Jerome Waye, MD, MACG, titled his presentation for the David Sun Lecture at the American College of Gastroenterology’s (ACG) Postgraduate Course “Colon Polyps: Going and Gone,” addressing the remarkable advances in procedures to visualize and remove polyps from the colon and how colorectal cancer surveillance is likely to progress into the future.

Dr. Waye is Professor Emeritus at the Icahn School and director of the Center for Advanced Colonoscopy and Polypectomy at Mount Sinai Medical Center in New York City.

Most colon polyps can be removed colonoscopically today, Dr Waye said, noting that “endoscopic mucosal resection (EMR) is the standard of care for large (>20 mm) polyps. We can actually, piece by piece, take off even very large polyps now.”

Thanks to these advances in colonoscopy, “We can markedly decrease the incidence of colon cancer by removing polyps,” he said. And he noted that the ACG “was ahead of the curve by recommending that screening colonoscopy begin at age 45, which is now the accepted rule.”

However, Dr Waye said, “Screening won’t eradicate colon cancer. Now we are looking for that one small cell that becomes abnormal,” using artificial intelligence to detect tiny irregularities with the potential to develop into carcinoma. He explained, “AI can detect a very small polyp and even predict if it’s likely to be an adenoma or hyperplastic polyp. AI definitely seems to be the way to go.”

He noted that there are multiple opportunities to intervene between the early beginnings of abnormality in a single cell and the development of carcinoma, with perhaps the most promising being “the detection of methylation abnormalities.”

Vascularity in colonic polyps is a critical factor, Dr Waye stated. “There are 10 million crypts in the colon, each containing about 2000 cells and being replaced every week, all surrounded by vascularity. Tumors in the colon are markedly vascularized, even more than normal crypts; as these cells are being replaced tumor DNA can be ejected into the vascular system.”

This allows the detection of “all sorts of information that we can extract to find out what’s going on in the colon; we can even find cell tumor DNA. We can find multiple opportunities for intervention, to send ‘stop’ signals back to the tumor cells in the colon,” he stated.

Liquid biopsies are probably the wave of the future,” Dr Waye continued. “We could eradicate colon cancers. This will be the end of colonoscopy for neoplastic diseases.”

However, he added, these advances will come through scientific breakthroughs that will require time to develop. “There will still be work for us to do for a long time to come.”

--Rebecca Mashaw

Waye, JD. The David Sun lecture – colon polyps: going and gone. Presented at the American College of Gastroenterology Postgraduate Course. October 23, 2021.