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PubMed1985

[Endoscopic polypectomy of the colon in children].

Colon Polyps constitute are one of the most frequent causes of rectal bleeding in infancy. The advent of endoscopic polypectomy through colonoscopy has resulted very useful in their treatment. From 1979 to 1984, 73 polypectomies were performed in 64 patients with colonic polyps, between 2 and 14 years old, 26 girls and 38 boys. 103 polyps were resected, 71 pedunculated and 32 sessiles. The most frequent location was the recto-sigmoid (85.6%), with 14.4% situated above it. 55.7% of the removed polyps were more than 1 cm., juvenile histologic type predominating (90%). No complication was observed either during or after this procedure. It is demonstrated that, endoscopic polypectomy in children is a safe, simple and effective method which avoids complications that may or surgery might produce.

Adolescent↗
PubMed2004

Detection of murine intestinal adenomas using targeted molecular autofluorescence.

There is a significant need for noninvasive methods of evaluating dysplastic and neoplastic lesions in the luminal gastrointestinal tract. We have optimized an approach based on autofluorescence to study dysplastic adenomatous polyps in Apc(min/+) mice. We made recordings from both normal intestinal mucosa and from polyps using a xenon lamp-based fiberoptic device. Seventy-eight polyps in 11 mice revealed an increase in mean autofluorescence intensity ratios of 1.29 +/- 0.04 (72 small intestinal polyps; P < 0.0001) and 1.28 +/- 0.05 (6 colon polyps; P = 0.0016). Serial measurements of autofluorescence discriminated polyps from normal mucosa with a sensitivity, verified histologically, of 95%. To understand the chemical basis for increased autofluorescence, we examined the tryptophan content of intestinal polyps and the adjacent normal mucosa in a small subset of animals. The findings revealed an increased concentration of tryptophan in polyps (990 +/- 240 ng/mg) compared to normal mucosa (720 +/- 150 ng/mg; P = 0.03). In conclusion, these findings suggest that autofluorescence intensity increases in the setting of intestinal neoplasia and can be used to detect adenomas in the mouse intestine in real time.

Adenomatous Polyps↗
PubMed1990

Natural history and current management of colorectal polyps.

There are numerous histological types of colon polyps. The neoplastic polyp, the precursor to colon cancer, is called an adenoma. Adenomas vary in frequency throughout the world and are particularly prevalent in Western countries. The belief that after several years of development some adenomas will become cancers is termed the adenoma-carcinoma sequence. These adenomas occur in both males and females and their incidence increases with age. While small polyps were once considered unimportant, it is now recognized that adenomas may be small. The clinical importance of other small polyps, most often hyperplastic polyps, is still being investigated. When adenomas are found in the colon a full colonoscopy with removal of all polyps and review of their pathology should be performed.

Adenoma↗
PubMed1990

[Soft skin fibromas: study of their importance and diagnostic significance for colonic neoplasms].

The aims of this study were (a) to examine the association of skin tags and colonic polyps and (b) to identify factors influencing skin tags. Therefore, a consecutive series of 157 medical ward patients with gastrointestinal symptoms who underwent colonoscopy underwent dermatological examination. Skin tags were found in 52% of these patients regardless of sex. (a) There was a statistically significant association between skin tags and colonic polyps (P = 0.33). This association, however, was based solely on an age effect. (b) Influencing factors were weight and age for the number of skin tags and the interaction between sex and the concentration of triglycerides for their size. At any given triglyceride concentration, men had larger skin tags.

Aged↗
PubMed1975

[The diagnostic and prognostic significance of epithelial blood group isoantigens in carcinomas and polyps of the colon (author's transl)].

Blood group isoantigens (BG) were detected in carcinomas and polyps of the colon and were related to the degree of differentiation, the histologic type, the age of the patients and the histologic signs of malignancy. 1. BG were found in 60-70% of colon carcinomas regardless of their differentiation. 2. BG-positive carcinomas were less often surrounded by lymphocytes and plasma cells than BG-negative ones. 3. BG were present in colon polyps as mucusassociated and as membrane-associated antigens depending on the differentiation of the cells. Hence, BG-activity can be regarded as additional criterium to assess objectively the differentiation of the tumor cells in a polyp. 4. The percentage of BG-positive polyps increased with dedifferentiation. 5. Polyps with foci of malignant degeneration were consistently BG-positive. 6. Villous polyps contained BG more often than the adenomatous ones. 7. The results support the concept that both villous and adenomatous polyps of the colon are precancerous lesions.

Blood Group Antigens↗
PubMed2001

Twin-endoscope scissors resection (T-ESR): a new minimally invasive technique for performing colonic mucosectomy.

BACKGROUND: Piecemeal resection is currently the safest method for the endoscopic removal of large sessile colonic polyps. However, this method has its limitations, including the quality of the specimen received for histopathology and the need for early follow-up due to the possibility of incomplete resection and recurrence. New methods enabling en bloc resection would be advantageous in these respects. METHODS: We developed a new technique that uses endoscopic scissors and two endoscopes to perform mucosal resection in a porcine model. So far, the technique has been evaluated in two animals. RESULTS: The resection of intact mucosal specimens measuring 1.5 x 1 cm and 2.2 x 3.5 cm was achieved, with no procedural or late hemorrhage and no clinical or radiological evidence of perforation. CONCLUSION: After further development and evaluation, this technique should be suitable for the resection of large sessile colonic polyps in humans.

Animals↗
PubMed1989

Sono-enterocolonography by oral water administration.

A new ultrasound technique for intestinal examination, named "sono-enterocolonography by oral water administration," was devised. The diagnostic usefulness and limitations of this procedure were studied in 56 subjects including 42 normal patients, 10 patients with 13 colonic polyps and 4 patients with colon carcinomas. Except for the rectum, almost all the intestines were clearly visualized by ultra-sonography as tubular structures filled with water. In every case, ileocecal valve movement was clearly observed dynamically. Eight of the 9 elevated polypoid lesions of the bowel, ranging in size from 10 mm to 20 mm, were detected by this method without any special pretreatment. Although this method may not be indicated for the screening of minute lesions, it may possibly be useful as a supportive diagnostic modality for intestinal disorders, especially in the ileocecal region.

Administration, Oral↗
PubMed2001

Heterogeneity of TT virus related sequences isolated from human tumour biopsy specimens.

TT viruses have recently been reported in serum samples from varying percentages of human blood donors and in patients with chronic liver disease. However, no association with human pathology has yet been reported. In a pilot study we analysed 162 biopsy specimens from various human cancers and from colon polyps for the presence of TT virus related sequences by polymerase chain reaction using three sets of nested primers for TT virus detection. All gels were subjected to Southern blot hybridisation, and DNA from hybridising bands was cloned and sequenced. A total of 54.3% of tumour specimens contained identifiable TT virus related sequences. Specimens from hypopharynx, larynx, endometrial, ovarian and bladder cancers were 14-35% positive and gastrointestinal cancers (oesophagus, stomach, colon, rectum) and colon polyps 57-100% positive. Lung cancers (68.4%), mammary cancers (50%), multiple myelomas (85.7%) and human leukaemias (53.3%) also revealed a high prevalence of TT virus related sequences. Since normal control tissues were not available for the tumour biopsy specimens tested, these data do not permit conclusions concerning a possible causal relationship between the virus infections and carcinogenesis. Another aspect, however, deserves attention: the heterogeneity of TT virus clones obtained from the specimens tested here was striking: 66 novel sequences, probably belonging to new types were identified. Only 16 clones corresponded by more than 97% of their sequences to established prototypes. Even individual tumours commonly contained sequences substantially diverging in nucleic acid composition. Up to five different types were identified within an individual tumour. The high variability of these virus types suggests that additional primer combinations within the highly conserved region of the genome would detect a still higher rate of positive tumours.

Biopsy↗
PubMed2000

Circulating p53 antibody in patients with colorectal cancer: relation to clinicopathologic features and survival.

The presence of serum anti-p53 antibody has been reported to be associated with survival of patients with breast cancer, ovarian cancer, and hepatocellular carcinoma. To clarify prognostic significance of p53 antibody in colorectal cancer, serum p53 antibody was measured in patients with colorectal cancer. The 89 patients included 71 with colorectal cancer and 18 with colon polyp. An enzyme-linked immunosorbent assay was used to detect p53 antibodies in serum. Clinicopathological parameters such as age, sex, degree of differentiation of cancer, location of tumor, liver metastasis, stage classification, Dukes classification, CEA, CA19-9, and immunostaining of p53 and anti-p53 antibody were evaluated as prognostic factors of colorectal cancer. p53 antibody was positive in 18 of 71 (25%) with colorectal cancer, whereas it was positive in only 1 of 18 (6%) with colon polyp. The patients with p53 antibody had higher CEA and CA19-9 levels, higher positive rates of p53 protein expression in cancer cells, and higher liver metastasis rates. The p53 antibody positivity at stage classification I-IIIb/ Dukes classification A-C was significantly lower than that at stage classification IV/Dukes classification D. Overall survival in colorectal cancer patients with p53 antibody was significantly shorter than in those without p53 antibody. A Cox regression analysis showed that liver metastasis, stage classification, Dukes classification, CA19-9, and p53 antibody were significant prognostic factors in colorectal cancer. Serum anti-p53 antibody could serve as one of the prognostic factors in patients with colorectal cancer.

Aged↗
PubMed2005

Association between 6-n-propylthiouracil (PROP) bitterness and colonic neoplasms.

Inadequate vegetable intake appears to increase colon cancer risk. Since genetic variation in taste influences vegetable preference, we tested associations between bitterness of 6-n-propylthiouracil (PROP), a measure of taste genetics, and number of colonic polyps, a measure of colon cancer risk, in 251 men who underwent screening lower endoscopy. Patients used the general Labeled Magnitude Scale to rate bitterness of 1.6 mg PROP delivered via filter paper. A subset of 86 patients reported weekly vegetable intakes, excluding salad or potatoes. PROP bitterness correlated significantly with polyp number, an effect separate from age-associated increases in polyp number. The PROP-polyp relationship was strongest in men over 66 years, and older men with polyps were most likely to be overweight or obese. In the subset reporting vegetable intake, men who tasted PROP as more bitter consumed fewer vegetables. These preliminary findings suggest that taste genetics may influence colon cancer risk, possibly through intake of vegetables.

Adult↗
PubMed1982

Immunological reactivity to soluble tumour extracts (STE) in gastrointestinal tumours and related risk groups.

One of the mose important demands on tumour diagnosis is the detection of early and recurring cancer. Recently, immunological tests have revealed possibilities of meeting these expectations. By means of the leukocyte adherence inhibition test (LAI) as tube test we investigated the immunoreactivity of leukocytes of leukocytes to STE in patients with colonic and gastric carcinoma, and the risk groups of Biermer's disease and colonic polyps. As control groups we used 30 blood donors and 37 patients with non malignant colonic diseases. The detection of autoantibodies with the indirect immunofluorescence technique and immune complexes supplemented the immunological investigations. The LAI and STE used are suitable for the diagnosis of gastric and colonic cancer with a rate of accuracy of more than 90 per cent. In the risk groups of colonic polyps the LAI offers a good possibility of detecting early carcinomas, and of monitoring the successful removal of polyps. Problems of autoimmunity in Biermer's disease and colitis ulcerosa do not allow a definite decision regarding a malignant stage in LAI positive patients.

Adult↗
PubMed1988

Colonic metaplasia with colonic-type polyps on an ileostomy stoma in polyposis coli. Report of a case.

A unique case is reported in which chronic physical and chemical irritation of an ileostomy stoma (after proctocolectomy for polyposis coli) was associated with colonic metaplasia and formation of colonic-type tubular adenomas on the external surface of the ileostomy. The remainder of the terminal ileum and the upper gastrointestinal tract were normal, with no evidence of Gardner's syndrome. This case demonstrates that even metaplastic colonic epithelium is susceptible to the formation of adenomas in polyposis coli patients.

Adenomatous Polyposis Coli↗
PubMed2001

Automated polyp detection at CT colonography: feasibility assessment in a human population.

PURPOSE: To test the feasibility of and improve a computer algorithm to automatically detect colonic polyps in real human computed tomographic (CT) colonographic data sets. MATERIALS AND METHODS: Twenty patients with known polyps underwent CT colonography in the supine position. CT colonographic data were processed by using a shape-based algorithm that depicts masses that protrude into the lumen. We studied nine shape criteria and three isosurface threshold settings. Results were compared with those of conventional colonoscopy performed the same day. RESULTS: There were 50 polyps (28 were > or =10 mm in size; 12, 5-9 mm; 10, <5 mm). The sensitivity with optimal settings for detecting polyps 10 mm or greater was 64% (18 of 28). Sensitivity improved to 71% (10 of 14) for polyps 10 mm or greater in well-distended colonic segments. Performance decreased for polyps less than 10 mm, poorly distended colonic segments, and other shape algorithms. There was a mean of six false-positive lesion sites per colon. These sites were reduced 39% to 3.5 per colon by sampling CT attenuation at the lesion site and discarding sites having attenuation less than a threshold. CONCLUSION: Automated detection of colonic polyps, especially clinically important large polyps, is feasible. Colonic distention is an important determinant of sensitivity. Further increases in sensitivity may be achieved by adding prone CT colonography.

Adult↗
PubMed1990

Colon-cancer screening in dialysis patients.

The usefulness of colon-cancer screening using stool-guaiac testing has been established in large control populations, but not in dialysis patients. In 72 asymptomatic dialysis patients [51 treated with hemodialysis (HD), and 21 with peritoneal dialysis (PD)] who underwent outpatient stool occult blood testing, the test result was positive in 11 (15%) patients (8 HD and 3 PD). Eight of the 11 were investigated further by colonoscopy and, when deemed necessary by the treating physician, esophagogastroduodenoscopy and/or barium enema were also performed. A site of active bleeding was identified in three of the eight patients (hemorrhoids, telangiectasia, ulcerative colitis). In each of the five other patients, potentially bleeding lesions were identified: colonic polyps (two malignant and two benign) in four patients. Barrett's esophagus in one, diverticulosis in two, and colonic vascular deformities in two. These results were compared with those of a large ongoing fecal occult blood screening program in which the prevalence of positive stool occult blood tests is 5% and in which 42% of the positive patients have colonic neoplasms. Thus, although the baseline incidence of positive guaiac tests may be higher in dialysis patients than in nonuremic controls, our results suggest that stool guaiac testing of dialysis patients may not only be useful in detecting colonic polyps, but may also identify other previously unsuspected causes of gastrointestinal bleeding.

Adult↗
PubMed1975

Endoscopic polypectomy. Therapeutic and clinicopathologic aspects.

The problem of the malignant potential of neoplastic colonic polyps is being, in large measure, resolved by newly derived techniques. Now most polyps may be removed endoscopically using the fiberoptic colonoscope. The largest world experience is at the Beth Israel Medical Center in New York, where over 2000 polyps have been endoscopically removed without a single death and with but one complication requiring operative intervention. Laparotomy is now reserved for polyps not suitable for endoscopic resection or where a question of residual cancer exists. Experience with endoscopic resection has called for: 1) re-assessment of colonic polyps in terms of their malignant potential; and 2) clarification of the indications for laparotomy and bowel resection subsequent to or instead of endoscopic removal. Among all polypoid lesions 0.5 cm or greater in size in the Beth Israel series, a variety of pathologic types was encountered. If only the neoplastic polyps were considered, the incidence of "malignant change" was 10.5% for 855 polyps analyzed. There is, however, a need to clarify terminology and to differentiate between carcinoma in situ and invasive cancer whenever possible. Superficial cancers (carcinomas in situ) do not recur or metastasize and require no treatment other than polyp removal. When "invasive" cancer is present (4.5% of neoplastic polyps) or the lesion is a "polypoid carcinoma" each case must be individually evaluted. Criteria for diagnosis, gross morphological features suggesting cancerous change, and current management of "malignant" polyps are discussed. Colonoscopy is an important component of the followup program whether malignant polyps are resected endoscopically or by the transabdominal route.

Adenoma↗
PubMed1992

Epithelial renewal in premalignant conditions of the gastrointestinal tract: a review.

The constant rapid renewal of the epithelium of the gastrointestinal (GI) tract is important in the development of neoplasms that are derived from the epithelium as well as in maintaining the functional integrity of the mucosa. An abnormality of epithelial proliferation, characterized by an increase in numbers of proliferating cells and expansion of the proliferative zone, is common to all human premalignant conditions of the GI tract that have been studied, including Barrett's epithelium, chronic gastritis, ulcerative colitis, and colonic polyps, and is a consistent observation after the use of experimental carcinogens, such as N-methyl-N-amylnitrosamine and N-methyl-N'-nitro-N-nitrosoguanidine. These abnormalities also have been observed in some relatives of patients with colonic polyps or cancers who themselves do not have any demonstrable colonic lesion. Calcium, vitamins A, C, and E, and other agents have been shown to reverse the abnormalities in proliferation in some experimental and clinical conditions, which raises the question of whether some of these agents can be used to reduce the risk of development of cancer in patients with known premalignant conditions of the GI tract.

Epithelial Cells↗
PubMed1998

Is ileoscopy with biopsy worthwhile in patients presenting with symptoms of inflammatory bowel disease?

OBJECTIVE: To assess the value of adding ileoscopy with biopsy to colonoscopy, hence increasing the indications for ileoscopy in patients presenting with symptoms of inflammatory bowel disease. METHODS: Two hundred fifty-seven patients with persistent diarrhea and 43 patients with sporadic colonic polyps were studied prospectively. The final diagnosis based on clinical and follow-up data, the histology of multiple ileal biopsies, and endoscopic findings were analyzed. RESULTS: Endoscopic lesions of the terminal ileum were found in 123 of 300 patients. In the 43 patients with colonic polyps, no ileal lesions were seen. Ileal disease without colonic involvement was present in 44 of 123 patients. Microscopic lesions of the ileum were present in 125 of 300, or in 125 of 257 (49%) with symptoms of diarrhea. Two of these had a normal endoscopy. Thirteen patients had a diffuse colitis and 11 had a predominantly left-sided colitis, both originally suggestive of ulcerative colitis. Crohn's disease was diagnosed in 88 patients and infectious disease in 17. Ileal biopsies were essential for the diagnosis in 15 patients and were contributive in 53. Granulomas, solitary giant cells, pseudopyloric gland metaplasia, eosinophils, and a disturbed villous architecture were the most important lesions observed in Crohn's disease and were contributive for this diagnosis. CONCLUSIONS: Ileoscopy with biopsy is useful in carefully selected patients presenting with symptoms of inflammatory bowel disease. The main indications are diagnosis of isolated ileal disease in the presence of a normal colon and differential diagnosis in patients with pancolitis and predominantly left-sided colitis. Multiple biopsy specimens show definite pathology in almost half of the patients.

Adolescent↗