Introduction

A significant amount of the population, especially the elderly, are receiving antithrombotic drugs. There is a significant association between antithrombotic therapy (AT) and gastrointestinal bleeding that leads to gastrointestinal cancer detection.

Aims & Methods

The aim of our study is to investigate the possibility that the administration of AT contributes, through the early onset of symptoms, to the early diagnosis of digestive neoplasms. Patients of the department’s gastroenterology and oncology units who were followed for gastric or colon neoplasm were analyzed retrospectively. Exclusion criteria included screening colonoscopy, and patients with idiopathic inflammatory bowel diseases or neuroendocrine neoplasms. AT was defined as anticoagulant or antiplatelet therapy.

Results

152 patients were included, with a mean age of 69.6 ± 10 years, of which 89 were men (58.6%). The majority (84.2%) had colorectal cancer. Forty-nine patients were diagnosed with a bleeding episode (32.2%) and 42 in the context of anemia investigation (27.6%). Fifty-five patients were receiving AT (36.2%). The main reason for receiving AT was the presence of coronary artery disease. Most patients were diagnosed with cancer stage III (45.4%) and II (30.3%). A statistically significant association was observed between the use of AT and an earlier cancer stage at diagnosis (p=0.001). 54.5% of patients receiving AT were diagnosed at an early stage (I or II), compared to 30.9% of patients not receiving AT. Patients diagnosed after a bleeding episode or onset of anemia while receiving AT had an earlier stage of disease at diagnosis than the rest of the sample (p=0.002). 62.5% of these patients were diagnosed at an early stage (I or II), compared to 32.1 % of patients in other groups.

Table: Cancer stage at diagnosis according to AT use

Conclusion

Antithrombotic drugs may promote an earlier diagnosis of neoplasms of the digestive tract due to the earlier appearance of bleeding, diffuse or occult. In this subset of patients, a bleeding event, barring significant short term morbidity, may facilitate earlier diagnosis and treatment of the underlying disease..

Introduction

Currently, gastric cancer screening is only cost-effective in countries with high incidence. Colorectal cancer screening is an effective method for the reduction of CRC incidence and receives high attendance rates. Integrated screening, where gastroscopy is performed in conjunction with colonoscopy, could help reduce the gastric cancer screening procedure burden in countries with low or intermediate incidence. However, there is a lack of population-based studies providing data on groups at high risk for mortality from gastric malignancies that might benefit from this approach.

Aims & Methods

In this retrospective analysis of a colorectal cancer screening program database, we used Cox proportional hazards model to identify an association of high-risk and low-risk finding (polyps ≥ 10mm or with high-grade dysplasia vs <10 mm and no high-grade dysplasia or advanced adenoma vs non-advanced adenoma) with time to death from
upper gastrointestinal (esophageal and gastric) cancer. To quantify the burden of deaths from upper GI cancer in screening participants with high-risk or low-risk polyps in relation to the general population, we calculated standardized mortality ratios.

Results

We included 331,284 CRC high-quality screening colonoscopies in our study. The median follow-up time was 5.04 years (95% CI 5.03-5.07). 4.4% of participants had polyps ≥10 mm or with HGD and 7.7% had advanced adenomas. At the end of the study period, 296 deaths of upper GI cancer had occurred, corresponding to a rate of 10.29 deaths per 100,000 person years in women and 26.61 deaths per 100,000 person years in men. In participants with non-advanced adenomas, hazards for upper GI cancer death were similar compared to participants with advanced adenomas (HR 1.37, 95% CI 1.01-1.72 and HR 1.35, 95% CI 0.94-1.95) when taking participants with a negative colonoscopy as the reference. However, in participants with polyps ≥10 mm or HGD, hazards for upper GI cancer death were higher (HR 1.70, 95% CI 1.07-1.66). Participants with polyps <10 mm and no HGD experienced significantly fewer deaths from upper GI cancer than the general population (SMR 0.71, 95% CI 0.61-0.83, p<0.001), however, participants with high-risk polyps had an upper GI cancer mortality which was similar to that of the population (SMR 0.90, 95% CI 0.60-1.29, p = 0.6).

Conclusion

CRC screening participants with polyps <10 mm and no HGD have a lower risk for mortality from upper gastrointestinal cancers compared to participants with polyps >10 mm and HGD or the general population. In these participants, additional upper GI screening efforts might not be useful. However, future studies will demonstrate whether integrated screening with additional gastroscopy is effective in CRC screening participants with large or highly dysplastic polyps.

Introduction

It remains unknown whether gastric histopathology is associated with the occurrence of colorectal diseases.

Aims & Methods

Aims：We aimed to clarify the association between gastric histopathology and colorectal diseases, especially colorectal polyps (CP). On this basis, we established risk prediction models for different colorectal diseases.
Methods: A retrospective cross-sectional study was conducted on 2540 patients who underwent gastroscopy and colonoscopy simultaneously in The Affiliated Wuxi People's Hospital of Nanjing Medical University from January 1, 2021 to August 31, 2023. Basic demographic data, previous medical history, clinical symptoms, important laboratory indicators, and gastric histopathology classification were collected for univariate and multivariate analysis. The nomogram model was constructed with R language while its calibration was tested by Hosmer-Lemeshow, its discrimination was evaluated by Area Under the ROC Curve (AUC), and its clinical efficacy was evaluated by Decision Curve Analysis (DCA).

Results

1: According to the results of colonoscopy, patients were divided into Normal group (N=601); Non-adenomatous polyp group (N=576); Adenomatous polyp group (N=1116); Inflammatory bowel disease group (N=149) and Colorectal cancer group (N=98). The average age of the five groups was (55.04±13.95) years, (58.74±11.58) years, (61.83±10.19) years, (50.48±16.64) years, and (66.10±10.80) years, respectively. The CRC group had the largest proportion of males, accounting for 59.2% (n=58).
2: The results of gastroscopy were divided into: Normal; NAG (non-atrophic gastritis); AG or IM (atrophic gastritis/intestinal metaplasia); Gastric polyps; Esophageal cancer; and SC-patho (pathological gastric cancer). The association between indicators and colonoscopy results was analyzed to establish risk prediction models for different colorectal diseases. We found that gastric histopathology was significantly correlated with NAP and AP; for clinical symptoms, abdominal pain was significantly correlated with colorectal diseases, and the contribution ranking was: NAP>IBD>CRC>AP; hematochezia was significantly correlated with IBD; for clinical indicators, anemia was significantly correlated with AP, and CEA was significantly correlated with CRC; for previous medical history, previous colonoscopy examination was significantly correlated with colorectal diseases, and the contribution ranking was: NAP>CRC>AP>IBD; history of hypertension and rheumatism disease were significantly correlated with NAP; history of chronic kidney disease and rheumatism disease were significantly correlated with AP; history of chronic kidney disease and gastrointestinal tumor were significantly correlated with CRC; history of hypertension and thyroid nodules were significantly correlated with IBD; for demographic indicators, age was significantly correlated with NAP, AP, and CRC; while BMI was significantly correlated with IDB.
3: Using R language to establish the nomogram prediction model, we could find that: all the prediction models had good discrimination, and the AUC of the CRC model reached 0.885. Through the calibration curve, we could find that all prediction models has strong consistency, among which the AP model has the highest consistency and the smallest absolute error value of 0.007.

Conclusion

The nomogram prediction model has good discrimination and calibration, and has good clinical value for predicting the occurrence probability of different colorectal diseases.

Introduction

Colorectal cancer (CRC) screening reduces cancer risk, yet real-world adherence to screening remains variable. We aimed to leverage a large healthcare organization longitudinal cohort to evaluate factors that influence the timeliness of adherence to screening guidelines.

Aims & Methods

We included average-risk Maccabi Healthcare Services members aged 50–75 years who were alive on 1 January 2025. Demographics, comorbidities, hemoglobin values, and dates of fecal immunochemical test(FIT), CT-colonography (CTC) and colonoscopy were extracted.
Adherence was defined as annual FIT, colonoscopy every 10 years, or CTC every 5 years.
Patients covered for >50 % versus ≤50 % of follow-up time by screening guidelines were compared with Wilcoxon rank-sum (continuous) and χ²/Fisher’s exact (categorical) tests.
In order to study factors associated with adherence times, longitudinal adherence was modelled with a gap-time Andersen–Gill Cox regression. The dependent variable was time (in periods) to the recurrent event active adherence. Adjusted hazard ratios (HRs) and 95 % confidence intervals (CI) were estimated with robust variance, clustering on patient ID to account for within-subject correlation.

Results

Our cohort comprised 590,550 adults at screening age, contributing 6,581,044 person-years of follow-up. In a baseline comparison between individuals whose proportion of time covered was less than 50%(n=282,347) vs more than 50%(n=308,203), the latter group was older (60.00 [55.00, 68.00] years vs 62.00 [57.00, 67.00] years, p-value<0.001) with a longer median follow up (9.0 [4.0, 17.0] years vs 11.0 [6.0, 16.0] years, p-value<0.001). Higher prevalence of hypertension (17.5 % vs 12.0 %, p-value<0.001), diabetes mellitus (8.2 % vs 5.8 %, p-value<0.001), pre-diabetes (22.4 % vs 17.5 %, p-value<0.001), and cardiac disease (4.8 % vs 3.4 %, p-value<0.001) were seen among the more compliant group. Consistent with greater adherence, endoscopic referral was more common at baseline in the more compliant group (6.2 % vs 1.0 %, p-value<0.001). Interestingly. Although the differences in distributions of sector, district and socioeconomic rank categories were significant, the absolute percentage differences across strata were small and unremarkable (<3 percentage points for any category).
A gap-time survival model demonstrated that each additional year of age was associated with longer intervals and a lower aHR for active adherence (aHR 0.94, 95 % CI 0.94–0.94). Men undergone screening tests marginally sooner than women (aHR 1.05, 95% CI 1.04–1.05). Adherence was lower in the orthodox sector (aHR 0.84, 95% CI 0.84–0.85). Metabolic or cardiovascular conditions translated into earlier adherence: pre-diabetes (aHR 1.63, 95% CI 1.62-1.63), diabetes (aHR 1.54, 95% CI 1.54-1.55), hypertension (aHR 1.22, 95% CI 1.21-1.23), cardiac disease (aHR 1.14, 95% CI 1.14-1.15), and obesity (aHR 1.10, 95% CI 1.10-1.11). Severe conditions and subjects included in severe disease registry were associated with lower adherence (aHR 0.33, 95% CI 0.30-0.38; and aHR 0.63, 95% CI 0.59-0.67, respectively). Recent higher hemoglobin levels delayed active adherence (aHR 0.97 per each increase of 1 g/dL, 95% CI 0.97-0.98).

Conclusion

Our results suggest that long term compliance for CRC screening is related to age as well as for chronic medical conditions, particularly metabolic and cardiovascular. Screening efforts should therefore be aimed at healthy subjects or those with minor contact with medical providers.

Introduction

​The actual screening of colorectal cancer (CRC) includes people of 45 years old and patients with alcoholic liver cirrhosis (LC) have an elevated risk of developing colon cancer. Curative treatment of CRC in patients with an existing diagnosis of LC can be a challenge, requiring major surgical resection and may include liver-toxic chemotherapy. Postoperative morbidity and mortality are elevated in patients with LC. For improved survival, optimization of liver function is more important than adjuvant chemotherapy.

Aims & Methods

Our study included 149 hospitalized LC patients Classes Child- Pugh A, B and C, meanage 56 years old, during April 2023-March 2024, of which 13 cases presented lower bleeding, iron deficiency anemia, intestinal transit disorders, abdominal pain, and familial history of CRC. Clinical and paraclinical diagnostic of CRC in LC patients were made by digital rectal examination, hematological samples, rectosigmoidoscopy, total colonoscopy, abdominal ultrasound, computed tomography and magnetic resonance imaging.

Results

Biological tests indicated anemia, trombocitopenia, increased ESR, biochemical liver tests increased, occult bleeding (FIT), and the increase of the tumor markers CA19-9, AFP, CEA that is particularly useful for monitoring treated CRC. Flexible rectosigmoidoscopy detected six cases of rectal cancer, three cases of rectosigmoidian tumors, and total colonoscopy was the "gold standard" imaging investigation that detected two cases of descending colon cancer, one case of hepatic flexure tumor and one patient with ascending colon cancer. Of patients with LC Class Child Pugh A, 6 cases were operated by laparotomy, being referred to Oncology Institute with favorable outcomes, and the rest of seven patients with LC Class Child Pugh B and C had advanced CRC, being treated by chemotherapy. Abdominal ultrasound visualizes liver metastases, abdominal lymph nodes and CT, MRI were the main methods used for staging CRC before surgical and oncological treatment.

Conclusion

Colonoscopy is the exploration of choice in CRC detection with 97% sensitivity, providing histopathological examination by tumor biopsy and also diagnosis of synchronous cancer. Early diagnosis of CRC is essential to prevent complications and increase the survival rate in LC. Men with LC are predominantly affected of CRC. Abdominal ultrasound, CT or MRI are the main imaging investigations recommended in CRC staging before the surgical and oncological treatment. Laparotomy should be preferred in patients with LC. Survival rate is strongly associated with the improvements in liver function. Echoendoscopy, immunoscintigraphy with monoclonal antibodies can be useful in CRC and genetic testing of tumor DNA markers in stool can be recommended in families with genetic syndromes (Turcot, FAP).

Introduction

Aims & Methods

Aims: To assess for evidence of association between a symptomatic FIT ≥10μgHb/g and 1 year risk of other GI cancers and influence of age and anaemia on these associations.
Methods: A regional cohort study inclusive of all patients who underwent a symptomatic FIT between 2017-2023 in Nottingham. Heatmaps, stratifying by age group and blood results were constructed to display the cumulative 1-year cancer risks using Kaplan-Meier estimates.

Results

370 (0.54%) out of 68,538 patients were diagnosed with a non-colorectal GI cancer within 1-year of symptomatic FIT. 242/54,855 (0.44%) patients diagnosed with non-colorectal GI cancer had a FIT<10μgHb/g compared to 128/13,683 (0.94%) with a FIT≥10μgHb/g (p<0.0001). A FIT≥10μgHb/g was associated with increased risk of oesophagogastric (p<0.0001) and small bowel (p<0.0001) cancer compared to FIT<10μgHb/g, yet the absolute risks of each were low (<0.5%). There was no association between FIT result and subsequent hepatopancreatobiliary malignancy. When stratified by FIT result, age and blood results the highest risks were seen in patients with anaemia (Table 1). The cumulative risk of small bowel cancer with a FIT≥10μgHb/g in patients under 40 years with anaemia was 0.8% (95%CI: 0-2.35%). The cumulative risk of oesophagogastric cancer with FIT≥10μgHb/g and anaemia in the age group 71-85 was 0.85% (95%CI: 0.49-1.2%).

Conclusion