Does Increased Adenoma Detection Reduce the Risk of Colorectal Cancer, and How Good Do We Need to Be?

Dilly, Christen K.; Kahi, Charles J.

doi:10.1007/s11894-019-0678-5

Cited by 3 publications

(4 citation statements)

References 48 publications

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“…The primary outcome measure of this study is the new CAP occurrence in 1 and 2 years. The Secondary outcome measure is the occurrence of advanced adenomas [1] (defined as those with cancer, high-grade dysplasia, more than 25% villous features, or an estimated diameter of at least 1 cm as assessed by the endoscopist), and high-risk findings (any advanced adenoma and/or >2 adenomas) in 1 and 2 years.…”

Section: Interventionsmentioning

confidence: 99%

“…It was widely accepted that colorectal adenomatous polyp (CAP) was well-known precursor of colorectal cancer (CRC). [1] CAP constituted over 95% of CRC. [2] In a recent study, [3,4] Up to 30% of average risk asymptomatic individuals 50 years or older had at least one colorectal adenoma and one-third of young individuals, including in their 30 seconds and 40 seconds had colorectal polyps.…”

Section: Introductionmentioning

confidence: 99%

“…[6] Colonoscopy and early treatment of CAP was thought to be associated with about 80% reduction in CRC incidence. [1] Based on the American Cancer Society guidelines, [7] nearly half the population will be counseled to undergo a colonoscopy from 40 years old based on a positive family history of adenoma.…”

Section: Introductionmentioning

confidence: 99%

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Traditional Chinese medicine (Xiaoai Jiedu Decoction) as an adjuvant treatment for prevention new colorectal adenomatous polyp occurrence in post-polypectomy

et al. 2019

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Background: Colorectal Adenomatous Polyp (CAP) was one precursor of colorectal cancer (CRC) and having a high chance of developing into CRC. There was a lack of conclusive chemoprevention evidences to prevention new CAP occurrence in post-polypectomy. Xiaoai Jiedu Decoction , Chinese National Medical Professor (Zhou Zhongying)'s experience formula, has been used to treat new CAP occurrence in post-polypectomy from the 20th century in China. However, clinical research of Xiaoai Jiedu Decoction in the treatment of CAP recurrence was lack. We design this study to evaluate the efficacy and safety of Xiaoai Jiedu Decoction in the treatment of new CAP occurrence in post-polypectomy on colonoscopy. Methods/Design: A randomized, controlled, blind and multicenter trial to evaluate the efficacy and safety of Xiaoai Jiedu Decoction is proposed. CAP patients (after complete polypectomy under colonoscopy) will be randomly assigned into Xiaoai Jiedu Decoction group and Xiaoai Jiedu Decoction mimetic agent group. Patients will receive 6-course treatments and a 2-year follow-up. Follow-up colonoscopy will be anticipated to perform in 1 and 2 years after the baseline examinations. The primary outcome measure is the new CAP occurrence in 1 and 2 years. The secondary outcome measure is the occurrence of advanced adenoma in 1 and 2 years. Discussion: This study will provide objective evidences to evaluate the efficacy and safety of Xiaoai Jiedu Decoction as an adjuvant treatment for new CAP occurrence in post-polypectomy. Trial registration: NCT03616444.

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Section: Interventionsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Traditional Chinese medicine (Xiaoai Jiedu Decoction) as an adjuvant treatment for prevention new colorectal adenomatous polyp occurrence in post-polypectomy

et al. 2019

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“…Colorectal adenoma is a relatively common benign lesion with potential for carcinogenesis ( 1 – 3 ). Its incidence increases with age after 30 years, and it is common in Chinese people >40 years (~40–50%), including sporadic and familial cases ( 4 ).…”

Section: Introductionmentioning

confidence: 99%

Regulatory effect between HMGA2 and the Wnt/β‑catenin signaling pathway in the carcinogenesis of sporadic colorectal tubular adenoma

Cao

Wang

et al. 2021

Oncol Lett

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Due to the high incidence of colorectal cancer worldwide, the underlying molecular mechanisms have been extensively investigated. The Wnt/β-catenin signaling pathway plays a key role in the carcinogenesis of colorectal adenoma. In addition, the high mobility group AT-hook 2 (HMGA2) protein, which is involved in several biological processes, such as proliferation, differentiation, transformation and metastasis, is expressed at significantly high levels in colorectal cancer tissues compared with adjacent normal tissues. Currently, the role of HMGA2 in the carcinogenesis of sporadic colorectal tubular adenoma remains unclear. The downstream Wnt/β-catenin signaling molecule, T-cell factor/lymphoid enhancing factor (TCF/LEF), shares a similar domain with HMGA2, which enhances β-catenin transcriptional activity and TCF/LEF binding. Thus, the present study investigated the association between HMGA2 and the Wnt/β-catenin signaling pathway, and their role in the carcinogenesis of sporadic colorectal tubular adenoma via immunohistochemistry, siRNA, quantitative PCR and western blot analyses. The results demonstrated that the positive rate of HMGA2 expression gradually increased during tumor progression. Furthermore, HMGA2 expression was positively correlated with Wnt/β-catenin signaling protein expression [Wnt, β-catenin, cyclin-dependent kinase 4 (CDK4) and cyclin D1], suggesting its involvement in the carcinogenesis of sporadic colorectal tubular adenoma and its potential to synergistically interact with the Wnt/β-catenin signaling pathway. HMGA2 knockdown in the human colorectal cancer cell line, HCT 116 decreased β-catenin expression and its downstream targets, CDK4 and cyclin D1. Furthermore, silencing of Wnt or β-catenin decreased HMGA2 expression. Taken together, the results of the present study suggest the coordinated regulation of HMGA2 and the Wnt/β-catenin signaling pathway in the carcinogenesis of sporadic colorectal tubular adenoma.

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A prospective multicenter randomized controlled trial on artificial intelligence assisted colonoscopy for enhanced polyp detection

Park,

Kim,

et al. 2024

Sci Rep

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Colon polyp detection and removal via colonoscopy are essential for colorectal cancer screening and prevention. This study aimed to develop a colon polyp detection program based on the RetinaNet algorithm and verify its clinical utility. To develop the AI-assisted program, the dataset was fully anonymized and divided into 10 folds for 10-fold cross-validation. Each fold consisted of 9,639 training images and 1,070 validation images. Video data from 56 patients were used for model training, and transfer learning was performed using the developed still image-based model. The final model was developed as a real-time polyp-detection program for endoscopy. To evaluate the model's performance, a prospective randomized controlled trial was conducted at six institutions to compare the polyp detection rates (PDR). A total of 805 patients were included. The group that utilized the AI model showed significantly higher PDR and adenoma detection rate (ADR) than the group that underwent colonoscopy without AI assistance. Multivariate analysis revealed an OR of 1.50 for cases where polyps were detected. The AI-assisted polyp-detection program is clinically beneficial for detecting polyps during colonoscopy. By utilizing this AI-assisted program, clinicians can improve adenoma detection rates, ultimately leading to enhanced cancer prevention.Colorectal cancer occurs sporadically in approximately 75% of the cases and follows the adenoma-carcinoma sequence theory 1 . Therefore, the removal of colorectal adenomas is crucial for preventing colorectal cancer. Colonoscopy is the standard screening approach. Quality control in colonoscopy is of utmost importance, and numerous guidelines have emphasized the importance of ensuring high-quality examinations. Moreover, the term 'high quality examination' is frequently highlighted in various colonoscopy-related guidelines. Quality control in colonoscopy involves several parameters, one of which is minimizing the adenoma missing rate (AMR) or increasing the adenoma detection rate (ADR) 2 . This encompasses factors such as bowel preparation and endoscopist skill. The ADR in colonoscopy serves as a relatively objective indicator for assessing the quality of the procedure and has been utilized as an essential metric to enhance colonoscopy performance. Many attempts have been made to improve ADR, including the use of transparent caps, attached devices for scope stabilization, adequate examination time, and improved endoscopic techniques.Recently, the development of artificial intelligence (AI) has resulted in numerous AI-related solutions in the medical field. Gastroenterology has made significant efforts in the application of use AI, particularly for the detection of colorectal polyps during colonoscopy. Various AI-assisted technologies have been developed, and

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Does Increased Adenoma Detection Reduce the Risk of Colorectal Cancer, and How Good Do We Need to Be?

Cited by 3 publications

References 48 publications

Traditional Chinese medicine (Xiaoai Jiedu Decoction) as an adjuvant treatment for prevention new colorectal adenomatous polyp occurrence in post-polypectomy

Traditional Chinese medicine (Xiaoai Jiedu Decoction) as an adjuvant treatment for prevention new colorectal adenomatous polyp occurrence in post-polypectomy

Regulatory effect between HMGA2 and the Wnt/β‑catenin signaling pathway in the carcinogenesis of sporadic colorectal tubular adenoma

A prospective multicenter randomized controlled trial on artificial intelligence assisted colonoscopy for enhanced polyp detection

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