MOLECULAR-GENETIC CRITERIA AND PROSPECTIVE BIOMARKERS OF SERRATED ADENOMAS OF COLORECTAL LOCALIZATION

A retrospective analysis of the database of patients with histologically verified serrated adenomas of the colon was carried out as part of an observational study. Inclusion criteria: patients with serrated colon adenomas who underwent a molecular genetic study to detect mutations and further sequencing 16 sRNAs of intestinal microbiota from January 2021 to October 2021. The exclusion criteria: patients with a primary tumor of the colon who had previously received complex treatment, who had accompanying pathologies of the other organs and systems, which did not allow for the planned examination. According to the results of the study, BRAF mutations are diagnosed in half of the cases in serrated adenomas and in one-third of cases - KRAS mutations. As a result of a comparative analysis of the intestinal microbiome of young patients with serrated colon adenomas with summary statistical data on the presence of bacteria in the intestines of people from the Russian population; promising markers were found for the development of effective approaches for the early diagnosis of colorectal cancer.

The Prevalence of Adenomas, AAs, and CRCs in Colonoscopy Screening Among Average-Risk Individuals in China

Background: Screening colonoscopy has historically been recommended starting at the age of 50. However, the recommended age for beginning screening has recently been reduced to 45 independent of sex. However, studies on screening colonoscopies of average-risk individuals in China are sparse. This study aimed to determine and compare the prevalence of adenomas, advanced adenomas (AAs), and colorectal cancers (CRCs) and the number of individuals needing screening in an average-risk Chinese population of different ages and sexes.Methods: A total of 53,152 individuals undergoing colonoscopy were included from January 2013 to December 2019. We analysed and compared the prevalence of adenomas, AAs, and CRCs and the number of individuals needing screening in different age groups of men and women.Results: The average age of males was 48.80 years (SD, 8.47 years), that of females was 50.00 years (SD, 9.00 years), and the sex ratio was 66.28% (n=35,226) vs. 33.72% (n=17,926). The prevalence of adenomas, AAs, serrated adenomas and CRCs was 14.51% ([95% CI 14.21–14.81], n=7713), 3.04% ([95% CI 2.90–3.19], n=1617), 1.23% ([95% CI 1.01–1.32], n=653) and 0.59% ([95% CI 0.52–0.65], n=313), respectively. Male sex was significantly associated with a high prevalence of adenomas (17.14% [95% CI 16.74–17.53] vs 9.36% [95% CI 8.94–9.79], P<0.001), AAs (3.67% [95% CI 3.47–3.87] vs 1.81% [95% CI 1.61–2.00], P<0.001) and serrated adenomas (1.56% [95% CI 1.43–1.69] vs. 0.59% [95% CI 0.47–0.70], P<0.001). The prevalence of AAs in 45- to 49-year-old individuals was 3.17% (95% CI 2.80–3.55) in men and 1.49% (95% CI 1.12–1.86) in women. The number of men needing screening(NNS) was 31.55 (95% CI 28.17–35.71), while the number of women was 67.11 (95% CI 53.76–89.29). The prevalence and number of patients needing screening for AAs in men aged 45–49 years were close to those in women aged 65–69 years (31.55 [95% CI, 28.17–35.71] vs. 29.07 [95% CI, 21.05–46.73]).Conclusions: The prevalence of adenomas, AAs, and serrated adenomas increased with age. Males had a higher prevalence rate than females. The prevalence and NNS of AAs in 45- to 49-year-old men were close to those in 65- to 69-year-old women.

Cold snare polypectomy without submucosal injection: safety and efficacy in 615 large serrated lesions

Background and study aim Cold resection is becoming the standard of care for the resection of nonpedunculated colon lesions up to 10 mm in diameter. Sessile serrated adenomas/polyps (SSA/Ps), including those ≥ 10 mm, present various characteristics that make them ideal candidates for cold snare polypectomy (CSP). Patients and methods A prospectively maintained database was searched retrospectively for consecutive patients with lesions ≥ 10 mm resected between March 2013 and March 2018. During that period, all SSA/P-appearing lesions were resected using CSP without submucosal injection, except for lesions with endoscopic suspicion of dysplasia or submucosal invasion. Patients with a pathological diagnosis of SSA/P were included in the analysis. Adverse events were recorded up to 21 days following colonoscopy. Results 615 SSA/Ps ≥ 10 mm were resected during 452 colonoscopy procedures in 379 patients (mean age 54.1 years; standard deviation [SD] 11.9 years). Mean polyp size was 13.7 (SD 5.2) mm; 122 lesions (19.8 %) were ≥ 20 mm and 479 lesions (77.9 %) underwent piecemeal resection. Immediate adverse events included persistent abdominal pain that resolved spontaneously within 2 hours in three patients (0.8 %; 95 % confidence interval [CI] 0.2 %–2.3 %). One patient with persistent intraprocedural bleeding was successfully treated with a hemostatic clip. No late adverse events were detected. Surveillance colonoscopy was performed in 293 patients (77.3 %) at 23.4 (SD 11.6) months following index colonoscopy; residual/recurrent lesions were diagnosed in 23 patients (7.8 %; 95 %CI 5.0 %–11.6 %). Conclusion CSP without submucosal injection appeared to be safe and effective for the resection of large SSA/Ps.

Risk stratification for colorectal cancer in individuals with subtypes of serrated polyps

ObjectiveThe longitudinal risk of colorectal cancer (CRC) associated with subtypes of serrated polyps (SPs) remains incompletely understood.DesignThis community-based, case–control study included 317 178 Kaiser Permanente Northern California members who underwent their first colonoscopy during 2006–2016. Nested within this population, we identified 695 cases of CRC and 3475 CRC-free controls (matched 5:1 to cases for age, sex and year of colonoscopy). Two expert pathologists reviewed the tissue slides of all SPs identified on the first colonoscopy and reclassified them to sessile serrated lesions (SSLs), hyperplastic polyps (HPs) and traditional serrated adenomas. SPs with borderline characteristics of SSLs but insufficient to make a definitive diagnosis were categorised as unspecified SPs. The association with development of CRC was assessed using multivariable logistic regression.ResultsCompared with individuals with no polyp, the adjusted ORs (aORs) for SSL alone or with synchronous adenoma were 2.9 (95% CI: 1.8 to 4.8) and 4.4 (95% CI: 2.7 to 7.2), respectively. The aORs for SSL with dysplasia, large proximal SSL,and small proximal SSL were 10.3 (95% CI: 2.1 to 50.3), 12.8 (95% CI: 3.5 to 46.9) and 1.9 (95% CI: 0.8 to 4.7), respectively. Proximal unspecified SP also conferred an increased risk (aOR: 5.8, 95% CI: 2.2 to 15.2). Women with SSL were associated with higher risk (aOR: 4.4; 95% CI: 2.3 to 8.2) than men (aOR: 1.7; 95% CI: 0.8 to 3.8).ConclusionIncreased risk of CRC was observed in individuals with SSLs, particularly large proximal ones or with dysplasia, supporting close endoscopic surveillance. Proximal unspecified SPs were also associated with increased risk of CRC and should be managed as SSLs.