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Background Surveillance colonoscopy after polyps have been detected at screening aims to reduce the risk for subsequent colorectal cancer, so-called post-colonoscopy colorectal cancer (PCCRC). Inconsistencies exist as to whether the risk should be stratified by histologic subtype. We aimed to compare the risk for PCCRC mortality in screening participants with sessile serrated lesions (SSLs)/traditional serrated adenomas (TSAs), hyperplastic polyps (HPPs), or conventional adenomas. Methods Screening colonoscopy registry data were linked to death registry data between 2010 and 2022. We assessed the association of PCCRC death after a diagnosis of SSL/TSA, conventional adenoma, or HPP by Cox regression, and stratified by polyp size ≥10 and <10 mm. Results 383,801 participants were included in the analysis. There were 1490 HPPs ≥10 mm (2.6%), compared with 1853 SSL/TSAs (19.6%) and 10,960 conventional adenomas (12.9%). When adjusted for polyp location, the association of polyp size ≥10 mm with PCCRC death was of similar magnitude in participants with conventional adenomas (hazard ratio [HR] 3.68, 95%CI 2.49–5.44), SSL/TSAs (HR 2.55, 95%CI 1.13–5.72), and HPPs (HR 5.01, 95%CI 2.45–10.22). Participants with HPPs mostly died of tumors in the distal colon (54.1%; n = 20), while participants with SSL/TSAs more frequently died of proximal tumors (33.3%; n = 3). Conclusions Across all histologic types, participants with polyps ≥10 mm had at least a two-fold increase in the likelihood of PCCRC death compared with those with polyps <10 mm. These data suggest that size, rather than histologic subtype, should be a determinant for risk stratification after screening colonoscopy. [ABSTRACT FROM AUTHOR]

Background Missed lesions are common during standard colonoscopy and are correlated with post-colonoscopy colorectal cancer. Contrast-enhanced technologies have recently been developed to improve polyp detection. We aimed to evaluate the impact of linked color imaging (LCI) on the proximal adenoma miss rate in routine colonoscopy. Methods This national, multicenter, tandem, randomized trial compared the outcomes of colonoscopy with white-light imaging (WLI) versus LCI for polyp detection in the right colon. Two consecutive examinations of the right colon (upstream of the hepatic flexure) were made with WLI and LCI by the same operator. First-pass examination by WLI or LCI was randomized 1:1 after cecal intubation. According to statistical calculations, 10 endoscopy units had to include approximately 700 patients. The primary outcome was proximal adenoma miss rate. Secondary outcomes were the proximal miss rates for sessile serrated lesions (SSL), advanced adenomas, and polyps. Results 764 patients were included from 1 January 2020 to 22 December 2022, and 686 patients were randomized (345 WLI first vs. 341 LCI first). Both groups were comparable in terms of demographics and indications. The proximal adenoma miss rate was not significantly higher in the WLI-first group (36.7%) vs. the LCI-first group (31.8%) (estimated mean absolute difference: 4.9% [95%CI –5.2% to 15.0%], P = 0.34). There was also no significant difference in miss rates for SSLs, advanced adenomas, and polyps in the proximal colon. Conclusions In contrast to previous data, this study does not support the benefit of LCI to the proximal adenoma miss rate in routine colonoscopy. [ABSTRACT FROM AUTHOR]

Background Recognition of submucosal invasive cancer (SMIC) in large (≥20 mm) nonpedunculated colonic polyps (LNPCPs) informs selection of the optimal resection strategy. LNPCP location, morphology, and size influence the risk of SMIC; however, currently no meaningful application of this information has simplified the process to make it accessible and broadly applicable. We developed a decision-making algorithm to simplify the identification of LNPCP subtypes with increased risk of potential SMIC. Methods Patients referred for LNPCP resection from September 2008 to November 2022 were enrolled. LNPCPs with SMIC were identified from endoscopic resection specimens, lesion biopsies, or surgical outcomes. Decision tree analysis of lesion characteristics identified in multivariable analysis was used to create a hierarchical classification of SMIC prevalence. Results 2451 LNPCPs were analyzed: 1289 (52.6%) were flat, 1043 (42.6%) nodular, and 118 (4.8%) depressed. SMIC was confirmed in 273 of the LNPCPs (11.1%). It was associated with depressed and nodular vs. flat morphology (odds ratios [ORs] 35.7 [95%CI 22.6–56.5] and 3.5 [95%CI 2.6–4.9], respectively; P <0.001); rectosigmoid vs. proximal location (OR 3.2 [95%CI 2.5–4.1]; P <0.001); nongranular vs. granular appearance (OR 2.4 [95%CI 1.9–3.1]; P <0.001); and size (OR 1.12 per 10-mm increase [95%CI 1.05–1.19]; P <0.001). Decision tree analysis targeting SMIC identified eight terminal nodes: SMIC prevalence was 62% in depressed LNPCPs, 19% in nodular rectosigmoid LNPCPs, and 20% in nodular proximal colon nongranular LNPCPs. Conclusions This decision-making algorithm simplifies identification of LNPCPs with an increased risk of potential SMIC. When combined with surface optical evaluation, it facilitates accurate lesion characterization and resection choices. [ABSTRACT FROM AUTHOR]

Background Although polyp size dictates surveillance intervals, endoscopists often estimate polyp size inaccurately. We hypothesized that an intervention providing didactic instruction and real-time feedback could significantly improve polyp size classification. Methods We conducted a multicenter randomized controlled trial to evaluate the impact of different components of an online educational module on polyp sizing. Participants were randomized to control (no video, no feedback), video only, feedback only, or video + feedback. The primary outcome was accuracy of polyp size classification into clinically relevant categories (diminutive [1–5mm], small [6–9mm], large [≥10mm]). Secondary outcomes included accuracy of exact polyp size (inmm), learning curves, and directionality of inaccuracy (over- vs. underestimation). Results 36 trainees from five training programs provided 1360 polyp size assessments. The feedback only (80.1%, P =0.01) and video + feedback (78.9%, P=0.02) groups had higher accuracy of polyp size classification compared with controls (71.6%). There was no significant difference in accuracy between the video only group (74.4%) and controls (P =0.42). Groups receiving feedback had higher accuracy of exact polyp size (inmm) and higher peak learning curves. Polyps were more likely to be overestimated than underestimated, and 29.3% of size inaccuracies impacted recommended surveillance intervals. Conclusions Our online educational module significantly improved polyp size classification. Real-time feedback appeared to be a critical component in improving accuracy. This scalable and no-cost educational module could significantly decrease under- and overutilization of colonoscopy, improving patient outcomes while increasing colonoscopy access. [ABSTRACT FROM AUTHOR]

Background Recent studies demonstrated that a higher proximal serrated polyp detection rate (PSPDR) among endoscopists is associated with a lower risk of post-colonoscopy colorectal cancer (PCCRC) incidence and death for their patients. Our objective was to evaluate the effect of an e-learning resource on PSPDR. Methods We performed a multicenter randomized controlled trial within the Dutch fecal immunochemical test-based colorectal cancer screening program. Endoscopists were randomized using block randomization per center to either receive a 60-minute e-learning resource on serrated polyp detection or not. PSPDR was calculated based on all colonoscopies performed during a 27-month pre-intervention and a 17-month post-intervention period. The primary end point was difference in PSPDR between intervention and control arms (intention to treat) using mixed effect logistic regression modeling, with time (pre-intervention/post-intervention) and interaction between time and arm (intervention/control) as fixed effects, and endoscopists as random effects. Results 116 endoscopists (57 intervention, 59 controls) were included, and performed 27494 and 33888 colonoscopies, respectively. Median PSPDR pre-intervention was 13.6% (95%CI 13.0–14.1) in the intervention arm and 13.8% (95%CI 13.3–14.3) in controls. Post-intervention PSPDR was significantly higher over time in the intervention arm than in controls (17.1% vs. 15.4%, P=0.01). Conclusion In an era of increased awareness and increasing PSPDRs, endoscopists who undertook a one-time e-learning course significantly accelerated the increase in PSPDR compared with endoscopists who did not undertake the e-learning. Widespread implementation might reduce PCCRC incidence. [ABSTRACT FROM AUTHOR]

The article discusses the outcomes of colon polyp surveillance based on size and histology. Studies from Norway, the UK, and Austria show that patients with small adenomas have a lower risk of fatal colorectal cancer (CRC) compared to the general population, while those with high-risk adenomas have an increased risk. The research emphasizes the importance of polyp size in predicting future CRC risk, regardless of histology. The study aligns with European guidelines recommending surveillance intervals based on polyp size rather than histology, highlighting the need for continued assessment of predictors of post-colonoscopy CRC. [Extracted from the article]

Background Adenoma detection rate (ADR) is an important indicator of colonoscopy quality and colorectal cancer incidence. Both linked-color imaging (LCI) with artificial intelligence (LCA) and LCI alone increase adenoma detection during colonoscopy, although it remains unclear whether one modality is superior. This study compared ADR between LCA and LCI alone, including according to endoscopists' experience (experts and trainees) and polyp size. Methods Patients undergoing colonoscopy for positive fecal immunochemical tests, follow-up of colon polyps, and abdominal symptoms at a single institution were randomly assigned to the LCA or LCI group. ADR, adenoma per colonoscopy (APC), cecal intubation time, withdrawal time, number of adenomas per location, and adenoma size were compared. Results The LCA (n=400) and LCI (n=400) groups showed comparable cecal intubation and withdrawal times. The LCA group showed a significantly higher ADR (58.8% vs. 43.5%; P<0.001) and mean (95%CI) APC (1.31 [1.15 to 1.47] vs. 0.94 [0.80 to 1.07]; P<0.001), particularly in the ascending colon (0.30 [0.24 to 0.36] vs. 0.20 [0.15 to 0.25]; P=0.02). Total number of nonpolypoid-type adenomas was also significantly higher in the LCA group (0.15 [0.09 to 0.20] vs. 0.08 [0.05 to 0.10]; P=0.02). Small polyps (≤5, 6–9mm) were detected significantly more frequently in the LCA group (0.75 [0.64 to 0.86] vs. 0.48 [0.40 to 0.57], P<0.001 and 0.34 [0.26 to 0.41] vs. 0.24 [0.18 to 0.29], P=0.04, respectively). In both groups, ADR was not significantly different between experts and trainees. Conclusions LCA was significantly superior to LCI alone in terms of ADR. [ABSTRACT FROM AUTHOR]

Background To address mismatch between routine endoscopy capacity and demand, centers often implement initiatives to increase capacity, such as weekend working or using locums/agency staff (insourcing). However, there are concerns that such initiatives may negatively impact quality. We investigated polyp detection for weekend vs. weekday and insourced vs. standard procedures using data from the UK National Endoscopy Database. Methods We conducted a national, retrospective, cross-sectional study of diagnostic colonoscopies performed during 01/01–04/04/2019. The primary outcome was mean number of polyps (MNP) and the secondary outcome was polyp detection rate (PDR). Multi-level mixed-effect regression, fitting endoscopist as a random effect, was used to examine associations between procedure day (weekend/weekday) and type (insourced/standard) and these outcomes, adjusting for patient age, sex, and indication. Results 92 879 colonoscopies (weekends: 19 977 [21.5 %]; insourced: 9909 [10.7 %]) were performed by 2496 endoscopists. For weekend colonoscopies, patients were less often male or undergoing screening-related procedures; for insourced colonoscopies, patients were younger and less often undergoing screening-related procedures (all P < 0.05). Fully adjusted MNP was significantly lower for weekend vs. weekday (incidence rate ratio [IRR] 0.86 [95 %CI 0.83–0.89]) and for insourced vs. standard procedures (IRR 0.91 [95 %CI 0.87–0.95]). MNP was highest for weekday standard procedures and lowest for weekend insourced procedures; there was no interaction between procedure day and type. Similar associations were found for PDR. Conclusions Strategies to increase colonoscopy capacity may negatively impact polyp detection and should be monitored for quality. Reasons for this unwarranted variation require investigation. [ABSTRACT FROM AUTHOR]

Background This study aimed to evaluate the benefits of a self-developed computer-aided polyp detection system (SD-CADe) and a commercial system (CM-CADe) for high adenoma detectors compared with white-light endoscopy (WLE) as a control. Methods Average-risk 50–75-year-old individuals who underwent screening colonoscopy at five referral centers were randomized to SD-CADe, CM-CADe, or WLE groups (1:1:1 ratio). Trainees and staff with an adenoma detection rate (ADR) of ≥35% were recruited. The primary outcome was ADR. Secondary outcomes were the proximal adenoma detection rate (pADR), advanced adenoma detection rate (AADR), and the number of adenomas, proximal adenomas, and advanced adenomas per colonoscopy (APC, pAPC, and AAPC, respectively). Results The study enrolled 1200 participants. The ADR in the control, CM-CADe, and SD-CADe groups was 38.3%, 50.0%, and 54.8%, respectively. The pADR was 23.0%, 32.3%, and 38.8%, respectively. AADR was 6.0%, 10.3%, and 9.5%, respectively. After adjustment, the ADR and pADR in both intervention groups were significantly higher than in controls (all P<0.05). The APC in the control, CM-CADe, and SD-CADe groups was 0.66, 1.04, and 1.16, respectively. The pAPC was 0.33, 0.53, and 0.64, respectively, and the AAPC was 0.07, 0.12, and 0.10, respectively. Both CADe systems showed significantly higher APC and pAPC than WLE. AADR and AAPC were improved in both CADe groups versus control, although the differences were not statistically significant. Conclusion Even in high adenoma detectors, CADe significantly improved ADR and APC. The AADR tended to be higher with both systems, and this may enhance colorectal cancer prevention. [ABSTRACT FROM AUTHOR]

Background Detection and treatment of recurrence after piecemeal endoscopic mucosal resection of nonpedunculated colorectal polyps are crucial for avoidance of post-colonoscopy cancer. Linked-color imaging (LCI) has demonstrated improved polyp detection but has never been assessed for evaluation of post-polypectomy scars. Our aim was to compare sensitivity and negative predictive value (NPV) between LCI and white-light endoscopy (WLE) for detection of post-polypectomy recurrence. Methods Patients undergoing surveillance colonoscopy after resection of lesions ≥15 mm were included in this prospective, single-center, randomized, crossover study. Each post-polypectomy scar underwent two examinations, one with LCI and the other with WLE, performed by two blinded endoscopists. Blue-light imaging (BLI) was then applied. A diagnosis of recurrence with a level of confidence was made for each modality and histopathology was the gold standard. Results 129 patients with 173 scars were included. Baseline patient, lesion, and procedural characteristics were similar in both arms. Recurrence was detected in 56/173 (32.4%), with 27/56 (48.2%) adenomas and 29/56 (51.8%) serrated lesions. LCI had greater sensitivity (96.4% [95%CI 87.8%–99.5%]) versus WLE (89.3% [95%CI 78.1%–95.9%]) and greater NPV (98.1% [95%CI 93.4%–99.8%] versus 94.6% [95%CI 88.7%–98.0%]). Paired concordance between modalities was 96.0%. In discordant cases, LCI identified four true-positive cases not detected by WLE and reclassified one false-positive of WLE. WLE reclassified two false positives of LCI without any increase in recurrence detection. Conclusions LCI was highly accurate and had greater ability than WLE to rule out recurrence on post-polypectomy scars after resection of large polyps. [ABSTRACT FROM AUTHOR]

Background The choice of polypectomy device and surveillance intervals for colorectal polyps are primarily decided by polyp size. We developed a deep learning-based system (ENDOANGEL-CPS) to estimate colorectal polyp size in real time. Methods ENDOANGEL-CPS calculates polyp size by estimating the distance from the endoscope lens to the polyp using the parameters of the lens. The depth estimator network was developed on 7297 images from five virtually produced colon videos and tested on 730 images from seven virtual colon videos. The performance of the system was first evaluated in nine videos of a simulated colon with polyps attached, then tested in 157 real-world prospective videos from three hospitals, with the outcomes compared with that of nine endoscopists over 69 videos. Inappropriate surveillance recommendations caused by incorrect estimation of polyp size were also analyzed. Results The relative error of depth estimation was 11.3% (SD 6.0%) in successive virtual colon images. The concordance correlation coefficients (CCCs) between system estimation and ground truth were 0.89 and 0.93 in images of a simulated colon and multicenter videos of 157 polyps. The mean CCC of ENDOANGEL-CPS surpassed all endoscopists (0.89 vs. 0.41 [SD 0.29]; P <0.001). The relative accuracy of ENDOANGEL-CPS was significantly higher than that of endoscopists (89.9% vs. 54.7%; P <0.001). Regarding inappropriate surveillance recommendations, the system's error rate is also lower than that of endoscopists (1.5% vs. 16.6%; P <0.001). Conclusions ENDOANGEL-CPS could potentially improve the accuracy of colorectal polyp size measurements and size-based surveillance intervals. [ABSTRACT FROM AUTHOR]

Background Cold snare polypectomy (CSP) is safer than and equally efficacious as hot snare polypectomy (HSP) for the removal of small (<10mm) colorectal polyps. The maximum polyp size that can be effectively managed by piecemeal CSP (p-CSP) without an excessive burden of recurrence is unknown. Methods Resection error risks (RERs), defined as the estimated likelihood of incomplete removal of adenomatous tissue for a single snare resection pass, for CSP and HSP were calculated, based on an incomplete resection rate. Polyp area, snare size, estimated number of resections, and optimal resection defect area were modeled. Overall risk of incomplete resection (RIR) was defined as RIR=1 – (1 – p)n, where p is the RER and n the number of resections. Results A 40-mm polyp has a four times greater area than a 20-mm polyp (314.16mm2 vs. 1256.64mm2), and requires three times more resections (11 vs. 33, respectively, assuming 8-mm piecemeal resection pieces for p-CSP). RIRs for a 40-mm polyp by HSP and p-CSP were 15.1%–23% and 40.74%–60.60% respectively. Conclusion RER is more important with p-CSP than with HSP. The number of resections, n, and consequently RIR increases with increasing polyp size. Given the overwhelming safety of CSP, specific techniques to minimize the RER should be studied and developed. [ABSTRACT FROM AUTHOR]

Background Large (≥20mm) adenomatous anastomotic polyps (LAAPs) are uncommon. Data pertaining to their prevalence, characteristics, and the efficacy of endoscopic resection (ER) are absent. A safe and effective strategy for ER would reduce morbidity and healthcare costs. Methods Large nonpedunculated colorectal polyps of ≥20mm (LNPCPs) referred for ER were prospectively studied. Multiple data points were recorded including anastomotic location, polyp morphology, resection modality, complications, and technical success. Results Over 7 years until November 2022, 2629 lesions were referred. Of these, 10 (0.4%) were LAAPs (median size 35 mm [interquartile range (IQR) 30–40mm]). All LAAPs were removed by piecemeal endoscopic mucosal resection (EMR), most (n=9; 90%) in combination with cold-forceps avulsion with adjuvant snare-tip soft coagulation (CAST). On comparison of the LAAP group with the conventional LNPCP group, CAST was more commonly used (90% vs. 9%; P <0.001) and deep mural injury (DMI) type II was more frequent (40% vs. 11%, P =0.003); however, significant DMI (III–V) did not occur. At 6 month (IQR 5.25–6 months) surveillance, there was no recurrence in any of the 10 cases. There were no serious adverse events. Conclusions LAAPs present unique challenges owing to their location overlying an anastomosis. Despite these challenges they can be safely and effectively managed endoscopically without recurrence at endoscopic follow-up. [ABSTRACT FROM AUTHOR]

Background Cold snare defect protrusions (CSDPs) that occur after cold snare polypectomy (CSP) are considered indicators of incomplete polyp resection (IPR). We have sometimes experienced difficulty resecting polyps with snaring alone; in such cases, a forcible pull on the snare by the endoscopist is necessary. We call this procedure "forced CSP (FCSP)." However, no previous studies have evaluated this procedure. Methods This was a prospective observational study. From November 2020 to June 2021, the frequency, safety, and validity of FCSP were evaluated at our hospital. We distinguished CSP with snaring alone performed by the assistant as conventional CSP, and CSP requiring a forcible pull on the snare by the endoscopist as FCSP. Results Of 1315 polyps removed, 105 underwent FCSP (8%). The perforation rate was 0% in both groups. The rate of CSDP after the procedure was 96.2% (101/105) with FCSP and 6.4% (77/1210) with conventional CSP (P <0.001). The rate of IPR was 12.5% (13/104) with FCSP and 6.2% (75/1208) with conventional CSP (P =0.02). Multivariable analysis identified polyps located in the cecum (risk ratio [RR], 1.13; 95%CI 1.050–1.179; P =0.003) and polyps ≥6mm in diameter (RR, 2.37; 95%CI 2.146–2.542; P <0.001) as independent risk factors for FCSP. Conclusions FCSP was performed on 105 polyps (8%) in this study. FCSP may be associated with the occurrence of CSDP and IPR. Further studies are necessary to confirm our results. [ABSTRACT FROM AUTHOR]

This article discusses a study that compares the performance of different computer-aided detection (CADe) systems in detecting polyps during colonoscopies. The study found that the CADe systems have varying levels of sensitivity and accuracy in detecting polyps, with some systems performing better than others. However, certain systems did miss some polyps, which could potentially lead to delays in patient follow-up. The study provides valuable insights into the performance of CADe systems and can help clinicians choose the system that best suits their needs. [Extracted from the article]

This article is a systematic review and meta-analysis of the effectiveness and safety of cold snare endoscopic mucosal resection (CS-EMR) for colon polyps. The analysis found that CS-EMR is a safe and effective technique for removing colon polyps, particularly smaller polyps and sessile serrated lesions (SSLs). The technical success rate of CS-EMR was high at 97.2%, and the polyp recurrence rate was 6.7%. The analysis also found low rates of bleeding and no reports of perforation or post-polypectomy syndrome. However, more research is needed to evaluate the efficacy of CS-EMR for larger polyps and to compare it with other resection techniques. [Extracted from the article]

Background: Cold snare polypectomy (CSP) is increasingly used for polypectomy and is recommended as first-line modality for small (<10mm) polyps. This study aimed to evaluate incomplete resection rates (IRRs) when using CSP for 4-20mm colorectal polyps.Methods: Adults (45-80y) undergoing screening, surveillance, or diagnostic colonoscopy were included to undergo CSP by nine endoscopists. Primary outcome was IRR for 4-20mm colorectal polyps, defined as presence of polyp tissue in marginal biopsies after resection serrated polyps or adenomas. Secondary outcomes included IRR for serrated polyps, ease of resection and complications.Results: Overall, 413 patients were included (mean age 63; female 48.2%) and 182 polyps 4-20mm were detected and removed by CSP. CSP required conversion to hot snare resection in <1% of polyps <10mm and 44.4% of polyps 10-20mm. IRR for polyps <10mm and ≥10mm was 18.4% and 21.4%. IRR was higher for serrated polyps (25.6%) compared to adenomas (15.7%). IRR was higher for flat (IIa) polyps (OR=2.9, 95% Confidence Interval [CI]=1.13-7.41), when resection was judged as difficult (OR=4.2, 95%CI=1.47-12.13), when piecemeal resection was performed (OR=6.6, 95%CI=1.97-22.01), or when visible residual polyp was present after initial resection (OR=5.4, 95%CI=1.97-14.88). Polyp location, using a dedicated cold snare, or submucosal injection was not associated with incomplete resection. Intraprocedural bleeding requiring endoscopic intervention occurred in 4.7%.Conclusions: CSP for 4-9mm polyps is safe and feasible. However, for lesions ≥10mm, CSP failure occurs frequently, and IRR remains high even after technical success. Incomplete resection was associated with flat polyps, visual residual polyp, piecemeal resection, and difficult polypectomies. [ABSTRACT FROM AUTHOR]

As a new feature of our polyp detection system, "EndoMind", Poseidon analyzed the images containing a waterjet to determine the polyp size [19]. Artificial intelligence (AI) was introduced in clinical practice several years ago, with the main focus being polyp detection [12][13]; however, AI-based diagnosis has been further explored for polyp characterization [14] and other gastroenterological diseases, such as eosinophilic esophagitis [15] and Crohn's disease [12]. The waterjet should be aimed adjacent to a polyp to be equally distanced away from the endoscope, and the polyp needs to be recognized by our polyp detection system. [Extracted from the article]

The article in the journal "Endoscopy" discusses the importance of surveillance after polyp removal to prevent colorectal cancer. A study in Denmark evaluated the risk of CRC and advanced adenomas in participants with high and intermediate risk adenomas. The results showed that patients in the intermediate risk group had a higher risk of developing CRC than those in the high risk group, highlighting the importance of the quality of the baseline colonoscopy. The study emphasizes the need for quality metrics for endoscopists performing screening colonoscopies to improve surveillance and screening strategies. [Extracted from the article]

A letter to the editor of the journal Endoscopy discusses the topic of linked color imaging (LCI) versus white-light imaging (WLI) in colonoscopy. The authors of the letter point out two important factors that may have influenced the conflicting results of previous studies. First, they suggest that patient age stratification should be considered when exploring the polyp or adenoma detection rate (ADR) because both rates increase with age. Second, they argue that the experience of the endoscopists should be taken into account, as it may affect the results. The authors conclude that further research is needed to fully understand the impact of these factors on the proximal adenoma miss rate. [Extracted from the article]

Background Previous studies have reported the effectiveness of narrow-band imaging (NBI) and linked-color imaging (LCI) in improving the detection of colorectal neoplasms. There has however been no direct comparison between LCI and NBI in the detection of colorectal sessile serrated lesions (SSLs). The present study aimed to compare the effectiveness of LCI and NBI in detecting colorectal SSLs. Methods A prospective, parallel, randomized controlled trial was conducted. The participants were randomly assigned to the LCI or NBI arms. The primary end point was the SSL detection rate (SDR). Results 406 patients were involved; 204 in the LCI arm and 202 in the NBI arm. The total polyp detection rate, adenoma detection rate, and SDR were 54.2 %, 38.7 %, and 10.8%, respectively. The SDR was not significantly different between the LCI and NBI arms (12.3 % vs. 9.4 %; P = 0.36). The differences in the detection rate and the per-patient number of polyps, adenomas, diminutive lesions, and flat lesions between LCI and NBI also were not statistically significant. Multivariate analysis showed that LCI and NBI were not independent factors associated with SDR, whereas Boston Bowel Preparation Scale score (odds ratio [OR] 1.35, 95 %CI 1.03–1.76; P = 0.03), withdrawal time (OR 1.13, 95 %CI 1.00–1.26; P = 0.04), and operator experience (OR 3.73, 95 %CI 1.67–8.32; P = 0.001) were independent factors associated with SDR. Conclusions LCI and NBI are comparable for SSL detection, as well as for the detection of polyps and adenomas. [ABSTRACT FROM AUTHOR]

Aims Advanced serrated polyps (ASPs) have a comparable risk as advanced adenomas (AAs) to progress into colorectal cancer (CRC). The yield of most CRC screening programs, however, is based on AAs and CRC only. We assessed the ASP detection rate, and increase in positive predictive value (PPV) including ASPs in the yield of a FIT-based screening program. Methods We analysed findings of follow-up colonoscopies of FIT-positive screenees in the Dutch CRC screening program from 2014 until 2020. Data was retrieved from the national screening and pathology database. ASP was defined as any serrated polyp ≥10mm, sessile serrated lesion with dysplasia or traditional serrated adenoma. ASP detection rate was defined as the proportion of colonoscopies with ≥1 ASP. PPV was defined as proportion of persons with a CRC or AA. The updated PPV definition included CRC, AA and/or ASPs. Results In total, 322,882 colonoscopies were included in the analyses. Overall detection rate of ASPs was 5.9%. ASPs were more often detected in females than males (6.3% vs 5.6%, p<0.001). ASP detection rates in individuals aged 55-59, 60-64, 65-69 and 70+ were 5.2%; 6.1%; 6.1%; 5.9% (p<0.001), respectively. The PPV for CRC and AA was 41.1% and increased to 43.8% when including ASP. The PPV increase was larger in females than in males (3.2% vs 2.4%). Conclusion A proportion of 5.9% FIT-positive screenees had ASPs, but half of these were detected in combination with CRC or AA. Therefore, including ASPs results in a small increase in the yield of FIT-based screening. [ABSTRACT FROM AUTHOR]

This article, published in the journal Endoscopy, examines the presence of residual malignant disease in surgical specimens after the endoscopic removal of a malignant polyp without endoscopic cure. The study included 74 patients who underwent surgery after the removal of a malignant polyp. The results showed that a minority of patients had residual malignant disease in the surgical specimen, with a higher risk for those with polyps with a flat component or those that were removed using piecemeal endoscopic mucosal resection (EMR). The study highlights the importance of careful evaluation of the polyp before removal and the need for removal in one fragment, especially in cases of suspected submucosal invasion. [Extracted from the article]

This article compares the safety and effectiveness of two treatment options for gallbladder polyps: laparoscopic cholecystectomy (LC) and pure NOTES gallbladder preserving polypectomy (GPP). The study found that both procedures had a 100% technical success rate, but the median procedure time was significantly longer for GPP. Patients who underwent GPP experienced no postoperative pain, while those who had LC reported incision-related pain. The duration of fasting was shorter for LC, but the overall hospital stay was similar for both procedures. During the follow-up period, patients who had LC were more likely to experience post-cholecystectomy syndrome, while no symptoms were observed in the GPP group. The study concludes that both procedures are feasible and effective, but GPP offers advantages such as gallbladder preservation, quicker recovery, no abdominal wall incision, and fewer long-term complications. However, the long-term complications of LC, including post-cholecystectomy syndrome, require further study. [Extracted from the article]

This article, published in the journal Endoscopy, aims to estimate the prevalence of gastric polyps associated with long-term use of proton pump inhibitors (PPIs) and identify the risk factors and characteristics of these polyps. The study was conducted on patients at two hospital centers in Beirut over a period of 12 months. The results showed that the prevalence of gastric polyps linked to chronic daily use of PPIs in Lebanon was 30%, with a minimum duration of 24 months required for polyp formation. The study highlights the importance of limiting the prescription of PPIs to well-defined indications and understanding the risks associated with their use. [Extracted from the article]

This article, published in the journal Endoscopy, examines the relationship between diverticular disease and the detection of colonic polyps in consecutive colonoscopies. The study reviewed colonoscopies performed between January 2007 and December 2015, dividing the patients into two groups: those with diverticulosis and those without. The primary endpoint was the comparison of the Polyp Detection Rate (PDR) between the two groups. The study found no significant difference in the number of polyps detected between the groups, suggesting that diverticulosis is not a risk factor for a lower polyp detection rate. Additionally, diverticulosis appeared to be a protective factor against the development of adenomas in consecutive colonoscopies. [Extracted from the article]

This article, published in the journal Endoscopy, discusses a study conducted to assess the risk of recurrence and metastasis in patients with pT1 colorectal cancer (CRC) who underwent endoscopic or surgical treatment. The study analyzed various histological biomarkers, including conventional ones such as grade of differentiation and lymphovascular invasion, as well as novel ones like desmoplastic response and tumor infiltrating lymphocytes. The analysis included 75 patients, and after a median follow-up time of 3.7 years, 10.6% of patients experienced recurrence or metastases. The study identified two novel biomarkers that, when combined with conventional ones, could optimize endoscopic treatment of T1 CRC. [Extracted from the article]

This article, published in the journal Endoscopy, examines the outcomes of patients with malignant polyps that were not successfully treated through endoscopy. The study included 80 patients who had undergone endoscopic removal of a malignant polyp, with 49 of them not achieving endoscopic cure. Factors such as age and comorbidities influenced the decision of whether to proceed with surgery or surveillance. The study found that in patients with older age and multiple comorbidities, surveillance was a suitable approach that did not compromise oncologic outcomes. [Extracted from the article]

This article discusses the applicability of the Scottish Screen-detected Polyp Cancer Study (SSPoCS) algorithm in managing malignant colorectal polyps. The algorithm is based on two easily obtainable variables: resection margin and lymphovascular invasion. The study included 211 patients from five centers in Portugal, and the main outcome measured was residual/recurrent malignancy. The results showed that the SSPoCS algorithm had good accuracy in predicting residual/recurrent malignancy, with a negative predictive value of 95% in low-risk lesions. The study also found that deep submucosal invasion was relevant in the decision-making process. [Extracted from the article]

This article describes a case series in which a novel technique called transcecal endoscopic appendectomy (TEA) was used to remove complex appendiceal orifice polyps. The traditional technique of endoscopic full thickness resection (EFTR) is limited in managing larger polyps or those that extend deeply into the appendiceal lumen. TEA involves making an incision around the polyp in the base of the cecum and dissecting the appendix from the mesoappendix. The study found that TEA was successful in achieving complete removal of the appendix and polyp in all cases, with minimal complications. However, further research is needed to standardize the technique. [Extracted from the article]

This article, published in the journal Endoscopy, explores patients' perspectives on the use of artificial intelligence (AI) during colonoscopies. The study conducted a survey of 291 participants undergoing colon cancer screening/surveillance colonoscopies at Mayo Clinic-Rochester. The results showed that most participants were familiar with AI and believed it was important for physicians to utilize. However, while many participants were comfortable with AI-assisted polyp detection, fewer accepted AI-assisted polyp diagnosis tools in clinical practice. The study also found that demographic differences influenced patients' perspectives on AI. [Extracted from the article]

This article, published in the journal Endoscopy, discusses the re-evaluation of colorectal polyps that were initially diagnosed as "normal mucosa" in pathology. The study used expert endoscopists and Computer Assisted Diagnosis (CADx) evaluation to obtain optical diagnoses for these polyps. The results showed that a significant number of polyps diagnosed as "normal mucosa" were actually adenomas, hyperplastic, or sessile serrated lesions. The study suggests that errors in pathologic processing and evaluation may be the cause of misdiagnosis, and recommends the routine use of CADx and photo or video documentation for arbitration of polyps diagnosed as normal mucosa in pathology. [Extracted from the article]

This article presents the findings of a multicentric retrospective study conducted in Italy on patients with autoimmune atrophic gastritis (AAG). The study aimed to investigate the incidence and characteristics of gastric polyps in patients with AAG. The study included 375 patients with AAG, and it was found that 50.4% of these patients had at least one incidental polyp. The polyps observed included inflammatory, adenomatous, fundic gland polyps, gastric neuroendocrine tumors (gNETs), adenocarcinomas, and one MALT lymphoma. The study highlights the importance of proactive endoscopic monitoring and comprehensive histopathological evaluation in patients with AAG to effectively identify and manage these different gastric lesions. [Extracted from the article]

A study published in the journal Endoscopy compared the performance of a novel colonoscope with extra-wide field of view optics to a standard colonoscope in detecting polyps. The study used a 3D-printed silicon model of a colon with 12 polyps placed throughout. The results showed that the novel colonoscope detected significantly more polyps compared to the standard colonoscope. The handling, optical performance, and maneuverability of the novel colonoscope were also rated as equally good or better by all endoscopists. However, further clinical studies are needed to confirm these findings. [Extracted from the article]

This article discusses the use of three-dimensional (3D) scanning to obtain accurate measurements of polyp size, morphology, and volume. The researchers used a virtual scale endoscope (VSE) during colonoscopies to measure the size of polyps, which were then removed and measured using a digital Vernier caliper. The polyps were also 3D scanned to obtain volumetric information. The study found that 3D scanning can capture the shape, geometries, and textures of polyps, providing valuable data for the development of artificial intelligence (AI) solutions in polyp detection and classification. [Extracted from the article]

The article discusses the importance of accurate polyp size estimation during colonoscopies and the potential impact on patient care and healthcare systems. It highlights the limitations of current methods and introduces new technologies that may improve accuracy, including a laser-based measurement device and an artificial intelligence (AI) tool. The AI tool, called ENDOANGEL-CPS, showed high performance in estimating polyp size without the need for a reference standard. The article acknowledges the need for further validation through clinical trials and expresses anticipation for the future of size estimation in endoscopy. [Extracted from the article]

Background: Clinical implementation of the resect-and-discard strategy has been difficult because optical diagnosis is highly operator dependent. This prospective study aimed to evaluate a resect-and-discard strategy that is not operator dependent.Methods: The study evaluated a resect-and-discard strategy that uses the anatomical polyp location to classify colonic polyps into non-neoplastic or low risk neoplastic. All rectosigmoid diminutive polyps were considered hyperplastic and all polyps located proximally to the sigmoid colon were considered neoplastic. Surveillance interval assignments based on these a priori assumptions were compared with those based on actual pathology results and on optical diagnosis. The primary outcome was ≥ 90 % agreement with pathology in surveillance interval assignment.Results: 1117 patients undergoing complete colonoscopy were included and 482 (43.1 %) had at least one diminutive polyp. Surveillance interval agreement between the location-based strategy and pathological findings using the 2020 US Multi-Society Task Force guideline was 97.0 % (95 % confidence interval [CI] 0.96-0.98), surpassing the ≥ 90 % benchmark. Optical diagnoses using the NICE and Sano classifications reached 89.1 % and 90.01 % agreement, respectively (P < 0.001), and were inferior to the location-based strategy. The location-based resect-and-discard strategy allowed a 69.7 % (95 %CI 0.67-0.72) reduction in pathology examinations compared with 55.3 % (95 %CI 0.52-0.58; NICE and Sano) and 41.9 % (95 %CI 0.39-0.45; WASP) with optical diagnosis.Conclusion: The location-based resect-and-discard strategy achieved very high surveillance interval agreement with pathology-based surveillance interval assignment, surpassing the ≥ 90 % benchmark and outperforming optical diagnosis in surveillance interval agreement and the number of pathology examinations avoided. [ABSTRACT FROM AUTHOR]

Background: Use of artificial intelligence may increase detection of colorectal neoplasia at colonoscopy by improving lesion recognition (CADe) and reduce pathology costs by improving optical diagnosis (CADx).Methods: A multicenter library of ≥ 200 000 images from 1572 polyps was used to train a combined CADe/CADx system. System testing was performed on two independent image sets (CADe: 446 with polyps, 234 without; CADx: 267) from 234 polyps, which were also evaluated by six endoscopists (three experts, three non-experts).Results: CADe showed sensitivity, specificity, and accuracy of 92.9 %, 90.6 %, and 91.7 %, respectively. Experts showed significantly higher accuracy and specificity, and similar sensitivity, while non-experts + CADe showed comparable sensitivity but lower specificity and accuracy than CADe and experts. CADx showed sensitivity, specificity, and accuracy of 85.0 %, 79.4 %, and 83.6 %, respectively. Experts showed comparable performance, whereas non-experts + CADx showed comparable accuracy but lower specificity than CADx and experts.Conclusions: The high accuracy shown by CADe and CADx was similar to that of experts, supporting further evaluation in a clinical setting. When using CAD, non-experts achieved a similar performance to experts, with suboptimal specificity. [ABSTRACT FROM AUTHOR]

Background: Systematic training in colonoscopy is highly recommended; however, we have limited knowledge of the effects of "training-the-colonoscopy-trainer" (TCT) courses. Using a national quality register on colonoscopy performance, we aimed to evaluate the effects of TCT participation on defined quality indicators.Methods: This observational study compared quality indicators (pain, cecal intubation, and polyp detection) between centers participating versus not participating in a TCT course. Nonparticipating centers were assigned a pseudoparticipating year to match their participating counterparts. Results were compared between first year after and the year before TCT (pseudo)participation. Time trends up to 5 years after TCT (pseudo)participation were also compared. Generalized estimating equation models, adjusted for age, sex, and bowel cleansing, were used.Results: 11 participating and 11 nonparticipating centers contributed 18 555 and 10 730 colonoscopies, respectively. In participating centers, there was a significant increase in detection of polyps ≥ 5 mm, from 26.4 % to 29.2 % (P = 0.035), and reduction in moderate/severe pain experienced by women, from 38.2 % to 33.6 % (P = 0.043); no significant changes were found in nonparticipating centers. Over 5 years, 20 participating and 18 nonparticipating centers contributed 85 691 and 41 569 colonoscopies, respectively. In participating centers, polyp detection rate increased linearly (P = 0.003), and pain decreased linearly in women (P = 0.004). Nonparticipating centers did not show any significant time trend during the study period.Conclusions: Participation in a TCT course improved polyp detection rates and reduced pain experienced by women. These effects were maintained during a 5-year follow-up. [ABSTRACT FROM AUTHOR]

A study published in the journal Endoscopy highlights the benefits of using a cold snare technique for the removal of small colorectal polyps. The study found that cold snaring was successful in resecting polyps ≤10mm in size with a success rate of over 99%. This approach not only simplifies procedures and reduces costs, but it also has a positive environmental impact by reducing plastic waste. The study suggests that adopting universal cold snaring for polyps ≤10mm can contribute to efficiency, sustainability, and environmental conservation in healthcare facilities. [Extracted from the article]

This letter is a response to critiques of a study titled "Cold snare endoscopic mucosal resection for colon polyps: a systematic review and meta-analysis." The authors address the comments and clarify their methodological choices. They explain that they used the Newcastle-Ottawa Scale uniformly to assess the included studies and treated the cold snare endoscopic mucosal resection (CS-EMR) arm as cohorts rather than comparing groups. They also discuss their data transformation approach and state that their study provides valuable information for clinicians regarding the safety and efficacy of CS-EMR for colon polyp resection. The authors suggest that future randomized controlled trials will further assess the efficacy and safety of CS-EMR compared to other methods. [Extracted from the article]

BACKGROUND AND STUDY AIM : Delayed bleeding is a common adverse event following endoscopic mucosal resection (EMR) of large colorectal polyps. Prophylactic clip closure of the mucosal defect after EMR of nonpedunculated polyps larger than 20 mm reduces the incidence of severe delayed bleeding, especially in proximal polyps. This study aimed to evaluate factors associated with complete prophylactic clip closure of the mucosal defect after EMR of large polyps. METHODS : This is a post hoc analysis of the CLIP study (NCT01936948). All patients randomized to the clip group were included. Main outcome was complete clip closure of the mucosal resection defect. The defect was considered completely closed when no remaining mucosal defect was visible and clips were less than 1 cm apart. Factors associated with complete closure were evaluated in multivariable analysis. RESULTS : In total, 458 patients (age 65, 58 % men) with 494 large polyps were included. Complete clip closure of the resection defect was achieved for 338 polyps (68.4 %); closure was not complete for 156 (31.6 %). Factors associated with complete closure in adjusted analysis were smaller polyp size (odds ratio 1.06 for every millimeter decrease [95 % confidence interval 1.02-1.08]), good access (OR 3.58 [1.94-9.59]), complete submucosal lifting (OR 2.28 [1.36-3.90]), en bloc resection (OR 5.75 [1.48-22.39]), and serrated histology (OR 2.74 [1.35-5.56]). CONCLUSIONS : Complete clip closure was not achieved for almost one in three resected large nonpedunculated polyps. While stable access and en bloc resection facilitate clip closure, most factors associated with clip closure are not modifiable. This highlights the need for alternative closure options and measures to prevent bleeding. [ABSTRACT FROM AUTHOR]

Background: To decrease the risk of bleeding or perforation, ischemic polypectomy is performed using a detachable snare or endoclip with double-balloon endoscopy (DBE) for small-bowel polyps in patients with Peutz - Jeghers syndrome. The aim of this study was to determine the effectiveness and feasibility of ischemic polypectomy.Methods: We retrospectively reviewed patients who underwent two or more sessions of ischemic polypectomy using DBE from July 2004 to August 2017.Results: 67 therapeutic DBEs were performed in nine patients during the study period and 352 polyps were treated. The median observation period was 34 months (range 12 - 66). There was a declining trend over time in the median number of polyps > 15 mm treated per patient first DBE session 6, second 2, third 1.5, fourth 0.5, fifth 0.5; P = 0.11, Friedman test). No patient required laparotomy due to intussusception during the study period. One patient developed mild acute pancreatitis after the procedure.Conclusions: Ischemic polypectomy was feasible for the control of small-bowel polyps in patients with Peutz - Jeghers syndrome. [ABSTRACT FROM AUTHOR]

Background: Colon capsule endoscopy (CCE) is a technology that might contribute to colorectal cancer (CRC) screening programs as a filter test between fecal immunochemical testing and standard colonoscopy. The aim was to systematically review the literature for studies investigating the diagnostic yield of second-generation CCE compared with standard colonoscopy.Methods: A systematic literature search was performed in PubMed, Embase, and Web of Science. Study characteristics including quality of bowel preparation and completeness of CCE transits were extracted. Per-patient sensitivity and specificity were extracted for polyps (any size, ≥ 10 mm, ≥ 6 mm) and lesion characteristics. Meta-analyses of diagnostic yield were performed.Results: The literature search revealed 1077 unique papers and 12 studies were included. Studies involved a total of 2199 patients, of whom 1898 were included in analyses. The rate of patients with adequate bowel preparation varied from 40 % to 100 %. The rates of complete CCE transit varied from 57 % to 100 %. Our meta-analyses demonstrated that mean (95 % confidence interval) sensitivity, specificity, and diagnostic odds ratio were: 0.85 (0.73-0.92), 0.85 (0.70-0.93), and 30.5 (16.2-57.2), respectively, for polyps of any size; 0.87 (0.82-0.90), 0.95 (0.92-0.97), and 136.0 (70.6-262.1), respectively, for polyps ≥ 10 mm; and 0.87 (0.83-0.90), 0.88 (0.75-0.95), and 51.1 (19.8-131.8), respectively, for polyps ≥ 6 mm. No serious adverse events were reported for CCE.Conclusion: CCE had high sensitivity and specificity for per-patient polyps compared with standard colonoscopy However, the relatively high rate of incomplete investigations limits the application of CCE in a CRC screening setting. [ABSTRACT FROM AUTHOR]

This article examines the certainty of optical diagnoses for colonic polyps at a Reference Center in Latin America. The study aimed to assess the optical-histological certainty of colonic polyps among trainee endoscopists at the National Institute of Medical Sciences and Nutrition "Salvador Zubirán" in Mexico. The results showed that the sensitivity and specificity in the optical diagnosis of polyps fell below European guideline recommendations. The authors suggest the implementation of teaching and learning techniques to enhance diagnostic standards, especially in low and middle-income countries. [Extracted from the article]

This article, published in the journal Endoscopy, discusses the techniques used for the removal of diminutive polyps (size≤5 mm) in the colon and rectum. The preferred technique recommended by the European Society of Gastrointestinal Endoscopy (ESGE) is cold snare polypectomy (CSP), which has been found to cause less damage to blood vessels and result in a reduced incidence of hemorrhage compared to hot snare polypectomy (HSP). The study analyzed the resection modalities of 715 patients in a tertiary care center and found a wide variability in the techniques used, with forceps polypectomy being the predominantly used method. The authors suggest that larger, multicentric studies are needed to investigate the most widely used technique and its cost-effectiveness. [Extracted from the article]

This article, published in the journal Endoscopy, presents a case report of a 68-year-old woman who complained of substernal discomfort and occasional regurgitation of a fleshy mass. The woman underwent upper endoscopy, which revealed a polypoid digitiform mass in the upper esophagus. A CT scan showed an elongated intraluminal esophageal mass, and endoscopic ultrasound revealed a subepithelial lesion. The decision was made to perform an endoscopic polypectomy, which was successful. The histology revealed a fibrovascular polyp. The authors highlight the rarity and atypical presentation of this case. [Extracted from the article]

This article, published in the journal Endoscopy, presents a review of patients over the age of 85 who were referred to a complex polyp meeting over a 5-year period. The study found that advanced polypectomy in this age group is generally safe, although there is an increased risk of complications. The authors recommend that the risks and benefits of the procedure be discussed with the patient before considering advanced polypectomy. The study also suggests that further research is needed to develop tools to help patients make informed decisions about their treatment options. [Extracted from the article]

This article, published in the journal Endoscopy, discusses the quality of endoscopic image capture and its impact on decision making in a complex polyp multidisciplinary team (MDT) meeting. The study reviewed polyp MDT referrals over a 6-month period at a single academic center and assessed the quality of endoscopic imaging. The majority of referrals were made by interventional endoscopists, and the most common polyp location was the rectum. The study found that in 31% of cases, image quality was deemed suboptimal and negatively impacted decision making. The authors suggest that quality improvement initiatives, such as training and competency assessments, are needed to promote high-quality image capture standards. [Extracted from the article]

This article, published in the journal Endoscopy, presents a case study of an 81-year-old patient who underwent a hybrid-ESD technique to remove a lateral spreading tumor in the colon. However, the procedure resulted in a full-thickness perforation and arterial bleeding. The bleeding vessel was found to be located outside the colon and was successfully clipped and the defect closed endoscopically. The patient was treated with antibiotics and discharged without complications or the need for surgery. The article provides a video link for further reference. [Extracted from the article]