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Original Article
Utility of narrow-band imaging with or without dual focus magnification in neoplastic prediction of small colorectal polyps: a Vietnamese experience
Tien Manh Huynh, Quang Dinh Le, Nhan Quang Le, Huy Minh Le, Duc Trong Quach
Clin Endosc 2023;56(4):479-489.   Published online May 24, 2023
DOI: https://doi.org/10.5946/ce.2022.212
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Accurate neoplastic prediction can significantly decrease costs associated with pathology and unnecessary colorectal polypectomies. Narrow band imaging (NBI) and dual-focus (DF) mode are promising emerging optical technologies for recognizing neoplastic features of colorectal polyps digitally. This study aimed to clarify the clinical usefulness of NBI with and without DF assistance in the neoplastic prediction of small colorectal polyps (<10 mm).
Methods
This cross-sectional study included 530 small colorectal polyps from 343 consecutive patients who underwent colonoscopy at the University Medical Center from September 2020 to May 2021. Each polyp was endoscopically diagnosed in three successive steps using white-light endoscopy (WLE), NBI, and NBI-DF and retrieved for histopathological assessment. The diagnostic accuracy of each modality was evaluated with reference to histopathology.
Results
There were 295 neoplastic polyps and 235 non-neoplastic polyps. The overall accuracies of WLE, WLE+NBI, and WLE+NBI+NBI-DF in the neoplastic prediction of colorectal polyps were 70.8%, 87.4%, and 90.8%, respectively (p<0.001). The accuracy of WLE+NBI+NBI-DF was significantly higher than that of WLE+NBI in the polyp size ≤5 mm subgroup (87.3% vs. 90.1%, p<0.001).
Conclusions
NBI improved the real-time neoplastic prediction of small colorectal polyps. The DF mode was especially useful in polyps ≤5 mm in size.

Citations

Citations to this article as recorded by  
  • Effectiveness of Dual-Focus Magnification on Confidence Levels in Optical Diagnosis of Small Colorectal Polyps
    Tien M Huynh, Quang D Le, Nhan Q Le , Huy M Le , Duc T Quach
    Cureus.2024;[Epub]     CrossRef
  • Implementing narrow banding imaging with dual focus magnification for histological prediction of small rectosigmoid polyps in Vietnamese setting
    Tien Manh Huynh, Quang Dinh Le, Nhan Quang Le, Huy Minh Le, Duc Trong Quach
    JGH Open.2024;[Epub]     CrossRef
  • The role of narrow-band imaging with or without dual focus in the detection of polyps smaller than 10 mm, especially diminutive polyps
    Jin Hwa Park
    Clinical Endoscopy.2023; 56(4): 455.     CrossRef
  • Strategy for post-polypectomy colonoscopy surveillance: focus on the revised Korean guidelines
    Yong Soo Kwon, Su Young Kim
    Journal of the Korean Medical Association.2023; 66(11): 652.     CrossRef
  • 2,590 View
  • 90 Download
  • 4 Web of Science
  • 4 Crossref
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Systematic Review and Meta-Analysis
Outcomes of thin versus thick-wire snares for cold snare polypectomy: a systematic review and meta-analysis
Suprabhat Giri, Vaneet Jearth, Harish Darak, Sridhar Sundaram
Clin Endosc 2022;55(6):742-750.   Published online November 9, 2022
DOI: https://doi.org/10.5946/ce.2022.141
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Cold snare polypectomy (CSP) is commonly used for the resection of colorectal polyps ≤10 mm. Data regarding the influence of snare type on CSP effectiveness are conflicting. Hence, this meta-analysis aimed to compare the outcomes and safety of thin- and thick-wire snares for CSP.
Methods
A comprehensive search of the literature published between 2000 and 2021 was performed of various databases for comparative studies evaluating the outcomes of thin- versus thick-wire snares for CSP.
Results
Five studies with data on 1,425 polyps were included in the analysis. The thick-wire snare was comparable to the thin-wire snare with respect to complete histological resection (risk ratio [RR], 1.03; 95% confidence interval [CI], 0.97–1.09), overall bleeding (RR, 0.98; 95% CI, 0.40–2.40), polyp retrieval (RR, 1.01; 95% CI, 0.97–1.04), and involvement of submucosa in the resection specimen (RR, 1.28; 95% CI, 0.72–2.28). There was no publication bias and a small study effect, and the relative effects remained the same in the sensitivity analysis.
Conclusions
CSP using a thin-wire snare has no additional benefit over thick-wire snares in small colorectal polyps. Factors other than snare design may play a role in improving CSP outcomes.

Citations

Citations to this article as recorded by  
  • Factors determining the resection ability of snares in cold snare polypectomy: Construction of an ex vivo model for accurately evaluating resection ability
    Ryohei Hirose, Takuma Yoshida, Naohisa Yoshida, Katsuma Yamauchi, Hajime Miyazaki, Naoto Watanabe, Risa Bandou, Ken Inoue, Hiroshi Ikegaya, Takaaki Nakaya, Yoshito Itoh
    Digestive Endoscopy.2024; 36(5): 573.     CrossRef
  • Effectiveness and safety of thin vs. thick cold snare polypectomy of small colorectal polyps: Systematic review and meta-analysis
    Rishad Khan, Sunil Samnani, Marcus Vaska, Samir C Grover, Catharine M Walsh, Jeffrey Mosko, Michael Bourke, Steven J Heitman, Nauzer Forbes
    Endoscopy International Open.2024; 12(01): E99.     CrossRef
  • International Digestive Endoscopy Network consensus on the management of antithrombotic agents in patients undergoing gastrointestinal endoscopy
    Seung Joo Kang, Chung Hyun Tae, Chang Seok Bang, Cheol Min Shin, Young-Hoon Jeong, Miyoung Choi, Joo Ha Hwang, Yutaka Saito, Philip Wai Yan Chiu, Rungsun Rerknimitr, Christopher Khor, Vu Van Khien, Kee Don Choi, Ki-Nam Shim, Geun Am Song, Oh Young Lee
    Clinical Endoscopy.2024; 57(2): 141.     CrossRef
  • IDEN Consensus on Management of Antithrombotic Agents in Patients Undergoing Gastrointestinal Endoscopy
    Seung Joo Kang, Chung Hyun Tae, Chang Seok Bang, Cheol Min Shin, Young-Hoon Jeong, Miyoung Choi, Joo Ha Hwang, Yutaka Saito, Philip Wai Yan Chiu, Rungsun Rerknimitr, Christopher Khor, Vu Van Khien, Kee Don Choi, Ki-Nam Shim, Geun Am Song, Oh Young Lee
    The Korean Journal of Gastroenterology.2024; 83(6): 217.     CrossRef
  • Does the wire diameter really determine the outcomes in cold snare polypectomy?
    S Giri, S Sundaram
    Journal of Gastroenterology and Hepatology.2023; 38(4): 665.     CrossRef
  • Cold resection for colorectal polyps: where we are and where we are going?
    Antonio Capogreco, Ludovico Alfarone, Davide Massimi, Alessandro Repici
    Expert Review of Gastroenterology & Hepatology.2023; 17(7): 719.     CrossRef
  • Endoscopic treatment of colorectal polyps and early colorectal cancer
    Yunho Jung
    Journal of the Korean Medical Association.2023; 66(11): 642.     CrossRef
  • 2,671 View
  • 160 Download
  • 6 Web of Science
  • 7 Crossref
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Original Article
Optical diagnosis by near-focus versus normal-focus narrow band imaging colonoscopy in colorectal polyps based on combined NICE and WASP classification: a randomized controlled trial
Nisa Netinatsunton, Natcha Cheewasereechon, Tanawat Pattarapuntakul, Jaksin Sottisuporn, Kanet Kanjanapradit, Bancha Ovartlarnporn
Clin Endosc 2022;55(5):645-654.   Published online September 8, 2022
DOI: https://doi.org/10.5946/ce.2022.048
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Narrow Band Imaging (NBI) International Colorectal Endoscopic (NICE) and Workgroup Serrated Polyps and Polyposis (WASP) classifications were developed for optical diagnosis of neoplastic and sessile serrated polyps, respectively. Near-focus NBI with NICE combined with WASP criteria for optical diagnosis of colonic polyps has not yet been evaluated. We aimed to compare the accuracy of near-focus NBI (group A) with normal-focus NBI (group B) in real-time optical diagnosis of colorectal polyps using combined NICE and WASP criteria.
Methods
Among 362 patients, 118 with 227 polyps were recruited. Groups A and B included 62 patients with 130 polyps (three lost polyps) and 56 patients with 106 polyps (six lost polyps), respectively. Optical diagnoses were compared with pathological reports.
Results
The accuracy of optical diagnosis of neoplastic polyps in groups A and B was not significantly different (76% vs. 71%, p=0.52). WASP criteria provided all false positive diagnoses of sessile polyps as serrated polyps in 31 (16.2%) patients.
Conclusions
Near-focus NBI was not superior to normal-focus NBI in optical diagnostics of neoplastic polyps using NICE criteria. In our study, WASP classification yielded all false positives in the diagnosis of sessile serrated adenomas/polyps. Routine real-life optical diagnosis of polyps is still unadvisable.

Citations

Citations to this article as recorded by  
  • Colonoscopy Quality, Innovation, and the Assessment of New Technology
    Sanjay R.V. Gadi, Sriya S. Muralidharan, Jeremy R. Glissen Brown
    Techniques and Innovations in Gastrointestinal Endoscopy.2024; 26(2): 177.     CrossRef
  • Endoscopic characteristics and performance of WASP classification in the diagnosis of colorectal sessile‐serrated lesions in Vietnamese patients
    Nhu Thi Hanh Vu, Huy Minh Le, Diem Thi‐Ngoc Vo, Nhan Quang Le, Dung Dang Quy Ho, Duc Trong Quach
    JGH Open.2024;[Epub]     CrossRef
  • Classification and endoscopic diagnosis of colorectal polyps
    Ji Hyun Kim, Sung Chul Park
    Journal of the Korean Medical Association.2023; 66(11): 633.     CrossRef
  • Understanding colorectal polyps to prevent colorectal cancer
    Dong-Hoon Yang
    Journal of the Korean Medical Association.2023; 66(11): 626.     CrossRef
  • AI-powered medical devices for practical clinicians including the diagnosis of colorectal polyps
    Donghwan Kim, Eunsun Kim
    Journal of the Korean Medical Association.2023; 66(11): 658.     CrossRef
  • Detecting colorectal lesions with image-enhanced endoscopy: an updated review from clinical trials
    Mizuki Nagai, Sho Suzuki, Yohei Minato, Fumiaki Ishibashi, Kentaro Mochida, Ken Ohata, Tetsuo Morishita
    Clinical Endoscopy.2023; 56(5): 553.     CrossRef
  • 2,427 View
  • 147 Download
  • 6 Web of Science
  • 6 Crossref
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Reviews
Post-polypectomy surveillance: the present and the future
Masau Sekiguchi, Takahisa Matsuda, Kinichi Hotta, Yutaka Saito
Clin Endosc 2022;55(4):489-495.   Published online July 11, 2022
DOI: https://doi.org/10.5946/ce.2022.097
AbstractAbstract PDFPubReaderePub
An appropriate post-polypectomy surveillance program requires the effectiveness of reducing colorectal cancer and safety. In addition, the post-polypectomy surveillance program should consider the burden of limited medical resource capacity, cost-effectiveness, and patient adherence. In this sense, a risk-stratified surveillance program based on baseline colonoscopy results is ideal. Major international guidelines for post-polypectomy surveillance, such as those from the European Union and the United States, have recommended risk-stratified surveillance programs. Both guidelines have recently been updated to better differentiate between high- and low-risk individuals. In both updated guidelines, more individuals have been downgraded to lower-risk groups that require less frequent or no surveillance. Furthermore, increased attention has been paid to the surveillance of patients who undergo serrated polyp removal. Previous guidelines in Japan did not clearly outline the risk stratification in post-polypectomy surveillance. However, the new colonoscopy screening and surveillance guidelines presented by the Japan Gastroenterological Endoscopy Society include a risk-stratified post-polypectomy surveillance program. Further discussion and analysis of unresolved issues in this field, such as the optimal follow-up after the first surveillance, the upper age limit for surveillance, and the ideal method for improving adherence to surveillance guidelines, are warranted.

Citations

Citations to this article as recorded by  
  • Protocolo diagnóstico del seguimiento de pólipos colónicos
    S. Redondo Evangelista, M. Sierra Morales, I. Bartolomé Oterino, P. García Centeno, A. Santos Rodríguez
    Medicine - Programa de Formación Médica Continuada Acreditado.2024; 14(4): 219.     CrossRef
  • Approaches and considerations in the endoscopic treatment of T1 colorectal cancer
    Yunho Jung
    The Korean Journal of Internal Medicine.2024; 39(4): 563.     CrossRef
  • Metabolic‐associated fatty liver disease is associated with colorectal adenomas in young and older Korean adults
    Jiwon Chang, Yoosoo Chang, Yoosun Cho, Hyun‐Suk Jung, Dong‐Il Park, Soo‐Kyung Park, Soo‐Youn Ham, Sarah H. Wild, Christopher D. Byrne, Seungho Ryu
    Liver International.2023; 43(11): 2548.     CrossRef
  • Detecting colorectal lesions with image-enhanced endoscopy: an updated review from clinical trials
    Mizuki Nagai, Sho Suzuki, Yohei Minato, Fumiaki Ishibashi, Kentaro Mochida, Ken Ohata, Tetsuo Morishita
    Clinical Endoscopy.2023; 56(5): 553.     CrossRef
  • Strategy for post-polypectomy colonoscopy surveillance: focus on the revised Korean guidelines
    Yong Soo Kwon, Su Young Kim
    Journal of the Korean Medical Association.2023; 66(11): 652.     CrossRef
  • Endoscopic treatment of colorectal polyps and early colorectal cancer
    Yunho Jung
    Journal of the Korean Medical Association.2023; 66(11): 642.     CrossRef
  • Understanding colorectal polyps to prevent colorectal cancer
    Dong-Hoon Yang
    Journal of the Korean Medical Association.2023; 66(11): 626.     CrossRef
  • 3,673 View
  • 256 Download
  • 5 Web of Science
  • 7 Crossref
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Can Computed Tomography Colonography Replace Optical Colonoscopy in Detecting Colorectal Lesions?: State of the Art
Alessia Chini, Michele Manigrasso, Grazia Cantore, Rosa Maione, Marco Milone, Francesco Maione, Giovanni Domenico De Palma
Clin Endosc 2022;55(2):183-190.   Published online February 24, 2022
DOI: https://doi.org/10.5946/ce.2021.254
AbstractAbstract PDFPubReaderePub
Colorectal cancer is an important cause of morbidity and mortality worldwide. Optical colonoscopy (OC) is widely accepted as the reference standard for the screening of colorectal polyps and cancers, and computed tomography colonography (CTC) is a valid alternative to OC. The purpose of this review was to assess the diagnostic accuracy of OC and CTC for colorectal lesions. A literature search was performed in PubMed, Embase, and Cochrane Library, and 18 articles were included. CTC has emerged in recent years as a potential screening examination with high accuracy for the detection of colorectal lesions. However, the clinical application of CTC as a screening technique is limited because it is highly dependent on the size of the lesions and has poor performance in detecting individual lesions <5 mm or flat lesions, which, although rarely, can have a malignant potential.

Citations

Citations to this article as recorded by  
  • Multi-view orientational attention network combining point-based affinity for polyp segmentation
    Yan Liu, Yan Yang, Yongquan Jiang, Zhuyang Xie
    Expert Systems with Applications.2024; 249: 123663.     CrossRef
  • The Influence of Mechanical Bowel Preparation on Volatile Organic Compounds for the Detection of Gastrointestinal Disease—A Systematic Review
    Ashwin Krishnamoorthy, Subashini Chandrapalan, Sofie Bosch, Ayman Bannaga, Nanne K.H. De Boer, Tim G.J. De Meij, Marcis Leja, George B. Hanna, Nicoletta De Vietro, Donato Altomare, Ramesh P. Arasaradnam
    Sensors.2023; 23(3): 1377.     CrossRef
  • The Detection of Colorectal Cancer through Machine Learning-Based Breath Sensor Analysis
    Inese Poļaka, Linda Mežmale, Linda Anarkulova, Elīna Kononova, Ilona Vilkoite, Viktors Veliks, Anna Marija Ļeščinska, Ilmārs Stonāns, Andrejs Pčolkins, Ivars Tolmanis, Gidi Shani, Hossam Haick, Jan Mitrovics, Johannes Glöckler, Boris Mizaikoff, Mārcis Lej
    Diagnostics.2023; 13(21): 3355.     CrossRef
  • 3,899 View
  • 238 Download
  • 4 Web of Science
  • 3 Crossref
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Original Articles
Artificial Intelligence-Based Colorectal Polyp Histology Prediction by Using Narrow-Band Image-Magnifying Colonoscopy
Istvan Racz, Andras Horvath, Noemi Kranitz, Gyongyi Kiss, Henriett Regoczi, Zoltan Horvath
Clin Endosc 2022;55(1):113-121.   Published online September 23, 2021
DOI: https://doi.org/10.5946/ce.2021.149
AbstractAbstract PDFPubReaderePub
Background
/Aims: We have been developing artificial intelligence based polyp histology prediction (AIPHP) method to classify Narrow Band Imaging (NBI) magnifying colonoscopy images to predict the hyperplastic or neoplastic histology of polyps. Our aim was to analyze the accuracy of AIPHP and narrow-band imaging international colorectal endoscopic (NICE) classification based histology predictions and also to compare the results of the two methods.
Methods
We studied 373 colorectal polyp samples taken by polypectomy from 279 patients. The documented NBI still images were analyzed by the AIPHP method and by the NICE classification parallel. The AIPHP software was created by machine learning method. The software measures five geometrical and color features on the endoscopic image.
Results
The accuracy of AIPHP was 86.6% (323/373) in total of polyps. We compared the AIPHP accuracy results for diminutive and non-diminutive polyps (82.1% vs. 92.2%; p=0.0032). The accuracy of the hyperplastic histology prediction was significantly better by NICE compared to AIPHP method both in the diminutive polyps (n=207) (95.2% vs. 82.1%) (p<0.001) and also in all evaluated polyps (n=373) (97.1% vs. 86.6%) (p<0.001)
Conclusions
Our artificial intelligence based polyp histology prediction software could predict histology with high accuracy only in the large size polyp subgroup.

Citations

Citations to this article as recorded by  
  • Colon polyps: updates in classification and management
    David Dornblaser, Sigird Young, Aasma Shaukat
    Current Opinion in Gastroenterology.2024; 40(1): 14.     CrossRef
  • Employing deep learning for predicting the thermal properties of water and nano-encapsulated phase change material
    Saihua Xu, Ali Basem, Hasan A Al-Asadi, Rishabh Chaturvedi, Gulrux Daminova, Yasser Fouad, Dheyaa J Jasim, Javid Alhoee
    International Journal of Low-Carbon Technologies.2024; 19: 1453.     CrossRef
  • Detecting colorectal lesions with image-enhanced endoscopy: an updated review from clinical trials
    Mizuki Nagai, Sho Suzuki, Yohei Minato, Fumiaki Ishibashi, Kentaro Mochida, Ken Ohata, Tetsuo Morishita
    Clinical Endoscopy.2023; 56(5): 553.     CrossRef
  • AI-powered medical devices for practical clinicians including the diagnosis of colorectal polyps
    Donghwan Kim, Eunsun Kim
    Journal of the Korean Medical Association.2023; 66(11): 658.     CrossRef
  • Artificial Intelligence-Based Colorectal Polyp Histology Prediction: High Accuracy in Larger Polyps
    Naoki Muguruma, Tetsuji Takayama
    Clinical Endoscopy.2022; 55(1): 45.     CrossRef
  • Artificial intelligence-based colorectal polyp histology prediction using narrow-band image-magnifying colonoscopy: a stepping stone for clinical practice
    Ji Young Chang
    Clinical Endoscopy.2022; 55(5): 699.     CrossRef
  • Response to Artificial intelligence-based colorectal polyp histology prediction using narrow-band image-magnifying colonoscopy: a stepping stone for clinical practice
    Istvan Racz, Andras Horvath, Zoltán Horvath
    Clinical Endoscopy.2022; 55(5): 701.     CrossRef
  • 4,272 View
  • 188 Download
  • 7 Web of Science
  • 7 Crossref
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Is Submucosal Injection Helpful in Cold Snare Polypectomy for Small Colorectal Polyps?
Ji Hyun Song, Shai Friedland
Clin Endosc 2021;54(3):397-403.   Published online February 9, 2021
DOI: https://doi.org/10.5946/ce.2020.226
AbstractAbstract PDFPubReaderePub
Background
/Aims: Cold snare polypectomy (CSP) is an effective method of polyp removal for small colorectal polyps. However, the effect of submucosal injection in cold snare endoscopic mucosal resection (CS-EMR) for small polyps is unclear. Therefore, this study aimed to evaluate the effect of submucosal injection in CS-EMR for small polyps.
Methods
Between 2018 and 2019, 100 consecutive small colorectal polyps (5–10 mm) were identified in 58 patients. The first 50 consecutive polyps were removed by CS-EMR, and the remaining 50 were removed by CSP. Demographic data, clinical data, endoscopic findings, procedure times, complication rates, and pathology data were collected.
Results
No difference in the complete resection rate was observed between the CS-EMR and CSP groups. A total of 9 polyps showed post-polypectomy bleeding (7 had immediate bleeding, 1 had delayed bleeding, and 1 had both immediate and delayed bleeding). No difference in the bleeding rate was observed between the two groups. In multivariate analysis, warfarin (odds ratio [OR], 42.334; 95% confidence interval [CI], 1.006–1,781.758) and direct-acting oral anticoagulants (OR, 35.244; 95% CI, 3.853–322.397) showed a significantly increased risk of bleeding.
Conclusions
The effect of submucosal injection in CSP was not significant for small colorectal polyps.

Citations

Citations to this article as recorded by  
  • Cold sub-mucosal injection versus traditional cold snare polypectomy for diminutive and small colorectal polyps: A systematic review and meta-analysis
    Yong-Cai Lv, Quan Dong, Yan-Hua Yao, Jing-Jing Lei
    Indian Journal of Gastroenterology.2024;[Epub]     CrossRef
  • Colorectal cold snare polypectomy: Current standard technique and future perspectives
    Fumiaki Ishibashi, Sho Suzuki, Mizuki Nagai, Kentaro Mochida, Tetsuo Morishita
    Digestive Endoscopy.2023; 35(3): 278.     CrossRef
  • The efficacy and safety of cold snare polypectomy with submucosal injection for the removal of polyps less than 20 mm in size: a systematic review and meta‐analysis
    Zheng Liang, Yongqiu Wei, Shutian Zhang, Peng Li
    Journal of Gastroenterology and Hepatology.2023; 38(11): 1892.     CrossRef
  • Impact of Submucosal Saline Injection During Cold Snare Polypectomy for Colorectal Polyps Sized 3–9 mm: A Multicenter Randomized Controlled Trial
    Yi Mou, Liansong Ye, Xiaobo Qin, Rui Feng, Lifan Zhang, Qin Hu, Tingting Cao, Xinyue Zhou, Wu Wen, Chuanming Zhang, Zonghua Chen, Yi Liu, Zhimin Yang, Tao Huo, Fang Pan, Xuelian Li, Bing Hu
    American Journal of Gastroenterology.2023; 118(10): 1848.     CrossRef
  • Cold resection for colorectal polyps: where we are and where we are going?
    Antonio Capogreco, Ludovico Alfarone, Davide Massimi, Alessandro Repici
    Expert Review of Gastroenterology & Hepatology.2023; 17(7): 719.     CrossRef
  • Cold snare endoscopic mucosal resection for colon polyps: a systematic review and meta-analysis
    Mohamed Abdallah, Khalid Ahmed, Daniyal Abbas, Mouhand F. H. Mohamed, Gaurav Suryawanshi, Nicholas McDonald, Natalie Wilson, Shifa Umar, Aasma Shaukat, Mohammad Bilal
    Endoscopy.2023; 55(12): 1083.     CrossRef
  • Endoscopic treatment of colorectal polyps and early colorectal cancer
    Yunho Jung
    Journal of the Korean Medical Association.2023; 66(11): 642.     CrossRef
  • 4,426 View
  • 167 Download
  • 7 Web of Science
  • 7 Crossref
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Review
Should We Resect and Discard Low Risk Diminutive Colon Polyps
Pujan Kandel, Michael B. Wallace
Clin Endosc 2019;52(3):239-246.   Published online January 21, 2019
DOI: https://doi.org/10.5946/ce.2018.136
AbstractAbstract PDFPubReaderePub
Diminutive colorectal polyps <5 mm are very common and almost universally benign. The current strategy of resection with histological confirmation of all colorectal polyps is costly and may increase the risk of colonoscopy. Accurate, optical diagnosis without histology can be achieved with currently available endoscopic technologies. The American Society of Gastrointestinal Endoscopy Preservation and Incorporation of Valuable endoscopic Innovations supports strategies for optical diagnosis of small non neoplastic polyps as long as two criteria are met. For hyperplastic appearing polyps <5 mm in recto-sigmoid colon, the negative predictive value should be at least 90%. For diminutive low grade adenomatous appearing polyps, a resect and discard strategy should be sufficiently accurate such that post-polypectomy surveillance recommendations based on the optical diagnosis, agree with a histologically diagnosis at least 90% of the time. Although the resect and discard as well as diagnose and leave behind approach has major benefits with regard to both safety and cost, it has yet to be used widely in practice. To fully implement such as strategy, there is a need for better-quality training, quality assurance, and patient acceptance. In the article, we will review the current state of the science on optical diagnose of colorectal polyps and its implications for colonoscopy practice.

Citations

Citations to this article as recorded by  
  • The role of artificial intelligence in colonoscopy
    Hyun Jae Kim, Nasim Parsa, Michael F. Byrne
    Seminars in Colon and Rectal Surgery.2024; 35(1): 101007.     CrossRef
  • Artificial intelligence for characterization of colorectal polyps: Prospective multicenter study
    Glenn De Lange, Victor Prouvost, Gabriel Rahmi, Geoffroy Vanbiervliet, Catherine Le Berre, Sahar Mack, Thibaud Koessler, Emmanuel Coron
    Endoscopy International Open.2024; 12(03): E413.     CrossRef
  • Ecogastroenterology: cultivating sustainable clinical excellence in an environmentally conscious landscape
    Kassem Sharif, Enrique Rodriguez de Santiago, Paula David, Arnon Afek, Ian M Gralnek, Shomron Ben-Horin, Adi Lahat
    The Lancet Gastroenterology & Hepatology.2024; 9(6): 550.     CrossRef
  • Rationalising the use of specimen pots following colorectal polypectomy: a small step towards greener endoscopy
    Karl King Yong, Yun He, Hoi Ching Annie Cheung, Ramya Sriskandarajah, William Jenkins, Robert Goldin, Sabina Beg
    Frontline Gastroenterology.2023; 14(4): 295.     CrossRef
  • Measurements, Algorithms, and Presentations of Reality: Framing Interactions with AI-Enabled Decision Support
    Niels van Berkel, Maura Bellio, Mikael B. Skov, Ann Blandford
    ACM Transactions on Computer-Human Interaction.2023; 30(2): 1.     CrossRef
  • Real-World Validation of a Computer-Aided Diagnosis System for Prediction of Polyp Histology in Colonoscopy: A Prospective Multicenter Study
    James Weiquan Li, Clement Chun Ho Wu, Jonathan Wei Jie Lee, Raymond Liang, Gwyneth Shook Ting Soon, Lai Mun Wang, Xuan Han Koh, Calvin Jianyi Koh, Wei Da Chew, Kenneth Weicong Lin, Mann Yie Thian, Ronnie Matthew, Guowei Kim, Christopher Jen Lock Khor, Kwo
    American Journal of Gastroenterology.2023; 118(8): 1353.     CrossRef
  • The Utility of Narrow-Band Imaging International Colorectal Endoscopic Classification in Predicting the Histologies of Diminutive Colorectal Polyps Using I-Scan Optical Enhancement: A Prospective Study
    Yeo Wool Kang, Jong Hoon Lee, Jong Yoon Lee
    Diagnostics.2023; 13(16): 2720.     CrossRef
  • Optical diagnosis of colorectal polyps using novel blue light imaging classification among trainee endoscopists
    Christopher Koehn, Douglas K. Rex, Jimmy Allen, Umer Bhatti, Indira Bhavsar‐Burke, Viveksandeep Thoguluva Chandrasekar, Abhishek Challa, Abhiram Duvvuri, Lara Dakhoul, John Ha, Nour Hamade, S. Bradley Hicks, Claire Jansson‐Knodell, Edward Krajicek, Shanke
    Digestive Endoscopy.2022; 34(1): 191.     CrossRef
  • Too Good to Be True? Evaluation of Colonoscopy Sensitivity Assumptions Used in Policy Models
    Carolyn M. Rutter, Pedro Nascimento de Lima, Jeffrey K. Lee, Jonathan Ozik
    Cancer Epidemiology, Biomarkers & Prevention.2022; 31(4): 775.     CrossRef
  • Non-optical polyp-based resect and discard strategy: A prospective clinical study
    Mahsa Taghiakbari, Celia Hammar, Mira Frenn, Roupen Djinbachian, Heiko Pohl, Erik Deslandres, Simon Bouchard, Mickael Bouin, Daniel von Renteln
    World Journal of Gastroenterology.2022; 28(19): 2137.     CrossRef
  • No-Code Platform-Based Deep-Learning Models for Prediction of Colorectal Polyp Histology from White-Light Endoscopy Images: Development and Performance Verification
    Eun Jeong Gong, Chang Seok Bang, Jae Jun Lee, Seung In Seo, Young Joo Yang, Gwang Ho Baik, Jong Wook Kim
    Journal of Personalized Medicine.2022; 12(6): 963.     CrossRef
  • Artificial intelligence-assisted colonoscopy: a narrative review of current data and clinical applications
    JW Li, LM Wang, TL Ang
    Singapore Medical Journal.2022; 63(3): 118.     CrossRef
  • Impact of the Volume and Distribution of Training Datasets in the Development of Deep-Learning Models for the Diagnosis of Colorectal Polyps in Endoscopy Images
    Eun Jeong Gong, Chang Seok Bang, Jae Jun Lee, Young Joo Yang, Gwang Ho Baik
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Focused Review Series: Current Status of Image-Enhanced Endoscopy (IEE)
Image-Enhanced Endoscopy in Lower Gastrointestinal Diseases: Present and Future
Han Hee Lee, Bo-In Lee
Clin Endosc 2018;51(6):534-540.   Published online November 30, 2018
DOI: https://doi.org/10.5946/ce.2018.187
AbstractAbstract PDFPubReaderePub
From dye-assisted conventional chromoendoscopy to novel virtual chromoendoscopy, image-enhanced endoscopy (IEE) is continuously evolving to meet clinical needs and improve the quality of colonoscopy. Dye-assisted chromoendoscopy using indigo carmine or crystal violet, although slightly old-fashioned, is still useful to emphasize the pit patterns of the colonic mucosa and predict the histological structures of relevant lesions. Equipment-based virtual chromoendoscopy has the advantage of being relatively easy to use. There are several types of virtual chromoendoscopy that vary depending on the manufacturer and operating principle. IEE plays distinctive roles with respect to histologic characterization of colorectal polyps and prediction of the invasion depth of colorectal cancers. In addition, the newest models of IEE have the potential to increase adenoma and polyp detection rates in screening colonoscopy.

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Original Articles
A Randomized Controlled Clinical Study Comparing the Diagnostic Accuracy of the Histologic Prediction for Colorectal Polyps Depending on the Use of Either Magnified or Nonmagnified Narrow Band Imaging
Jin Joo Kim, Kyoung Sup Hong, Joo Sung Kim, Hyun Chae Jung
Clin Endosc 2015;48(6):528-533.   Published online November 30, 2015
DOI: https://doi.org/10.5946/ce.2015.48.6.528
AbstractAbstract PDFPubReaderePub
Background
/Aims: The aim of this study was to compare the diagnostic capabilities of narrow band imaging (NBI) colonoscopy with and without optical magnification in differentiating neoplastic from nonneoplastic colorectal polyps.
Methods
Between April 2012 and March 2013, 122 patients with colorectal polyps detected by using diagnostic conventional colonoscopy were prospectively enrolled. A total of 236 polyps were evaluated with NBI, in vivo in real time during therapeutic colonoscopy, by one experienced endoscopist. Whether magnification was used or not was determined by randomization. After an in vivo real-time endoscopic prediction of histology, all lesions were endoscopically excised. Surgical pathologic reports were used as the criterion standards. The sensitivity (Sn), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV) of identifying neoplastic polyps were calculated.
Results
A total of 236 lesions with an average size of 5.6 mm in 122 patients were assessed (159 neoplastic, 77 nonneoplastic). The Sn, Sp, PPV, and NPV in differentiating neoplastic from nonneoplastic lesions with the magnified NBI were 97.5%, 83.3%, 94.0%, and 92.6%, respectively, whereas those of the nonmagnified NBI group were 97.5%, 85.1%, 91.7%, and 95.2%, respectively.
Conclusions
Nonmagnified NBI colonoscopy distinguishes neoplastic from nonneoplastic colorectal polyps as accurately as does magnified NBI colonoscopy.

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Endoscopic Mucosal Resection with Circumferential Incision for the Treatment of Large Sessile Polyps and Laterally Spreading Tumors of the Colorectum
Young Mi Hong, Hyung Wook Kim, Su Bum Park, Cheol Woong Choi, Dae Hwan Kang
Clin Endosc 2015;48(1):52-58.   Published online January 31, 2015
DOI: https://doi.org/10.5946/ce.2015.48.1.52
AbstractAbstract PDFPubReaderePub
Background/Aims

Endoscopic mucosal resection (EMR) is the standard treatment for colorectal polyps such as adenomas and early cancers with no risk of lymph node metastasis. However, endoscopic resection of large colorectal polyps (≥20 mm diameter) is difficult to perform. We evaluated the clinical outcomes of EMR with circumferential incision (EMR-CI) for the resection of large sessile polyps (Is) and laterally spreading tumors (LSTs) in the colorectum.

Methods

Between February 2009 and March 2011, we resected 80 large colorectal polyps by EMR-CI. We retrospectively investigated the en bloc resection rate, histologic complete resection rate, recurrence rate, and complications.

Results

The median polyp size was approximately 25 mm (range, 20 to 50), and the morphologic types included Is (13 cases), LST-granular (37 cases), and LST-nongranular (30 cases). The en bloc and complete histologic resection rates were 66.3% and 45.0%, respectively. The recurrence rate was 0% (median follow-up duration, 23 months), and perforation occurred in five cases (6.3%).

Conclusions

EMR-CI is an effective treatment modality for 20 to 30 mm-sized colorectal polyps, and may be considered as a second line therapeutic option if ESD is difficult.

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Review
Equipment-Based Image-Enhanced Endoscopy for Differentiating Colorectal Polyps
Ja Seol Koo
Clin Endosc 2014;47(4):330-333.   Published online July 28, 2014
DOI: https://doi.org/10.5946/ce.2014.47.4.330
AbstractAbstract PDFPubReaderePub

The use of colonoscopy for the screening and surveillance of colorectal cancer has increased. However, the miss rate of advanced colorectal neoplasm is known to be 2% to 6%, which could be affected by the image intensity of colorectal lesions. Image-enhanced endoscopy (IEE) is capable of highlighting lesions, which can improve the colorectal adenoma detection rate and diagnostic accuracy. Equipment-based IEE methods, such as narrow band imaging (NBI), Fujinon intelligent color enhancement (FICE), and i-Scan, are used to observe the mucosal epithelium of the microstructure and capillaries of the lesion, and are helpful in the detection and differential diagnosis of colorectal tumors. Although NBI is similar to chromoendoscopy in terms of adenoma detection rates, NBI can be used to differentiate colorectal polyps and to predict the submucosal invasion of malignant tumors. It is also known that FICE and i-Scan are similar to NBI in their detection rates of colorectal lesions. Through more effective and advanced endoscopic equipment, diagnostic accuracy could be improved and new treatment paradigms developed.

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Original Article
Diagnostic Yield and Therapeutic Impact of Rectal Retroflexion: A Prospective, Single-Blind Study Conducted in Three Centers
Félix Téllez-Ávila, Josué Barahona-Garrido, Sandra García-Osogobio, Gustavo López-Arce, Jesús Camacho-Escobedo, Angela Saúl, Salvador Herrera-Gómez, Javier Elizondo-Rivera, Rafael Barreto-Zúñiga
Clin Endosc 2014;47(1):79-83.   Published online January 24, 2014
DOI: https://doi.org/10.5946/ce.2014.47.1.79
AbstractAbstract PDFPubReaderePub
Background/Aims

No clear data have been established and validated regarding whether rectal retroflexion has an important and therapeutic impact. The aim of the present study was to evaluate the diagnostic yield and therapeutic impact of rectal retroflexion compared with straight view examination.

Methods

A prospective single-blind study was conducted. Consecutive patients evaluated between October 2011 and April 2012 were included.

Results

A total of 934 patients (542 women, 58%) were included. The mean age was 57.4±14.8 years. Retroflexion was successful in 917 patients (98.2%). Distinct lesions in the anorectal area were detected in 32 patients (3.4%), of which 10 (1%) were identified only on retroflex view and 22 (2.4%) on both straight and retroflex views. Of the 32 identified lesions, 16 (50%) were polyps, nine (28.1%) were angiodysplasias, six (18.8%) were ulcers, and one (3.1%) was a flat lesion. All 10 patients (1%) in whom lesions were detected only by rectal retroflexion showed a therapeutic impact.

Conclusions

Rectal retroflexion has minimal diagnostic yield and therapeutic impact. However, its low rate of major complications and the possibility of detecting lesions undetectable by straight viewing justify its use.

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    N. Musquer
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    Jesse Samuel Moore, Tess Hannah Aulet
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Focused Review Series: Optical Diagnosis and New Management Strategy of Colorectal Polyps
Introduction: What Are New Roles of Current Colonoscopy?
Hyung Wook Kim
Clin Endosc 2013;46(2):118-119.   Published online March 31, 2013
DOI: https://doi.org/10.5946/ce.2013.46.2.118
AbstractAbstract PDFPubReaderePub

The recent advances in endoscopic imaging technologies make great changes in the management of colorectal polyps. These changes include optical histologic diagnosis with high definition colonscopy, new management strategies such as resect and discard or do not resect, and differentiation of depth of submucosal invasion. In this focused review series, these new paradigms in management of colorectal polyps are discussed by three, world famous authors. First, Amit Rastogi explained optical diagnosis of small colorectal polyp with high definition colonoscopy using narrow band imaging. Second, Cesare Hassan explained new paradigms for colonoscopic management of diminutive colorectal polyps: resect and discard or do not resect. In the last, Shinji Tanaka described, in detail, endoscopic assessment of invasive colorectal cancer: slight vs. deep submucosal invasion. These focused review series introduce the new roles of current colonoscopy to readers and will help the readers to know how to use the new imaging technologies and paradigms in clinical practices.

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    Chun-Chieh Chen, Mo A Baikoghli, R Holland Cheng
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Clinical Observation of Colorectal Polyps
Won Ook Ko, M.D., Jong In Kim, M.D., Ju Yeon Nam, M.D., Jung Im Jung, M.D., Jin Kwang An, M.D., Kwang Jin Kim, M.D., Hyung Wook Kim, M.D., Won Il Park, M.D. and Ung Suk Yang, M.D.
Korean J Gastrointest Endosc 2008;37(2):105-111.   Published online August 30, 2008
AbstractAbstract PDF
Background/Aims: The detection and removal of colorectal polyps are important for secondary prevention of colorectal cancer. We investigated the characteristics and histopathologic finding of polyps to better plan their management. Methods: We analyzed 334 patients who underwent polypectomies for 770 colorectal polyps between October, 2005 and April, 2007 at Bong Seng Memorial Hospital. Results: Colorectal polyps were frequent in the sixth decade in both sexes. The ratio of male to female patients was 1.72:1. Abdominal pain/discomfort was the most common symptom (34.4%), and the most common site of polyp localization was the rectosigmoid colon. Histopathologic examination showed tubular adenomas (54.6%), hyperplastic polyps (36.4%), and inflammatory polyps (5.6%). Adenomatous polyps were more common in patients with multiple polyps than in patients with a single polyp. Adenomatous polyps with villous histology were more common in patients with large polyps than in patients with small polyps. Non-neoplastic polyps were common before the fifth decade. Neoplastic polyps were common past the fifth decade. Conclusions: In this study, tubular adenomas were frequently found on histopathologic examination, sessile type were frequently found on gross examination, and colorectal polyps were found principally in the rectosigmoid colon. Neoplastic polyps were more frequent in patients beyond the fifth decade. There fore colonoscopy examination is recommended for secondary prevention of colon cancer. (Korean J Gastrointest Endosc 2008;37:105-111)
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The Pathological Differences of Colorectal Polyps Examined between the Use of a Forcep Biopsy and Endoscopic Resection
In Do Song, M.D., Jeong Wook Kim, M.D. and In Soo Oh, M.D.
Korean J Gastrointest Endosc 2008;37(1):14-19.   Published online July 30, 2008
AbstractAbstract PDF
Background
/Aims: Complete excision of colorectal polyps is not always performed for various reasons. We investigated the discrepancy between the histologic findings of polyps excised by a forcep biopsy and histologic findings of polyps excised by endoscopic resection. Methods: We reviewed 137 patients with 206 colorectal polyps removed by endoscopic resection following forcep biopsies. Endoscopic records and pathological reports of patients were analyzed retrospectively. Results: The discrepancy of the histological type was 18.4% between the histologic findings of a polyp evaluated after a forceps biopsy and the histologic findings of a polyp evaluated after endoscopic resection. The discrepancy of high-grade dysplasia (HGD) and a cancerous condition was 22.3% using the two procedures. A total of 15.5% of adenomas without HGD and 3.0% of hyperplasia in the forcep biopsy specimens were identified as adenomas with HGD in the resected specimens. A total of 18.2% of adenomas with HGD and 4.1% of adenomas without HGD in the forcep biopsy specimens were identified as adenomas with carcinoma in the resected specimens. The discrepancy rates of the histological type for HGD and a cancerous condition were high for penduculated polyps with a diameter of less than 10 mm and for polyps with a diameter of greater than 16 mm. Conclusions: Approaches to review the histology of an entire colorectal polyp should be performed, especially for polyps with an adenomatous histology and for polyps of the pedunculated form with a diameter of less than 10 mm and a diameter of greater than 16 mm after a forcep biopsy. (Korean J Gastrointest Endosc 2008;37:14-19)
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Comparison of Colonoscopy and Virtual Colonoscopy for the Detection of Colorectal Polyps
In Young Go, M.D., Sang Young Han, M.D., Jung Nam Yoo, M.D., Young Hun Koo, M.D., Seung Hoon Ryu, M.D., Jeong Hwan Cho, M.D., Seung Ho Han, M.D., Dong Hyun Lee, M.D., Sung Wook Lee, M.D., Jin Seok Jang, M.D., Jong Hun Lee, M.D., Myung Hwan Noh, M.D., Seok
Korean J Gastrointest Endosc 2005;30(1):7-11.   Published online January 30, 2005
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Background
/Aims: Virtual colonoscopy using abdominal spiral computed tomography scanning allows total colonic evaluation with minimal invasiveness. We compared the performance of virtual colonoscopy and colonoscopy for the detection of colorectal polyps. Methods: We performed colonoscopy before the virtual colonoscopy. Virtual colonoscopy was performed immediately before the colonoscopic polypectomy in 24 adults (16 men and 8 women: mean age, 59 years). Results: A total of 48 polyps were found by colonoscopy. Virtual colonoscopy identified 20 of 28 polyps that were 10 mm or more in diameter (71%), 3 of 4 that were 6 to 9 mm (75%), and 9 of 16 that were 5 mm or smaller (56%). Overall sensitivity of virtual colonoscopy for colorectal polyps was 67%. Conclusions: Our result of virtual colonoscopy showed lower sensitivity for detection of significant colorectal lesions than previously reported studies. Further large group study may be needed to determine the usefulness of virtual colonoscopy. (Korean J Gastrointest Endosc 2005;30:7⁣11)
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Endoscopic Removal of Large Colorectal Polyps: Study of a Serise of 72 Cases
Wan Sik Lee, Jae Hong Park, Jeung Ho Park, Soo Jung Lee, Chang Hwan Park, Young Eun Joo, Hyun Soo Kim, Sung Kyu Choi, Jong Sun Rew, Sei Jong Kim
Korean J Gastrointest Endosc 2003;27(5):477-477.   Published online November 20, 2003
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Colonoscopic Miss-rate of Colorectal Polyp and Adenoma
Kyu Yong Choi, M.D., Bo In Lee, M.D., Se Young Lee, M.D.*, Won Chul Lee, M.D.*,
Korean J Gastrointest Endosc 2003;26(4):199-204.   Published online April 30, 2003
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Backgound/Aims: While colonoscopy is the gold standard diagnostic test for the detection of colorectal polyps (especially adenomas), it is also an imperfect method. We prospectively estimated the colonoscopic miss-rate of colorectal polyp and adenoma. Methods: We performed polypectomies in 603 out of 2,006 patients over age of 40 who underwent their first time colonoscopy between September 1999 and June 2001. A follow-up colonoscopy was performed within 60 days in 235 (53.4%) among 440 enrolled patients. Results: Seventy-three (31.0%) of 235 patients with polyps on initial colonoscopy were missed polyps and 37 (23.2%) of 159 patients with adenomas on initial colonoscopy were missed adenomas. As the number of polyps on the initial examination increased, the miss-rate increased significantly (p=0.01). The most frequent size of missed polyp was 3∼4 mm (55.5%, p=0.00) and the most frequent location was sigmoid colon (27.3%, p=0.00). Conclusion: It may be a fallacy to declare that all colorectal polyps are removed just after one session of colonoscopy. Examiners should make every effort to reduce the miss-rate of colorectal polyps during colonoscopy. (Korean J Gastrointest Endosc 2003;26:199⁣204)
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1,683예의 대장내시경 검사에서의 대장용종에 대한 전향적 분석 ( Prospective Evaluation of Colorectal Polyps in 1,683 Consecutive Colonoscopies )
Korean J Gastrointest Endosc 1999;19(6):887-896.   Published online November 30, 1998
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Background
/Aims: The colorectal polyp, particularly the adenoma, has been regarded as a precursor of cancer. The incidence of colorectal polyps has been reported at various rates according to investigation centers in foreign countries. In Korea, the incidence of colorectal polyps has been reported as very low according to the few reports, which was involved a few cases and were partial. Therefore, the aim of this study is to evaluate prospectively the incidence and the clinicopathologic features of colorectal polyps. Methods: A colonoscope was inserted up into the cecum in 1,889 patients among 2,001 trials from Oct. 1996 to Aug. 1997 (success rate: 94.4%). Of the 1,889 full colonoscopies, the following were excluded; 1) referred patients with suspicious colorectal cancer or polyps, 2) patients with suspicious rectal cancer determined by rectal examination, 3) patients who had follow-up colonoscopy after a polypectomy or cancer surgery, and 4) patients who had periodic colonoscopy due to FAP or HNPCC. There were a total of 1,683 full colonoscopies in this study. The majority of the total cases involved a colonoscopy due to benign anal disease, irritable bowel syndrome, or routinechecks for health. Results: There were 946 men (56.2%) and 737 women (43.8%). The mean age was 48.2 yrs (13∼88 yrs) for men and 48.1 yrs (18∼89 yrs) for women. 422 patients were found to have 645 colorectal polyps (1.52 polyps per patient). The incidence of polyps was 25.1% (32.0% for men, 16.1% for women) and increased after the 6th decade in men (44.0%) and in women (23.0%). 281 patients were found to have 426 colorectal adenomas. The incidence of adenomas was 16.6% (21.9% for men, 9.9% for women) and increased after the 6th decade, 32.0% in men, and 15.9% in women. Solitary polyps were present in 277 patients (65.6%) while 94 patients (22.3%) had two polyps and 51 patients (12.1%) had between 3 and 8 polyps. The polyp retrieval rate was 96.9%. There were 426 adenomas (66.0%), 75 hyperplastic (11.7%), 120 inflammatory (18.6%), and 24 miscellaneous (3.7%) polyps. Of the 426 adenoma, there were 397 tubular adenoma (93.2%), 18 tubulovillous adenoma (4.3%), 4 villous adenoma (0.9%), 6 in situ carcinoma (1.4%), and 1 invasive carcinoma (0.2%). 6 in situ carcinoma's were detected in tubular adenoma and 1 invasive carcinoma in tubulovillous adenoma. Of 645 polyps, the sessile type was 87.9%. The polyp size varied from 1 mm to 25 mm and 79.2% were under 5mm. Also, 85.7% of adenomas were sessile and 74.7% were under 5mm. 22.0% of polyps were located in rectum, 35.4% in sigmoid colon, 9.5% in descending colon, 13.3% in transverse colon, 19.8% in ascending colon and cecum. The distribution of adenoma was similar to that of polyp. 40.1% of adenoma showed moderate to severe dysplasia. Conclusions: This study revealed that the incidence of polyp in Korea was higher than that in previous reports and 42.6% of polyps were proximal to rectosigmoid colon. Therefore, we suggest that we should try to detect and remove colorectal polyps by more active colonoscopy. (Korean J Gastrointest Endosc 19: 887∼896, 1999)
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