Retrospective Cohort Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Mar 15, 2024; 16(3): 750-760
Published online Mar 15, 2024. doi: 10.4251/wjgo.v16.i3.750
Mucosa color and size may indicate malignant transformation of chicken skin mucosa-positive colorectal neoplastic polyps
Ying-Jie Zhang, Meng-Xia Yuan, Wu Wen, Fan Li, Yi Jian, Chuan-Ming Zhang, Ye Yang, Feng-Lin Chen
Ying-Jie Zhang, Meng-Xia Yuan, Wu Wen, Fan Li, Yi Jian, Chuan-Ming Zhang, Department of Digestive Diseases, Chengdu Second People’s Hospital, Chengdu 610000, Sichuan Province, China
Ye Yang, Feng-Lin Chen, Graduate School, Chengdu Medical College, Chengdu 610000, Sichuan Province, China
Author contributions: All authors contributed to the study conception and design; material preparation, Zhang YJ, Wen W, Li F, and Yuan MX performed data curation, and formal analysis; Zhang YJ, Jian Y, Zhang CM, and Yuan MX performed project administration and supervision; Zhang YJ wrote the original draft; Yuan MX, Yang Y, and Chen FL contributed to review and editing; All authors commented on subsequent versions of the manuscript, and all authors read and approved the final manuscript.
Supported by the Science and Technology Plan Project of Chengdu Municipal Health Commission, No. 2019007.
Institutional review board statement: This study was approved by the Ethics Committee of Chengdu Second People's Hospital, No. 2021018.
Informed consent statement: The requirement for informed consent was waived because our study does not invade personal privacy and has little risk to patients.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Meng-Xia Yuan, MD, Doctor, Department of Digestive Diseases, Chengdu Second People’s Hospital, No. 10 Qingyun South Street, Chengdu 610000, Sichuan Province, China. 1062274198@qq.com
Received: October 26, 2023
Peer-review started: October 26, 2023
First decision: December 5, 2023
Revised: January 2, 2024
Accepted: February 6, 2024
Article in press: February 6, 2024
Published online: March 15, 2024
Abstract
BACKGROUND

Lipid metabolism reprogramming is suspected to exist in pre-cancerous lesions, including colorectal adenoma. Screening colonoscopy frequently reveals chicken skin mucosa (CSM; white or yellow-white speckled mucosa) surrounding colorectal polyps, caused by macrophages engulfing and accumulating the lipids decomposed by colon cells or adjacent tumors. CSM-positive colorectal polyps are associated with various diseases; however, their prognosis varies greatly. Cold snare polypectomy is commonly used to resect lesions up to 10 to 15 mm in diameter without signs of submucosal invasion but is controversial for CSM-positive colorectal polyps. Improved imaging is required to diagnose and treat CSM-positive colorectal polyps.

AIM

To highlight the clinical significance of CSM surrounding colorectal polyps and clarify the associated treatment for endoscopists.

METHODS

This retrospective cohort study included 177 patients with CSM-positive colorectal polyps diagnosed using endoscopy. All patient-related information was extracted from the Goldisc soft-clinic DICOM system or electronic medical record system. Based on the pathological results, patients were classified as non-neoplastic polyps (five juvenile polyps), neoplastic polyps, non-invasive high-grade neoplasia (NHGN), or submucosal invasive carcinoma (SM stage cancer). We analyzed and compared the clinical features, suspected risk factors for malignant transformation of neoplastic polyps, and early infiltration of submucosal carcinoma.

RESULTS

The diameters of NHGN and SM polyps were much smaller than those of neoplastic polyps. Most NHGN polyps had a deeper red mucosal color. On logistic regression analyses, diameter and deeper red mucosal color were independent risk factors for malignant transformation of neoplastic polyps. Type 1 CSM was more common in high-grade intraepithelial neoplasia and SM; type 2 CSM was more common in neoplastic polyps. Logistic regression analyses revealed no significant differences in the malignant transformation of neoplastic polyps or early submucosal invasion of CSM-positive colorectal cancer. Changes in the CSM mucosa surrounding neoplastic polyps and submucosal invasion of colorectal cancer disappeared within 12 months. No tumor recurrence was found during either partial or complete endoscopic resection of the CSM.

CONCLUSION

CSM-positive colorectal polyps > 1 cm in diameter or with deeper red mucosa may be related to NHGN. Resection of CSM surrounding colorectal adenomas did not affect tumor recurrence.

Keywords: Chicken skin mucosa, Colorectal cancer, Colorectal polyps, Endoscopic resection, Malignant transformation, White light endoscopy

Core tip: Chicken skin mucosa (CSM) has emerged as a critical feature of early colorectal cancer or pre-cancerous lesions. We performed further risk stratification analysis of CSM-positive colorectal polyps under white light endoscopy. Possible risk factors of malignant transformation and submucosal infiltration of CSM-positive colorectal polyps were proposed. Cold snare polypectomy was determined to be inadequate. CSM type was not associated with malignant transformation of neoplastic polyps or early submucosal invasion. We also confirmed that partial or complete resection of the CSM around colorectal adenomas did not affect tumor recurrence. The CSM disappeared within 12 months after polypectomy.