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Accuracy of capsule colonoscopy in detecting colorectal polyps in a screening population.
Rex DK, Adler SN, Aisenberg J, Burch WC, Carretero C, Chowers Y, Fein SA, Fern SE, Fernandez-Urien Sainz I, Fich A, Gal E, Horlander JC, Isaacs KL, Kariv R, Lahat A, Leung WK, Malik PR, Morgan D, Papageorgiou N, Romeo DP, Shah SS, Waterman M
(2015) Gastroenterology 148: 948-957.e2
MeSH Terms: Adenomatous Polyps, Capsule Endoscopy, Colonic Polyps, Colonoscopy, Colorectal Neoplasms, False Negative Reactions, Female, Humans, Hyperplasia, Intestinal Polyps, Israel, Male, Mass Screening, Middle Aged, Predictive Value of Tests, Prospective Studies, Rectal Diseases, Tumor Burden, United States
Show Abstract · Added May 18, 2016
BACKGROUND & AIMS - Capsule colonoscopy is a minimally invasive imaging method. We measured the accuracy of this technology in detecting polyps 6 mm or larger in an average-risk screening population.
METHODS - In a prospective study, asymptomatic subjects (n = 884) underwent capsule colonoscopy followed by conventional colonoscopy (the reference) several weeks later, with an endoscopist blinded to capsule results, at 10 centers in the United States and 6 centers in Israel from June 2011 through April 2012. An unblinded colonoscopy was performed on subjects found to have lesions 6 mm or larger by capsule but not conventional colonoscopy.
RESULTS - Among the 884 subjects enrolled, 695 (79%) were included in the analysis of capsule performance for all polyps. There were 77 exclusions (9%) for inadequate cleansing and whole-colon capsule transit time fewer than 40 minutes, 45 exclusions (5%) before capsule ingestion, 15 exclusions (2%) after ingestion and before colonoscopy, and 15 exclusions (2%) for site termination. Capsule colonoscopy identified subjects with 1 or more polyps 6 mm or larger with 81% sensitivity (95% confidence interval [CI], 77%-84%) and 93% specificity (95% CI, 91%-95%), and polyps 10 mm or larger with 80% sensitivity (95% CI, 74%-86%) and 97% specificity (95% CI, 96%-98%). Capsule colonoscopy identified subjects with 1 or more conventional adenomas 6 mm or larger with 88% sensitivity (95% CI, 82%-93) and 82% specificity (95% CI, 80%-83%), and 10 mm or larger with 92% sensitivity (95% CI, 82%-97%) and 95% specificity (95% CI, 94%-95%). Sessile serrated polyps and hyperplastic polyps accounted for 26% and 37%, respectively, of false-negative findings from capsule analyses.
CONCLUSIONS - In an average-risk screening population, technically adequate capsule colonoscopy identified individuals with 1 or more conventional adenomas 6 mm or larger with 88% sensitivity and 82% specificity. Capsule performance seems adequate for patients who cannot undergo colonoscopy or who had incomplete colonoscopies. Additional studies are needed to improve capsule detection of serrated lesions. Clinicaltrials.gov number: NCT01372878.
Copyright © 2015 AGA Institute. Published by Elsevier Inc. All rights reserved.
0 Communities
1 Members
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19 MeSH Terms
Associations between dietary fiber and colorectal polyp risk differ by polyp type and smoking status.
Fu Z, Shrubsole MJ, Smalley WE, Ness RM, Zheng W
(2014) J Nutr 144: 592-8
MeSH Terms: Adenomatous Polyps, Adult, Aged, Case-Control Studies, Colonic Polyps, Colonoscopy, Colorectal Neoplasms, Dietary Fiber, Female, Humans, Male, Middle Aged, Precancerous Conditions, Risk Factors, Risk Reduction Behavior, Smoking, Tennessee
Show Abstract · Added March 10, 2014
The association of dietary fiber intake with colorectal cancer risk is established. However, the association may differ between cigarette smokers and nonsmokers. We evaluated this hypothesis in a large colonoscopy-based case-control study. Dietary fiber intakes were estimated by self-administered food frequency questionnaire. Unconditional logistic regression analysis was used to estimate ORs and 95% CIs with adjustment for potential confounders. Analysis also was stratified by cigarette smoking and sex. High dietary fiber intake was associated with reduced risk of colorectal polyps (P-trend = 0.003). This association was found to be stronger among cigarette smokers (P-trend = 0.006) than nonsmokers (P-trend = 0.21), although the test for multiplicative interaction was not statistically significant (P = 0.11). This pattern of association was more evident for high-risk adenomatous polyps (ADs), defined as advanced or multiple ADs (P-interaction smoking and dietary fiber intake = 0.09). Among cigarette smokers who smoked ≥23 y, a 38% reduced risk of high-risk ADs was found to be associated with high intake of dietary fiber compared with those in the lowest quartile fiber intake group (P-trend = 0.004). No inverse association with dietary fiber intake was observed for low-risk ADs, defined as single nonadvanced ADs. Cigarette smoking may modify the association of dietary fiber intake with the risk of colorectal polyps, especially high-risk ADs, a well-established precursor of colorectal cancer.
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2 Members
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17 MeSH Terms
Lifestyle factors and their combined impact on the risk of colorectal polyps.
Fu Z, Shrubsole MJ, Smalley WE, Wu H, Chen Z, Shyr Y, Ness RM, Zheng W
(2012) Am J Epidemiol 176: 766-76
MeSH Terms: Adenomatous Polyps, Aged, Alcohol Drinking, Anti-Inflammatory Agents, Non-Steroidal, Body Mass Index, Case-Control Studies, Colon, Colonic Polyps, Colonoscopy, Diet, Educational Status, Exercise, Female, Health Behavior, Humans, Hyperplasia, Life Style, Male, Middle Aged, Rectum, Risk Factors, Smoking
Show Abstract · Added March 7, 2014
Understanding patterns of shared and type-specific etiologies for colorectal polyps may provide insights into colorectal carcinogenesis. The authors present the first systematic comparison of risk factors by colorectal polyp type in a large colonoscopy-based case-control study of 3,764 polyp-free controls and 2,543 polyp patients, including 1,444 cases with adenomas only, 662 cases with hyperplastic polyps (HPPs) only, and 437 cases with synchronous HPPs and adenomas. Surveys were completed to obtain information on usual dietary intake and other lifestyle factors. Six lifestyle factors, including cigarette smoking, obesity, no regular use of nonsteroidal anti-inflammatory drugs, high intake of red meat, low intake of fiber, and low intake of calcium, were found to be independently associated with the risk of polyps. The risk of polyps increased progressively with an increasing number of adverse lifestyle factors. Compared with participants with no or only 1 risk factor, odds ratios for those with 5 to 6 risk factors were 2.72 (95% confidence interval: 1.94, 3.79) for adenoma only, 4.12 (95% confidence interval: 2.78, 6.09) for HPPs only, and 9.03 (95% confidence interval: 5.69, 14.34) for synchronous HPPs and adenomas. This study provides strong evidence that lifestyle modification is important for the prevention of colorectal polyps, especially advanced and multiple adenomas, which are established precursors of colorectal cancer.
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4 Members
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22 MeSH Terms
Fertility drugs and the risk of breast and gynecologic cancers.
Brinton LA, Sahasrabuddhe VV, Scoccia B
(2012) Semin Reprod Med 30: 131-45
MeSH Terms: Adenomatous Polyps, Adolescent, Adult, Breast Neoplasms, Female, Fertility Agents, Genital Neoplasms, Female, Humans, Infertility, Female, Ovarian Neoplasms, Ovulation Induction, Risk, Young Adult
Show Abstract · Added March 5, 2014
The evaluation of cancer risk among patients treated for infertility is complex, given the need to consider indications for use, treatment details, and the effects of other factors (including parity status) that independently affect cancer risk. Many studies have had methodologic limitations. Recent studies that have overcome some of these limitations have not confirmed a link between drug use and invasive ovarian cancers, although there is still a lingering question as to whether borderline tumors might be increased. It is unclear whether this merely reflects increased surveillance. Investigations regarding breast cancer risk have produced inconsistent results. In contrast, an increasing number of studies suggest that fertility drugs may have a special predisposition for the development of uterine cancers, of interest given that these tumors are recognized as particularly hormonally responsive. Additional studies are needed to clarify the effects on cancer risk of fertility drugs, especially those used in conjunction with in vitro fertilization. Because many women who have received such treatments are still relatively young, further monitoring should be pursued in large well-designed studies that enable assessment of effects within a variety of subgroups defined by both patient and disease characteristics.
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
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1 Members
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13 MeSH Terms
Dietary intake of PUFAs and colorectal polyp risk.
Murff HJ, Shrubsole MJ, Cai Q, Smalley WE, Dai Q, Milne GL, Ness RM, Zheng W
(2012) Am J Clin Nutr 95: 703-12
MeSH Terms: Adenomatous Polyps, Adult, Aged, Biomarkers, Case-Control Studies, Colonic Polyps, Colonoscopy, Colorectal Neoplasms, Dietary Supplements, Dinoprostone, Fatty Acids, Omega-3, Female, Humans, Male, Middle Aged, Risk Factors, Surveys and Questionnaires
Show Abstract · Added March 5, 2014
BACKGROUND - Marine-derived n-3 (omega-3) PUFAs may reduce risk of developing colorectal cancer; however, few studies have investigated the association of n-3 PUFA intakes on colorectal polyp risk.
OBJECTIVE - The objective of this study was to examine the associations of dietary PUFA intake on risk of colorectal adenomatous and hyperplastic polyps.
DESIGN - This was a colonoscopy-based case-control study that included 3166 polyp-free control subjects, 1597 adenomatous polyp cases, and 544 hyperplastic polyp cases. Dietary PUFA intake was calculated from food-frequency questionnaires and tested for association by using unconditional logistic regression. The urinary prostaglandin E(2) metabolite, which is a biomarker of prostaglandin E(2) production, was measured in 896 participants by using liquid chromatography and tandem mass spectrometry.
RESULTS - n-6 PUFAs were not associated with adenomatous or hyperplastic polyps in either men or women. Marine-derived n-3 PUFAs were associated with reduced risk of colorectal adenomas in women only, with an adjusted OR of 0.67 (95% CI: 0.47, 0.97) for the highest quintile of intake compared with the lowest quintile of intake (P-trend = 0.01). Dietary intake of α-linolenic acid was associated with an increased risk of hyperplastic polyps in men (P-trend = 0.03), which was not seen in women. In women, but not in men, dietary intake of marine-derived n-3 PUFAs was negatively correlated with urinary prostaglandin E(2) production (r = -0.18; P = 0.002).
CONCLUSION - Higher intakes of marine-derived n-3 PUFAs are associated with lower risk of adenomatous polyps in women, and the association may be mediated in part through a reduction in the production of prostaglandin E(2). This trial was registered at clinicaltrials.gov as NCT00625066.
1 Communities
5 Members
0 Resources
17 MeSH Terms
Nonsteroidal anti-inflammatory drug use and risk of adenomatous and hyperplastic polyps.
Murff HJ, Shrubsole MJ, Chen Z, Smalley WE, Chen H, Shyr Y, Ness RM, Zheng W
(2011) Cancer Prev Res (Phila) 4: 1799-807
MeSH Terms: Adenoma, Adenomatous Polyps, Adult, Aged, Anti-Inflammatory Agents, Non-Steroidal, Case-Control Studies, Colonic Polyps, Colonoscopy, Female, Humans, Hyperplasia, Male, Middle Aged, Prognosis, Risk Factors
Show Abstract · Added February 13, 2014
Adenomatous polyps are known precursor lesions for colorectal cancer and some hyperplastic polyps also have malignant potential. The use of aspirin and nonsteroidal anti-inflammatory drugs (NSAID) is associated with a reduced risk of adenomatous polyps; however, less evidence exists with regard to NSAID use and hyperplastic polyp risk. We conducted a colonoscopy-based case-control study including 2,028 polyp cases (1,529 adenomatous and 499 hyperplastic) and 3,431 polyp-free controls. Multivariate logistic regression models were constructed to derived adjusted ORs and 95% CIs as the measure of the association between NSAID use and polyp risk. Use of baby aspirin, regular aspirin, and nonaspirin NSAIDs, were associated with a reduced risk of adenomatous polyps (OR = 0.79, 95% CI: 0.66-0.93, OR = 0.73, 95% CI: 0.58-0.90, and OR = 0.67, 95% CI: 0.53-0.86, respectively). Baby aspirin was also associated with a reduced risk of hyperplastic polyps (OR = 0.74, 0.56-0.97). Although a dose response was seen with adenoma risk and regular use of any NSAIDs (less than 7 doses per week, 7 doses per week, and greater than 7 doses per week), a dose response was not seen with hyperplastic polyps. We found no evidence of interaction between NSAID dose and duration and polyp risk. The use of any NSAID regardless of type was associated with a reduced risk of adenomatous polyps; however, regular aspirin and COX-2 inhibitors use was not associated with hyperplastic polyp risk.
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5 Members
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15 MeSH Terms
Biochromoendoscopy: molecular imaging with capsule endoscopy for detection of adenomas of the GI tract.
Zhang H, Morgan D, Cecil G, Burkholder A, Ramocki N, Scull B, Lund PK
(2008) Gastrointest Endosc 68: 520-7
MeSH Terms: Adenomatous Polyps, Animals, Capsule Endoscopy, Cathepsin B, Colonic Neoplasms, Colonoscopy, Diagnosis, Differential, Diagnostic Imaging, Disease Models, Animal, Image Enhancement, Inflammatory Bowel Diseases, Injections, Intravenous, Mice, Mice, Inbred C57BL, Molecular Biology, Molecular Probe Techniques, Molecular Probes, Random Allocation, Risk Factors, Sensitivity and Specificity, Spectroscopy, Near-Infrared
Show Abstract · Added May 20, 2016
BACKGROUND - Current capsule endoscopy (CE) provides minimally invasive technology for GI imaging but has limited ability to discriminate different types of polyps. Near infrared fluorescent (NIRF) probes activated by biomarkers upregulated in adenomas (eg, cathepsin B) are potentially powerful tools to distinguish premalignant or malignant lesions from benign or inflammatory lesions.
OBJECTIVES - To examine whether CE can be integrated with NIRF probes to detect adenomas and whether cathepsin B-activated NIRF probes are activated by benign or inflammatory lesions.
DESIGN - Mouse models of adenomas, hyperplactic/lymphoid polyps, and acute or chronic intestinal inflammation were injected intravenously with a cathepsin B-activated probe (Prosense 680). Dissected intestine was imaged with CE under white or NIRF light. For NIRF excitation (680 nm), dichroic and emission (700 nm) filters were combined with CE when images were recorded. Prosense 680 samples with or without protease were used as positive and negative controls. CE-based imaging data were verified by using and independent imaging system (Xenogen IVIS system).
MAIN OUTCOME MEASUREMENTS - Proof of principal that CE integrated with NIRF probes can detect and discriminate adenomas from other lesions.
RESULTS - CE-based NIRF imaging with Prosense 680 readily visualized adenomas, including in the colitis model. NIRF signals of different intensities were detected. Prosense 680 was not activated by benign or inflammatory lesions.
LIMITATION - Optical filters external to the capsule were used.
CONCLUSIONS - We demonstrate proof of the principle that biochromoendoscopy-CE combined with molecular probes--provides a novel approach that differentiates adenomas from benign polyps and inflammatory lesions.
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1 Members
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21 MeSH Terms
Alcohol drinking, cigarette smoking, and risk of colorectal adenomatous and hyperplastic polyps.
Shrubsole MJ, Wu H, Ness RM, Shyr Y, Smalley WE, Zheng W
(2008) Am J Epidemiol 167: 1050-8
MeSH Terms: Adenomatous Polyps, Alcohol Drinking, Case-Control Studies, Colonoscopy, Colorectal Neoplasms, Confidence Intervals, Female, Humans, Male, Middle Aged, Risk Factors, Smoking, Social Class, Tennessee
Show Abstract · Added April 11, 2016
The authors evaluated alcohol drinking and cigarette smoking in relation to risk of colorectal polyps in a Nashville, Tennessee, colonoscopy-based case-control study. In 2003-2005, cases with adenomatous polyps only (n = 639), hyperplastic polyps only (n = 294), and both types of polyps (n = 235) were compared with 1,773 polyp-free controls. Unordered polytomous logistic regression was used to calculate adjusted odds ratios and 95% confidence intervals. Consumption of at least five alcoholic drinks per week was not strongly associated with development of polyps. Odds ratios for all polyp types were increased for dose, duration, and pack-years of cigarette smoking and were stronger for hyperplastic polyps than for adenoma. Compared with never smoking, dose-response relations were particularly strong for current smoking and duration; for > or =35 years of smoking, odds ratios were 1.9 (95% confidence interval (CI): 1.4, 2.5) for adenomatous polyps only, 5.0 (95% CI: 3.3, 7.3) for hyperplastic polyps only, and 6.9 (95% CI: 4.4, 11.1) for both types of polyps. Compared with current smoking, time since cessation was associated with substantially reduced odds; for > or =20 years since quitting, odds ratios were 0.4 (95% CI: 0.3, 0.6) for adenoma only, 0.2 (95% CI: 0.1, 0.3) for hyperplastic polyps only, and 0.2 (95% CI: 0.2, 0.4) for both polyp types. These findings support the adverse role of cigarette smoking in colorectal tumorigenesis and suggest that quitting smoking may substantially reduce the risk of colorectal polyps.
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14 MeSH Terms
The relation of magnesium and calcium intakes and a genetic polymorphism in the magnesium transporter to colorectal neoplasia risk.
Dai Q, Shrubsole MJ, Ness RM, Schlundt D, Cai Q, Smalley WE, Li M, Shyr Y, Zheng W
(2007) Am J Clin Nutr 86: 743-51
MeSH Terms: Adenoma, Adenomatous Polyps, Calcium, Dietary, Case-Control Studies, Colonic Polyps, Colorectal Neoplasms, Diet, Female, Genetic Predisposition to Disease, Genotype, Humans, Hyperplasia, Magnesium, Magnesium Deficiency, Male, Middle Aged, Nutrigenomics, Odds Ratio, Polymorphism, Genetic, Protein-Serine-Threonine Kinases, Risk Factors, TRPM Cation Channels
Show Abstract · Added March 5, 2014
BACKGROUND - Mean magnesium intake in the US population does not differ from that in East Asian populations with traditionally low risks of colorectal cancer and other chronic diseases, but the ratio of calcium to magnesium (Ca:Mg) intake is much higher in the US population. Transient receptor potential melastatin 7 (TRPM7) is a newly found gene essential to magnesium absorption and homeostasis.
OBJECTIVE - We aimed to test whether the association of colorectal polyps with intake of calcium, magnesium, or both and Thr1482Ile polymorphism in the TRPM7 gene is modified by the Ca:Mg intake.
DESIGN - Included in the study were a total of 688 adenoma cases, 210 hyperplastic polyp cases, and 1306 polyp-free controls from the Tennessee Colorectal Polyp Study.
RESULTS - We found that total magnesium consumption was linked to a significantly lower risk of colorectal adenoma, particularly in those subjects with a low Ca:Mg intake. An inverse association trend was found for hyperplastic polyps. We also found that the common Thr1482Ile polymorphism was associated with an elevated risk of both adenomatous and hyperplastic polyps. Moreover, this polymorphism significantly interacted with the Ca:Mg intake in relation to both adenomatous and hyperplastic polyps. The subjects who carried >or=1 1482Ile allele and who consumed diets with a high Ca:Mg intake were at a higher risk of adenoma (odds ratio: 1.60; 95% CI: 1.12, 2.29) and hyperplastic polyps (odds ratio: 1.85; 95% CI: 1.09, 3.14) than were the subjects who did not carry the polymorphism.
CONCLUSION - These findings, if confirmed, may provide a new avenue for the personalized prevention of magnesium deficiency and, thus, colorectal cancer.
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3 Members
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22 MeSH Terms
The interaction of age and hormone replacement therapy on colon adenoma risk.
Murff HJ, Shrubsole MJ, Smalley WE, Wu H, Shyr Y, Ness RM, Zheng W
(2007) Cancer Detect Prev 31: 161-5
MeSH Terms: Adenoma, Adenomatous Polyps, Adult, Age Factors, Aged, Case-Control Studies, Colonic Neoplasms, Colonic Polyps, Colonoscopy, Female, Hormone Replacement Therapy, Humans, Middle Aged, Postmenopause, Risk Factors, Time Factors
Show Abstract · Added March 5, 2014
BACKGROUND - Several studies have identified a possible interaction between age and hormone replacement therapy on colon neoplasm risk. We re-evaluated this interaction and determined if this interaction may be explained by the longer duration of estrogen use in older, rather than younger, women.
METHODS - Included in the case-control study were 755 women (169 cases and 586 controls.) who were recruited from patients with no prior history of colorectal neoplasm and undergoing an elective colonoscopy examination.
RESULTS - There was a significant interaction between age and hormone replacement therapy use (P=0.03) with current estrogen users who were over 56 years of age having a reduced odds of colon adenoma (OR, 0.40; 95% CI, 0.16-0.98) when compared to never users. Both older women who had used hormone replacement therapy for 3 or less years (OR, 0.07; 95% CI, 0.006-0.81) and those reporting greater than 10 years of use (OR, 0.27; 95% CI, 0.09-0.80) had a reduced adjusted odds for adenomas when compared to non-users. No apparent association with estrogen replacement therapy was found among younger women (<56 years).
CONCLUSIONS - Duration of use is not likely to explain the stronger association of hormone replacement therapy use with colon neoplasm in older women. Additional work is needed to better characterize the underlying mechanisms associated with this interaction.
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2 Members
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16 MeSH Terms