Prevalence of colonic adenomas in patients with metabolic syndrome Występowanie gruczolaków jelita grubego u chorych z zespołem metabolicznym

Abstract Introduction: Seventy percent of colonic polyps are adenomas -benign neoplastic tissue deriving from epithelium with various grades of dysplasia. Metabolic syndrome is discussed as one of the risk factors for development of colonic adenomas. Aim: To evaluate the relation between metabolic syndrome and prevalence of colonic polyps. Material and methods: In 2008-2011, 151 patients (aged 50-70 years) from the city of Strzegom were enrolled in a prophylactic programme. Each patient had the following examinations performed: physical examination, abdomen ultrasound, chest X-ray, oesophagogastroduodenoscopy, colonoscopy, ECG and laboratory tests. In females mammography and gynaecological examination were performed, and in males prostate-specific antigen (PSA) level was evaluated. Results: The prevalence of adenomas was higher in patients with metabolic syndrome (33.3% vs. 20.6%, p < 0.05). Also higher prevalence of adenomas larger than 10 mm was found in patients with metabolic syndrome. HDL level above 95 mg% and HDL level 45-95 mg% with fulfilled criteria of metabolic syndrome were determined as risk factors of colonic adenoma development. Conclusions: Metabolic syndrome can be a risk factor for development of colonic adenomas. Adenoma growth can be accelerated in metabolic syndrome. HDL molecules can promote colonic proliferation and formation of adenomas

The preparation of patients taking anticoagulants for endoscopic procedures

Drugs that inhibit platelet aggregation and  anticoagulants are widely used in  primary and  secondary prevention of thromboembolism and treatment of venous thrombosis. The use of these drugs is associated with an increased risk of bleeding during an endoscopic procedure, and their discontinuation leads to an increased risk of a thromboembolic event. The paper presents how to assess risk and how to prepare a patient treated with antiplatelet or anticoagulant drugs for endoscopic procedures. In each case, one should consider indications and planned duration of treatment as well as urgency of  the procedure. Diagnostic gastroscopy and  colonoscopy do  not usually require treatment modification, while the procedures with increased risk of bleeding require a change in therapy. In the case of antiplatelet drugs, it may be needed to stop it at a proper time before endoscopy. In the case of a dual antiplatelet therapy, when there are absolute indications for its use, one should consider postponing the procedure. Patients with increased risk of bleeding, treated with vitamin K antagonists, should have the treatment temporarily stopped and replaced with a bridging therapy with low molecular weight heparin; if the thromboembolic risk is assessed as low, a bridge therapy is not needed. The time to suspend the use of oral anticoagulants which are non-vitamin K antagonists depends on the risk of bleeding and renal function. Decisions concerning treatment may require consultation of a specialist ordering the anticoagulant or antiplatelet therapy as well as the opinion of an endoscopy centre in which the procedure is to be conducted. The doctor performing the examination should be informed about the treatment used by the patient and its modification