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Background and Study Aims: Positron emission tomography/computed tomography (PET/CT) with 2-[18F]FDG (FDG) has been increasingly used to detect or monitor neoplasms. Gastrointestinal tract (GIT) is one of the most common sites of FDG uptake, leading to increasing requests for endoscopic examinations. We aimed to evaluate the nature and significance of unexpected PET/CT-FDG findings in the GIT. Patients and Methods: We retrospectively analyzed 371 consecutive patients with incidental GIT findings on PET/CT-FDG between June 2016 and October 2021 who were subsequently referred to endoscopic examinations. Demographic data, PET/CT-FDG results, endoscopic findings, and histological analysis were analyzed. Results: Of 194 colonic incidental uptakes, 102 (52.6%) corresponded to at least premalignant lesions, being 57 (29.4%) advanced adenomas and 23 (11.9%) adenocarcinomas. Of 193 upper GIT incidental uptakes, there were 11 (13.8%) esophageal and 14 (14.4%) gastric malignant/premalignant lesions. The maximum standardized uptake value (SUVmax) significantly varied according to the nature of the lesion, being higher in malignant lesions (in the esophagus, stomach, and colon). However, an optimal SUVmax cutoff was only found for stomach (SUVmax 8.2; sensitivity of 79% and specificity of 76%). There was a significant association between the site of uptake and the nature of the lesion – left colon and gastric body uptake were associated with neoplastic origin whereas rectum and lower esophagus were associated with inflammatory or no endoscopic changes. Conclusions: Any incidental uptake in the lower GIT should be investigated provided that patients are suitable for further treatment. However, in the upper GIT the characteristics of uptake on 18F‐FDG‐PET/CT may allow to select those who need endoscopic examination.

Background:A colorectal polyp (CRP) is a growth on the lining of the colon or rectum. The incidence of CRPs is rapidly increasing with age. They are most often benign. The rectum is the most commonly affected site. Objectives:To determine the incidence, clinical presentation, and histopathologic types of CRP in Iraqi patients. Materials and Methods:It is a cross-sectional screening study conducted in the medical city of Baghdad,Iraq. The total number of colonoscopies done in the medical city/GIT center was 2658 from May 2020–September 2022, where 100 patients with the diagnosis of CRP has collected. The males comprised 60/100 and their ages ranged from 4 to 75 years. Results:The most common age group affected was 46–59 years. There was a significant relationship between site and types of CRP, where the rectum showed 48% involvement, followed by the sigmoid colon at 34%. The villous adenomatous polyps look of large size ranging from 1.5 to 4 cm. The tubulovillous adenoma is the most common type, 25%. Lower gastrointestinal bleeding is the most common presentation, 25%. Conclusion:The most common age group affected was 46–59 years, with male-to-female ratio is 1.17. The most common site affected by CRPs was the rectum 48%, villous adenoma has the most significant size among all types (1.5–4 cm). No dysplasia was the most common finding (45%), and lower GIT bleeding and positive family history were the most common clinical presentation.

Colorectal polyps are noteworthy because of their role in the development of various clinical conditions and their malignant potential. McKittrick-Wheelock syndrome, one of these clinical conditions, is characterized by dehydration, tenesmus, secretory diarrhea, fluid-electrolyte disturbance (hyponatremia, hypokalemia, hypochloremia, metabolic acidosis), and prerenal acute renal failure accompanied by large colorectal villous adenomas. Large villous adenomas, which cause the syndrome due to the hormones and secretions they produce, carry a high risk of invasive cancer because of their size and histological type. Definitive surgery or endoscopic resection following supportive treatment for fluid-electrolyte disorders is essential in the syndrome’s treatment and leads to an increase in survival rate and quality of life. In this case report, we aim to present this rare syndrome and the synchronous tumor accompanying it for the first time in the literature.

Abstract Background To investigate the effect of different working periods on missed diagnoses in patients with colorectal polyps in colonoscopy. Methods We conducted a retrospective analysis of patients who were diagnosed with colorectal polyps during colonoscopy in an outpatient department between July and December 2022. These patients were subsequently hospitalized for resection during this period. Patients with missed diagnoses were those who had newly discovered polyps in a second colonoscopy. The working periods were categorized as work, near the end of work, and delayed work, respectively, in the morning and afternoon. Results A total of 482 patients were included, and the miss rate of diagnosis was 48.1% (232/482), mainly in the transverse colon (25%), and the ascending colon (23%). Patient age was a risk factor for the miss rate of diagnosis (OR = 1.025, 95%CI: 1.009–1.042, P = 0.003) and was also associated with the number of polyps detected for the first colonoscopy (χ2 = 18.196, P = 0.001). The different working periods had no statistical effect on the missed rate of diagnosis (χ2 = 1.998, P = 0.849). However, there was an increasing trend in miss rates towards the end of work and delayed work periods, both in the morning and afternoon. The highest miss rate (60.0%) was observed during delayed work in the afternoon. Additionally, poor bowel preparation was significantly more common during delayed work in the afternoon. Conclusions The increasing trend in miss rates towards the end of work and delayed work periods deserves clinical attention. Endoscopists cannot always stay in good condition under heavy workloads.

Objectives: Artificial intelligence (AI) with white light imaging (WLI) is not enough for detecting non-polypoid colorectal polyps and it still has high false positive rate (FPR). We developed AIs using blue laser imaging (BLI) and linked color imaging (LCI) to detect them with specific learning sets (LS). Methods: The contents of LS were as follows, LS (WLI): 1991 WLI images of lesion of 2-10 mm, LS (IEE): 5920 WLI, BLI, and LCI images of non-polypoid and small lesions of 2-20 mm. LS (IEE) was extracted from videos and included both in-focus and out-of-focus images. We designed three AIs as follows: AI (WLI) finetuned by LS (WLI), AI (IEE) finetuned by LS (WLI)+LS (IEE), and AI (HQ) finetuned by LS (WLI)+LS (IEE) only with images in focus. Polyp detection using a test set of WLI, BLI, and LCI videos of 100 non-polypoid or non-reddish lesions of 2-20 mm and FPR using movies of 15 total colonoscopy were analyzed, compared to 2 experts and 2 trainees. Results: The sensitivity for LCI in AI (IEE) (83%) was compared to that for WLI in AI (IEE) (76%: p=0.02), WLI in AI (WLI) (57%: p

Abstract National consensus recommendations have recently been developed to standardize colorectal tumour localization and documentation during colonoscopy. In this qualitative semi-structured interview study, we identified and contrast the perceived barriers and facilitators to using these new recommendations according to gastroenterologists and surgeons in a large central Canadian city. Interviews were analyzed according to the Consolidated Framework for Implementation Research (CFIR) through directed content analysis. Solutions were categorized using the Expert Recommendations for Implementing Change (ERIC) framework. Eleven gastroenterologists and ten surgeons participated. Both specialty groups felt that the new recommendations were clearly written, adequately addressed current care practice tensions, and offered a relative advantage versus existing practices. The new recommendations appeared appropriately complex, applicable to most participants, and could be trialed and adapted prior to full implementation. Major barriers included a lack of relevant external or internal organizational incentives, non-existing formal feedback processes, and a lack of individual familiarity with the evidence behind some recommendations. With application of the ERIC framework, common barriers could be addressed through accessing new funding, altering incentive structures, changing record systems, educational interventions, identifying champions, promoting adaptability, and employing audit/feedback processes. Future research is needed to test strategies for feasibility and effectiveness.

Evidence on serum biomarkers as a non-invasive tool to detect colorectal adenoma (CRA) in the general population is quite promising. However, the sensitivity and specificity of these serum biomarkers in detecting disease are still questionable. This study aimed to systematically review the evidence on the diagnostic performance of serum biomarkers associated with CRA. Database searches on PubMed, Scopus, and WoS from January 2014 to December 2023 using PRISMA guidelines resulted in 4,380 citations, nine of which met inclusion criteria. The quality of these studies was assessed using the QUADOMICS tool. These studies reported on 77 individual/panel biomarkers which were further analysed to find associated altered pathways using MetaboAnlyst 5.0. Diagnostic accuracy analysis of these biomarkers was conducted by constructing a receiver operating characteristic (ROC) curve using their reported sensitivity and specificity. This review identified six potential serum metabolite biomarkers with 0.7

Accurate recognition of colorectal images assists doctors in screening for malignant intestinal diseases. Colorectal cancer can be induced by colorectal polyps, ulcerative colitis, and papillary adenoma. Colorectal polyp segmentation can be used to rapidly locate polyps using automated colorectal polyp segmentation technology, saving the time and cost of manual screening and providing patients with valuable treatment time. Therefore, designing an automatic identification and accurate segmentation method is crucial for clinicians to improve diagnosis efficiency. Aiming at the problems in colorectal polyp image segmentation, such as large regional scale variation, variable location, blurred edges, and low contrast between polyps and normal tissues, which lead to low accuracy of lesion segmentation and artifacts on the segmentation boundary, an adaptive network based on the Swin Transformer and graphical reasoning is proposed. First, the Swin Transformer encoder is used to extract the global context information of the input image layer by layer, weaken the interference of background information, and analyze the salient characteristics of the lesion area on a multiscale. Second, a global and local feature interaction module is proposed to enhance the spatial perception ability of the network on complex lesions, highlight the key position information of the target to be segmented, and accurately locate the target. Third, a region-guided graph inference module is used to mine the higher-order dominant relationship between prior information in the way of graph cyclic recurrence to promote the transmission of information between graphs. Fourth, an edge constraint graph inference module oriented to edge details is designed to integrate edge details and improve the segmentation effect and segmentation precision. Experiments were performed on the CVC-ClinicDB, Kvasir, CVC-ColonDB, and ETIS datasets. The Dice coefficients were 0.939, 0.926, 0.810, and 0.788, respectively, and the average intersection ratios were 0.889, 0.879, 0.731, and 0.710, respectively. The mean absolute errors were 0.006, 0.017, 0.030, and 0.012, respectively. Compared with the SSformer method based on the transformer structure, the Dice coefficients are increased by 2.3%, 0.1%, 3.8%, and 2.1%, respectively, and the average crossover ratio is increased by 1.6%, 0.1%, 3.4%, and 1.2%, respectively. The overall segmentation performance of the algorithm test is better than that of the existing method. The simulation results show that the image segmentation accuracy of colorectal polyps with complex shapes and structures, low contrast, and blurred edges is high.

Abstract Background To systematically analyze risk factors for delayed postpolypectomy bleeding (DPPB) in colorectum. Methods We searched seven large databases from inception to July 2022 to identify studies that investigated risk factors for DPPB. The effect sizes were expressed by relative risk (RR) and 95% confidence interval (95% CI). The heterogeneity was analyzed by calculating I 2 values and performing sensitivity analyses. Results A total of 15 articles involving 24,074 subjects were included in the study. The incidence of DPPB was found to be 0.02% (95% CI, 0.01–0.03), with an I 2 value of 98%. Our analysis revealed that male sex (RR = 1.64), history of hypertension (RR = 1.54), anticoagulation (RR = 4.04), polyp size (RR = 1.19), polyp size ≥ 10 mm (RR = 2.43), polyp size > 10 mm (RR = 3.83), polyps located in the right semicolon (RR = 2.48) and endoscopic mucosal resection (RR = 2.99) were risk factors for DPPB. Conclusions Male sex, hypertension, anticoagulation, polyp size, polyp size ≥ 10 mm, polyps located in the right semicolon, and endoscopic mucosal resection were the risk factors for DPPB. Based on our findings, we recommend that endoscopists should fully consider and implement effective intervention measures to minimize the risk of DPPB.

Background/Aims Colorectal cancer (CRC) and colorectal polyps are intimately linked, with polyps acting as precursors to CRC. Understanding the molecular mechanisms governing their development is crucial for advancing diagnosis and treatment. Employing a systems biology approach, we investigated the molecular similarities between polyp and CRC. Methods We analyzed gene expression profiles, protein-protein interactions, transcription factors, and gene ontology to identify common differentially expressed genes (DEGs) and unravel shared molecular pathways. Results Our analysis revealed 520 commonly dysregulated genes in polyps and CRC, serving as potential biomarkers and pivotal contributors to disease progression. Gene ontology analysis elucidated distinct biological processes associated with upregulated and downregulated DEGs in both conditions, highlighting common pathways, including signal transduction, cell adhesion, and positive regulation of cell proliferation. Moreover, protein-protein interaction networks shed light on subnetworks involved in rRNA processing, positive regulation of cell proliferation, mRNA splicing, and cell division. Transcription factor analysis identified major regulators and differentially expressed transcription factors in polyp and CRC. Notably, we identified common differentially expressed transcription factors, including ZNF217, NR3C1, KLF5, GATA6, and STAT3, with STAT3 and NR3C1 exhibiting increased expression. Conclusions This comprehensive analysis enriches our understanding of the molecular mechanisms underlying polyp formation and CRC development, providing potential targets for further investigation and therapeutic intervention. Our findings contribute substantively to crafting personalized strategies for refining the diagnosis and treatment of polyps and CRC.

Abstract Background Most colorectal cancers originate from precancerous polyps. This study aimed to determine the prevalence of colorectal polyps with diverse pathological morphologies and to explore the risk factors for colorectal carcinoma in situ (CCS) and neoplastic polyps. Methods Inpatients admitted from January 2018 to May 2023 were screened through the hospital information system. Polyps were classified according to pathological morphology. The prevalence of polyps was described by frequency and 95% confidence interval. Univariate and multivariate logistic regression analyses were used to explore the risk factors for CCS and neoplastic polyps. Results In total, 2329 individuals with 3550 polyps were recruited. Among all patients, 76.99% had neoplastic polyps and 44.31% had advanced adenomas. Tubular adenoma had the highest prevalence at 60.15%, and the prevalence of CCS was 3.86%. Patients with a colorectal polyp diameter ≥ 1.0 cm or number ≥ 3 were 8.07 times or 1.98 times more likely to develop CCS than were those with a diameter 1.0 cm) or multifocal polyps. The levels of the tumor markers CA724 and CA211 show some potential usefulness for predicting CCS and may be exploited for early identification of high-risk populations.

Colorectal cancer is a malignant tumor that mainly occurs in the tissues of the colon and rectum, and its early detection and treatment are of great significance. The early detection and prevention of colorectal cancer mainly involves visual examination of the patient??s intestines to screen for colorectal polyps, but manual examination has the disadvantage of high misdiagnosis rate. The auxiliary diagnostic system based on convolutional neural networks (CNN) has shown the most advanced performance in the diagnosis of colorectal polyps, and is currently a research hotspot in the field of computer-aided diagnosis. Based on important literature published in recent years, a systematic review of the application of convolutional neural networks in the auxiliary diagnosis of colorectal polyps is conducted. Firstly, the commonly used datasets in the field of colorectal polyp diagnosis are introduced, including image and video datasets. Secondly, the application of CNN in colorectal polyp detection, segmentation, and classification is systematically elaborated. The main improvement ideas, advantages and disadvantages, and performance of each algorithm are analyzed in depth, aiming to provide researchers with a more systematic reference, and summarize the interpretability of deep learning models. Finally, a summary of various algorithms for assisting the diagnosis of colorectal polyps based on CNN is provided, and future research directions are prospected.

IntroductionNonalcoholic or metabolism-associated fatty liver disease (NAFLD or MAFLD) and colorectal polyps are chronic conditions strongly linked to lifestyle factors. However, the precise causal link between NAFLD or MAFLD and the development of colorectal polyps is not yet fully understood. This study aimed to evaluate the association between NAFLD or MAFLD and the risk of colorectal polyps based on a meta-analysis and two-sample Mendelian randomization (MR) analyses.MethodsPubMed, Embase, Cochrane Library databases were searched for eligible studies to be included in the meta-analysis. We conducted a thorough search of the PubMed, Embase, and Cochrane Library databases to identify eligible studies prior to 22 March 2024. Subgroup analyses were performed based on sex, age, and geographical region. Causality between NAFLD/MAFLD and colorectal polyps was explored by using two-sample Mendelian randomization (MR) analyses.ResultsBased on an analysis of 17 studies encompassed within this meta-analysis, a significant correlation was identified between the presence of NAFLD/MAFLD and elevated incidence of colorectal polyps (NAFLD: OR = 1.57, 95% CI: 1.43–1.73, I2 = 38%, p = 0.06; MAFLD: OR = 1.67, 95% CI: 1.40–2.00, I2 = 77%, p = 0.002). However, current evidence does not support a causal relationship between NAFLD/MAFLD and the prevalence of colorectal polyps (OR = 0.9998315, 95% CI: 0.9987566–1.000907, P = 0.7587638).ConclusionNAFLD/MAFLD demonstrated a significant positive correlation with an elevated risk of developing colorectal polyps. However, the MR analysis suggested that no causal relationship existed between NAFLD/MAFLD and colorectal polyps. Therefore, further research is required to identify the underlying mechanism of causal link between these diseases.

The prevalence of colorectal cancer, primarily emerging from polyps, underscores the importance of their early detection in colonoscopy images. Due to the inherent complexity and variability of polyp appearances, the task stands difficult despite recent advances in medical technology. To tackle these challenges, a deep learning model featuring a customized U-Net architecture, AdaptUNet is proposed. Attention mechanisms and skip connections facilitate the effective combination of low-level details and high-level contextual information for accurate polyp segmentation. Further, wavelet transformations are used to extract useful features overlooked in conventional image processing. The model achieves benchmark results with a Dice coefficient of 0.9104, an Intersection over Union (IoU) coefficient of 0.8368, and a Balanced Accuracy of 0.9880 on the CVC-300 dataset. Additionally, it shows exceptional performance on other datasets, including Kvasir-SEG and Etis-LaribDB. Training was performed using the Hyper Kvasir segmented images dataset, further evidencing the model's ability to handle diverse data inputs. The proposed method offers a comprehensive and efficient implementation for polyp detection without compromising performance, thus promising an improved precision and reduction in manual labour for colorectal polyp detection.

BackgroundLimited research has explored the association between dietary soy products and colorectal polyps and adenomas, with insufficient attention given to cooking methods and subtypes of polyps. This study aimed to comprehensively assess the relationship between soy intake, its cooking methods, and the risk of colorectal polyps and adenomas within a high-incidence population of colorectal cancer (CRC) in China.MethodsData were derived from 14,903 participants aged 40–80 years, enrolled in the extended Lanxi Pre-colorectal Cancer Cohort (LP3C) between March 2018 and December 2022. This cross-sectional study is based on the participants’ baseline information. Long-term dietary information was collected through a validated food frequency questionnaire (FFQ), and colorectal polyps and adenomas were identified through electronic colonoscopy. Employing multivariate logistic regression, results were expressed as odds ratios (ORs) with their corresponding 95% confidence intervals (95% CIs).Results4,942 cases of colorectal polyps and 2,678 cases of adenomas were ascertained. A significant positive association was found between total soy intake and the occurrence of polyps/adenomas. Considering cooking methods, a notable increase in polyp risk was associated with the consumption of fried soys while no association was detected for boiled or marinated soys. Furthermore, total soy intake demonstrated associations with large and multiple polyps, polyps Yamade-typed less than II, and polyps across all anatomical subsites.ConclusionWithin the high-risk CRC population in China, increased soy product intake was linked to a higher risk of polyps, primarily attributed to the consumption of fried soys. This suggests that modifying cooking methods to avoid fried soys may serve as a preventive strategy for colorectal polyps.

Relevance. Adenomatous colorectal polyps are associated with a high risk of developing a malignant tumor. They are considered precancerous conditions and can lead to the development of colorectal cancer. To date, colorectal cancer ranks third in the world in frequency of occurrence among all malignant neoplasms.Objective. Improving the results of diagnosis and surgical treatment of patients with colorectal adenomatous neoplasms by identifying development factors and identifying risk groups for this nosology.Materials and methods. Analysis of literary data.Results. Among the factors leading to the development of colorectal polyps, it is worth noting a genetic predisposition, so by immunoblotting, PCR sequencing of the entire exome in cases of patients with familial dentate polyposis, rare variants of the germ line in the WNK2 gene were identified. Functional studies have shown that variants of the WINK2 germ line affect protein function in the context of the MAPK pathway, a molecular trait of this disease. Also, in the course of many domestic and foreign randomized clinical trials, the following modifiable factors for the development of adenomatous colorectal polyps were identified.Conclusion. The study revealed the factors of development and recurrence of colorectal neoplasms and identified risk groups for this nosology. The study revealed low compliance of patients with respect to changes in certain living conditions (the use of ethyl alcohol and products containing it, tobacco smoking, both active and passive, the fight against obesity and inactivity), which leads to recurrence and increases the risks of malignancy of colorectal polyps.

ndoscopic mucosal resection (EMR) is a therapeutic technique developed for the resectioning of sessile and flat lesions localized in the mucosa of any part of the gastrointestinal tract. It is easy to learn and allows the resection of large polyps that would otherwise require radical surgery. For early detection of neoplasia of the gastrointestinal tract, the screening program for colorectal cancer proved to be the most important, and its wide acceptance led to a decrease in the incidence and mortality rate. This article reviews EMR techniques and focuses on large colorectal polyps, representing the most common indication for EMR. Before starting resection, the endoscopist should carefully and thoroughly examine the lesion and differentiate between resectable lesions and those potentially affected by the submucosal invasion. There are different methods of evaluating polyps; more recently advanced techniques are also used. The characteristics of colorectal lesions, including location, size, morphology, and histology, influence the choice of the optimal method of removal. The EMR removes part of the wall of the colorectum that contains the mucosa, the muscularis mucosa and partially or completely, the submucosal layer. In addition to removing benign adenomas of varying degrees of atypia, mucosectomy enables the treatment of early colorectal cancer where the risk of metastasis to the lymph glands is minimal. The primary goal of EMR is the complete and safe removal of colorectal lesions and the complete prevention of CRC. Techniques for performing EMR include conventional EMR with submucosal solution injection, hot loop, and electrocautery removal of colorectal lesions, as well as alternative EMR techniques such as cold loop EMR and "underwater" EMR. Major adverse events associated with EMR include bleeding and perforation after mucosectomy. Because of the risk of polyp recurrence regardless of the EMR technique, as well as the risk of metachronous polyps, control colonoscopies are necessary, especially in patients with the highest risk of recurrence.

Background: The World Health Organization introduced the entities of sessile serrated adenoma and traditional serrated adenoma, and hyperplastic polyps (HPs) under the serrated lesions category in 2010. Indian studies on demographic, clinical, and histopathological characteristics of colorectal polyps, especially on serrated lesions, are limited. Our study aimed to study the morphology of the colorectal polyps and estimate the percentage of serrated lesions in the polyps studied. Methodology: A cross-sectional hospital-based study was conducted on colorectal polyps received for routine histopathological examination from July 2013 to August 2015. The polyps were classified according to the WHO 2010 colon and rectum tumors classification. Data were compiled and analyzed using IBM SPSS statistics version 20.0. The interpretation was done in frequencies and percentages. Results: We studied a total of 200 colorectal polyps. The polyps were mostly seen in the descending colon (41%). Histologically, the majority of the colorectal polyps were adenomatous in nature (59%). The serrated lesions accounted for 29% of all colorectal polyps. The polyps were mostly seen in patients who were more than 40 years old. Conclusion: Adenomas were the most prevalent type of colorectal polyps, seen more in males, at a higher age, and distally located. Serrated lesions predominantly included HPs, mostly

Colorectal polyps, precursors to colorectal cancer (CRC), require precise identification for appropriate diagnosis and therapy. This study aims to investigate the differences in hematological and inflammatory markers, specifically the CALLY index, HALP score, and immuno-inflammatory indexes, between neoplastic and nonneoplastic polyps. A retrospective cross-sectional study was conducted on 758 patients aged 61.0 ± 11.8 who underwent polypectomy between June 2021 and May 2024. Patients with colorectal adenocarcinoma (n = 22) were excluded. The polyps were classified into neoplastic and nonneoplastic categories based on histopathological evaluation. The study compared the CALLY index, HALP score, and various inflammatory indexes between neoplastic and nonneoplastic polyps. Out of 758 polyps analyzed, 514 were neoplastic, and 244 were nonneoplastic. Neoplastic polyps exhibited significantly lower CALLY and HALP scores (p < 0.05) and higher immuno-inflammatory indexes (p < 0.05) compared to nonneoplastic polyps. Dysplasia status, polyp diameter, and sigmoid colon localization were significant factors in determining neoplastic growth potential. No significant differences were observed in polyp localization in the proximal and distal colon segments or in solitary versus multiple polyps. The CALLY and HALP scores and immuno-inflammatory indexes can serve as valuable markers for distinguishing neoplastic from nonneoplastic polyps. These indexes reflect underlying inflammatory and immune responses, highlighting their potential utility in the early detection and risk stratification of colorectal polyps. Integrating these markers into clinical practice may enhance diagnostic accuracy and improve patient management, leading to timely interventions and better outcomes for individuals at risk of CRC.

BackgroundPolyDeep is a computer-aided detection and classification (CADe/x) system trained to detect and classify polyps. During colonoscopy, CADe/x systems help endoscopists to predict the histology of colonic lesions.ObjectiveTo compare the diagnostic performance of PolyDeep and expert endoscopists for the optical diagnosis of colorectal polyps on still images.MethodsPolyDeep Image Classification (PIC) is an in vitro diagnostic test study. The PIC database contains NBI images of 491 colorectal polyps with histological diagnosis. We evaluated the diagnostic performance of PolyDeep and four expert endoscopists for neoplasia (adenoma, sessile serrated lesion, traditional serrated adenoma) and adenoma characterization and compared them with the McNemar test. Receiver operating characteristic curves were constructed to assess the overall discriminatory ability, comparing the area under the curve of endoscopists and PolyDeep with the chi- square homogeneity areas test.ResultsThe diagnostic performance of the endoscopists and PolyDeep in the characterization of neoplasia is similar in terms of sensitivity (PolyDeep: 89.05%; E1: 91.23%, p=0.5; E2: 96.11%, p

ABSTRACT Background: Polypectomy is an important treatment option for preventing colorectal cancer. Incomplete polyp resection (IPR) is recognized as a risk factor for interval cancer. Objective: The primary objective was to evaluate the complete polyp resection (CPR) rate for cold snare polypectomy (CSP) in small non-pedunculated polyps and, secondarily, specimen retrieval and complication rates. Methods: We prospectively evaluated 479 polyps 30 s) occurred in 1 case (0.2%), treated with argon plasma coagulation. No delayed bleeding or perforation occurred. Conclusion: CSP is a safe technique that provides good results for the resection of small non-pedunculated polyps, with a short learning curve.

Abstract Objective To investigate the correlation between colorectal polyps (CRP) and Helicobacter pylori (H. pylori) infection, and the correlation between CRP and the expression of phosphorylated ribosomal protein S6 kinase (p-S6K1). Besides, its related influencing factors were determined in the present study. Methods A total of 191 subjects who underwent colonoscopy in our hospital from January 2020 to February 2022 were selected for this study. Among them, 141 patients were diagnosed with CRP, and the other 50 subjects were no significant colorectal abnormalities. 141 CRP patients were divided into H. pylori-positive group (n = 89) and H. pylori-negative group (n = 52) according to the results of the H. pylori test. The expression of p-S6K1 in CRP tissue was detected. The relationship between the p-S6K1 expression and the clinicopathological characteristics of CRP patients was analyzed. The logistic analysis of factors influencing the occurrence of CRP was performed. Results There were significant differences in pathological type, site of disease, the number and size of polyps between the H. pylori negative group and the H. pylori positive group (P

Background: Colorectal Polyps are the main source of precancerous lesions in colorectal cancer. To increase the early diagnosis of tumors and improve their screening, we aimed to develop a simple and non-invasive diagnostic prediction model for colorectal polyps based on machine learning (ML) and using accessible health examination records. Methods: We conducted a single-center observational retrospective study in China. The derivation cohort, consisting of 5426 individuals who underwent colonoscopy screening from January 2021 to January 2024, was separated for training (cohort 1) and validation (cohort 2). The variables considered in this study included demographic data, vital signs, and laboratory results recorded by health examination records. With features selected by univariate analysis and Lasso regression analysis, nine machine learning methods were utilized to develop a colorectal polyp diagnostic model. Several evaluation indexes, including the area under the receiver-operating-characteristic curve (AUC), were used to compare the predictive performance. The SHapley additive explanation method (SHAP) was used to rank the feature importance and explain the final model. Results: 14 independent predictors were identified as the most valuable features to establish the models. The adaptive boosting machine (AdaBoost) model exhibited the best performance among the 9 ML models in cohort 1, with accuracy, sensitivity, specificity, positive predictive value, negative predictive value, F1 score, and AUC (95% CI) of 0.632 (0.618–0.646), 0.635 (0.550–0.721), 0.674 (0.591–0.758), 0.593 (0.576–0.611), 0.673 (0.654–0.691), 0.608 (0.560–0.655) and 0.687 (0.626–0.749), respectively. The final model gave an AUC of 0.675 in cohort 2. Additionally, the precision recall (PR) curve for the AdaBoost model reached the highest AUPR of 0.648, positioning it nearest to the upper right corner. SHAP analysis provided visualized explanations, reaffirming the critical factors associated with the risk of colorectal polyps in the asymptomatic population. Conclusions: This study integrated the clinical and laboratory indicators with machine learning techniques to establish the predictive model for colorectal polyps, providing non-invasive, cost-effective screening strategies for asymptomatic individuals and guiding decisions for further examination and treatment.

Abstract Background Scarce evidence exists on pediatric colorectal polyp risk factors. This study explored the clinical manifestations, morphological and pathological characteristics of, and risk factors for pediatric colorectal polyps. Methods This retrospective case-control study included children who received colonoscopy, divided into a colorectal polyp group and a normal control group based on colonoscopy results. The risk factors for colorectal polyps in children were analyzed through logistic regression analysis. Results The mean age of children with polyps was 6.77 ± 3.44 years. Polyps were detected predominantly in males (72.9%); hematochezia was the primary clinical manifestation (80.25%). Most polyps were juvenile (88.9%) and solitary (87.7%); 50.6% were located in the rectosigmoid area. Univariate analysis showed that gender (P = 0.037), age (P

الملخص: أهداف البحث: يعد سرطان القولون والمستقيم سببا شائعا للوفيات المرتبطة بالسرطان في المملكة العربية السعودية مع ارتفاع معدل الإصابة به. على الرغم من أن الأورام الحميدة الغدية معروفة جيدا كسلائف لسرطان القولون والمستقيم، إلا أن البيانات المحلية نادرة. لذلك هدفنا في هذه الدراسة إلى تقييم خصائص أورام القولون الغدية في السكان السعوديين. طريقة البحث: قمنا بمراجعة قواعد البيانات الإلكترونية بأثر رجعي لجميع المرضى الذين خضعوا لتنظير القولون لأي إشارة بين يناير 2015 وديسمبر 2019 في المستشفيات التخصصية. تضمنت هذه الدراسة المرضى البالغين الذين وجد أنهم مصابون بسلائل القولون والمستقيم مع تقارير علم التشريح المرضي المحددة. قمنا بجمع البيانات السريرية والمرضية، بما في ذلك عمر المريض والجنس وخصائص الزوائد اللحمية النسيجية. النتائج: تم تضمين ما مجموعه 183 مريضا يعانون من الاورام الحميدة القولون والمستقيم مع تقارير التشريح المرضي في التحليل. من بين هؤلاء ، كان 129 (70.4٪) مريضا تتراوح أعمارهم بين 50 سنة أو أكثر، و 134 (73.2٪) كانوا من الذكور. من بين جميع الأورام الحميدة، كان 126 منها غديا (68.8٪)، 31 (16.9٪) مفرط التنسج، و 24 (13.1٪) كانت التهابية. بالنسبة للزوائد اللحمية الغدية، لوحظ 31 (24.6٪) في المرضى الذين تقل أعمارهم عن 50 عاما، ولوحظ خلل التنسج عالي الدرجة في 23 (18٪) من الأورام الحميدة. بين المرضى الذين يعانون من الاورام الحميدة الغدية، كان الموقع التشريحي كالتالي: 27 (23٪) في القولون الصاعد ، 12 (9٪) في القولون المستعرض ، 45 (35٪) في القولون النازل والسيني ، 25 (19٪) في المستقيم ، و 18 (14٪) في مواقع متعددة. كان العمر> 50 سنة مرتبطا بشكل كبير مع الاورام الحميدة الغدية. الاستنتاجات: تم اكتشاف ما يقرب من ثلث الاورام الحميدة الغدية بالقرب من الثنية الطحال. على الرغم من أن الأورام الحميدة الغدية كانت مرتبطة بشكل كبير مع تقدم العمر، لوحظ 24 ٪ في المرضى الذين تقل أعمارهم عن 50 عاما. يدعم هذا الاكتشاف التوصية الحالية لبدء الفحص في سن 45. Abstract: Objectives: Colorectal cancer is a common cause of cancer-related mortality in KSA with a rising incidence. Although adenomatous polyps are well-recognized as precursors of colorectal cancer, local data are scarce. Therefore, in this study, we aimed to evaluate the characteristics of adenomatous colon polyps in the Saudi population. Methods: We retrospectively reviewed the electronic databases of all patients who underwent colonoscopy for any indication between January 2015 and December 2019 at a tertiary care hospital. This study included adult patients who were found to have colorectal polyps with identified histopathology reports. We collected clinical and pathological data, including patient age, sex, and histopathological polyp characteristics. A p-value 50 years was significantly associated with adenomatous polyps (P = 0.03). Conclusion: Approximately one-third of adenomatous polyps were detected proximal to the splenic flexure. Although adenomatous polyps were significantly associated with increasing age, 24% were observed in patients younger than 50 years of age. This finding supports the current recommendation to start screening at the age of 45.

Abstract Background and Aim A hemostatic gel, PuraStat (3‐D Matrix, Tokyo, Japan), is used for various gastrointestinal hemostasis. In this study, we analyzed the efficacy of PuraStat for perioperative bleeding (POB) and prevention of delayed bleeding (DB) to colorectal cold snare polypectomy (CSP) with continuous anticoagulant. Methods This was a single‐center, retrospective study. Subjects were lesions of 2–9 mm under continuous anticoagulant from 2021 to 2023 and treated with PuraStat for POB. The definition of POB was bleeding which did not stop spontaneously by 1.0–1.5 min after resection and needed hemostasis. Successful hemostasis was defined as cessation of bleeding within 1.0–1.5 min after spraying PuraStat and the rate of it and risk factors of POB were analyzed. For comparison, cases receiving previous CSP without PuraStat were extracted from all cases with CSP (2018‐2021), and POB and DB rate (DBR) were analyzed after propensity score matching. Results One hundred twenty‐two lesions (91: direct oral anticoagulant (DOAC), 31: warfarin) with anticoagulant were analyzed and the rate of successful hemostasis with PuraStat was 92.6% (DOAC/warfarin: 93.4%/80.6%, P = 0.01). The rate of DB was 0.0%. Multivariate analysis showed that significant risk factors about unsuccessful hemostasis for POB with PuraStat were lesion size 8–9 mm (P

BackgroundUp to 45.9% of polyps are missed during colonoscopy, which is the major cause of post-colonoscopy colorectal cancer (CRC). Computer-aided detection (CADe) techniques based on deep learning might improve endoscopists’ performance in detecting polyps. We aimed to evaluate the effectiveness of the CADe system in assisting endoscopists in a real-world clinical setting.MethodsThe CADe system was trained to detect colorectal polyps, recognize the ileocecal region, and monitor the speed of withdrawal during colonoscopy in real-time. Between 17 January 2021 and 16 July 2021. We recruited consecutive patients aged 18–75 years from three centers in China. We randomized patients in 1:1 groups to either colonoscopy with the CADe system or unassisted (control). The primary outcomes were the sensitivity and specificity of the endoscopists. We used subgroup analysis to examine the polyp detection rate (PDR) and the miss detection rate of endoscopists.ResultsA total of 1293 patients were included. The sensitivity of the endoscopists in the experimental group was significantly higher than that of the control group (84.97 vs. 72.07%, p < 0.001), and the specificity of the endoscopists in these two groups was comparable (100.00 vs. 100.00%). In a subgroup analysis, the CADe system improved the PDR of the 6–9 mm polyps (18.04 vs. 13.85%, p < 0.05) and reduced the miss detection rate, especially at 10:00–12:00 am (12.5 vs. 39.81%, p < 0.001).ConclusionThe CADe system can potentially improve the sensitivity of endoscopists in detecting polyps, reduce the missed detection of polyps in colonoscopy, and reduce the risk of CRC.RegistrationThis clinical trial was registered with the Chinese Clinical Trial Registry (Trial Registration Number: ChiCTR2100041988).Clinical trial registrationwebsite www.chictr.org.cn, identifier ChiCTR2100041988.

Colorectal cancer (CRC) is one of the most common tumors in the world. Colorectal polyps are local protuberant lesions that elevate the intestinal mucosa, and about 90% of CRC is evolved from polyp. According to the traditional concept, the occurrence and development of CRC is mostly through the "adenoma-cancer" sequence. However, studies have found that serrated polyps also form subclasses with different morphology and genes, and are closely related to microsatellite unstable CRC. About 15%-30% of CRC develops through the "serrated polyp-cancer" pathway. This article mainly reviewed the clinical characteristics of colorectal adenoma, serrated polyp and post-inflammatory polyps, through retrospective analysis of large samples, to summarize the incidence of different pathological types of colorectal polyps in the progression of carcinogenesis and the follow-up monitoring after polypectomy, so as to provide a better reference for follow-up monitoring of polyp patients and early screening and treatment of precancerous lesions.

Colorectal cancer is the second leading cause of global cancer-related deaths, and its precursor lesions are colorectal polyps (CAP). The study aimed to explore the effect of combinations of unhealthy lifestyles on CAP and investigate the mediation role of metabolic disorder in this process. A total of 1299 adults were recruited from a hospital in Jiangsu, China, including 811 cases and 488 adults without diseases. The information on demographic characteristics and lifestyles was collected through questionnaires and the medical record system. Serum biochemical parameters were determined using the automatic biochemical analyzer. Adjusted regression analysis showed that unhealthy lifestyles, including smoking, overnight meals, daily water intake, staying up late, and exercise associated with the risk of CAP. Furthermore, metabolic biomarkers, including BMI, triglycerides, and uric acid, were associated with the risk of CAP. Also, unhealthy lifestyle scores were positively associated with BMI, triglycerides, and CAP. The mediation effect of metabolic biomarkers, such as BMI and triglycerides on the association of unhealthy lifestyle scores with CAP was significant. Available data demonstrate the adverse effect of combinations of unhealthy lifestyle factors on CAP, and metabolic disorders to potentially mediate the association of unhealthy lifestyles with the risk of CAP.

Colorectal cancer has been one of the leading causes of mortality over the past decade, and colorectal polyps are the leading cause of this disease. Conventional polyp detection techniques are insufficient for proper detection; thus, an efficient detection method is indispensable. In this study, we collected colorectal images from a hospital in Taiwan, annotated the ground truth of polyp locations, and integrated them with a public dataset to create a colonoscopy dataset. Data augmentation techniques are further used to increase the training dataset’s diversity to improve the models’ detection performance. By developing the comparison system based on the recent state-of-the-art methods (i.e., FasterRCNN, SSD, YOLOv3, and YOLOv4), we compared the measurement metrics and statistically analyzed the performance of the models to identify the significant statistical difference in models’ performance. Moreover, we developed and integrated an error handling mechanism with each model to discard the false and null predictions. Finally, our model comparison system selects and proposes the best performing deep learning model to detect and classify colorectal polyps. We expect that the proposed model will accurately locate and classify different types of polyps. Eventually, this approach will ensure a valuable medical aid model.

Colorectal cancer (CRC) is marked by the development of tumors/outgrowths known as polyps. AI-assisted endoscopy is inevitable in the modern world for better and more efficient polyp detection and classification. Often, the risk associated with CRC is indicated by the polyp’s size. Automated size classification of colorectal polyps from endoscopic images is a boon to endoscopists to monitor and diagnose the polyps. While previous research efforts have predominantly centered around the pathological categorization of polyps, limited attention has been directed towards the classification of polyp size. In this paper, we have proposed a deep learning-based model for the multi-class classification of colorectal polyps into four classes: 0–5 mm, 5–10 mm, 10–14 mm, and $>=14$ mm. A narrow range in polyp size classification provides more information about the growth of the polyp as opposed to binary classification. We also show that the One vs Rest classification technique using binary classifiers outperforms the usual approach of using a single CNN for multi-class classification. Also, we use XGBoost with the binary classifiers to further increase the performance of the model. The experimental results report the effectiveness of our proposed model in performing multi-class polyp size classification. The approach is expected to assist clinicians in estimating polyp size efficiently.

Colorectal polyps is a prevalent medical condition that could lead to colorectal cancer, a leading cause of cancer-related mortality globally, if left undiagnosed. Colonoscopy remains the gold standard for detection and diagnosis of colorectal neoplasia; however, a significant proportion of neoplastic lesions are missed during routine examinations, particularly diminutive and flat lesions. Deep learning techniques have been employed to improve polyp detection rates in colonoscopy images and have proven successful in reducing the miss rate. However, accurate segmentation of small and flat polyps remains a major challenge to existing models as they struggle to differentiate polypoid and non-polypoid regions apart. To address this issue, we present an enhanced version of the Multi-Scale Attention Network (MA-NET) that incorporates a modified Mix-ViT transformer as the feature extractor. The modified Mix-ViT facilitates ultra-fine-grained visual categorization to improve the segmentation accuracy of polypoid and non-polypoid regions. Additionally, we introduce a pre-processing layer that performs histogram equalization on input images in the CIEL $^{\ast} \text{A}^{\ast} \text{B}^{\ast} $ color space to enhance their features. Our model was trained on a combined dataset comprising Kvasir-SEG and CVC-ClinicDB and cross-validated on CVC-ColonDB and ETIS-LaribDB. The proposed method demonstrates superior performance compared to existing methods, particularly in the detection of small and flat polyps.

Background and Aims: The 2012 and 2020 US Multi-Society Task Force postpolypectomy guidelines have recommended progressively longer surveillance intervals for patients with low-risk adenomas (LRAs). These guidelines require data from past colonoscopies. We examined the impact of the 2012 guidelines for second surveillance on clinical practice, including the availability of prior colonoscopy data, with the aim of informing the implementation of the 2020 guidelines. Methods: We identified surveillance colonoscopies at Stanford Health Care and the Palo Alto Veterans Affairs Health Care System in 3 periods: preguideline (March–August 2012), postguideline (January–June 2013), and delayed postguideline (July–September 2017). We collected data on the most recent previous colonoscopy, findings at the study entry surveillance colonoscopy, and recommendations for subsequent surveillance. Results: Among 977 patients, the most recent prior colonoscopy data were available in 78% of preguideline, 78% of postguideline, and 61% of delayed postguideline cases (P < .001). The fraction of surveillance colonoscopy reports that deferred recommendations awaiting pathology increased from 6% to 11% in preguideline and postguideline to 59% in delayed postguideline cases (P < .001). Overall adherence to guidelines for subsequent surveillance was similar in all 3 periods (54%–67%; P = .089). In the postguideline and delayed postguideline periods combined, a 10-year subsequent surveillance interval was recommended in 0 of 29 cases with LRA followed by normal surveillance colonoscopy. Conclusion: In patients undergoing surveillance, prior colonoscopy data were not always available and recommendations were often deferred awaiting pathology. Adherence to subsequent surveillance guidelines was suboptimal, especially for LRA followed by normal colonoscopy. Strategies addressing these gaps are needed to optimize implementation of the updated 2020 postpolypectomy guidelines.

Abstract Background It has not yet been determined whether gastroscopy and colonoscopy screening help patients with gallbladder diseases. We aim to retrospectively investigate the relationship between gallbladder diseases and gastrointestinal polyps in order to provide a theoretical basis for the early screening of gastrointestinal polyps in patients with gallbladder disease. Methods This is a retrospective cross-sectional study involving 1662 patients who underwent gastroscopy, colonoscopy, and abdominal ultrasound as part of their health check-up from January 2015 to July 2020. We also compared the patients with and without gallbladder diseases to determine the prevalence of gastrointestinal polyps. Results Patients with gallbladder polyps had greater odds of having colorectal polyps (adjusted odds ratio (OR)=1.77, 95% confidence interval [Cl]: 1.23 to 2.54, p=0.002) and gastric plus colorectal polyps (adjusted OR=2.94, 95%Cl: 1.62 to 5.32, p

IntroductionMultiple colonic polyps do not have a genetic origin in most patients, and the cause of this phenotype remains elusive. Environmental factors, such as diet, could be related to this phenotype. Our aim was to investigate the relationship between the adherence to Mediterranean diet and multiple colonic polyps of unknown origin.MethodsA case-control pilot study was carried out with a sample of 38 individuals, including 23 cases with more than 10 adenomatous or serrated polyps from the national multicenter project EPIPOLIP and 15 healthy controls with normal colonoscopy. A validated Spanish version of the MEDAS questionnaire was administered to cases and controls.ResultsAdherence to Mediterranean diet was higher in controls than in patients with multiple colonic polyps (MEDAS score: 8.6 ± 1.4 vs. 7.0 ± 1.6; p = 0.01). Optimal overall adherence to the Mediterranean diet pattern was significantly higher among the controls than among cases (MEDAS score >9: 46% vs. 13%; OR 0.17; 95% CI 0.03–0.83). Non-optimal adherence to the Mediterranean diet acts as a risk factor for developing colorectal cancer derived from colorectal polyps.ConclusionOur results suggest that environmental factors play a role in the pathogenesis of this phenotype.

Abstract Background A missed diagnosis of colorectal polyps during colonoscopy may be associated with the occurrence of interval colorectal cancer. The risk factors for a missed diagnosis or a method to predict the risk of a missed diagnosis of colorectal polyps during colonoscopy remain unidentified. Methods The clinical data of patients who underwent two colonoscopies within three months at the Affiliated Hospital of North Sichuan Medical College between February 2017 and August 2019 were retrospectively reviewed. Independent risk factors for missed diagnoses were identified, and a nomogram was established to predict the risk of missed diagnoses. The prediction performance of the nomogram was evaluated using C-index and calibration curves, and its clinical application value was assessed using the Youden index and decision curve analysis. Results Independent influencing factors for missed diagnoses included age, endoscopist experience, bowel preparation, retroflected view, withdrawal time, number of polyps in the right colon, and number of polyps ≥ 6 mm. The C-index of the nomogram in the training and validation cohorts was 0.763 (95% confidence interval [CI]: 0.724 − 0.807) and 0.726 (95%CI: 0.657 − 0.794), respectively. The optimal cut-off value of the nomogram calculated using the Youden index was 152.2 points. Under the cut-off value, the sensitivity, specificity, positive predictive value, and negative predictive value were 67.1%, 75.7%, 45.8%, and 88.2%, respectively, in the training cohort, and 57.1%, 79.9%, 53.3%, and 82.3%, respectively, in the validation cohort. Conclusions The nomogram provides a reference value for clinicians to analyse the risk of a missed diagnosis of colorectal polyps in individuals, identify high-risk groups, and formulate appropriate follow-up strategies.

Abstract This case report describes a fatal outcome due to delayed perforation after cold snare polypectomy in a patient with bullous pemphigoid receiving oral corticosteroids. Cold snare polypectomy has become the standard treatment for small colorectal polyps because of the procedure's safety and simplicity. In this case, however, corticosteroid therapy and vasculitis may have caused local necrosis and tearing of the intestinal wall. Corticosteroids are widely used, and perforation after cold snare polypectomy is extremely rare. However, some patients on corticosteroid therapy may have special pathologies, such as in this case, and we advise physicians to use appropriate judgment and extreme caution in determining the indication for endoscopic therapy.

IntroductionThe essence of enterotypes is to stratify the entire human gut microbiota, and dysregulation of gut microbiota is closely related to the development of colorectal adenoma. Enterotypes may therefore be a useful target for the prevention of colorectal adenoma. However, the relationship between gut microbiota and colorectal adenoma has not been fully elucidated. In this study, we aimed to analyze the differences in gut microbiome composition between adenoma and control populations.MethodsWe recruited 31 patients with colorectal adenoma and 71 non-adenoma controls. Patient demographics, risk factors, fecal samples from each subject were collected and metagenomic sequencing was performed. LEfSe analysis was used to reveal differences in intestinal microbiome composition. Multiple logistic regression analysis was used to determine the association between enterotypes and colorectal adenoma.ResultsThe results showed that Prevotella enterotype (enterotype 4) is only present in adenoma group. Logistic regression analysis showed that Prevotella enterotype was an independent risk factor for colorectal adenoma.DiscussionThe Prevotella enterotype may increase the occurrence of colorectal adenoma through inflammatory association and interference with glucose and lipid metabolism in human body. In conclusion, the differences we observed between different enterotypes add a new potential factor to the development of colorectal adenoma.

Yuanxi Jiang, Junwen Wang, Ying Chen, Huihui Sun, Zhiyu Dong, Shuchang Xu Department of Gastroenterology, Tongji Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of ChinaCorrespondence: Shuchang Xu; Zhiyu Dong, Department of Gastroenterology, Tongji Hospital, Tongji University School of Medicine, No. 389, Xincun Road, Putuo District, Shanghai, People’s Republic of China, Tel +86-136 0199 9711, Email xsc-students@hotmail.com; 1253292@tongji.edu.cnPurpose: To identify pathology discrepancy between forceps biopsies and polypectomy specimens in colorectal polyps, as well as the reliability of biopsy-based treatment strategy.Methods: All endoscopic polypectomy cases with forceps biopsies performed within 6 months were included in the study. The biopsies were compared with polypectomy specimens in terms of concordance of histological diagnosis. A logistic regression model was used to investigate the independent predictors of upgrade in histological diagnosis compared with concordance in histological diagnosis.Results: A total of 1686 paired screening-therapeutic colonoscopies and 1739 paired biopsy-polypectomy specimens were enrolled in the study. The grade of dysplasia in 84.5% of biopsy specimens were concordant to polypectomy specimens, but this proportion decreased to 75.4% when the specimens were classified using tubular or villousness structure. 10.1% and 5.4% of biopsy specimens were upgraded and downgraded in assessing grade of dysplasia, respectively, while 14.3% and 10.3% of biopsy specimens were upgraded and downgraded in assessing tubular or villousness structure, respectively. In subgroup analysis stratified by size of polyps, 9.0% and 10.6% of biopsies obtained from polyps smaller than 10 mm were upgraded in assessing dysplasia and tubular or villousness structure, respectively. This proportion increased to 10.7% and 21.3%, respectively, in biopsies obtained from polyps larger than 10 mm. Larger size of polyps and pedunculated polyps were associated with a higher incidence of upgrade in histological diagnosis. Nearly 25% of biopsy specimens with high-grade dysplasia were identified as adenocarcinoma in polypectomy specimens.Conclusion: The concordance between biopsy and polypectomy specimens is not adequate. The biopsy-based treatment strategy is not reliable and should not be considered as an indicator for further treatment, particularly in large or pedunculated polyps.Keywords: colorectal polyps, colorectal adenoma, colonoscopy, pathology

Colorectal cancer is an important cause of morbidity and mortality worldwide. Optical colonoscopy (OC) is widely accepted as the reference standard for the screening of colorectal polyps and cancers, and computed tomography colonography (CTC) is a valid alternative to OC. The purpose of this review was to assess the diagnostic accuracy of OC and CTC for colorectal lesions. A literature search was performed in PubMed, Embase, and Cochrane Library, and 18 articles were included. CTC has emerged in recent years as a potential screening examination with high accuracy for the detection of colorectal lesions. However, the clinical application of CTC as a screening technique is limited because it is highly dependent on the size of the lesions and has poor performance in detecting individual lesions

Artificial intelligence (AI) presents a novel platform for improving disease diagnosis. However, the clinical utility of AI remains limited to discovery studies, with poor translation to clinical practice. Current data suggests that 26% of diminutive pre-malignant lesions and 3.5% of colorectal cancers are missed during colonoscopies. The primary aim of this study was to explore the role of artificial intelligence in real-time histological prediction of colorectal lesions during colonoscopy. A systematic search using MeSH headings relating to “AI”, “machine learning”, “computer-aided”, “colonoscopy”, and “colon/rectum/colorectal” identified 2290 studies. Thirteen studies reporting real-time analysis were included. A total of 2958 patients with 5908 colorectal lesions were included. A meta-analysis of six studies reporting sensitivities (95% CI) demonstrated that endoscopist diagnosis was superior to a computer-assisted detection platform, although no statistical significance was reached (p = 0.43). AI applications have shown encouraging results in differentiating neoplastic and non-neoplastic lesions using narrow-band imaging, white light imaging, and blue light imaging. Other modalities include autofluorescence imaging and elastic scattering microscopy. The current literature demonstrates that despite the promise of new endoscopic AI models, they remain inferior to expert endoscopist diagnosis. There is a need to focus developments on real-time histological predictions prior to clinical translation to demonstrate improved diagnostic capabilities and time efficiency.

Background: Colonic endoscopic submucosal dissection (ESD) at “challenging sites” such as the cecum, ascending colon, and colonic flexures could be difficult even for expert endoscopists due to poor endoscope stability/maneuverability, steep angles, and thinner wall thickness. A double-balloon endoluminal intervention platform (EIP) has been introduced in the market to fasten and facilitate ESD, particularly when located at difficult sites. Here, we report our initial experience with an EIP comparing the outcomes of an EIP versus standard ESD (S-ESD) at “challenging sites”. Materials and methods: We retrospectively collected data on consecutive patients with colonic lesions located in the right colon and at flexures who underwent ESD in our tertiary referral center between March 2019 and May 2023. Endoscopic and clinical outcomes (technical success, en bloc resection rate, R0 resection rate, procedure time, time to reach the lesion, and adverse events) and 6-month follow-up outcomes were analyzed. Results: Overall, 139 consecutive patients with lesions located at these challenging sites were enrolled (EIP: 31 and S-ESD: 108). Demographic characteristics did not differ between groups. En bloc resection was achieved in 92.3% and 93.5% of patients, respectively, in the EIP and S-ESD groups. Both groups showed a comparable R0 resection rate (EIP vs. S-ESD: 92.3% vs. 97.2%). In patients undergoing EIP-assisted ESD, the total procedure time was shorter (96.1 [30.6] vs. 113.6 [42.3] minutes, p = 0.01), and the mean size of the resected lesions was smaller (46.2 ± 12.7 vs. 55.7 ± 17.6 mm, p = 0.003). The time to reach the lesion was significantly shorter in the EIP group (1.9 ± 0.3 vs. 8.2 ± 2.7 min, p ≤ 0.01). Procedure speed was comparable between groups (14.9 vs. 16.6 mm2/min, p = 0.29). Lower adverse events were observed in the EIP patients (3.8 vs. 10.2%, p = 0.31). Conclusions: EIP allows results that do not differ from S-ESD in the resection of colorectal superficial neoplasms localized in “challenging sites” in terms of efficacy and safety. EIP reduces the time to reach the lesions and may more safely facilitate endoscopic resection.

Background/Aims We have been developing artificial intelligence based polyp histology prediction (AIPHP) method to classify Narrow Band Imaging (NBI) magnifying colonoscopy images to predict the hyperplastic or neoplastic histology of polyps. Our aim was to analyze the accuracy of AIPHP and narrow-band imaging international colorectal endoscopic (NICE) classification based histology predictions and also to compare the results of the two methods. Methods We studied 373 colorectal polyp samples taken by polypectomy from 279 patients. The documented NBI still images were analyzed by the AIPHP method and by the NICE classification parallel. The AIPHP software was created by machine learning method. The software measures five geometrical and color features on the endoscopic image. Results The accuracy of AIPHP was 86.6% (323/373) in total of polyps. We compared the AIPHP accuracy results for diminutive and non-diminutive polyps (82.1% vs. 92.2%; p=0.0032). The accuracy of the hyperplastic histology prediction was significantly better by NICE compared to AIPHP method both in the diminutive polyps (n=207) (95.2% vs. 82.1%) (p

Background and Aims: Current postpolypectomy surveillance guidelines are based primarily on data from non-Hispanic Whites (NHWs); thus, generalizability to non-Hispanic Blacks (NHBs) remains unknown. Hence, the primary objective of this study was to assess the validity of these guidelines for NHBs by comparing the prevalence of metachronous advanced colorectal neoplasia (ACN) between NHWs and NHBs undergoing surveillance colonoscopy. Methods: This was a retrospective cross-sectional study of NHWs (N = 1500) and NHBs (N = 1260) aged 40–75 years who underwent surveillance colonoscopy at an academic safety net hospital between 2007 and 2017. The primary outcome measure was the prevalence of metachronous ACN, defined as an advanced adenoma, advanced sessile polyp, or invasive cancer. Multivariate logistic regression was used to measure associations between race/ethnicity and ACN prevalence after adjustment for potential confounding factors. Results: Overall, the prevalence of metachronous ACN was similar for NHBs and NHWs (6.8% vs 7.4%, respectively; P = .60). The prevalence of metachronous cancers (0.2% vs 0.1%; P = .48), advanced adenomas (2.8% vs 3.8%; P = .14), advanced serrated polyps (3.5% vs 3.3%; P = .82), and large hyperplastic polyps ≥10 mm (0.2% vs 0.6%, P = .24) were also similar between the 2 groups. Moreover, race was not a determinant of metachronous ACN after adjustment for age, sex, education, type of insurance, indication (screen/surveillance) for baseline colonoscopy, surveillance interval, and findings at baseline colonoscopy (adjusted odds ratio, 0.96; 95% confidence interval, 0.70–1.30; P = .78). Conclusion: Our study finds no significant difference in the prevalence of metachronous ACN between NHWs and NHBs undergoing appropriate postpolypectomy surveillance at an urban safety net hospital, suggesting that current guidelines are appropriate for both NHWs and NHBs.

BackgroundColorectal polyps are the most common precursors of colorectal cancer (CRC). The close relationship has been observed between colorectal polyps and gut microbiota. However, gut microbiota signatures among sampling sites in patients with colorectal polyps and healthy adults remain elusive.AimsTo learn about gut microbiota signatures in tissues of the colorectal polyp and normal colorectal mucosa, and faeces.MethodsWe performed 16S rRNA gene sequencing and bioinformatic analysis for the microbiota in the normal colorectal mucosa, the colorectal polyps and faeces of adults with colorectal polyps (n = 24) and in faeces and normal mucosa of healthy adults (n = 16) in this preliminary trial.ResultsThe Ace and Chao indexes were higher in the normal colorectal mucosa and polyp tissues compared to faecal samples (P < 0.05). The composition of microbiota based on PCoA and ANOSIM analysis showed the significant differences only between faeces and tissues of the normal mucosa and polyp (P < 0.05). Based on the LEfSe analysis, the abundances of Bacteroides, Prevotella-2 and Agathobacter were higher, whereas the abundances of Haemophilus, Escherichia_Shigella, Fusobacterium and Streptococcus were lower in faeces both in patients with colorectal polyp and healthy individuals, compared with those in the normal mucosa in two groups or polyp tissues. In healthy individuals, the abundance of Fusobacterium was significantly higher in the normal colorectal mucosa than in faeces. Moreover, there was no significant difference in the abundance of Fusobacterium between the normal colorectal mucosa and polyps in patients with colorectal polyps, but it was significantly higher in the mucosa and polyps than in faeces. Remarkably, the abundance of Fusobacterium in the normal colorectal mucosa was significantly higher in healthy individuals than in the polyp group.ConclusionsThe microbial structure in faeces differs from that in tissues of polyp and normal mucusa. Additionally, Fusobacterium may be a normal colonizer in colonic mucosa, and an abnormal increase of Fusobacterium detected in faeces may be related with the injury of the colorectal mucosa. The difference of the faecal microbiota and mucosal microbiota should be carefully considered in studies on gut microbiota in patients with colorectal lesions.

Colonoscopic polypectomy is extremely effective in protecting against colorectal cancers, and recognition of adenomas by colonoscopy is of paramount importance in preventing colorectal cancer (CRC) and CRC-associated mortality. Incomplete polyp resection (IPR) occurs routinely in medical practice following polypectomy. We conducted a comprehensive literature search to identify studies that reported on the potential risk factors for IPR using MEDLINE, EMBASE, and PubMed. Publication time was limited between January 2004 and July 2021. Our search revealed assessments of the position, morphology, and histologic variation of the polyps—as well as the relevant skills that may interfere with IPR. The included studies showed that colonic polyps with a diameter >20 mm and proximal in location should be dealt with cautiously. For smaller polyps, cold-snare polypectomy appeared to be the most effective method used to accomplish comprehensive polyp removal. In addition, endoscopist experience in narrow-band imaging in polyp detection were also associated with IPR. Therefore, polypectomy should be performed cautiously if the polyp growth is expected to be cancerous and situated in the proximal portion of the colon or rectum, and modalities should be standardized so as to lower the potential risk for IPR.

Abstract Background Artificial intelligence (AI) assistance has been considered as a promising way to improve colonoscopic polyp detection, but there are limited prospective studies on real‐time use of AI systems. Methods We conducted a prospective, multicenter, randomized controlled trial of patients undergoing colonoscopy at six centers. Eligible patients were randomly assigned to conventional colonoscopy (control group) or AI‐assisted colonoscopy (AI group). AI assistance was our newly developed AI system for real‐time colonoscopic polyp detection. Primary outcome is polyp detection rate (PDR). Secondary outcomes include polyps per positive patient (PPP), polyps per colonoscopy (PPC), and non‐first polyps per colonoscopy (PPC‐Plus). Results A total of 2352 patients were included in the final analysis. Compared with the control, AI group did not show significant increment in PDR (38.8% vs. 36.2%, p = 0.183), but its PPC‐Plus was significantly higher (0.5 vs. 0.4, p

ABSTRACT BACKGROUND: Since 2012, a new technique for resection of large polyps has been described, the underwater endoscopic mucosal resection (UEMR). Some advantages that emerge from it is the needless of injection in submucosal layer and a greater chance of complete capture of the polyp. OBJECTIVE: There are few studies of UEMR in Brazil. The aim of this study is to evaluate the safety and efficacy of this technique in one Brazilian center. METHODS: This case series was conducted from February to December of 2020. Colorectal polyps greater than 9 mm without features of deep submucosal invasion were resected using UEMR. RESULTS: Twenty-four large polyps were resected with the UEMR approach from 24 patients. The mean size of the polys was 19 mm, ranging from 12 to 35 mm. All lesions were successful resected and 66% (16/24) were resected en bloc. In histologic analyses, most of them were adenomas (70.8%) and only one had deep submucosal invasion. There were no cases of acute complications, such perforation or acute bleeding. CONCLUSION: The UEMR is a safe and feasible procedure. With the emerging data on the procedure, it seems to be a wonderful tool in preventing colorectal cancer and its applicability and scope should be encourage to surpass reference centers.

BackgroundPostoperative symptoms, bowel dysfunction and recurrence are common problems after resection of colorectal polyps. We aimed to evaluate the efficacy of Bifidobacterium in the postoperative patients.MethodsIn this single-center, randomized, double-blind, placebo-controlled trial, adults (≥ 18 years) undergoing endoscopic resection of colorectal polyps were treated with probiotics (Bifidobacterium animalis subsp. lactis MH-02, 2 × 109 colony-forming units per packet) or placebo once daily for 7 days. The primary clinical endpoint was a reduction in the mean total postoperative symptoms score within 7 days postoperatively. Secondary clinical endpoints were the single symptom scores, time to recovery of bowel function, and changes in the intestinal microbiota. This study is registered with the number ChiCTR2100046687.ResultsA total of 100 individuals were included (48 in probiotic group and 52 in placebo group). No difference was seen in the mean scores between the two groups (0.29 vs. 0.43, P = 0.246). Colorectal polyps size (P = 0.008) and preoperative symptoms (P = 0.032) were influential factors for the primary endpoint. Besides, MH-02 alleviated difficult defecation (P = 0.045), and reduced the time to recovery of bowel function (P = 0.032). High-throughput analysis showed that MH-02 can help restore the diversity of intestinal microbiota, and increased the relative abundance of Bifidobacterium, Roseburia, Gemmiger, Blautia and Ruminococcus, while reduced the relative abundance of Clostridium at genus level (P < 0.05).ConclusionIn this prospective trial, MH-02 showed efficacy in patients with resection of colorectal polyps, particularly in the recovery of bowel function, and the changes in the intestinal microbiota may provide evidence for further exploration of the therapeutic mechanisms.

Abstract Background The platelet-to-lymphocyte ratio (PLR) and C-reactive protein (CRP) level are markers that have been reported to predict the histological type of various tumors, and here, we evaluated their utility in predicting colorectal polyp histological types. Methods We retrospectively reviewed 172 patients with colorectal polyps who underwent endoscopic polypectomy. The associations between histological type and clinicopathologic parameters were assessed by multivariate analysis. Results The optimal PLR and CRP cut-off values were 113.32 and 0.39, respectively. The PLR (P = 0.002) and CRP (P = 0.009) values were associated with the histological type according to the univariate analysis, whereas low PLR (P ≤ 0.001) and CRP (P = 0.017) values were independent risk factors in the multivariate analysis together with maximum tumor diameter (P ≤ 0.001) and tumor number (P = 0.0014). Conclusions Preoperative PLR and CRP are correlated with the colorectal polyp histological type.