Analysis of the relation between APC mutation site and phenotype identifies subgroups of FAP patients at high risk for major extracolonic disease, which is useful for surveillance and prevention.

The nature and the extent of the autofluorescence modification between normal and tumor tissue in sections explain at least partly the evidence of the "in vivo" analysis and highlight the importance of excitation for full exploitation of the potentials of autofluorescence in diagnosis.

Laparoscopic surgery has already begun to influence the management of diverticular disease, but the randomized controlled trials needed to support therapy decisions are largely missing.

Our objective was to assess the overall risk of subsequent colorectal neoplasms (cancer or adenoma) in relation with the various characteristics of the index lesion in a cohort of patients who underwent endoscopic polypectomies of colorectal adenomas. A total of 1,086 patients with adenomas of the large bowel were reported between 1979 and 1999 at the National Cancer Institute of Milan during a screening program for colorectal carcinoma. Data on patients who had colonoscopic examinations and treatments were collected prospectively. The relation between colorectal cancer (CRC) and adenoma features was assessed by computing the hazard ratio (HR) values and corresponding confidence intervals (95% CI) according to Cox proportional hazard models. Of the 1,086 eligible patients (487 females, 579 males), 736 had single adenomas (67.7%) and 350 had multiple adenomas (32.3%). Histologic examination revealed 772 cases of tubular adenoma (73%), 205 cases of tubulovillous adenoma and 80 cases of villous adenoma (7.5%). Severe dysplasia was found in 3.3% of the cases. During the 11,393 person-years of followup, with an average time of surveillance of 10.5 years, colorectal carcinomas developed in 10 patients (0.8%) and a new adenoma in 323 patients (29%). Multivariate analysis showed that male gender (HR 1.6; 95% CI 1.3-2.0), multiple polyps (HR 1.6; 95% CI 1.3-2.0), polyps larger than 2 cm (HR 1.5; 95% CI 1.1-2.1), tubulovillous and villous histology (HR 1.3; 95% CI 1.0 -1.6 and HR 1.8; 95% CI 1.2-2.6, respectively) at index polypectomy were statistically significant risk factors for developing metachronous adenomatous polyps. The standardized incidence rates (SIR) for CRC was 0.52 (95% CI 0.25-0.95). The SIR was increased in subjects with severe dysplasia (2.8; 95% CI 0.34 -1.02). Some features of large bowel adenomas are strongly correlated with an increased risk of metachronous adenomas and colorectal cancer. However, the endoscopic polypectomy is able to reduce by 50% the incidence of CRC in patients with large bowel adenomas. © 2003 Wiley-Liss, Inc. Key words: colorectal adenomas; endoscopic polypectomy; colorectal cancer prevention; adenoma surveillanceColorectal cancer is the second most common cancer in developed countries, its incidence having markedly increased over the years. Subjects with uncommon familial syndrome and with inflammatory bowel diseases are at highest risk of colorectal cancer. 1-3 Other principal risk factors include a history of colorectal neoplasm in a first-degree relative and a personal history of a large adenoma or colorectal, endometrial, breast and ovarian cancer. [1][2][3] It is widely accepted that most colorectal cancers arise from a preexisting adenoma, and molecular genetic studies have further validated the concept of the adenoma-carcinoma sequence demonstrating that a series of genetic abnormalities are associated with adenoma development, growth and progression to malignancy. 4,5 The subjects with adenomas generally have a high proliferate activity of colonic mucosa, i.e., a biolog...

ObjectivesMost outcome data for placement of self-expanding metal stents (SEMS) within the gastrointestinal tract comes from experience of their use within the esophagus and biliary tree. In 1992, Spinelli et al. first reported placement of a modified Gianturco-Rösch stent within the colon for management of large bowel obstruction, and a large amount of data has accrued concerning SEMS use within the large bowel. The goal of this article is to define the clinical indications for insertion of SEMS for colonic obstruction, the types of stents used, the techniques of insertion, and the outcomes. Basic PrinciplesColorectal SEMS may be placed under endoscopic guidance, with or without the aid of fluoroscopy, by endoscopists, or by interventional radiologists using only fluoroscopic guidance. The advantages of endoscopic placement of SEMS over placement by interventional radiology arise because of the greater accessibility to these sites and the improved mechanical advantage of being able to pass some stents directly through the working channel of the endoscope ("through the scope" [TTS]). This advantage is especially found when the obstruction is proximal to the rectosigmoid, or in patients with very angulated rectosigmoid anatomy [1,2]. Interventional radiologists, however, have much more experience both in the finer points of passing guide wires through obstructive lesions and in deploying SEMS. Although many of the principles for placement of SEMS for colonic obstruction apply to both endoscopic and radiological insertion, this article will focus on the endoscopic techniques of placement.