syndrome (PJS) is a rare inherited autosomal dominant disease characterised by mucocutaneous pigmentation and multiple polyps in the gastrointestinal tract. In up to 25% of cases, there is no family history of PJS (sporadic cases). Acute intestinal intussusception due to multiple polyps is the most common complication of PJS. PJS is associated with cancers of the gastrointestinal tract and in other organs. Adenocarcinoma arising in hamartomatous polyps is heavily debated. A 23-year-old gentleman presented with sporadic PJS with recurrent ileal intussusceptions and multifocal well-differentiated adenocarcinomas arising in the background of hamartomatous polyps following hamartoma-dysplasia-carcinoma sequence, which is herein discussed. The hamartoma-dysplasia-carcinoma sequence is one of the pathways of carcinogenesis within hamartomatous polyps in PJS. [ABSTRACT FROM AUTHOR]

Based on the analysis of patients with Peutz-Jeghers syndrome (PJS), Serine threonine kinase11 (STK11) is known as a tumor suppressor gene, which is involved in cell polarization, regulation of apoptosis, and DNA damage response. In this case report study, we examined STK11 gene sequencing in a 42-year-old woman with mucocuta neous pigmentation and positive family history. Endoscopy and colonoscopy showed >1000 polyps throughout the stomach/colon (PJ-type hamartomas). The larger polyp in the stomach was resected and the small bowel imaging detected multiple jejunum/ileum small polyps. The data released from the sequencing results revealed five alterations in exons 1 to 5. The major mutation in stop codon was reported as converted to the amino acid tryptophan (TRP) to tyrosine (TER). The TGG codon was converted to TAG by mutation. Finally, another novel mutation in STK11 stop codon as a 'de novo' variant was seen. It is predicted that stop codon mutations make the affected person susceptible to developing colorectal cancer. [ABSTRACT FROM AUTHOR]

In this paper, a new protocol is described, based on solid phase microextraction (SPME) coupled with gas chromatography–mass spectrometry (GC-MS), to monitor ex vivo changes in endogenous volatile organic compounds (VOCs) released by surgically resected colonic tissues (normal colonic mucosa and adenomatous polyps) from seven patients undergoing operative colonoscopy to identify their molecular pattern. The exhalated volatile organic molecules from these patients were sampled by the ReCIVA® breath sampler, shortly before surgery, and analyzed by GC-MS. Comparing VOC patterns identified in the tissues and in the breath of the same patients, a possible correlation can be found between the levels of methylbenzene and benzaldehyde exhaled and the presence of colonic adenomatous polypoid lesions. [ABSTRACT FROM AUTHOR]

Introduction: Peutz--Jeghers Syndrome (PJS) is an autosomal dominant disease presenting with hamartomatous polyps in the gastrointestinal tract and hyperpigmented macules on lips and oral mucosa. The incidence of this syndrome is approximately 1 in 1,20,000 births. Materials and Methods: In this article, we are presenting 11 cases of PJS which were misdiagnosed and patients were compelled to visit hospital repeatedly. All these cases were diagnosed based on clinical suspicion, family history, and histopathological examination of specimens. Most of the cases presented with intussusception and required emergency surgical management. Results: PJS can be diagnosed by the presence of microscopically confirmed hamartomatous polyps and a minimum of two of the following clinical criteria: Family history, mucocutaneous melanotic spots, and small bowel polyps with bleeding per rectally. The diagnosis can be missed if the melanotic spots on the face are missed. Routine investigations, imaging, and endoscopy were done in all cases. PJS patients need regular follow-up due to chance of recurrence of symptoms and susceptibility to cancer. Conclusion: PJS needs a high index of suspicion for diagnosis in cases of recurrent abdominal pain with bleeding per rectum. Proper family history and meticulous clinical examination for melanosis are very important to prevent the misdiagnosis of these cases. [ABSTRACT FROM AUTHOR]

Considering the complex characteristics of low contrast, blurred boundaries, and irregular shapes in the lesion area and surrounding mucus in colorectal polyp images, most of the existing algorithms cannot achieve high-precision segmentation of colorectal polyps. In view of the above difficulties, this paper proposed a colorectal polyp segmentation algorithm combining PVTv2 and multi-scale boundary polymerization. Firstly, using PVTv2 to extract the lesion features in the intestinal polyp image layer by layer, to solve the problem that the traditional convolutional neural network has insufficient ability to extract the features of the lesion area. It constructed a multi-scale context space awareness module at the network skip connection. Then, it designed a multi-scale extrusion adaptation fusion module to aggregate the feature information of different scales to reduce the semantic difference of each scale feature. Finally, in order to further strengthen the edge detail features recognition ability, creatively constructed residual axial double boundary refinement module. The algorithm verified by a large number of experiments on the Kvasir-SEG dataset and the CVC-ClinicDB dataset, the similarity coefficients were 93. 29% and 94. 52%, and the average intersectional merge ratio was 88. 36% and 89. 88% respectively. The experimental results show that the segmentation accuracy of the proposed model has been greatly improved for the complex lesion area and the blurred lesion boundary. [ABSTRACT FROM AUTHOR]

BACKGROUND/AIMS: Little is known about the national colonoscopy volume in Asian countries. This study aimed to assess the national colonoscopy volume in Korea over a 12-year period on the basis of a nationwide population-based database. METHODS: We conducted a population-based study for colonoscopy claims (14,511,158 colonoscopies performed on 13,219,781 patients) on the basis of the Korean National Health Insurance Service database from 2002 to 2013. The 12-year national colonoscopy burden was analyzed according to patient age, patient sex, and healthcare facility type. RESULTS: The overall volume of colonoscopy increased 8-fold over the 12-year period. The annual colonoscopic polypectomy rate significantly increased in all patient sex and age groups over the 12-years period (all p

Cronkhite–Canada syndrome is a rare non-hereditary disease characterized by gastrointestinal hamartomatous polyposis and protein-losing enteropathy. The presenting symptoms are onychodystrophy, skin pigmentation, alopecia, weight loss, and diarrhea. Diagnosis is suggested by a combination of clinical, imaging, and endoscopy findings, and histology is necessary for confirmation. Here we describe a case of a 54-year-old man presenting with watery diarrhea, colicky abdominal pain, nasal obstruction, and weight loss for 6 months. Endoscopy showed multiple polyps in the stomach, duodenum, and colon. These were seen on computed tomography (CT) enterography along with polyps in the small bowel. A final diagnosis was made after the biopsy.