Colorectal cancer remains a major health concern,with colorectal polyps as key precursors.Endoscopic mucosal resection(EMR)is a common treatment,but recurrence rates remain high.Traditional surveillance strategies rel...Colorectal cancer remains a major health concern,with colorectal polyps as key precursors.Endoscopic mucosal resection(EMR)is a common treatment,but recurrence rates remain high.Traditional surveillance strategies rely on polyp characteristics and completeness of the resection potentially missing key risk factors.Machine learning(ML)offers a transformative approach by integrating patient-specific data to refine risk stratification.Recent studies highlight ML models,such as Extreme Gradient Boosting,which outperform conventional methods in predicting polyp recurrence within one-year post-EMR.These models incorporate factors like age,smoking status,family history,and pathology,optimizing follow-up recommendations and minimizing unnecessary procedures.Artificial intelligence(AI)-driven tools and web-based calculators enhance clinical workflow by providing real-time,personalized risk assessments.However,challenges remain in external validation,model interpretability,and clinical integration.Future surveillance strategies should combine expert judgment with AI insights to optimize patient outcomes.As gastroenterology embraces AI,MLdriven surveillance represents a paradigm shift,advancing precision medicine in colorectal polyp management.This editorial explores AI’s role in transforming post-EMR follow-up,addressing benefits,limitations,and future directions.展开更多
BACKGROUND Colorectal polyps are precancerous diseases of colorectal cancer.Early detection and resection of colorectal polyps can effectively reduce the mortality of colorectal cancer.Endoscopic mucosal resection(EMR...BACKGROUND Colorectal polyps are precancerous diseases of colorectal cancer.Early detection and resection of colorectal polyps can effectively reduce the mortality of colorectal cancer.Endoscopic mucosal resection(EMR)is a common polypectomy proce-dure in clinical practice,but it has a high postoperative recurrence rate.Currently,there is no predictive model for the recurrence of colorectal polyps after EMR.AIM To construct and validate a machine learning(ML)model for predicting the risk of colorectal polyp recurrence one year after EMR.METHODS This study retrospectively collected data from 1694 patients at three medical centers in Xuzhou.Additionally,a total of 166 patients were collected to form a prospective validation set.Feature variable screening was conducted using uni-variate and multivariate logistic regression analyses,and five ML algorithms were used to construct the predictive models.The optimal models were evaluated based on different performance metrics.Decision curve analysis(DCA)and SHapley Additive exPlanation(SHAP)analysis were performed to assess clinical applicability and predictor importance.RESULTS Multivariate logistic regression analysis identified 8 independent risk factors for colorectal polyp recurrence one year after EMR(P<0.05).Among the models,eXtreme Gradient Boosting(XGBoost)demonstrated the highest area under the curve(AUC)in the training set,internal validation set,and prospective validation set,with AUCs of 0.909(95%CI:0.89-0.92),0.921(95%CI:0.90-0.94),and 0.963(95%CI:0.94-0.99),respectively.DCA indicated favorable clinical utility for the XGBoost model.SHAP analysis identified smoking history,family history,and age as the top three most important predictors in the model.CONCLUSION The XGBoost model has the best predictive performance and can assist clinicians in providing individualized colonoscopy follow-up recommendations.展开更多
This editorial,inspired by a recent study published in the World Journal of Gastrointestinal Oncology,covers the research findings on microbiota changes in various diseases.In recurrent colorectal polyps,the abundance...This editorial,inspired by a recent study published in the World Journal of Gastrointestinal Oncology,covers the research findings on microbiota changes in various diseases.In recurrent colorectal polyps,the abundances of Klebsiella,Parvimonas,and Clostridium increase,while those of Bifidobacterium and Lactoba-cillus decrease.This dysbiosis may promote the formation and recurrence of polyps.Similar microbial changes have also been observed in colorectal cancer,inflammatory bowel disease,autism spectrum disorder,and metabolic syndrome,indicating the role of increased pathogens and decreased probiotics in these conditions.Regulating the gut microbiota,particularly by increasing probiotic levels,may help prevent polyp recurrence and promote gut health.This microbial intervention strategy holds promise as an adjunctive treatment for patients with colorectal polyps.展开更多
BACKGROUND Colorectal polyps(CPs)are important precursor lesions of colorectal cancer,and endoscopic surgery remains the primary treatment option.However,the shortterm recurrence rate post-surgery is high,and the risk...BACKGROUND Colorectal polyps(CPs)are important precursor lesions of colorectal cancer,and endoscopic surgery remains the primary treatment option.However,the shortterm recurrence rate post-surgery is high,and the risk factors for recurrence remain unknown.AIM To comprehensively explore risk factors for short-term recurrence of CPs after endoscopic surgery and develop a nomogram prediction model.METHODS Overall,362 patients who underwent endoscopic polypectomy between January 2022 and January 2024 at Nanjing Jiangbei Hospital were included.We screened basic demographic data,clinical and polyp characteristics,surgery-related information,and independent risk factors for CPs recurrence using univariate and multivariate logistic regression analyses.The multivariate analysis results were used to construct a nomogram prediction model,internally validated using Bootstrapping,with performance evaluated using area under the curve(AUC),calibration curve,and decision curve analysis.RESULTS CP re-occurred in 166(45.86%)of the 362 patients within 1 year post-surgery.Multivariate logistic regression analysis showed that age(OR=1.04,P=0.002),alcohol consumption(OR=2.07,P=0.012),Helicobacter pylori infection(OR=2.34,P<0.001),polyp number>2(OR=1.98,P=0.005),sessile polyps(OR=2.10,P=0.006),and adenomatous pathological type(OR=3.02,P<0.001)were independent risk factors for post-surgery recurrence.The nomogram prediction model showed good discriminatory(AUC=0.73)and calibrating power,and decision curve analysis showed that the model had good clinical benefit at risk probabilities>20%.CONCLUSION We identified multiple independent risk factors for short-term recurrence after endoscopic surgery.The nomogram prediction model showed a certain degree of differentiation,calibration,and potential clinical applicability.展开更多
Colorectal polyps remain a significant health concern because they can develop into cancer.Therefore,accurate assessment and diagnosis of polyps,along with appropriate treatment decisions,are crucial in preventing com...Colorectal polyps remain a significant health concern because they can develop into cancer.Therefore,accurate assessment and diagnosis of polyps,along with appropriate treatment decisions,are crucial in preventing complications or malignant transformation.Some polyps are classified as complex polyps,which means they fail to elevate due to a scar from a previously removed polyp or can be determined by a scoring system like the size/morphology/site/access score,which considers factors like site,morphology,size,and access.Management of complex colorectal polyps involves various options,including endoscopic and surgical approaches.Endoscopic mucosal resection(EMR)may be challenging in scarred polyps,as inadequate lifting can result in incomplete resection or recurrence.As a more advanced alternative,endoscopic submucosal dissection(ESD)is suitable for larger lesions,enabling en-bloc resection even in complex cases with EMR.However,ESD requires expertise and is more time-consuming than EMR,often necessitating hospitalization due to its complexity.Endoscopic full-thickness resection could be a viable alternative for managing scarred polyps.Endoscopic powered resection,either alone or in combination with other modalities,can also be used to achieve less extensive resection.Managing complications during the procedure or post-procedurally is equally important,as bleeding or perforations can be fatal.Careful patient selection based on individual profiles and risk factors,along with the identification of any signs of malignancy,is crucial before treatment to avoid negative post-treatment outcomes.展开更多
In 2025,Shi et al constructed a model utilizing machine learning techniques to predict the one-year recurrence of colorectal polyps following endoscopic mucosal resection,showing excellent discriminatory performance w...In 2025,Shi et al constructed a model utilizing machine learning techniques to predict the one-year recurrence of colorectal polyps following endoscopic mucosal resection,showing excellent discriminatory performance with an area under the curve exceeding 0.90.However,limitations exist regarding its narrow temporal scope,potential overestimation due to feature collinearity and imputation opacity,and limited generalizability due to single-center derivation and validation.Moreover,no clear clinical implementation strategy was outlined.Prospective multicenter validation and integration of endoscopist variability,longitudinal outcome data,and deployment mechanisms are warranted to ensure broader applicability and clinical utility.展开更多
The machine learning model developed by Shi et al for predicting colorectal polyp recurrence after endoscopic mucosal resection represents a significant advancement in the field of clinical gastroenterology.By integra...The machine learning model developed by Shi et al for predicting colorectal polyp recurrence after endoscopic mucosal resection represents a significant advancement in the field of clinical gastroenterology.By integrating patient-specific factors,such as age,smoking history,and Helicobacter pylori infection,the eXtreme Gradient Boosting algorithm enables precise personalised colonoscopy follow-up planning and risk assessment.This predictive tool offers substantial benefits by optimising surveillance intervals and directing healthcare resources more efficiently toward high-risk individuals.However,real-world implementation requires consideration of the generalisability of our findings across diverse patient populations and clinician training backgrounds.展开更多
BACKGROUNDColorectal cancer(CRC)typically progresses from benign colorectal polyps,whichrepresent a precursor to malignancy.Identifying the factors influencing thisprogression is crucial for early intervention and pre...BACKGROUNDColorectal cancer(CRC)typically progresses from benign colorectal polyps,whichrepresent a precursor to malignancy.Identifying the factors influencing thisprogression is crucial for early intervention and prevention.Although genetic andenvironmental factors have been widely studied,the role of lifestyle factors suchas physical activity,diet,smoking,sleep,and stress remains underexplored,especially in patients with early stage CRC or polyps.Recent evidence suggeststhat lifestyle behaviors may influence cancer progression by modulating inflammatorypathways,metabolic health,and immune function.For instance,highlevels of physical activity are linked to a reduced risk of CRC development,whereas poor dietary habits,smoking,and inadequate sleep have all beenimplicated in increased cancer risk and progression.Moreover,early-stage CRCpatients,who are often asymptomatic or have minimal symptoms,may particularlybenefit from lifestyle modifications to slow disease progression andimprove overall prognosis.The gap in understanding the specific influence ofthese lifestyle factors on colorectal polyps and early stage cancer progressionunderscores the need for comprehensive studies.By assessing several modifiablelifestyle factors and their association with disease progression,clinicians canidentify practical intervention points.These interventions could ultimately reducethe need for more aggressive treatments and improve the long-term outcomes inaffected patients.AIMTo investigate the association between lifestyle factors and disease progression inpatients with colorectal polyps and early stage cancer.METHODSIn this observational study conducted from January 2022 to December 2023,werecruited 120 patients with colorectal polyps or early stage cancer from Jiangshan People's Hospital.Lifestyle factors,including physical activity,dietary patterns,smoking status,sleep quality,andstress levels,were assessed using validated questionnaires.Disease progression was evaluated using standardizedfollow-up colonoscopies and pathological examinations.Cox proportional hazards models were used to analyzethe association between lifestyle factors and disease progression after adjusting for potential confounders.RESULTSDuring the median follow-up of 18.4 months,42(35.0%)patients experienced disease progression.High levels ofphysical activity were associated with reduced progression risk[adjusted hazard ratio(HR)0.55,95%confidenceinterval(CI):0.38-0.80,P=0.002]compared to low activity levels.High adherence to a healthy dietary patternshowed similar protective effects(adjusted HR 0.62,95%CI:0.43-0.89,P=0.009).Current smoking(adjusted HR1.92,95%CI:1.35-2.73,P<0.001)and poor sleep quality(adjusted HR 1.38,95%CI:1.05-1.82,P=0.021)wereassociated with increased progression risk.The impact of lifestyle factors was particularly pronounced in patientsyounger than 60 years and those with multiple polyps at baseline.CONCLUSIONThis study demonstrated significant associations between lifestyle factors and disease progression in colorectalpolyps and early stage cancer.Physical activity,dietary patterns,smoking status,and sleep quality have emergedas key modifiable factors influencing disease progression.These findings support the integration of lifestyleassessments and modifications in the clinical management of patients with colorectal neoplasia.展开更多
BACKGROUND Colorectal cancer has high global incidence and mortality rates.Colorectal polyps are relatively common,with adenomatous polyps having a higher risk of malignant transformation.Non-alcoholic fatty liver dis...BACKGROUND Colorectal cancer has high global incidence and mortality rates.Colorectal polyps are relatively common,with adenomatous polyps having a higher risk of malignant transformation.Non-alcoholic fatty liver disease(NAFLD)has been identified as a risk factor for the development of colorectal adenomas.Here,inpatients with NAFLD from the Second People's Hospital of Xining,in Qinghai Province,and the Second People's Hospital of Tianjin were investigated,comparing the biochemical indicators,colonoscopy findings,and pathological results of polyps between patients from low-altitude(Tianjin)and high-altitude(Qinghai Province)areas.Risk factors associated with the occurrence of adenomatous polyps in NAFLD patients from high-altitude areas were also explored.AIM To investigate the clinical characteristics of colorectal polyps in NAFLD patients from high-altitude areas.METHODS A total of 848 patients with NAFLD were enrolled.Of these,118 underwent colonoscopy between January 2021 and January 2024 at the Second People's Hospital of Tianjin(low-altitude),while the remaining 730 patients were assessed during the same period at the Second People's Hospital of Xining,Qinghai(high-altitude).All enrolled patients met the diagnostic criteria for NAFLD,and the excised colorectal polyps were analyzed pathologically.RESULTS Colorectal polyps were found in 585 cases(80.1%)in the Qinghai cohort and 91 patients(77.1%)in the Tianjin group,indicating a slightly higher incidence in the Qinghai group,although the difference was non-significant(P=0.449,P>0.05).The two groups showed no significant difference in sex(P=0.153,P>0.05)but differed significantly in the proportion of younger patients(P<0.01),although no differences were seen in terms of middleaged and elderly patients(P>0.05).No differences in polyp numbers were observed between the two regions(P>0.05),while significant differences were found between the≤0.5 cm and>1 cm and≤2 cm proportions in both regions(P<0.05),with no differences in other size categories(P>0.05).Polyp locations(proximal colon,distal colon)also differed significantly(P<0.05).Patients in Qinghai were more prone to adenomatous polyps,accounting for 89.2%of polyps,compared to those from Tianjin(P<0.05).Patients in Qinghai had a higher incidence of tubular adenomas with low-grade dysplasia,while tubular adenomas with high-grade dysplasia predominated in patients from Tianjin(P<0.05).Patients in Tianjin had a significantly higher proportion of mixed hyperplastic-adenomatous polyps(P<0.05),as well as greater proportions of mixed hyperplastic-adenomas with low-grade dysplasia(P<0.05).The incidence of hyperplastic polyps was markedly higher in Tianjin,accounting for 58.4%(P<0.05).Multivariate logistic regression indicated that sex[OR=1.693,95%confidence interval(CI):1.131-2.536],smoking(OR=0.604,95%CI:0.406-0.897),hypertension(OR=0.683,95%CI:0.471-0.991),and white blood cell counts(WBC)(OR=1.091,95%CI:1.015-1.173)were risk factors for the occurrence of adenomatous polyps in patients with NAFLD in high-altitude areas(Qinghai Province).CONCLUSION Patients with NAFLD from high-altitude regions have a higher incidence of colorectal polyps,with a significantly higher incidence of adenomatous polyps compared to other polyp types.Sex,smoking,hypertension,and WBC are risk factors for adenomatous polyps in NAFLD patients in high-altitude regions.展开更多
BACKGROUND Endoscopic cold snare resection(CSP)can enhance postoperative recovery and minimize bleeding risk in patients with 5-15 mm colorectal polyps.However,more detailed evaluations are required to assess their ad...BACKGROUND Endoscopic cold snare resection(CSP)can enhance postoperative recovery and minimize bleeding risk in patients with 5-15 mm colorectal polyps.However,more detailed evaluations are required to assess their advantages over conventional methods.AIM To evaluate the effects of endoscopic CSP on postoperative recovery and bleeding risk in patients with 5-15 mm colorectal polyps.METHODS This randomized controlled study included 193 patients(mean age:57.91±5.41 years;97 men and 96 women)with 5-15 mm colorectal polyps treated at Dongyang People's Hospital between March and June 2023.The patients were randomly assigned to the experimental group(n=100),who underwent CSP,and the control group(n=93),who underwent conventional endoscopic mucosal resection(EMR).Operation time,hospital stay,dietary status,and bleeding rate within 3 days were compared.RESULTS The CSP group had significantly shorter operation times(15.02±2.44 minutes vs 18.78±5.48 minutes,P<0.001)and hospital stays(3.11±1.08 days vs 4.89±1.35 days,P<0.001)than the EMR group.The fasting rate on the day of surgery was also lower in the CSP group(P<0.05).The complete resection rates were similar between groups(98.00%vs 94.62%,P=0.210),and no perforations occurred in either group.The 3-day postoperative bleeding rate was slightly lower in the CSP group(2.00%)than in the EMR group(6.45%),although this difference was not statistically significant(P=0.234),indicating limited clinical relevance.CONCLUSION CSP was safe and efficient for removing 5-15 mm colorectal polyps,offering faster recovery and comparable safety to EMR.The procedural efficiency of CSP supports its broad clinical application.展开更多
BACKGROUND The gold standard for colorectal polyp screening is currently colonoscopy,but the miss rate is still high and the adenoma detection rate and polyp detection rate are still low.The risk factors include the p...BACKGROUND The gold standard for colorectal polyp screening is currently colonoscopy,but the miss rate is still high and the adenoma detection rate and polyp detection rate are still low.The risk factors include the patient,operators,and the tools used.The use of artificial intelligence(AI)in colonoscopy has gained popularity by assisting endoscopists in the detection and characterization of polyps.AIM To evaluate the diagnostic performance of AI-assisted colonoscopy[computer assisted diagnosis(CAD)eye function]for colorectal polyp characterization.METHODS This study used a cross-sectional design conducted at the Gastrointestinal Endoscopy Center of Dr.Cipto Mangunkusumo Hospital in January-May 2024 on adult patients with suspected colorectal polyps.RESULTS A total of 60 patients with 100 polyps were involved in this study.Based on the results of the examination,it was found that the AI CAD eye function examination had a sensitivity of 79.17%,specificity of 75.00%,positive predictive value(PPV)of 89.06%,negative predictive value(NPV)of 58.33%,and accuracy of 78.00%.In polyps with diminutive size,sensitivity was 86.27%,specificity was 60.00%,PPV was 95.65%,NPV was 30.00%,and accuracy was 83.93%.Meanwhile,in polyps with non-diminutive size,sensitivity was 61.90%,specificity was 78.26%,PPV was 72.22%,NPV was 69.23%,and accuracy was 70.45%.In polyps on the left side of the colon,sensitivity was 78.85%,specificity was 81.25%,PPV was 93.18%,NPV was 54.17%,and accuracy was 79.41%.Meanwhile,in rightsided polyps the sensitivity was 80.00%,specificity was 66.67%,PPV was 80.00%,NPV was 66.67%,and accuracy was 75.00%.In sessile polyps the sensitivity was 81.54%,specificity was 50.00%,PPV was 91.38%,NPV was 29.41%,and accuracy was 77.33%.Meanwhile,in non-sessile polyps,the sensitivity was 57.14%,specificity was 88.89%,PPV was 66.67%,NPV was 84.21%,and accuracy was 80.00%.CONCLUSION AI CAD eye function examination had a high sensitivity value in diminutive,sessile polyps and right-sided polyps and a high specificity in non-diminutive,non-sessile polyps and left-sided polyps.展开更多
BACKGROUND Cold snare polypectomy(CSP)is comparatively safe and effective for removing polyps less than 10 mm in size with lower rates of postpolypectomy syndrome and delayed postpolypectomy bleeding compared with hot...BACKGROUND Cold snare polypectomy(CSP)is comparatively safe and effective for removing polyps less than 10 mm in size with lower rates of postpolypectomy syndrome and delayed postpolypectomy bleeding compared with hot snare polypectomy(HSP).Recently,CSP is also expanded for removing polyps larger than 10 mm in size.AIM To compare the efficiency and safety of CSP and HSP in the management of 10-19 mm non-pedunculated colorectal polyps.METHODS A total of 1686 inpatients with at least one 10-19 mm non-pedunculated colorectal polyp,who underwent CSP(study group,n=843)or HSP(control group,n=843)at our Digestive Endoscopy Center between February 2020 and February 2024 were enrolled.The outcome measures including complete resection rate,intraoperative bleeding rate,and healthcare expenses such as procedure time and treatment cost were compared between the CSP vs HSP groups.RESULTS No statistically significant intergroup difference was observed in histological complete resection rates(P>0.05).Polyp resection time in the study group(76.5±23.6 seconds)was notably shorter than that in the control group(91.24±32.06 seconds;P<0.05).The immediate intraoperative bleeding rate was significantly higher in the study group than in the control group(12.7%vs 4.9%,P<0.05).No instances of delayed bleeding or perforation were documented in either group.Hospitalization duration was significantly reduced in the study group(2.42±0.61 days)compared to the control group(3.21±1.02 days;P<0.05).CONCLUSION For 10-19 mm non-pedunculated colorectal polyps,CSP demonstrates operational efficiency advantages over HSP in terms of procedure time,treatment cost,and length of hospital stay.Both techniques demonstrate robust safety profiles;however,CSP is associated with a higher intraoperative bleeding rate.Clinical decision-making should incorporate individualized assessment of these factors.展开更多
OBJECTIVE:To explore the relationship between colorectal polyps and pulmonary nodules from the perspective of the lung and the large intestine being internally and externally connected,aiming to provide a theoretical ...OBJECTIVE:To explore the relationship between colorectal polyps and pulmonary nodules from the perspective of the lung and the large intestine being internally and externally connected,aiming to provide a theoretical basis for clinical diagnosis and treatment.METHODS:We retrospectively analyzed the data of patients who underwent electronic colonoscopy and were found to have colorectal polyps at the Gastrointestinal Endoscopy Center of Dongfang Hospital,Beijing University of Chinese Medicine,from January 1,2017,to December 31,2023.We also reviewed their lung CT results and used statistical software to analyze the recurrence,location,size,and pathology of colorectal polyps in relation to the presence,number,and size of pulmonary nodules.RESULTS:Both colorectal polyps and pulmonary nodules are more common in elderly males.Patients with recurrent colorectal polyps are more likely to have pulmonary nodules,which tend to be located in the left colon and are more likely to be adenomatous in nature;those without pulmonary nodules show no clear pattern in polyp distribution,with a tendency towards inflammatory and hyperplastic pathology;the data from this study suggests that the proportion of lung nodules larger than 0.5 cm in the recurrent group is higher than in the non-recurrent group,and the proportion of colorectal polyps larger than 1 cm in the recurrent group is also higher than in the non-recurrent group.CONCLUSION:There is a certain connection between the pathogenesis and treatment of colorectal polyps and pulmonary nodules.Cold,phlegm,dampness,blood stasis,and toxic coagulation are common pathogenic factors of the two diseases.Patients with larger colorectal polyps should be advised to undergo regular colonoscopy.Patients with recurrent polyps or those with left colon necrosis or cancer indicated by colonoscopy should be advised to complete lung related examinations to rule out the possibility of pulmonary nodules.展开更多
BACKGROUND Artificial intelligence(AI)has potential in the optical diagnosis of colorectal polyps.AIM To evaluate the feasibility of the real-time use of the computer-aided diagnosis system(CADx)AI for ColoRectal Poly...BACKGROUND Artificial intelligence(AI)has potential in the optical diagnosis of colorectal polyps.AIM To evaluate the feasibility of the real-time use of the computer-aided diagnosis system(CADx)AI for ColoRectal Polyps(AI4CRP)for the optical diagnosis of diminutive colorectal polyps and to compare the performance with CAD EYE^(TM)(Fujifilm,Tokyo,Japan).CADx influence on the optical diagnosis of an expert endoscopist was also investigated.METHODS AI4CRP was developed in-house and CAD EYE was proprietary software provided by Fujifilm.Both CADxsystems exploit convolutional neural networks.Colorectal polyps were characterized as benign or premalignant and histopathology was used as gold standard.AI4CRP provided an objective assessment of its characterization by presenting a calibrated confidence characterization value(range 0.0-1.0).A predefined cut-off value of 0.6 was set with values<0.6 indicating benign and values≥0.6 indicating premalignant colorectal polyps.Low confidence characterizations were defined as values 40%around the cut-off value of 0.6(<0.36 and>0.76).Self-critical AI4CRP’s diagnostic performances excluded low confidence characterizations.RESULTS AI4CRP use was feasible and performed on 30 patients with 51 colorectal polyps.Self-critical AI4CRP,excluding 14 low confidence characterizations[27.5%(14/51)],had a diagnostic accuracy of 89.2%,sensitivity of 89.7%,and specificity of 87.5%,which was higher compared to AI4CRP.CAD EYE had a 83.7%diagnostic accuracy,74.2%sensitivity,and 100.0%specificity.Diagnostic performances of the endoscopist alone(before AI)increased nonsignificantly after reviewing the CADx characterizations of both AI4CRP and CAD EYE(AI-assisted endoscopist).Diagnostic performances of the AI-assisted endoscopist were higher compared to both CADx-systems,except for specificity for which CAD EYE performed best.CONCLUSION Real-time use of AI4CRP was feasible.Objective confidence values provided by a CADx is novel and self-critical AI4CRP showed higher diagnostic performances compared to AI4CRP.展开更多
Since the advent of artificial intelligence(AI)technology,it has been constantly studied and has achieved rapid development.The AI assistant system is expected to improve the quality of automatic polyp detection and c...Since the advent of artificial intelligence(AI)technology,it has been constantly studied and has achieved rapid development.The AI assistant system is expected to improve the quality of automatic polyp detection and classification.It could also help prevent endoscopists from missing polyps and make an accurate optical diagnosis.These functions provided by AI could result in a higher adenoma detection rate and decrease the cost of polypectomy for hyperplastic polyps.In addition,AI has good performance in the staging,diagnosis,and segmentation of colorectal cancer.This article provides an overview of recent research focusing on the application of AI in colorectal polyps and cancer and highlights the advances achieved.展开更多
BACKGROUND Underwater endoscopic mucosal resection(UEMR)of colorectal lesions is emerging as an alternative method to conventional endoscopic mucosal resection(EMR);however,it is still controversial whether there is a...BACKGROUND Underwater endoscopic mucosal resection(UEMR)of colorectal lesions is emerging as an alternative method to conventional endoscopic mucosal resection(EMR);however,it is still controversial whether there is a difference in the effectiveness between UEMR and EMR.AIM To evaluate the effectiveness and safety of UEMR in the treatment of colorectal polyps.METHODS Clinical studies comparing the effectiveness or safety of UEMR in the treatment of colorectal polyps were searched in medical databases,including Pub Med,Embase,Cochrane Library,CNKI,and Wanfang Data,monographs,theses,and papers presented at conferences.Statistical analyses were performed using Revman 5.3 software.RESULTS Seven non-randomized controlled trials and one randomized controlled trial met the inclusion criteria.In total,1382 patients(1511 polyps)were included in the study,including 722 who received UEMR and 789 who received EMR.In the UEMR and EMR groups,the en bloc resection rates were 85.87%and 73.89%,respectively,with a relative risk(RR)value of 1.14(95%confidence interval[CI]:1.01-1.30;P<0.05).In the sub-group analysis,the en bloc resection rate showed no statistically significant difference between the EMR and UEMR groups for polyps less than 20 mm in diameter.However,a statistically significant difference was found between the EMR and UEMR groups for polyps equal to or greater than 20 mm in diameter.The post-endoscopic resection recurrence rates at 3-6 mo of the UEMR and EMR groups were 3.26%and 15.17%,respectively,with an RR value of 0.27(95%CI:0.09-0.83;P<0.05).The post-endoscopic resection recurrence rates of UEMR and EMR at 12 mo were 6.25%and 14.40%,respectively,with an RR value of 0.43(95%CI:0.20-0.92;P<0.05).Additionally,the incidence of adverse events was 8.17%and 6.21%,respectively,with an RR value of 1.07(95%CI:0.50-2.30;P>0.05).CONCLUSION UEMR is an effective technique for colorectal polyps and appears to have some advantages over EMR,particularly with regard to some treatment outcomes.展开更多
BACKGROUND Colorectal cancer remains a considerable challenge in healthcare nowadays.Approximately 60%-80%of colorectal cancer is caused by intestinal polyps,and resection of intestinal polyps has been proved to reduc...BACKGROUND Colorectal cancer remains a considerable challenge in healthcare nowadays.Approximately 60%-80%of colorectal cancer is caused by intestinal polyps,and resection of intestinal polyps has been proved to reduce the incidence of colorectal cancer.The vast majority of intestinal polyps can be found during colonoscopy and removed endoscopically.Therefore,more attention has been paid to the development of endoscopic resection of intestinal polyps.In this study,we compared the efficacy and safety of cold snare polypectomy(CSP)and hot snare polypectomy(HSP).AIM To investigate the efficacy and safety of CSP and HSP for colorectal polyps.METHODS Between January and December 2020,301 patients with colorectal polyps 4-9 mm in diameter were treated with endoscopic therapy in our hospital,and were divided into the CSP group(n=154)and HSP group(n=147).The operating time,incidence of bleeding and perforation,use of titanium clips,and complete resection rate were compared between the two groups.RESULTS We included 249 patients(301 polyps).No differences in gender,age,and polyp size,location,shape and type were observed between the CSP and HSP groups,and the resection rates in these two groups were 93.4%and 94.5%,respectively,with no significant difference.The use of titanium clips was 15.6%and 95.9%,the operating time was 3.2±0.5 min and 5.6±0.8 min,the delayed bleeding rate was 0%and 2.0%,and delayed perforation was 0%and 0.7%,in the CSP and HSP groups,respectively.CONCLUSIONFor sessile colorectal polyps < 10 mm, CSP had the same resection rate of impaired tissue integrityas traditional HSP had. The rate of complications was lower in the CSP group. CSP is a safe andeffective method for polypectomy.展开更多
BACKGROUND The optimal method to remove sessile colorectal lesions sized 10-20 mm remains uncertain.Piecemeal and incomplete resection are major limitations in current practice,such as endoscopic mucosal resection(EMR...BACKGROUND The optimal method to remove sessile colorectal lesions sized 10-20 mm remains uncertain.Piecemeal and incomplete resection are major limitations in current practice,such as endoscopic mucosal resection(EMR)and cold or hot snare polypectomy.Recently,EMR with circumferential precutting(EMR-P)has emerged as an effective technique,but the quality of current evidence in comparative studies of conventional EMR(CEMR)and EMR-P is limited.AIM To investigate whether EMR-P is superior to CEMR in removing sessile colorectal polyps.METHODS This multicenter randomized controlled trial involved seven medical institutions in China.Patients with colorectal polyps sized 10-20 mm were enrolled and randomly assigned to undergo EMR-P or CEMR.EMR-P was performed following submucosal injection,and a circumferential mucosa incision(precutting)was conducted using a snare tip.Primary outcomes included a comparison of the rates of en bloc and R0 resection,defined as one-piece resection and one-piece resection with histologically assessed clear margins,respectively.RESULTS A total of 110 patients in the EMR-P group and 110 patients in the CEMR group were finally evaluated.In the per-protocol analysis,the proportion of en bloc resections was 94.3%[95%confidence interval(CI):88.2%-97.4%]in the EMR-P group and 86%(95%CI:78.2%-91.3%)in the CEMR group(P=0.041),while subgroup analysis showed that for lesions>15 mm,EMR-P also resulted in a higher en bloc resection rate(92.0%vs 58.8%P=0.029).The proportion of R0 resections was 81.1%(95%CI:72.6%-87.4%)in the EMR-P group and 76.6%(95%CI:68.8%-84.4%)in the CEMR group(P=0.521).The EMR-P group showed a longer median procedure time(6.4 vs 3.0 min;P<0.001).No significant difference was found in the proportion of patients with adverse events(EMR-P:9.1%;CEMR:6.4%;P=0.449).CONCLUSION In this study,EMR-P served as an alternative to CEMR for removing nonpedunculated colorectal polyps sized 10-20 mm,particularly polyps>15 mm in diameter,with higher R0 and en bloc resection rates and without increasing adverse events.However,EMR-P required a relatively longer procedure time than CEMR.Considering its potential benefits for en bloc and R0 resection,EMR-P may be a promising technique in colorectal polyp resection.展开更多
Colonoscopy remains the gold standard investigation for colorectal cancer screening as it offers the opportunity to both detect and resect pre-malignant and neoplastic polyps.Although technologies for image-enhanced e...Colonoscopy remains the gold standard investigation for colorectal cancer screening as it offers the opportunity to both detect and resect pre-malignant and neoplastic polyps.Although technologies for image-enhanced endoscopy are widely available,optical diagnosis has not been incorporated into routine clinical practice,mainly due to significant inter-operator variability.In recent years,there has been a growing number of studies demonstrating the potential of convolutional neural networks(CNN)to enhance optical diagnosis of polyps.Data suggest that the use of CNNs might mitigate the inter-operator variability amongst endoscopists,potentially enabling a“resect and discard”or“leave in”strategy to be adopted in real-time.This would have significant financial benefits for healthcare systems,avoid unnecessary polypectomies of non-neoplastic polyps and improve the efficiency of colonoscopy.Here,we review advances in CNN for the optical diagnosis of colorectal polyps,current limitations and future directions.展开更多
BACKGROUND Colorectal polyps refer to all neoplasms that protrude into the intestinal cavity.Researchers believe that 50%-70%of colorectal cancers originate from adenomatous polyps.AIM To investigate the endoscopic mo...BACKGROUND Colorectal polyps refer to all neoplasms that protrude into the intestinal cavity.Researchers believe that 50%-70%of colorectal cancers originate from adenomatous polyps.AIM To investigate the endoscopic morphologic features,pathologic types,and clinical situation;evaluate the efficacy and safety of endoscopic mucosal resection(EMR);and guide clinicians in their daily practice.METHODS Two hundred thirty-four patients who underwent EMR in our hospital from January 1,2018 to December 31,2019 were recruited.Data including sex,age,endoscopic morphology of the polyps,and pathological characteristics were analyzed among groups.RESULTS A total of 295 polyps were resected from the 234 subjects enrolled in the study,of which 4(1.36%)were Yamada type I.There were 75(25.42%)type II,101(34.24%)type III,and 115(38.98%)type IV adenomas.Among them,41 were nonadenomas,110 were low-risk adenomas,139 were high-risk adenomas,and 5 were carcinomas.The differences in distribution were not statistically significant,with P values greater than 0.05.The risk of cancer significantly increased for polyps≥1 cm in diameter(c2=199.825,P=0.00).Regarding the endoscopic morphological features,congestion,erosion,and lobulation were more common on the surface morphology of high-risk adenomas and cancerous polyps(c2=75.257,P=0.00),and most of them were Yamada types III and IV.In all,6 of the 295 polyps could not be removed completely,with a one-time resection rate of 97.97%.There were two cases of postoperative bleeding and no cases of perforation,with an overall complication rate of 0.09%.CONCLUSION Colorectal polyps ranging from non-adenomatous polyps,low-risk adenomas,and high-risk adenomas to adenocarcinomas each has their own endoscopic features,while EMR,as a mature intervention,has good safety and operability and should be promoted clinically,especially at the primary care level.展开更多
基金Supported by Ministry of Science and Higher Education of the Russian Federation,No.FGMF-2025-0003.
文摘Colorectal cancer remains a major health concern,with colorectal polyps as key precursors.Endoscopic mucosal resection(EMR)is a common treatment,but recurrence rates remain high.Traditional surveillance strategies rely on polyp characteristics and completeness of the resection potentially missing key risk factors.Machine learning(ML)offers a transformative approach by integrating patient-specific data to refine risk stratification.Recent studies highlight ML models,such as Extreme Gradient Boosting,which outperform conventional methods in predicting polyp recurrence within one-year post-EMR.These models incorporate factors like age,smoking status,family history,and pathology,optimizing follow-up recommendations and minimizing unnecessary procedures.Artificial intelligence(AI)-driven tools and web-based calculators enhance clinical workflow by providing real-time,personalized risk assessments.However,challenges remain in external validation,model interpretability,and clinical integration.Future surveillance strategies should combine expert judgment with AI insights to optimize patient outcomes.As gastroenterology embraces AI,MLdriven surveillance represents a paradigm shift,advancing precision medicine in colorectal polyp management.This editorial explores AI’s role in transforming post-EMR follow-up,addressing benefits,limitations,and future directions.
文摘BACKGROUND Colorectal polyps are precancerous diseases of colorectal cancer.Early detection and resection of colorectal polyps can effectively reduce the mortality of colorectal cancer.Endoscopic mucosal resection(EMR)is a common polypectomy proce-dure in clinical practice,but it has a high postoperative recurrence rate.Currently,there is no predictive model for the recurrence of colorectal polyps after EMR.AIM To construct and validate a machine learning(ML)model for predicting the risk of colorectal polyp recurrence one year after EMR.METHODS This study retrospectively collected data from 1694 patients at three medical centers in Xuzhou.Additionally,a total of 166 patients were collected to form a prospective validation set.Feature variable screening was conducted using uni-variate and multivariate logistic regression analyses,and five ML algorithms were used to construct the predictive models.The optimal models were evaluated based on different performance metrics.Decision curve analysis(DCA)and SHapley Additive exPlanation(SHAP)analysis were performed to assess clinical applicability and predictor importance.RESULTS Multivariate logistic regression analysis identified 8 independent risk factors for colorectal polyp recurrence one year after EMR(P<0.05).Among the models,eXtreme Gradient Boosting(XGBoost)demonstrated the highest area under the curve(AUC)in the training set,internal validation set,and prospective validation set,with AUCs of 0.909(95%CI:0.89-0.92),0.921(95%CI:0.90-0.94),and 0.963(95%CI:0.94-0.99),respectively.DCA indicated favorable clinical utility for the XGBoost model.SHAP analysis identified smoking history,family history,and age as the top three most important predictors in the model.CONCLUSION The XGBoost model has the best predictive performance and can assist clinicians in providing individualized colonoscopy follow-up recommendations.
文摘This editorial,inspired by a recent study published in the World Journal of Gastrointestinal Oncology,covers the research findings on microbiota changes in various diseases.In recurrent colorectal polyps,the abundances of Klebsiella,Parvimonas,and Clostridium increase,while those of Bifidobacterium and Lactoba-cillus decrease.This dysbiosis may promote the formation and recurrence of polyps.Similar microbial changes have also been observed in colorectal cancer,inflammatory bowel disease,autism spectrum disorder,and metabolic syndrome,indicating the role of increased pathogens and decreased probiotics in these conditions.Regulating the gut microbiota,particularly by increasing probiotic levels,may help prevent polyp recurrence and promote gut health.This microbial intervention strategy holds promise as an adjunctive treatment for patients with colorectal polyps.
文摘BACKGROUND Colorectal polyps(CPs)are important precursor lesions of colorectal cancer,and endoscopic surgery remains the primary treatment option.However,the shortterm recurrence rate post-surgery is high,and the risk factors for recurrence remain unknown.AIM To comprehensively explore risk factors for short-term recurrence of CPs after endoscopic surgery and develop a nomogram prediction model.METHODS Overall,362 patients who underwent endoscopic polypectomy between January 2022 and January 2024 at Nanjing Jiangbei Hospital were included.We screened basic demographic data,clinical and polyp characteristics,surgery-related information,and independent risk factors for CPs recurrence using univariate and multivariate logistic regression analyses.The multivariate analysis results were used to construct a nomogram prediction model,internally validated using Bootstrapping,with performance evaluated using area under the curve(AUC),calibration curve,and decision curve analysis.RESULTS CP re-occurred in 166(45.86%)of the 362 patients within 1 year post-surgery.Multivariate logistic regression analysis showed that age(OR=1.04,P=0.002),alcohol consumption(OR=2.07,P=0.012),Helicobacter pylori infection(OR=2.34,P<0.001),polyp number>2(OR=1.98,P=0.005),sessile polyps(OR=2.10,P=0.006),and adenomatous pathological type(OR=3.02,P<0.001)were independent risk factors for post-surgery recurrence.The nomogram prediction model showed good discriminatory(AUC=0.73)and calibrating power,and decision curve analysis showed that the model had good clinical benefit at risk probabilities>20%.CONCLUSION We identified multiple independent risk factors for short-term recurrence after endoscopic surgery.The nomogram prediction model showed a certain degree of differentiation,calibration,and potential clinical applicability.
文摘Colorectal polyps remain a significant health concern because they can develop into cancer.Therefore,accurate assessment and diagnosis of polyps,along with appropriate treatment decisions,are crucial in preventing complications or malignant transformation.Some polyps are classified as complex polyps,which means they fail to elevate due to a scar from a previously removed polyp or can be determined by a scoring system like the size/morphology/site/access score,which considers factors like site,morphology,size,and access.Management of complex colorectal polyps involves various options,including endoscopic and surgical approaches.Endoscopic mucosal resection(EMR)may be challenging in scarred polyps,as inadequate lifting can result in incomplete resection or recurrence.As a more advanced alternative,endoscopic submucosal dissection(ESD)is suitable for larger lesions,enabling en-bloc resection even in complex cases with EMR.However,ESD requires expertise and is more time-consuming than EMR,often necessitating hospitalization due to its complexity.Endoscopic full-thickness resection could be a viable alternative for managing scarred polyps.Endoscopic powered resection,either alone or in combination with other modalities,can also be used to achieve less extensive resection.Managing complications during the procedure or post-procedurally is equally important,as bleeding or perforations can be fatal.Careful patient selection based on individual profiles and risk factors,along with the identification of any signs of malignancy,is crucial before treatment to avoid negative post-treatment outcomes.
基金Supported by the Wuhu Municipal Science and Technology Bureau Project,No.2024kj072.
文摘In 2025,Shi et al constructed a model utilizing machine learning techniques to predict the one-year recurrence of colorectal polyps following endoscopic mucosal resection,showing excellent discriminatory performance with an area under the curve exceeding 0.90.However,limitations exist regarding its narrow temporal scope,potential overestimation due to feature collinearity and imputation opacity,and limited generalizability due to single-center derivation and validation.Moreover,no clear clinical implementation strategy was outlined.Prospective multicenter validation and integration of endoscopist variability,longitudinal outcome data,and deployment mechanisms are warranted to ensure broader applicability and clinical utility.
文摘The machine learning model developed by Shi et al for predicting colorectal polyp recurrence after endoscopic mucosal resection represents a significant advancement in the field of clinical gastroenterology.By integrating patient-specific factors,such as age,smoking history,and Helicobacter pylori infection,the eXtreme Gradient Boosting algorithm enables precise personalised colonoscopy follow-up planning and risk assessment.This predictive tool offers substantial benefits by optimising surveillance intervals and directing healthcare resources more efficiently toward high-risk individuals.However,real-world implementation requires consideration of the generalisability of our findings across diverse patient populations and clinician training backgrounds.
文摘BACKGROUNDColorectal cancer(CRC)typically progresses from benign colorectal polyps,whichrepresent a precursor to malignancy.Identifying the factors influencing thisprogression is crucial for early intervention and prevention.Although genetic andenvironmental factors have been widely studied,the role of lifestyle factors suchas physical activity,diet,smoking,sleep,and stress remains underexplored,especially in patients with early stage CRC or polyps.Recent evidence suggeststhat lifestyle behaviors may influence cancer progression by modulating inflammatorypathways,metabolic health,and immune function.For instance,highlevels of physical activity are linked to a reduced risk of CRC development,whereas poor dietary habits,smoking,and inadequate sleep have all beenimplicated in increased cancer risk and progression.Moreover,early-stage CRCpatients,who are often asymptomatic or have minimal symptoms,may particularlybenefit from lifestyle modifications to slow disease progression andimprove overall prognosis.The gap in understanding the specific influence ofthese lifestyle factors on colorectal polyps and early stage cancer progressionunderscores the need for comprehensive studies.By assessing several modifiablelifestyle factors and their association with disease progression,clinicians canidentify practical intervention points.These interventions could ultimately reducethe need for more aggressive treatments and improve the long-term outcomes inaffected patients.AIMTo investigate the association between lifestyle factors and disease progression inpatients with colorectal polyps and early stage cancer.METHODSIn this observational study conducted from January 2022 to December 2023,werecruited 120 patients with colorectal polyps or early stage cancer from Jiangshan People's Hospital.Lifestyle factors,including physical activity,dietary patterns,smoking status,sleep quality,andstress levels,were assessed using validated questionnaires.Disease progression was evaluated using standardizedfollow-up colonoscopies and pathological examinations.Cox proportional hazards models were used to analyzethe association between lifestyle factors and disease progression after adjusting for potential confounders.RESULTSDuring the median follow-up of 18.4 months,42(35.0%)patients experienced disease progression.High levels ofphysical activity were associated with reduced progression risk[adjusted hazard ratio(HR)0.55,95%confidenceinterval(CI):0.38-0.80,P=0.002]compared to low activity levels.High adherence to a healthy dietary patternshowed similar protective effects(adjusted HR 0.62,95%CI:0.43-0.89,P=0.009).Current smoking(adjusted HR1.92,95%CI:1.35-2.73,P<0.001)and poor sleep quality(adjusted HR 1.38,95%CI:1.05-1.82,P=0.021)wereassociated with increased progression risk.The impact of lifestyle factors was particularly pronounced in patientsyounger than 60 years and those with multiple polyps at baseline.CONCLUSIONThis study demonstrated significant associations between lifestyle factors and disease progression in colorectalpolyps and early stage cancer.Physical activity,dietary patterns,smoking status,and sleep quality have emergedas key modifiable factors influencing disease progression.These findings support the integration of lifestyleassessments and modifications in the clinical management of patients with colorectal neoplasia.
基金Supported by Tianjin Key Medical Discipline Construction Project,No.TJYXZDXK-3-019B.
文摘BACKGROUND Colorectal cancer has high global incidence and mortality rates.Colorectal polyps are relatively common,with adenomatous polyps having a higher risk of malignant transformation.Non-alcoholic fatty liver disease(NAFLD)has been identified as a risk factor for the development of colorectal adenomas.Here,inpatients with NAFLD from the Second People's Hospital of Xining,in Qinghai Province,and the Second People's Hospital of Tianjin were investigated,comparing the biochemical indicators,colonoscopy findings,and pathological results of polyps between patients from low-altitude(Tianjin)and high-altitude(Qinghai Province)areas.Risk factors associated with the occurrence of adenomatous polyps in NAFLD patients from high-altitude areas were also explored.AIM To investigate the clinical characteristics of colorectal polyps in NAFLD patients from high-altitude areas.METHODS A total of 848 patients with NAFLD were enrolled.Of these,118 underwent colonoscopy between January 2021 and January 2024 at the Second People's Hospital of Tianjin(low-altitude),while the remaining 730 patients were assessed during the same period at the Second People's Hospital of Xining,Qinghai(high-altitude).All enrolled patients met the diagnostic criteria for NAFLD,and the excised colorectal polyps were analyzed pathologically.RESULTS Colorectal polyps were found in 585 cases(80.1%)in the Qinghai cohort and 91 patients(77.1%)in the Tianjin group,indicating a slightly higher incidence in the Qinghai group,although the difference was non-significant(P=0.449,P>0.05).The two groups showed no significant difference in sex(P=0.153,P>0.05)but differed significantly in the proportion of younger patients(P<0.01),although no differences were seen in terms of middleaged and elderly patients(P>0.05).No differences in polyp numbers were observed between the two regions(P>0.05),while significant differences were found between the≤0.5 cm and>1 cm and≤2 cm proportions in both regions(P<0.05),with no differences in other size categories(P>0.05).Polyp locations(proximal colon,distal colon)also differed significantly(P<0.05).Patients in Qinghai were more prone to adenomatous polyps,accounting for 89.2%of polyps,compared to those from Tianjin(P<0.05).Patients in Qinghai had a higher incidence of tubular adenomas with low-grade dysplasia,while tubular adenomas with high-grade dysplasia predominated in patients from Tianjin(P<0.05).Patients in Tianjin had a significantly higher proportion of mixed hyperplastic-adenomatous polyps(P<0.05),as well as greater proportions of mixed hyperplastic-adenomas with low-grade dysplasia(P<0.05).The incidence of hyperplastic polyps was markedly higher in Tianjin,accounting for 58.4%(P<0.05).Multivariate logistic regression indicated that sex[OR=1.693,95%confidence interval(CI):1.131-2.536],smoking(OR=0.604,95%CI:0.406-0.897),hypertension(OR=0.683,95%CI:0.471-0.991),and white blood cell counts(WBC)(OR=1.091,95%CI:1.015-1.173)were risk factors for the occurrence of adenomatous polyps in patients with NAFLD in high-altitude areas(Qinghai Province).CONCLUSION Patients with NAFLD from high-altitude regions have a higher incidence of colorectal polyps,with a significantly higher incidence of adenomatous polyps compared to other polyp types.Sex,smoking,hypertension,and WBC are risk factors for adenomatous polyps in NAFLD patients in high-altitude regions.
文摘BACKGROUND Endoscopic cold snare resection(CSP)can enhance postoperative recovery and minimize bleeding risk in patients with 5-15 mm colorectal polyps.However,more detailed evaluations are required to assess their advantages over conventional methods.AIM To evaluate the effects of endoscopic CSP on postoperative recovery and bleeding risk in patients with 5-15 mm colorectal polyps.METHODS This randomized controlled study included 193 patients(mean age:57.91±5.41 years;97 men and 96 women)with 5-15 mm colorectal polyps treated at Dongyang People's Hospital between March and June 2023.The patients were randomly assigned to the experimental group(n=100),who underwent CSP,and the control group(n=93),who underwent conventional endoscopic mucosal resection(EMR).Operation time,hospital stay,dietary status,and bleeding rate within 3 days were compared.RESULTS The CSP group had significantly shorter operation times(15.02±2.44 minutes vs 18.78±5.48 minutes,P<0.001)and hospital stays(3.11±1.08 days vs 4.89±1.35 days,P<0.001)than the EMR group.The fasting rate on the day of surgery was also lower in the CSP group(P<0.05).The complete resection rates were similar between groups(98.00%vs 94.62%,P=0.210),and no perforations occurred in either group.The 3-day postoperative bleeding rate was slightly lower in the CSP group(2.00%)than in the EMR group(6.45%),although this difference was not statistically significant(P=0.234),indicating limited clinical relevance.CONCLUSION CSP was safe and efficient for removing 5-15 mm colorectal polyps,offering faster recovery and comparable safety to EMR.The procedural efficiency of CSP supports its broad clinical application.
文摘BACKGROUND The gold standard for colorectal polyp screening is currently colonoscopy,but the miss rate is still high and the adenoma detection rate and polyp detection rate are still low.The risk factors include the patient,operators,and the tools used.The use of artificial intelligence(AI)in colonoscopy has gained popularity by assisting endoscopists in the detection and characterization of polyps.AIM To evaluate the diagnostic performance of AI-assisted colonoscopy[computer assisted diagnosis(CAD)eye function]for colorectal polyp characterization.METHODS This study used a cross-sectional design conducted at the Gastrointestinal Endoscopy Center of Dr.Cipto Mangunkusumo Hospital in January-May 2024 on adult patients with suspected colorectal polyps.RESULTS A total of 60 patients with 100 polyps were involved in this study.Based on the results of the examination,it was found that the AI CAD eye function examination had a sensitivity of 79.17%,specificity of 75.00%,positive predictive value(PPV)of 89.06%,negative predictive value(NPV)of 58.33%,and accuracy of 78.00%.In polyps with diminutive size,sensitivity was 86.27%,specificity was 60.00%,PPV was 95.65%,NPV was 30.00%,and accuracy was 83.93%.Meanwhile,in polyps with non-diminutive size,sensitivity was 61.90%,specificity was 78.26%,PPV was 72.22%,NPV was 69.23%,and accuracy was 70.45%.In polyps on the left side of the colon,sensitivity was 78.85%,specificity was 81.25%,PPV was 93.18%,NPV was 54.17%,and accuracy was 79.41%.Meanwhile,in rightsided polyps the sensitivity was 80.00%,specificity was 66.67%,PPV was 80.00%,NPV was 66.67%,and accuracy was 75.00%.In sessile polyps the sensitivity was 81.54%,specificity was 50.00%,PPV was 91.38%,NPV was 29.41%,and accuracy was 77.33%.Meanwhile,in non-sessile polyps,the sensitivity was 57.14%,specificity was 88.89%,PPV was 66.67%,NPV was 84.21%,and accuracy was 80.00%.CONCLUSION AI CAD eye function examination had a high sensitivity value in diminutive,sessile polyps and right-sided polyps and a high specificity in non-diminutive,non-sessile polyps and left-sided polyps.
文摘BACKGROUND Cold snare polypectomy(CSP)is comparatively safe and effective for removing polyps less than 10 mm in size with lower rates of postpolypectomy syndrome and delayed postpolypectomy bleeding compared with hot snare polypectomy(HSP).Recently,CSP is also expanded for removing polyps larger than 10 mm in size.AIM To compare the efficiency and safety of CSP and HSP in the management of 10-19 mm non-pedunculated colorectal polyps.METHODS A total of 1686 inpatients with at least one 10-19 mm non-pedunculated colorectal polyp,who underwent CSP(study group,n=843)or HSP(control group,n=843)at our Digestive Endoscopy Center between February 2020 and February 2024 were enrolled.The outcome measures including complete resection rate,intraoperative bleeding rate,and healthcare expenses such as procedure time and treatment cost were compared between the CSP vs HSP groups.RESULTS No statistically significant intergroup difference was observed in histological complete resection rates(P>0.05).Polyp resection time in the study group(76.5±23.6 seconds)was notably shorter than that in the control group(91.24±32.06 seconds;P<0.05).The immediate intraoperative bleeding rate was significantly higher in the study group than in the control group(12.7%vs 4.9%,P<0.05).No instances of delayed bleeding or perforation were documented in either group.Hospitalization duration was significantly reduced in the study group(2.42±0.61 days)compared to the control group(3.21±1.02 days;P<0.05).CONCLUSION For 10-19 mm non-pedunculated colorectal polyps,CSP demonstrates operational efficiency advantages over HSP in terms of procedure time,treatment cost,and length of hospital stay.Both techniques demonstrate robust safety profiles;however,CSP is associated with a higher intraoperative bleeding rate.Clinical decision-making should incorporate individualized assessment of these factors.
基金Beijing Natural Science Foundation:Research on the Mechanism of Chaiqi Decoction in Improving Vascular Endothelial Injury in Metabolic Syndrome by Regulating Pyroptosis via miR-21(No.7212181)。
文摘OBJECTIVE:To explore the relationship between colorectal polyps and pulmonary nodules from the perspective of the lung and the large intestine being internally and externally connected,aiming to provide a theoretical basis for clinical diagnosis and treatment.METHODS:We retrospectively analyzed the data of patients who underwent electronic colonoscopy and were found to have colorectal polyps at the Gastrointestinal Endoscopy Center of Dongfang Hospital,Beijing University of Chinese Medicine,from January 1,2017,to December 31,2023.We also reviewed their lung CT results and used statistical software to analyze the recurrence,location,size,and pathology of colorectal polyps in relation to the presence,number,and size of pulmonary nodules.RESULTS:Both colorectal polyps and pulmonary nodules are more common in elderly males.Patients with recurrent colorectal polyps are more likely to have pulmonary nodules,which tend to be located in the left colon and are more likely to be adenomatous in nature;those without pulmonary nodules show no clear pattern in polyp distribution,with a tendency towards inflammatory and hyperplastic pathology;the data from this study suggests that the proportion of lung nodules larger than 0.5 cm in the recurrent group is higher than in the non-recurrent group,and the proportion of colorectal polyps larger than 1 cm in the recurrent group is also higher than in the non-recurrent group.CONCLUSION:There is a certain connection between the pathogenesis and treatment of colorectal polyps and pulmonary nodules.Cold,phlegm,dampness,blood stasis,and toxic coagulation are common pathogenic factors of the two diseases.Patients with larger colorectal polyps should be advised to undergo regular colonoscopy.Patients with recurrent polyps or those with left colon necrosis or cancer indicated by colonoscopy should be advised to complete lung related examinations to rule out the possibility of pulmonary nodules.
文摘BACKGROUND Artificial intelligence(AI)has potential in the optical diagnosis of colorectal polyps.AIM To evaluate the feasibility of the real-time use of the computer-aided diagnosis system(CADx)AI for ColoRectal Polyps(AI4CRP)for the optical diagnosis of diminutive colorectal polyps and to compare the performance with CAD EYE^(TM)(Fujifilm,Tokyo,Japan).CADx influence on the optical diagnosis of an expert endoscopist was also investigated.METHODS AI4CRP was developed in-house and CAD EYE was proprietary software provided by Fujifilm.Both CADxsystems exploit convolutional neural networks.Colorectal polyps were characterized as benign or premalignant and histopathology was used as gold standard.AI4CRP provided an objective assessment of its characterization by presenting a calibrated confidence characterization value(range 0.0-1.0).A predefined cut-off value of 0.6 was set with values<0.6 indicating benign and values≥0.6 indicating premalignant colorectal polyps.Low confidence characterizations were defined as values 40%around the cut-off value of 0.6(<0.36 and>0.76).Self-critical AI4CRP’s diagnostic performances excluded low confidence characterizations.RESULTS AI4CRP use was feasible and performed on 30 patients with 51 colorectal polyps.Self-critical AI4CRP,excluding 14 low confidence characterizations[27.5%(14/51)],had a diagnostic accuracy of 89.2%,sensitivity of 89.7%,and specificity of 87.5%,which was higher compared to AI4CRP.CAD EYE had a 83.7%diagnostic accuracy,74.2%sensitivity,and 100.0%specificity.Diagnostic performances of the endoscopist alone(before AI)increased nonsignificantly after reviewing the CADx characterizations of both AI4CRP and CAD EYE(AI-assisted endoscopist).Diagnostic performances of the AI-assisted endoscopist were higher compared to both CADx-systems,except for specificity for which CAD EYE performed best.CONCLUSION Real-time use of AI4CRP was feasible.Objective confidence values provided by a CADx is novel and self-critical AI4CRP showed higher diagnostic performances compared to AI4CRP.
文摘Since the advent of artificial intelligence(AI)technology,it has been constantly studied and has achieved rapid development.The AI assistant system is expected to improve the quality of automatic polyp detection and classification.It could also help prevent endoscopists from missing polyps and make an accurate optical diagnosis.These functions provided by AI could result in a higher adenoma detection rate and decrease the cost of polypectomy for hyperplastic polyps.In addition,AI has good performance in the staging,diagnosis,and segmentation of colorectal cancer.This article provides an overview of recent research focusing on the application of AI in colorectal polyps and cancer and highlights the advances achieved.
文摘BACKGROUND Underwater endoscopic mucosal resection(UEMR)of colorectal lesions is emerging as an alternative method to conventional endoscopic mucosal resection(EMR);however,it is still controversial whether there is a difference in the effectiveness between UEMR and EMR.AIM To evaluate the effectiveness and safety of UEMR in the treatment of colorectal polyps.METHODS Clinical studies comparing the effectiveness or safety of UEMR in the treatment of colorectal polyps were searched in medical databases,including Pub Med,Embase,Cochrane Library,CNKI,and Wanfang Data,monographs,theses,and papers presented at conferences.Statistical analyses were performed using Revman 5.3 software.RESULTS Seven non-randomized controlled trials and one randomized controlled trial met the inclusion criteria.In total,1382 patients(1511 polyps)were included in the study,including 722 who received UEMR and 789 who received EMR.In the UEMR and EMR groups,the en bloc resection rates were 85.87%and 73.89%,respectively,with a relative risk(RR)value of 1.14(95%confidence interval[CI]:1.01-1.30;P<0.05).In the sub-group analysis,the en bloc resection rate showed no statistically significant difference between the EMR and UEMR groups for polyps less than 20 mm in diameter.However,a statistically significant difference was found between the EMR and UEMR groups for polyps equal to or greater than 20 mm in diameter.The post-endoscopic resection recurrence rates at 3-6 mo of the UEMR and EMR groups were 3.26%and 15.17%,respectively,with an RR value of 0.27(95%CI:0.09-0.83;P<0.05).The post-endoscopic resection recurrence rates of UEMR and EMR at 12 mo were 6.25%and 14.40%,respectively,with an RR value of 0.43(95%CI:0.20-0.92;P<0.05).Additionally,the incidence of adverse events was 8.17%and 6.21%,respectively,with an RR value of 1.07(95%CI:0.50-2.30;P>0.05).CONCLUSION UEMR is an effective technique for colorectal polyps and appears to have some advantages over EMR,particularly with regard to some treatment outcomes.
文摘BACKGROUND Colorectal cancer remains a considerable challenge in healthcare nowadays.Approximately 60%-80%of colorectal cancer is caused by intestinal polyps,and resection of intestinal polyps has been proved to reduce the incidence of colorectal cancer.The vast majority of intestinal polyps can be found during colonoscopy and removed endoscopically.Therefore,more attention has been paid to the development of endoscopic resection of intestinal polyps.In this study,we compared the efficacy and safety of cold snare polypectomy(CSP)and hot snare polypectomy(HSP).AIM To investigate the efficacy and safety of CSP and HSP for colorectal polyps.METHODS Between January and December 2020,301 patients with colorectal polyps 4-9 mm in diameter were treated with endoscopic therapy in our hospital,and were divided into the CSP group(n=154)and HSP group(n=147).The operating time,incidence of bleeding and perforation,use of titanium clips,and complete resection rate were compared between the two groups.RESULTS We included 249 patients(301 polyps).No differences in gender,age,and polyp size,location,shape and type were observed between the CSP and HSP groups,and the resection rates in these two groups were 93.4%and 94.5%,respectively,with no significant difference.The use of titanium clips was 15.6%and 95.9%,the operating time was 3.2±0.5 min and 5.6±0.8 min,the delayed bleeding rate was 0%and 2.0%,and delayed perforation was 0%and 0.7%,in the CSP and HSP groups,respectively.CONCLUSIONFor sessile colorectal polyps < 10 mm, CSP had the same resection rate of impaired tissue integrityas traditional HSP had. The rate of complications was lower in the CSP group. CSP is a safe andeffective method for polypectomy.
基金the Institutional Review Board of First Affiliated Hospital,School of Medicine,Zhejiang University(No.20191477)Ningbo First Hospital,Zhejiang(No.2020-R013)and other participating institutions.
文摘BACKGROUND The optimal method to remove sessile colorectal lesions sized 10-20 mm remains uncertain.Piecemeal and incomplete resection are major limitations in current practice,such as endoscopic mucosal resection(EMR)and cold or hot snare polypectomy.Recently,EMR with circumferential precutting(EMR-P)has emerged as an effective technique,but the quality of current evidence in comparative studies of conventional EMR(CEMR)and EMR-P is limited.AIM To investigate whether EMR-P is superior to CEMR in removing sessile colorectal polyps.METHODS This multicenter randomized controlled trial involved seven medical institutions in China.Patients with colorectal polyps sized 10-20 mm were enrolled and randomly assigned to undergo EMR-P or CEMR.EMR-P was performed following submucosal injection,and a circumferential mucosa incision(precutting)was conducted using a snare tip.Primary outcomes included a comparison of the rates of en bloc and R0 resection,defined as one-piece resection and one-piece resection with histologically assessed clear margins,respectively.RESULTS A total of 110 patients in the EMR-P group and 110 patients in the CEMR group were finally evaluated.In the per-protocol analysis,the proportion of en bloc resections was 94.3%[95%confidence interval(CI):88.2%-97.4%]in the EMR-P group and 86%(95%CI:78.2%-91.3%)in the CEMR group(P=0.041),while subgroup analysis showed that for lesions>15 mm,EMR-P also resulted in a higher en bloc resection rate(92.0%vs 58.8%P=0.029).The proportion of R0 resections was 81.1%(95%CI:72.6%-87.4%)in the EMR-P group and 76.6%(95%CI:68.8%-84.4%)in the CEMR group(P=0.521).The EMR-P group showed a longer median procedure time(6.4 vs 3.0 min;P<0.001).No significant difference was found in the proportion of patients with adverse events(EMR-P:9.1%;CEMR:6.4%;P=0.449).CONCLUSION In this study,EMR-P served as an alternative to CEMR for removing nonpedunculated colorectal polyps sized 10-20 mm,particularly polyps>15 mm in diameter,with higher R0 and en bloc resection rates and without increasing adverse events.However,EMR-P required a relatively longer procedure time than CEMR.Considering its potential benefits for en bloc and R0 resection,EMR-P may be a promising technique in colorectal polyp resection.
文摘Colonoscopy remains the gold standard investigation for colorectal cancer screening as it offers the opportunity to both detect and resect pre-malignant and neoplastic polyps.Although technologies for image-enhanced endoscopy are widely available,optical diagnosis has not been incorporated into routine clinical practice,mainly due to significant inter-operator variability.In recent years,there has been a growing number of studies demonstrating the potential of convolutional neural networks(CNN)to enhance optical diagnosis of polyps.Data suggest that the use of CNNs might mitigate the inter-operator variability amongst endoscopists,potentially enabling a“resect and discard”or“leave in”strategy to be adopted in real-time.This would have significant financial benefits for healthcare systems,avoid unnecessary polypectomies of non-neoplastic polyps and improve the efficiency of colonoscopy.Here,we review advances in CNN for the optical diagnosis of colorectal polyps,current limitations and future directions.
文摘BACKGROUND Colorectal polyps refer to all neoplasms that protrude into the intestinal cavity.Researchers believe that 50%-70%of colorectal cancers originate from adenomatous polyps.AIM To investigate the endoscopic morphologic features,pathologic types,and clinical situation;evaluate the efficacy and safety of endoscopic mucosal resection(EMR);and guide clinicians in their daily practice.METHODS Two hundred thirty-four patients who underwent EMR in our hospital from January 1,2018 to December 31,2019 were recruited.Data including sex,age,endoscopic morphology of the polyps,and pathological characteristics were analyzed among groups.RESULTS A total of 295 polyps were resected from the 234 subjects enrolled in the study,of which 4(1.36%)were Yamada type I.There were 75(25.42%)type II,101(34.24%)type III,and 115(38.98%)type IV adenomas.Among them,41 were nonadenomas,110 were low-risk adenomas,139 were high-risk adenomas,and 5 were carcinomas.The differences in distribution were not statistically significant,with P values greater than 0.05.The risk of cancer significantly increased for polyps≥1 cm in diameter(c2=199.825,P=0.00).Regarding the endoscopic morphological features,congestion,erosion,and lobulation were more common on the surface morphology of high-risk adenomas and cancerous polyps(c2=75.257,P=0.00),and most of them were Yamada types III and IV.In all,6 of the 295 polyps could not be removed completely,with a one-time resection rate of 97.97%.There were two cases of postoperative bleeding and no cases of perforation,with an overall complication rate of 0.09%.CONCLUSION Colorectal polyps ranging from non-adenomatous polyps,low-risk adenomas,and high-risk adenomas to adenocarcinomas each has their own endoscopic features,while EMR,as a mature intervention,has good safety and operability and should be promoted clinically,especially at the primary care level.
