Post-colonoscopic colorectal cancer(PCCRC),also known as interval CRC,is defined as CRC diagnosed more than six months after a colonoscopy in which no cancer was detected.It typically arises from missed lesions or inc...Post-colonoscopic colorectal cancer(PCCRC),also known as interval CRC,is defined as CRC diagnosed more than six months after a colonoscopy in which no cancer was detected.It typically arises from missed lesions or incomplete resections and is now recognized as one of the most reliable quality indicators for assessing colonoscopy performance.With an incidence rate of 3.6%to 9.3%,PCCRC remains a significant concern,highlighting the limitations of colonoscopy in CRC screening—not only in terms of diagnostic accuracy but also in its preventive role and effectiveness in treating lesions.A range of clinical,endoscopic,and biological factors has been associated with an increased risk of PCCRC.Identifying these factors can help stratify high-risk patients,enabling earlier detection and improving preventive strategies for interval CRC.Reducing PCCRC should be a top priority for every endoscopy unit.While technological advancements will enhance polyp detection,minimize missed lesions,prevent incomplete resections,and improve overall procedural quality,the most impactful strategy remains internal self-assessment within each unit.This review should evaluate key performance metrics,including cecal intubation rate,adenoma detection rate,withdrawal time,PCCRC incidence,and incomplete resections—both at the individual endoscopist level and across the entire unit.展开更多
BACKGROUND Difficulty of colonoscopy insertion(DCI)significantly affects colonoscopy effectiveness and serves as a key quality indicator.Predicting and evaluating DCI risk preoperatively is crucial for optimizing intr...BACKGROUND Difficulty of colonoscopy insertion(DCI)significantly affects colonoscopy effectiveness and serves as a key quality indicator.Predicting and evaluating DCI risk preoperatively is crucial for optimizing intraoperative strategies.AIM To evaluate the predictive performance of machine learning(ML)algorithms for DCI by comparing three modeling approaches,identify factors influencing DCI,and develop a preoperative prediction model using ML algorithms to enhance colonoscopy quality and efficiency.METHODS This cross-sectional study enrolled 712 patients who underwent colonoscopy at a tertiary hospital between June 2020 and May 2021.Demographic data,past medical history,medication use,and psychological status were collected.The endoscopist assessed DCI using the visual analogue scale.After univariate screening,predictive models were developed using multivariable logistic regression,least absolute shrinkage and selection operator(LASSO)regression,and random forest(RF)algorithms.Model performance was evaluated based on discrimination,calibration,and decision curve analysis(DCA),and results were visualized using nomograms.RESULTS A total of 712 patients(53.8%male;mean age 54.5 years±12.9 years)were included.Logistic regression analysis identified constipation[odds ratio(OR)=2.254,95%confidence interval(CI):1.289-3.931],abdominal circumference(AC)(77.5–91.9 cm,OR=1.895,95%CI:1.065-3.350;AC≥92 cm,OR=1.271,95%CI:0.730-2.188),and anxiety(OR=1.071,95%CI:1.044-1.100)as predictive factors for DCI,validated by LASSO and RF methods.Model performance revealed training/validation sensitivities of 0.826/0.925,0.924/0.868,and 1.000/0.981;specificities of 0.602/0.511,0.510/0.562,and 0.977/0.526;and corresponding area under the receiver operating characteristic curves(AUCs)of 0.780(0.737-0.823)/0.726(0.654-0.799),0.754(0.710-0.798)/0.723(0.656-0.791),and 1.000(1.000-1.000)/0.754(0.688-0.820),respectively.DCA indicated optimal net benefit within probability thresholds of 0-0.9 and 0.05-0.37.The RF model demonstrated superior diagnostic accuracy,reflected by perfect training sensitivity(1.000)and highest validation AUC(0.754),outperforming other methods in clinical applicability.CONCLUSION The RF-based model exhibited superior predictive accuracy for DCI compared to multivariable logistic and LASSO regression models.This approach supports individualized preoperative optimization,enhancing colonoscopy quality through targeted risk stratification.展开更多
BACKGROUND Colorectal cancer(CRC)can be prevented by screening and early detection.Colonoscopy is used for screening,and adenoma detection rate(ADR)is used as a key quality indicator of sufficient colonoscopy.However,...BACKGROUND Colorectal cancer(CRC)can be prevented by screening and early detection.Colonoscopy is used for screening,and adenoma detection rate(ADR)is used as a key quality indicator of sufficient colonoscopy.However,ADR can vary significantly among endoscopists,leading to missed polyps or cancer.Artificial intelligence(AI)has shown promise in improving ADR by assisting in real-time polyp identification or diagnosis.While multiple randomized controlled trials(RCTs)and metanalyses highlight the benefits of AI in increasing detection rates and reducing missed polyps,concerns remain about its real-world applicability,impact on procedure time,and cost-effectiveness.AIM To explore the current status of AI assistance colonoscopy in adenoma detection and improving quality of colonoscopy.METHODS This systematic review followed PRISMA guidelines,both PubMed and Web of Science databases were used for articles search.Metanalyses and systematic reviews that assessed AI's role during colonoscopy.English article only published between January 2000 and January 2025 were included.Articles related to nonadenoma indications were excluded.Data extraction was independently performed by two researchers for accuracy and consistency.RESULTS 22 articles met the inclusion criteria,with significant heterogeneity(I2=28%-91%)observed in multiple studies.The number of studies per metanalysis ranged from 5 to 33,with higher heterogeneity in analyses involving more than 18 RCTs.AI demonstrated improvement in ADR,with an approximate 20%increase across multiple studies.However,its effectiveness in detecting flat or serrated adenomas remains unproven.Endoscopists with low ADR benefit more from AI-colonoscopies,while expert endoscopists outperformed AI in ADR,adenoma miss rate,and the identification of advanced lesions.No significant change in withdrawal time was observed when comparing AI-assisted colonoscopy to conventional endoscopy.CONCLUSION While AI-assisted colonoscopy has been shown to improve procedural quality,particularly for junior endoscopists and those with lower ADR,its performance decreases when compared to expert endoscopists in real-time clinical practice.This is especially evident in non-randomized studies,where AI demonstrates limited real-world benefits despite its benefit in controlled settings.Furthermore,no meta-analyses have specifically examined AI's impact on the learning experience of fellows and residents.Some experts caution that reliance on AI may prevent trainees from developing essential observational skills,potentially leading to less thorough examinations.Further research is needed to determine the actual benefits of AI-colonoscopy,particularly its role in cancer prevention.As technology advances,improved outcomes are expected,especially in detecting small,flat,and lesions at difficult anatomical locations.展开更多
The term“gut microbiota”primarily refers to the ecological community of various microorganisms in the gut,which constitutes the largest microbial community in the human body.Although adequate bowel preparation can i...The term“gut microbiota”primarily refers to the ecological community of various microorganisms in the gut,which constitutes the largest microbial community in the human body.Although adequate bowel preparation can improve the results of colonoscopy,it may interfere with the gut microbiota.Bowel preparation for colonoscopy can lead to transient changes in the gut microbiota,potentially affecting an individual’s health,especially in vulnerable populations,such as patients with inflammatory bowel disease.However,measures such as oral pro-biotics may ameliorate these adverse effects.We focused on the bowel prepa-ration-induced changes in the gut microbiota and host health status,hypothesized the factors influencing these changes,and attempted to identify measures that may reduce dysbiosis,thereby providing more information for individualized bowel preparation for colonoscopy in the future.展开更多
BACKGROUND Colonoscopy is essential for screening,diagnosing,and treating lower gastrointestinal diseases;however,access is limited in resource-constrained areas.Barriers to endoscopy services include a shortage of tr...BACKGROUND Colonoscopy is essential for screening,diagnosing,and treating lower gastrointestinal diseases;however,access is limited in resource-constrained areas.Barriers to endoscopy services include a shortage of trained specialists and inadequate equipment and infrastructure.Most gastroenterologists in Ethiopia work in major cities,leaving the 80%rural population with limited access to endoscopy due to economic and logistical challenges.Such inequitable access negatively impacts optimal patient care and outcomes and potentially skews data on disease prevalence.To address these issues we implemented weekend outreach endoscopy program in Southwest Ethiopia where such services were previously unavailable.Findings were documented electronically and stored safely.AIM To evaluate the findings,success,and impact of weekend outreach colonoscopy services in predominantly rural Southwest Ethiopia.METHODS In partnership with Jimma Awetu Hospital,a senior gastroenterologist from Addis Ababa University established an outreach endoscopy service in 2019,training local nursing staff as coordinators.Physicians selected and referred patients for colonoscopy,and informed consent was obtained before the procedure.A total of 1612 procedures were performed using a portable Fujinon EPX-2500-HD system,and findings were documented electronically.Data were analyzed using descriptive statistics on Statistical Package for the Social Sciences 29.RESULTS From 2019 to 20241612 colonoscopy procedures were performed,achieving an 83.0%diagnostic yield.The cohort was predominantly male(70.6%)with a mean age of 44 years;61%were under 50.Ninety-one percent of patients were referred by 21 hospitals across three regions.Primary indications included abdominal pain(26.8%)and lower gastrointestinal bleeding(25.3%).Abnormal findings included inflammation(39.5%),colorectal masses(13.2%),and hemorrhoid(11.8%).Histology confirmed inflammatory bowel disease in 11.5%,cancers in 11.0%,and polyps in 10.0%.In this study half of colorectal cancer cases occurred in patients under 50 with prevalence rates of 18.8%in females and 10.8%in males,challenging the global trend that shows this disease predominantly affects older individuals and males.CONCLUSION This weekend outreach colonoscopy service implemented standard diagnostics,improved the existing service,and generated vital evidence on local disease patterns with the potential to positively impact clinical practice and policy-making.展开更多
BACKGROUND The question of whether a colonoscopist should evaluate anal diseases is relevant.Endoscopists need to be aware of the possibility of anal neoplasms during a colonoscopy,as they can be easily overlooked if ...BACKGROUND The question of whether a colonoscopist should evaluate anal diseases is relevant.Endoscopists need to be aware of the possibility of anal neoplasms during a colonoscopy,as they can be easily overlooked if not properly examined.Specifically,one must clarify the responsibility of the colonoscopist in the diagnosis of anal neoplasms.Anal cancer is relatively rare,accounting for less than 2%of all cases annually.Owing to its rarity,population screening for anal cancer is not indicated,and monitoring is limited to high-risk groups.However,the number of anal cancer cases in high-risk groups has increased over the past four decades worldwide.AIM To assess the results of anal examinations performed during routine colonoscopy and emphasize the importance of diagnosing anal neoplasms.METHODS This was a retrospective study of 16836 patients who were screened by colonoscopy and received a detailed anal examination by videoanoscopy between 2006 and 2024.Among several other findings,the presence of anal neoplasms and suspicious anal cancer lesions was observed.All examinations,including complete anal examination,inspection,digital rectal examination,and videoanoscopy,were performed,and images were recorded and reported.The examinations were individually viewed by the work group,and the findings were analyzed.RESULTS Among the 22676 colonoscopies performed,16836 patients were identified,and 88 lesions suspected of neoplasia(0.52%)were found.Among them,there were 23 cases of neoplasia(0.13%),9 cases of confirmed squamous cell carcinoma of the anal canal(0.05%),5 cases of adenocarcinoma in the anal canal(0.03%),3 cases of rare neoplasms(0.01%),and 6 cases of adenoma(0.03%).CONCLUSION The systematic performance of anal examinations and anoscopy during routine colonoscopy allows the identification of numerous anal diseases,including incidental cases of anal cancer.展开更多
BACKGROUND Bowel preparation is a critical step in colonoscopy and endoscopic surgery.Adequate and effective bowel cleansing significantly improves lesion detection rates while reducing operative risks and complicatio...BACKGROUND Bowel preparation is a critical step in colonoscopy and endoscopic surgery.Adequate and effective bowel cleansing significantly improves lesion detection rates while reducing operative risks and complications.AIM To investigate the current state of inadequate bowel preparation in patients undergoing colonoscopy,identify the contributing factors,and develop interventions.METHODS This study was designed as a retrospective cohort study.A convenience sampling method was used to select 484 patients who underwent colonoscopy at Beijing Chao-Yang Hospital,Capital Medical University,from October 2023 to October 2024.General patient data,disease-related variables,and the Boston bowel preparation scale were collected.Logistic regression analysis was conducted to identify the factors associated with inadequate bowel preparation.RESULTS Among the 484 patients,the rate of inadequate bowel preparation was 25.8%(125/484).Influential factors for poor bowel preparation included history of colorectal surgery[odds ratio(OR)=5.814],low-residue diet 1 day prior(OR=0.145),time interval from last dose to start of examination(OR=1.447),total exercise time after medication(OR=0.992),and total number of bowel movements after medication(OR=0.900)(all P<0.05).CONCLUSION This study highlights several modifiable and non-modifiable factors influencing bowel preparation,such as surgical history and behavioral adherence.The findings support implementing dietary adjustments,optimized laxative timing,physical activity guidance,and tailored strategies for high-risk patients to improve bowel cleansing and enhance the diagnostic accuracy of colonoscopy.展开更多
This study discusses the impact of the increasing use of colonoscopy on the trends of colorectal cancer(CRC)in Korea.Different views are raised on the research methods and conclusions of Kim et al.It emphasizes the ne...This study discusses the impact of the increasing use of colonoscopy on the trends of colorectal cancer(CRC)in Korea.Different views are raised on the research methods and conclusions of Kim et al.It emphasizes the need to carefully consider the balance between the benefits of early detection and the risks of over-screening.This letter also suggests directions for future research and policy considerations in the field of CRC screening and prevention in Korea.展开更多
Background Unsedated colonoscopy is an important method used for diagnosing colorectal cancer,but it can cause discomfort such as pain and bloating,as well as anxiety.At present,the relief is mainly achieved through m...Background Unsedated colonoscopy is an important method used for diagnosing colorectal cancer,but it can cause discomfort such as pain and bloating,as well as anxiety.At present,the relief is mainly achieved through methods such as changing positions and manual pressing,but the efficacy is limited.Hence alternative therapies for sedation and analgesia in unsedated colonoscopy warrant further study.Electroacupuncture(EA)can simplify the procedure of anesthesia and analgesia,while the efficacy of EA on unsedated colonoscopy remains unclear.Therefore,a well-designed randomized controlled trial is needed to demonstrate the potential efficacy of acupuncture in unsedated colonoscopy,particularly for pain relief.Methods In this prospective randomized sham-controlled trial,105 eligible participants will be recruited and randomly assigned to either EA group(n=35),sham EA group(n=35),or control group(n=35)in a 1:1:1 ratio.The EA group will receive acupuncture intervention on bilateral Hegu(LI4),Neiguan(PC6),Zusanli(ST36),and Shenmen(HT7),with LI4 and PC6 on both sides connected to the EA device.The sham EA group will received non transdermal needling on points of no meridian,and deliberately connect the needle to the incorrect output socket of EA device to block the stimulation.The needling will conducted from 30 min before the unsedated colonoscopy to the end of the colonoscopy,the whole retention time would be approximately 40 min.The participants in the control group will not receive any acupuncture intervention.All participants of the three groups will not receive any other treatment.Primary outcomes:Numerical Rating Scale(NRS)reported by participants and Face Pain Scale Revised(FPS-R)evaluated by observers of four areas of the participants during the unsedated colonoscopy.Secondary outcomes:tolerance reported by endoscopists,tolerance reported by participants,satisfaction reported by endoscopists,satisfaction reported by participants,adverse events during the unsedated colonoscopy,postoperative discomfort,unsedated colonoscopy smoothness(cecal insertion time,unwinding time,success rate of one-time intubation).Both intention-to-treat(ITT)and per-protocol(PP)analyses will be performed to assess the efficacy of EA.Discussion The trial will explore the efficacy of relieving pain,improving tolerability,and reducing undesirable adverse events of EA for unsedated colonoscopy.The results of this trial will provide sound evidence for promoting the clinical application of EA for unsedated colonoscopy.Trial registration ClinicalTrials.gov Identifier:ChiCTR2300069903,retrospectively registered on March 16,2023.展开更多
Colonoscopy remains the cornerstone of colorectal cancer prevention and survei-llance,but the procedure’s effectiveness is entirely dependent upon various quali-ty indicators,such as detection rates,withdrawal time,a...Colonoscopy remains the cornerstone of colorectal cancer prevention and survei-llance,but the procedure’s effectiveness is entirely dependent upon various quali-ty indicators,such as detection rates,withdrawal time,adequate bowel prepara-tion,cecal intubation rate and patient outcomes.Despite progress in endoscopic techniques,challenges persist in maintaining endoscopists’consistent perfor-mance and improving quality metrics.Artificial intelligence(AI)has emerged as a“game changer”in the gastroenterology field,offering the opportunity to signifi-cantly increase colonoscopy quality.This review highlights the role of AI-driven technologies such as deep learning,computer vision,and real-time feedback me-chanisms in optimizing key quality indicators of colonoscopy.The implementa-tion of AI in colonoscopy may reduce human error,improve endoscopist’s consis-tency in real-time decision making,ensuring higher reliability and standardiza-tion during the procedure.Furthermore,AI has the potential to reshape how en-doscopists perform and evaluate procedures,while improved lesion characte-rization may enable more precise selection for resection,reducing morbidity and the incidence of interval cancers.The review also addresses challenges and limi-tations in AI integration,including cost-effectiveness and its impact on endosco-pist training.AI holds substantial promise for advancing colonoscopy quality and elevating overall patient care,paving the way for more effective and personalized medical approaches.展开更多
The bowel preparation is a crucial step to achieve an optimal quality in colonoscopy.The major clinical impact of an adequate colonic cleansing is to allow a more detailed and thorough inspection reducing the rates of...The bowel preparation is a crucial step to achieve an optimal quality in colonoscopy.The major clinical impact of an adequate colonic cleansing is to allow a more detailed and thorough inspection reducing the rates of missing lesions during the procedure and consequently reducing the incidence of interval colorectal carcinomas.Currently there are different colonoscopic preparation schemes,being the polyethylene glycol(PEG)based regimen one of the most used and recommended by the main international clinical guidelines.Nevertheless,PEG preparation requires the ingestion of considerably large volumes to achieve an optimal colonic cleansing,leading to poor tolerability in may patients,particularly in an elderly population.Other aspects that make accessibility to most colonoscopy preparation regimens difficult is their high cost and low availability.New options of colonoscopic preparation schemes based on oral lactulose are emerging with promising results,showing excellent efficacy-safety profiles and high tolerability indexes.Lactulose regimens present other benefits such as low cost and wide availability.The aim of this review is to analyze the scientific evidence to date and the current status of colonoscopy bowel preparation utilizing lactulose-based regimens,in order to consolidate this agent as a feasible“new player”in the field of colonoscopic preparation.展开更多
BACKGROUND Adenoma detection rate(ADR),a key colonoscopy quality metric,varies with patient demographics and procedural factors.AIM To identify independent predictors of≥25%ADR,develop a risk model,and propose withdr...BACKGROUND Adenoma detection rate(ADR),a key colonoscopy quality metric,varies with patient demographics and procedural factors.AIM To identify independent predictors of≥25%ADR,develop a risk model,and propose withdrawal durations based on different insertion times.METHODS We retrospectively analyzed 830 cases using logistic regression and identified four key factors,validated in a prospective cohort of 5699 patients.Their importance was confirmed using random forest(RF),extreme gradient boosting(XGBoost)and light gradient boosting machine(LightGBM).Attempts to determine targetachieving withdrawal time by grouping cases based on insertion time and Cox regression were inconclusive.Using the 5699-case dataset,we developed a predictive model combining support vector machine(SVM)with XGBoost.We built a Shiny app using this model for clinical application.RESULTS Multivariate logistic regression identified age[odds ratio(OR)=1.05;95%confidence interval(CI):1.03-1.08;P<0.001],male(OR=1.79;95%CI:1.32-2.41;P=0.005),higher endoscopist experience(OR=1.79;95%CI:1.20-2.68;P=0.005),and longer withdrawal time(P<0.001)as independent risk factors for colorectal adenoma.A nomogram demonstrated strong discrimination[area under the curve(AUC)=0.720],with robust calibration and decision-curve performance.Feature importance via RF,XGBoost,and LightGBM confirmed key predictors.A hybrid model combining SVM regression for withdrawal-time estimation and XGBoost classification achieved stable results,with XGBoost reporting AUCs of 0.640 in training and 0.610 in testing,and similar validation outcomes.Deployed via a Shiny app for clinical use.However,model discrimination was modest(AUC:0.61-0.64),suggesting that clinical utility requires further refinement.CONCLUSION A hybrid SVM-XGBoost model using four key endoscopic factors was independently validated and is available as a Shiny app,delivering real-time decision support to streamline endoscopy and enhance clinical outcomes.展开更多
Colorectal cancer(CRC)is the third most frequently diagnosed cancer and the second leading cause of cancer death worldwide.In this regard,CRC screening is one of the most important issues in modern preventive medicine...Colorectal cancer(CRC)is the third most frequently diagnosed cancer and the second leading cause of cancer death worldwide.In this regard,CRC screening is one of the most important issues in modern preventive medicine.Colorectal polyps are potential predictors of CRC,and therefore represent one of the leading targets for screening colonoscopy.The difficulty of analyzing the information obtained during colonoscopy,including the size,location,shape,type of polyps,the need to standardize morphological data,determines that recently a number of works have promoted the opinion on the advisability of using various artificial intelligence(AI)methods to improve the effectiveness of endoscopic screening for CRC.At the same time,they point to a number of errors and methodological problems in the use of AI systems for the diagnosis of colorectal polyps.In this regard,the interpretation of the work of Shi et al,devoted to the use of a machine learning-based predictive model for monitoring the results of colorectal polypectomy,is undoubtedly interesting.In our opinion,the prospects for using AI to assess endoscopic screening for CRC look certainly positive,but the road to its widespread use will not be easy.展开更多
BACKGROUND Currently,colonoscopy still needs continuous optimization and exploration of novel alternative approaches to enhance the experience of patients during co-lonoscopy.AIM To analyze the efficacy of water infus...BACKGROUND Currently,colonoscopy still needs continuous optimization and exploration of novel alternative approaches to enhance the experience of patients during co-lonoscopy.AIM To analyze the efficacy of water infusion combined with defoamers in colono-scopy.METHODS This study included 97 patients undergoing colonoscopy from January 2024 to June 2024.The participants were categorized into two groups,namely,the control group(n=47),who underwent conventional colonoscopy,and the experimental group(n=50),who received colonoscopy using water injection combined with defoamers.A comparative analysis was then conducted on the disease detection rate(colonic polyps,colonorrhagia,colonic ulcers,colonic mucosal lesions,and others),colonoscopy duration,abdominal pain[visual analog scale(VAS)],Boston bowel preparation scale(BBPS),self-rating anxiety scale(SAS),bowel preparation comfort,complications(intestinal perforation,bleeding,nausea and vomiting,abdominal pain,and abdominal distension),and patient satisfaction.RESULTS The experimental group demonstrated a significantly higher total disease detection rate,BBPS scores,and patient satisfaction compared with the control group.Further,the research group exhibited shorter colonoscopy duration,lower VAS and SAS scores and total complication rate,and better patient comfort and satisfaction.CONCLUSION These results indicate that the combination of water injection and defoamers exhibited an overall better therapeutic effect than conventional colonoscopy,mainly reflected in higher disease detection rate,faster examination ef-ficiency,lower abdominal pain,anxiety,and complication incidences,and significantly better bowel preparation,comfort,and patient satisfaction.展开更多
BACKGROUND Colorectal cancer has a high incidence and mortality rate,and the effectiveness of routine colonoscopy largely depends on the endoscopist’s expertise.In recent years,computer-aided detection(CADe)systems h...BACKGROUND Colorectal cancer has a high incidence and mortality rate,and the effectiveness of routine colonoscopy largely depends on the endoscopist’s expertise.In recent years,computer-aided detection(CADe)systems have been increasingly integrated into colonoscopy to improve detection accuracy.However,while most studies have focused on adenoma detection rate(ADR)as the primary outcome,the more sensitive adenoma miss rate(AMR)has been less frequently analyzed.AIM To evaluate the effectiveness of CADe in colonoscopy and assess the advantages of AMR over ADR.METHODS A comprehensive literature search was conducted in PubMed,Embase,and the Cochrane Central Register of Controlled Trials using predefined search strategies to identify relevant studies published up to August 2,2024.Statistical analyses were performed to compare outcomes between groups,and potential publication bias was assessed using funnel plots.The quality of the included studies was evaluated using the Cochrane Risk of Bias tool and the Grading of Recommendations,Assessment,Development,and Evaluation approach.RESULTS Five studies comprising 1624 patients met the inclusion criteria.AMR was significantly lower in the CADe-assisted group than in the routine colonoscopy group(147/927,15.9%vs 345/960,35.9%;P<0.01).However,CADe did not provide a significant advantage in detecting advanced adenomas or lesions measuring 6-9 mm or≥10 mm.The polyp miss rate(PMR)was also lower in the CADe-assisted group[odds ratio(OR),0.35;95% confidence interval(CI):0.23-0.52;P<0.01].While the overall ADR did not differ significantly between groups,the ADR during the first-pass examination was higher in the CADe-assisted group(OR,1.37;95%CI:1.10-1.69;P=0.004).The level of evidence for the included randomized controlled trials was graded as moderate.CONCLUSION CADe can significantly reduce AMR and PMR while improving ADR during initial detection,demonstrating its potential to enhance colonoscopy performance.These findings highlight the value of CADe in improving the detection of colorectal neoplasms,particularly small and histologically distinct adenomas.展开更多
A recent study by Nishizawa et al presented significant findings regarding the advantages of next-generation colonoscopes,specifically the CF-XZ1200 and CFEZ1500 models,in enhancing the adenoma and sessile serrated le...A recent study by Nishizawa et al presented significant findings regarding the advantages of next-generation colonoscopes,specifically the CF-XZ1200 and CFEZ1500 models,in enhancing the adenoma and sessile serrated lesion detection rates.As colorectal cancer remains a leading cause of cancer-related mortality globally,the implications of improved detection rates are substantial.This letter advocated the adoption of advanced colonoscopy technology,emphasizing the robust methodology of the study,including propensity score matching,which enhanced the validity of its conclusions.Notable improvements in image quality,facilitated by innovations such as 4 K resolution and texture enhancement imaging,enable endoscopists to identify even the smallest lesions,ultimately leading to improved patient outcomes.Given the compelling evidence presented,it is imperative for healthcare institutions to prioritize the integration of these advanced scopes into routine practice to enhance screening efficacy and reduce the burden of colorectal cancer.展开更多
Screening colonoscopy with adenoma removal is the gold standard strategy to reduce colorectal cancer(CRC)incidence.Nevertheless,it remains an imperfect tool as nearly Twenty-five percent of adenomas can be missed duri...Screening colonoscopy with adenoma removal is the gold standard strategy to reduce colorectal cancer(CRC)incidence.Nevertheless,it remains an imperfect tool as nearly Twenty-five percent of adenomas can be missed during inspection by experienced endoscopists.Missed lesions are one of the primary reasons for post colonoscopy CRC and are associated with a significant variability in adenoma detection rate(ADR),which is the most important quality indicator for colonoscopy.Increasing ADR unquestionably decreases carcinoma miss rate.Simple measures to improve ADR include among others slower withdrawal time and position change.The introduction of optical imaging innovations has improved mucosal visualization.Moreover,auxiliary devices attached to the colonoscope tip have been introduced,aiming to improve lumen visualization by flattening the folds and revealing lesions hidden in blind spots,thereby increasing ADR.Digital image analysis using artificial intelligence is the latest approach to polyp detection.All of the above approaches have been separately evaluated concerning their effect in ADR;however,it has not been thoroughly investigated whether any benefit exists from their combined use.We aim to review the available data on the efficacy of each technique/technology and whether their combination offers any additional benefit while remaining cost-effective.展开更多
BACKGROUND Sessile serrated lesions(SSLs)are premalignant polyps implicated in up to 30%of colorectal cancers.Australia reports high SSL detection rates(SSL-DRs),yet with marked variability(3.1%-24%).This substantial ...BACKGROUND Sessile serrated lesions(SSLs)are premalignant polyps implicated in up to 30%of colorectal cancers.Australia reports high SSL detection rates(SSL-DRs),yet with marked variability(3.1%-24%).This substantial variation raises concerns about missed lesions and post-colonoscopy colorectal cancer.This study investigates determinants associated with SSL-DR variation in regional Australia.AIM To study how patient,clinical,and colonoscopy factors are associated with SSL detection in a regional Australian practice.We aimed to contribute high-detection data to the literature by analyzing the association of SSL detection with various determinants.METHODS This retrospective,cross-sectional analysis examined 1450 colonoscopies performed at Port Macquarie Gastroenterology during 2023.Sigmoidoscopies and repeat procedures were excluded.Multivariate logistic regression analyzed associations between SSL detection and patient demographics,clinical indications,procedural factors,and comorbidities.RESULTS The overall SSL-DR was 30.7%.Multivariate analysis identified several independent predictors:Clinical indication,bowel preparation quality,inflammatory bowel disease status,and serrated polyposis syndrome.The faecal occult blood test positive(FOBT)(+)cohort showed the highest predicted SSL detection probability(39.8%),while clinical symptoms showed the lowest(22.3%).After adjustment,SSL detection odds were 2.3 times greater among FOBT(+)patients than those with clinical symptoms(adjusted odds ratio=2.30,95%confidence interval:1.20-4.40,P=0.004).CONCLUSION SSL-DR as a quality indicator requires contextualization regarding clinical indications,bowel preparation quality,and comorbidities.There was a significantly higher prevalence of SSLs in FOBT(+)patients.Despite comprehensive adjustment,this study cannot fully explain the wide SSL-DR variation in Australia,highlighting the need for standardized detection protocols and further research to ensure optimal cancer prevention outcomes.展开更多
This letter addresses the recent systematic review and meta-analysis by Wang et al,which evaluated the role of artificial intelligence-based computer-aided de-tection(CADe)in reducing adenoma and polyp miss rates duri...This letter addresses the recent systematic review and meta-analysis by Wang et al,which evaluated the role of artificial intelligence-based computer-aided de-tection(CADe)in reducing adenoma and polyp miss rates during colonoscopy.We commend the authors for highlighting adenoma miss rate(AMR)as a more clinically meaningful endpoint than the traditionally used adenoma detection rate.Their findings demonstrate a significant reduction in AMR and polyp miss rate with CADe-assisted colonoscopy,particularly in small and sessile serrated lesions.However,limitations,including limited study numbers,tandem study design of included studies,and heterogeneity of CADe systems,warrant cautious interpretation.We discuss the broader implications of these findings for real-world practice and future research directions.This letter reinforces the importance of AMR as a performance metric and supports the continued integration and eva-luation of artificial intelligence technologies in endoscopic practice to enhance colorectal cancer prevention strategies.展开更多
BACKGROUND Elevated plasma homocysteine(Hcy)levels are associated with increased risk of colorectal cancer(CRC),particularly in patients with systemic inflammation or AIM To evaluate serum Hcy levels as a predictive m...BACKGROUND Elevated plasma homocysteine(Hcy)levels are associated with increased risk of colorectal cancer(CRC),particularly in patients with systemic inflammation or AIM To evaluate serum Hcy levels as a predictive marker of lesion risk and CRC to prioritize patients undergoing diagnostic colonoscopy.METHODS We conducted a prospective cohort study of 301 fecal occult blood test-positive patients at San Agustín University Hospital in Asturias,Spain.Plasma Hcy levels were measured prior to the colonoscopy and classified into three thresholds:≤12,12-15,and>15μmol/L.Colonoscopy and histopathology determined the presence of low-risk,high-risk polyps or adenocarcinoma.Predictive performance of serum Hcy to detect lesions was assessed using logistic regression and diagnostic accuracy measures,including models adjusted for age and sex.RESULTS Median Hcy levels rose progressively with lesion severity,reaching 15.3μmol/L in adenocarcinoma(P<0.001).Higher levels were also observed in men and individuals aged 65 or older.A threshold above 15μmol/L showed good sensitivity(76.6%)and positive predictive value(87.2%)for detecting adenocarcinoma.When combined with age and sex,predictive accuracy improved(area under the receiver operating characteristic curve=0.706).Based on these findings,we propose a three-tier triage system:Green(≤12μmol/L in both sexes,colonoscopy within three months),Yellow(>12-15μmol/L in men,intervention within one month and red(≥15 in either sex or>12μmol/L in women,immediate colonoscopy).CONCLUSION Serum Hcy is a clinically useful biomarker for identifying high-risk colorectal lesions and cancer,particularly when interpreted in combination with age and sex.This composite model improves predictive accuracy and enables a structured three-tiered triage system that supports faster colonoscopy scheduling for at-risk groups.The traffic light approach offers a low cost,scalable strategy to reduce delays and optimize resource use in CRC screening,especially in public health systems with limited endoscopic capacity.展开更多
文摘Post-colonoscopic colorectal cancer(PCCRC),also known as interval CRC,is defined as CRC diagnosed more than six months after a colonoscopy in which no cancer was detected.It typically arises from missed lesions or incomplete resections and is now recognized as one of the most reliable quality indicators for assessing colonoscopy performance.With an incidence rate of 3.6%to 9.3%,PCCRC remains a significant concern,highlighting the limitations of colonoscopy in CRC screening—not only in terms of diagnostic accuracy but also in its preventive role and effectiveness in treating lesions.A range of clinical,endoscopic,and biological factors has been associated with an increased risk of PCCRC.Identifying these factors can help stratify high-risk patients,enabling earlier detection and improving preventive strategies for interval CRC.Reducing PCCRC should be a top priority for every endoscopy unit.While technological advancements will enhance polyp detection,minimize missed lesions,prevent incomplete resections,and improve overall procedural quality,the most impactful strategy remains internal self-assessment within each unit.This review should evaluate key performance metrics,including cecal intubation rate,adenoma detection rate,withdrawal time,PCCRC incidence,and incomplete resections—both at the individual endoscopist level and across the entire unit.
基金the Chinese Clinical Trial Registry(No.ChiCTR2000040109)approved by the Hospital Ethics Committee(No.20210130017).
文摘BACKGROUND Difficulty of colonoscopy insertion(DCI)significantly affects colonoscopy effectiveness and serves as a key quality indicator.Predicting and evaluating DCI risk preoperatively is crucial for optimizing intraoperative strategies.AIM To evaluate the predictive performance of machine learning(ML)algorithms for DCI by comparing three modeling approaches,identify factors influencing DCI,and develop a preoperative prediction model using ML algorithms to enhance colonoscopy quality and efficiency.METHODS This cross-sectional study enrolled 712 patients who underwent colonoscopy at a tertiary hospital between June 2020 and May 2021.Demographic data,past medical history,medication use,and psychological status were collected.The endoscopist assessed DCI using the visual analogue scale.After univariate screening,predictive models were developed using multivariable logistic regression,least absolute shrinkage and selection operator(LASSO)regression,and random forest(RF)algorithms.Model performance was evaluated based on discrimination,calibration,and decision curve analysis(DCA),and results were visualized using nomograms.RESULTS A total of 712 patients(53.8%male;mean age 54.5 years±12.9 years)were included.Logistic regression analysis identified constipation[odds ratio(OR)=2.254,95%confidence interval(CI):1.289-3.931],abdominal circumference(AC)(77.5–91.9 cm,OR=1.895,95%CI:1.065-3.350;AC≥92 cm,OR=1.271,95%CI:0.730-2.188),and anxiety(OR=1.071,95%CI:1.044-1.100)as predictive factors for DCI,validated by LASSO and RF methods.Model performance revealed training/validation sensitivities of 0.826/0.925,0.924/0.868,and 1.000/0.981;specificities of 0.602/0.511,0.510/0.562,and 0.977/0.526;and corresponding area under the receiver operating characteristic curves(AUCs)of 0.780(0.737-0.823)/0.726(0.654-0.799),0.754(0.710-0.798)/0.723(0.656-0.791),and 1.000(1.000-1.000)/0.754(0.688-0.820),respectively.DCA indicated optimal net benefit within probability thresholds of 0-0.9 and 0.05-0.37.The RF model demonstrated superior diagnostic accuracy,reflected by perfect training sensitivity(1.000)and highest validation AUC(0.754),outperforming other methods in clinical applicability.CONCLUSION The RF-based model exhibited superior predictive accuracy for DCI compared to multivariable logistic and LASSO regression models.This approach supports individualized preoperative optimization,enhancing colonoscopy quality through targeted risk stratification.
文摘BACKGROUND Colorectal cancer(CRC)can be prevented by screening and early detection.Colonoscopy is used for screening,and adenoma detection rate(ADR)is used as a key quality indicator of sufficient colonoscopy.However,ADR can vary significantly among endoscopists,leading to missed polyps or cancer.Artificial intelligence(AI)has shown promise in improving ADR by assisting in real-time polyp identification or diagnosis.While multiple randomized controlled trials(RCTs)and metanalyses highlight the benefits of AI in increasing detection rates and reducing missed polyps,concerns remain about its real-world applicability,impact on procedure time,and cost-effectiveness.AIM To explore the current status of AI assistance colonoscopy in adenoma detection and improving quality of colonoscopy.METHODS This systematic review followed PRISMA guidelines,both PubMed and Web of Science databases were used for articles search.Metanalyses and systematic reviews that assessed AI's role during colonoscopy.English article only published between January 2000 and January 2025 were included.Articles related to nonadenoma indications were excluded.Data extraction was independently performed by two researchers for accuracy and consistency.RESULTS 22 articles met the inclusion criteria,with significant heterogeneity(I2=28%-91%)observed in multiple studies.The number of studies per metanalysis ranged from 5 to 33,with higher heterogeneity in analyses involving more than 18 RCTs.AI demonstrated improvement in ADR,with an approximate 20%increase across multiple studies.However,its effectiveness in detecting flat or serrated adenomas remains unproven.Endoscopists with low ADR benefit more from AI-colonoscopies,while expert endoscopists outperformed AI in ADR,adenoma miss rate,and the identification of advanced lesions.No significant change in withdrawal time was observed when comparing AI-assisted colonoscopy to conventional endoscopy.CONCLUSION While AI-assisted colonoscopy has been shown to improve procedural quality,particularly for junior endoscopists and those with lower ADR,its performance decreases when compared to expert endoscopists in real-time clinical practice.This is especially evident in non-randomized studies,where AI demonstrates limited real-world benefits despite its benefit in controlled settings.Furthermore,no meta-analyses have specifically examined AI's impact on the learning experience of fellows and residents.Some experts caution that reliance on AI may prevent trainees from developing essential observational skills,potentially leading to less thorough examinations.Further research is needed to determine the actual benefits of AI-colonoscopy,particularly its role in cancer prevention.As technology advances,improved outcomes are expected,especially in detecting small,flat,and lesions at difficult anatomical locations.
文摘The term“gut microbiota”primarily refers to the ecological community of various microorganisms in the gut,which constitutes the largest microbial community in the human body.Although adequate bowel preparation can improve the results of colonoscopy,it may interfere with the gut microbiota.Bowel preparation for colonoscopy can lead to transient changes in the gut microbiota,potentially affecting an individual’s health,especially in vulnerable populations,such as patients with inflammatory bowel disease.However,measures such as oral pro-biotics may ameliorate these adverse effects.We focused on the bowel prepa-ration-induced changes in the gut microbiota and host health status,hypothesized the factors influencing these changes,and attempted to identify measures that may reduce dysbiosis,thereby providing more information for individualized bowel preparation for colonoscopy in the future.
文摘BACKGROUND Colonoscopy is essential for screening,diagnosing,and treating lower gastrointestinal diseases;however,access is limited in resource-constrained areas.Barriers to endoscopy services include a shortage of trained specialists and inadequate equipment and infrastructure.Most gastroenterologists in Ethiopia work in major cities,leaving the 80%rural population with limited access to endoscopy due to economic and logistical challenges.Such inequitable access negatively impacts optimal patient care and outcomes and potentially skews data on disease prevalence.To address these issues we implemented weekend outreach endoscopy program in Southwest Ethiopia where such services were previously unavailable.Findings were documented electronically and stored safely.AIM To evaluate the findings,success,and impact of weekend outreach colonoscopy services in predominantly rural Southwest Ethiopia.METHODS In partnership with Jimma Awetu Hospital,a senior gastroenterologist from Addis Ababa University established an outreach endoscopy service in 2019,training local nursing staff as coordinators.Physicians selected and referred patients for colonoscopy,and informed consent was obtained before the procedure.A total of 1612 procedures were performed using a portable Fujinon EPX-2500-HD system,and findings were documented electronically.Data were analyzed using descriptive statistics on Statistical Package for the Social Sciences 29.RESULTS From 2019 to 20241612 colonoscopy procedures were performed,achieving an 83.0%diagnostic yield.The cohort was predominantly male(70.6%)with a mean age of 44 years;61%were under 50.Ninety-one percent of patients were referred by 21 hospitals across three regions.Primary indications included abdominal pain(26.8%)and lower gastrointestinal bleeding(25.3%).Abnormal findings included inflammation(39.5%),colorectal masses(13.2%),and hemorrhoid(11.8%).Histology confirmed inflammatory bowel disease in 11.5%,cancers in 11.0%,and polyps in 10.0%.In this study half of colorectal cancer cases occurred in patients under 50 with prevalence rates of 18.8%in females and 10.8%in males,challenging the global trend that shows this disease predominantly affects older individuals and males.CONCLUSION This weekend outreach colonoscopy service implemented standard diagnostics,improved the existing service,and generated vital evidence on local disease patterns with the potential to positively impact clinical practice and policy-making.
文摘BACKGROUND The question of whether a colonoscopist should evaluate anal diseases is relevant.Endoscopists need to be aware of the possibility of anal neoplasms during a colonoscopy,as they can be easily overlooked if not properly examined.Specifically,one must clarify the responsibility of the colonoscopist in the diagnosis of anal neoplasms.Anal cancer is relatively rare,accounting for less than 2%of all cases annually.Owing to its rarity,population screening for anal cancer is not indicated,and monitoring is limited to high-risk groups.However,the number of anal cancer cases in high-risk groups has increased over the past four decades worldwide.AIM To assess the results of anal examinations performed during routine colonoscopy and emphasize the importance of diagnosing anal neoplasms.METHODS This was a retrospective study of 16836 patients who were screened by colonoscopy and received a detailed anal examination by videoanoscopy between 2006 and 2024.Among several other findings,the presence of anal neoplasms and suspicious anal cancer lesions was observed.All examinations,including complete anal examination,inspection,digital rectal examination,and videoanoscopy,were performed,and images were recorded and reported.The examinations were individually viewed by the work group,and the findings were analyzed.RESULTS Among the 22676 colonoscopies performed,16836 patients were identified,and 88 lesions suspected of neoplasia(0.52%)were found.Among them,there were 23 cases of neoplasia(0.13%),9 cases of confirmed squamous cell carcinoma of the anal canal(0.05%),5 cases of adenocarcinoma in the anal canal(0.03%),3 cases of rare neoplasms(0.01%),and 6 cases of adenoma(0.03%).CONCLUSION The systematic performance of anal examinations and anoscopy during routine colonoscopy allows the identification of numerous anal diseases,including incidental cases of anal cancer.
基金Supported by the Beijing Key Clinical Specialty Project.
文摘BACKGROUND Bowel preparation is a critical step in colonoscopy and endoscopic surgery.Adequate and effective bowel cleansing significantly improves lesion detection rates while reducing operative risks and complications.AIM To investigate the current state of inadequate bowel preparation in patients undergoing colonoscopy,identify the contributing factors,and develop interventions.METHODS This study was designed as a retrospective cohort study.A convenience sampling method was used to select 484 patients who underwent colonoscopy at Beijing Chao-Yang Hospital,Capital Medical University,from October 2023 to October 2024.General patient data,disease-related variables,and the Boston bowel preparation scale were collected.Logistic regression analysis was conducted to identify the factors associated with inadequate bowel preparation.RESULTS Among the 484 patients,the rate of inadequate bowel preparation was 25.8%(125/484).Influential factors for poor bowel preparation included history of colorectal surgery[odds ratio(OR)=5.814],low-residue diet 1 day prior(OR=0.145),time interval from last dose to start of examination(OR=1.447),total exercise time after medication(OR=0.992),and total number of bowel movements after medication(OR=0.900)(all P<0.05).CONCLUSION This study highlights several modifiable and non-modifiable factors influencing bowel preparation,such as surgical history and behavioral adherence.The findings support implementing dietary adjustments,optimized laxative timing,physical activity guidance,and tailored strategies for high-risk patients to improve bowel cleansing and enhance the diagnostic accuracy of colonoscopy.
文摘This study discusses the impact of the increasing use of colonoscopy on the trends of colorectal cancer(CRC)in Korea.Different views are raised on the research methods and conclusions of Kim et al.It emphasizes the need to carefully consider the balance between the benefits of early detection and the risks of over-screening.This letter also suggests directions for future research and policy considerations in the field of CRC screening and prevention in Korea.
基金Supported by National Basic Evidence-based Capacity Building Project of Traditional Chinese Medicine([2019]130)Natural Science Foundation of Liaoning Province:2024-MS-042+1 种基金Xingliao Talent Program Medical Master Project:YXMJ-QNMZY-10Liaoning University of Traditional Chinese Medicine Key Laboratory of Traditional Chinese Medicine Theory and Application of Ministry of Education open fund project:zyzx2302.
文摘Background Unsedated colonoscopy is an important method used for diagnosing colorectal cancer,but it can cause discomfort such as pain and bloating,as well as anxiety.At present,the relief is mainly achieved through methods such as changing positions and manual pressing,but the efficacy is limited.Hence alternative therapies for sedation and analgesia in unsedated colonoscopy warrant further study.Electroacupuncture(EA)can simplify the procedure of anesthesia and analgesia,while the efficacy of EA on unsedated colonoscopy remains unclear.Therefore,a well-designed randomized controlled trial is needed to demonstrate the potential efficacy of acupuncture in unsedated colonoscopy,particularly for pain relief.Methods In this prospective randomized sham-controlled trial,105 eligible participants will be recruited and randomly assigned to either EA group(n=35),sham EA group(n=35),or control group(n=35)in a 1:1:1 ratio.The EA group will receive acupuncture intervention on bilateral Hegu(LI4),Neiguan(PC6),Zusanli(ST36),and Shenmen(HT7),with LI4 and PC6 on both sides connected to the EA device.The sham EA group will received non transdermal needling on points of no meridian,and deliberately connect the needle to the incorrect output socket of EA device to block the stimulation.The needling will conducted from 30 min before the unsedated colonoscopy to the end of the colonoscopy,the whole retention time would be approximately 40 min.The participants in the control group will not receive any acupuncture intervention.All participants of the three groups will not receive any other treatment.Primary outcomes:Numerical Rating Scale(NRS)reported by participants and Face Pain Scale Revised(FPS-R)evaluated by observers of four areas of the participants during the unsedated colonoscopy.Secondary outcomes:tolerance reported by endoscopists,tolerance reported by participants,satisfaction reported by endoscopists,satisfaction reported by participants,adverse events during the unsedated colonoscopy,postoperative discomfort,unsedated colonoscopy smoothness(cecal insertion time,unwinding time,success rate of one-time intubation).Both intention-to-treat(ITT)and per-protocol(PP)analyses will be performed to assess the efficacy of EA.Discussion The trial will explore the efficacy of relieving pain,improving tolerability,and reducing undesirable adverse events of EA for unsedated colonoscopy.The results of this trial will provide sound evidence for promoting the clinical application of EA for unsedated colonoscopy.Trial registration ClinicalTrials.gov Identifier:ChiCTR2300069903,retrospectively registered on March 16,2023.
文摘Colonoscopy remains the cornerstone of colorectal cancer prevention and survei-llance,but the procedure’s effectiveness is entirely dependent upon various quali-ty indicators,such as detection rates,withdrawal time,adequate bowel prepara-tion,cecal intubation rate and patient outcomes.Despite progress in endoscopic techniques,challenges persist in maintaining endoscopists’consistent perfor-mance and improving quality metrics.Artificial intelligence(AI)has emerged as a“game changer”in the gastroenterology field,offering the opportunity to signifi-cantly increase colonoscopy quality.This review highlights the role of AI-driven technologies such as deep learning,computer vision,and real-time feedback me-chanisms in optimizing key quality indicators of colonoscopy.The implementa-tion of AI in colonoscopy may reduce human error,improve endoscopist’s consis-tency in real-time decision making,ensuring higher reliability and standardiza-tion during the procedure.Furthermore,AI has the potential to reshape how en-doscopists perform and evaluate procedures,while improved lesion characte-rization may enable more precise selection for resection,reducing morbidity and the incidence of interval cancers.The review also addresses challenges and limi-tations in AI integration,including cost-effectiveness and its impact on endosco-pist training.AI holds substantial promise for advancing colonoscopy quality and elevating overall patient care,paving the way for more effective and personalized medical approaches.
文摘The bowel preparation is a crucial step to achieve an optimal quality in colonoscopy.The major clinical impact of an adequate colonic cleansing is to allow a more detailed and thorough inspection reducing the rates of missing lesions during the procedure and consequently reducing the incidence of interval colorectal carcinomas.Currently there are different colonoscopic preparation schemes,being the polyethylene glycol(PEG)based regimen one of the most used and recommended by the main international clinical guidelines.Nevertheless,PEG preparation requires the ingestion of considerably large volumes to achieve an optimal colonic cleansing,leading to poor tolerability in may patients,particularly in an elderly population.Other aspects that make accessibility to most colonoscopy preparation regimens difficult is their high cost and low availability.New options of colonoscopic preparation schemes based on oral lactulose are emerging with promising results,showing excellent efficacy-safety profiles and high tolerability indexes.Lactulose regimens present other benefits such as low cost and wide availability.The aim of this review is to analyze the scientific evidence to date and the current status of colonoscopy bowel preparation utilizing lactulose-based regimens,in order to consolidate this agent as a feasible“new player”in the field of colonoscopic preparation.
基金Supported by the Young and Middle-Aged Talents Program of Wuxi Health Commission,No.BJ2020011Cohort Research Program of Wuxi Medical Center,Nanjing Medical University,No.WMCC202314Wuxi People’s Hospital 2024“Wild Goose Array Talent”Reserve Discipline Leader,No.2024-YZ-HBDTR-YC-2024.
文摘BACKGROUND Adenoma detection rate(ADR),a key colonoscopy quality metric,varies with patient demographics and procedural factors.AIM To identify independent predictors of≥25%ADR,develop a risk model,and propose withdrawal durations based on different insertion times.METHODS We retrospectively analyzed 830 cases using logistic regression and identified four key factors,validated in a prospective cohort of 5699 patients.Their importance was confirmed using random forest(RF),extreme gradient boosting(XGBoost)and light gradient boosting machine(LightGBM).Attempts to determine targetachieving withdrawal time by grouping cases based on insertion time and Cox regression were inconclusive.Using the 5699-case dataset,we developed a predictive model combining support vector machine(SVM)with XGBoost.We built a Shiny app using this model for clinical application.RESULTS Multivariate logistic regression identified age[odds ratio(OR)=1.05;95%confidence interval(CI):1.03-1.08;P<0.001],male(OR=1.79;95%CI:1.32-2.41;P=0.005),higher endoscopist experience(OR=1.79;95%CI:1.20-2.68;P=0.005),and longer withdrawal time(P<0.001)as independent risk factors for colorectal adenoma.A nomogram demonstrated strong discrimination[area under the curve(AUC)=0.720],with robust calibration and decision-curve performance.Feature importance via RF,XGBoost,and LightGBM confirmed key predictors.A hybrid model combining SVM regression for withdrawal-time estimation and XGBoost classification achieved stable results,with XGBoost reporting AUCs of 0.640 in training and 0.610 in testing,and similar validation outcomes.Deployed via a Shiny app for clinical use.However,model discrimination was modest(AUC:0.61-0.64),suggesting that clinical utility requires further refinement.CONCLUSION A hybrid SVM-XGBoost model using four key endoscopic factors was independently validated and is available as a Shiny app,delivering real-time decision support to streamline endoscopy and enhance clinical outcomes.
文摘Colorectal cancer(CRC)is the third most frequently diagnosed cancer and the second leading cause of cancer death worldwide.In this regard,CRC screening is one of the most important issues in modern preventive medicine.Colorectal polyps are potential predictors of CRC,and therefore represent one of the leading targets for screening colonoscopy.The difficulty of analyzing the information obtained during colonoscopy,including the size,location,shape,type of polyps,the need to standardize morphological data,determines that recently a number of works have promoted the opinion on the advisability of using various artificial intelligence(AI)methods to improve the effectiveness of endoscopic screening for CRC.At the same time,they point to a number of errors and methodological problems in the use of AI systems for the diagnosis of colorectal polyps.In this regard,the interpretation of the work of Shi et al,devoted to the use of a machine learning-based predictive model for monitoring the results of colorectal polypectomy,is undoubtedly interesting.In our opinion,the prospects for using AI to assess endoscopic screening for CRC look certainly positive,but the road to its widespread use will not be easy.
基金Supported by Foshan City Self-Raised Funds Science and Technology Innovation Project,No.2320001007369.
文摘BACKGROUND Currently,colonoscopy still needs continuous optimization and exploration of novel alternative approaches to enhance the experience of patients during co-lonoscopy.AIM To analyze the efficacy of water infusion combined with defoamers in colono-scopy.METHODS This study included 97 patients undergoing colonoscopy from January 2024 to June 2024.The participants were categorized into two groups,namely,the control group(n=47),who underwent conventional colonoscopy,and the experimental group(n=50),who received colonoscopy using water injection combined with defoamers.A comparative analysis was then conducted on the disease detection rate(colonic polyps,colonorrhagia,colonic ulcers,colonic mucosal lesions,and others),colonoscopy duration,abdominal pain[visual analog scale(VAS)],Boston bowel preparation scale(BBPS),self-rating anxiety scale(SAS),bowel preparation comfort,complications(intestinal perforation,bleeding,nausea and vomiting,abdominal pain,and abdominal distension),and patient satisfaction.RESULTS The experimental group demonstrated a significantly higher total disease detection rate,BBPS scores,and patient satisfaction compared with the control group.Further,the research group exhibited shorter colonoscopy duration,lower VAS and SAS scores and total complication rate,and better patient comfort and satisfaction.CONCLUSION These results indicate that the combination of water injection and defoamers exhibited an overall better therapeutic effect than conventional colonoscopy,mainly reflected in higher disease detection rate,faster examination ef-ficiency,lower abdominal pain,anxiety,and complication incidences,and significantly better bowel preparation,comfort,and patient satisfaction.
文摘BACKGROUND Colorectal cancer has a high incidence and mortality rate,and the effectiveness of routine colonoscopy largely depends on the endoscopist’s expertise.In recent years,computer-aided detection(CADe)systems have been increasingly integrated into colonoscopy to improve detection accuracy.However,while most studies have focused on adenoma detection rate(ADR)as the primary outcome,the more sensitive adenoma miss rate(AMR)has been less frequently analyzed.AIM To evaluate the effectiveness of CADe in colonoscopy and assess the advantages of AMR over ADR.METHODS A comprehensive literature search was conducted in PubMed,Embase,and the Cochrane Central Register of Controlled Trials using predefined search strategies to identify relevant studies published up to August 2,2024.Statistical analyses were performed to compare outcomes between groups,and potential publication bias was assessed using funnel plots.The quality of the included studies was evaluated using the Cochrane Risk of Bias tool and the Grading of Recommendations,Assessment,Development,and Evaluation approach.RESULTS Five studies comprising 1624 patients met the inclusion criteria.AMR was significantly lower in the CADe-assisted group than in the routine colonoscopy group(147/927,15.9%vs 345/960,35.9%;P<0.01).However,CADe did not provide a significant advantage in detecting advanced adenomas or lesions measuring 6-9 mm or≥10 mm.The polyp miss rate(PMR)was also lower in the CADe-assisted group[odds ratio(OR),0.35;95% confidence interval(CI):0.23-0.52;P<0.01].While the overall ADR did not differ significantly between groups,the ADR during the first-pass examination was higher in the CADe-assisted group(OR,1.37;95%CI:1.10-1.69;P=0.004).The level of evidence for the included randomized controlled trials was graded as moderate.CONCLUSION CADe can significantly reduce AMR and PMR while improving ADR during initial detection,demonstrating its potential to enhance colonoscopy performance.These findings highlight the value of CADe in improving the detection of colorectal neoplasms,particularly small and histologically distinct adenomas.
文摘A recent study by Nishizawa et al presented significant findings regarding the advantages of next-generation colonoscopes,specifically the CF-XZ1200 and CFEZ1500 models,in enhancing the adenoma and sessile serrated lesion detection rates.As colorectal cancer remains a leading cause of cancer-related mortality globally,the implications of improved detection rates are substantial.This letter advocated the adoption of advanced colonoscopy technology,emphasizing the robust methodology of the study,including propensity score matching,which enhanced the validity of its conclusions.Notable improvements in image quality,facilitated by innovations such as 4 K resolution and texture enhancement imaging,enable endoscopists to identify even the smallest lesions,ultimately leading to improved patient outcomes.Given the compelling evidence presented,it is imperative for healthcare institutions to prioritize the integration of these advanced scopes into routine practice to enhance screening efficacy and reduce the burden of colorectal cancer.
文摘Screening colonoscopy with adenoma removal is the gold standard strategy to reduce colorectal cancer(CRC)incidence.Nevertheless,it remains an imperfect tool as nearly Twenty-five percent of adenomas can be missed during inspection by experienced endoscopists.Missed lesions are one of the primary reasons for post colonoscopy CRC and are associated with a significant variability in adenoma detection rate(ADR),which is the most important quality indicator for colonoscopy.Increasing ADR unquestionably decreases carcinoma miss rate.Simple measures to improve ADR include among others slower withdrawal time and position change.The introduction of optical imaging innovations has improved mucosal visualization.Moreover,auxiliary devices attached to the colonoscope tip have been introduced,aiming to improve lumen visualization by flattening the folds and revealing lesions hidden in blind spots,thereby increasing ADR.Digital image analysis using artificial intelligence is the latest approach to polyp detection.All of the above approaches have been separately evaluated concerning their effect in ADR;however,it has not been thoroughly investigated whether any benefit exists from their combined use.We aim to review the available data on the efficacy of each technique/technology and whether their combination offers any additional benefit while remaining cost-effective.
文摘BACKGROUND Sessile serrated lesions(SSLs)are premalignant polyps implicated in up to 30%of colorectal cancers.Australia reports high SSL detection rates(SSL-DRs),yet with marked variability(3.1%-24%).This substantial variation raises concerns about missed lesions and post-colonoscopy colorectal cancer.This study investigates determinants associated with SSL-DR variation in regional Australia.AIM To study how patient,clinical,and colonoscopy factors are associated with SSL detection in a regional Australian practice.We aimed to contribute high-detection data to the literature by analyzing the association of SSL detection with various determinants.METHODS This retrospective,cross-sectional analysis examined 1450 colonoscopies performed at Port Macquarie Gastroenterology during 2023.Sigmoidoscopies and repeat procedures were excluded.Multivariate logistic regression analyzed associations between SSL detection and patient demographics,clinical indications,procedural factors,and comorbidities.RESULTS The overall SSL-DR was 30.7%.Multivariate analysis identified several independent predictors:Clinical indication,bowel preparation quality,inflammatory bowel disease status,and serrated polyposis syndrome.The faecal occult blood test positive(FOBT)(+)cohort showed the highest predicted SSL detection probability(39.8%),while clinical symptoms showed the lowest(22.3%).After adjustment,SSL detection odds were 2.3 times greater among FOBT(+)patients than those with clinical symptoms(adjusted odds ratio=2.30,95%confidence interval:1.20-4.40,P=0.004).CONCLUSION SSL-DR as a quality indicator requires contextualization regarding clinical indications,bowel preparation quality,and comorbidities.There was a significantly higher prevalence of SSLs in FOBT(+)patients.Despite comprehensive adjustment,this study cannot fully explain the wide SSL-DR variation in Australia,highlighting the need for standardized detection protocols and further research to ensure optimal cancer prevention outcomes.
文摘This letter addresses the recent systematic review and meta-analysis by Wang et al,which evaluated the role of artificial intelligence-based computer-aided de-tection(CADe)in reducing adenoma and polyp miss rates during colonoscopy.We commend the authors for highlighting adenoma miss rate(AMR)as a more clinically meaningful endpoint than the traditionally used adenoma detection rate.Their findings demonstrate a significant reduction in AMR and polyp miss rate with CADe-assisted colonoscopy,particularly in small and sessile serrated lesions.However,limitations,including limited study numbers,tandem study design of included studies,and heterogeneity of CADe systems,warrant cautious interpretation.We discuss the broader implications of these findings for real-world practice and future research directions.This letter reinforces the importance of AMR as a performance metric and supports the continued integration and eva-luation of artificial intelligence technologies in endoscopic practice to enhance colorectal cancer prevention strategies.
文摘BACKGROUND Elevated plasma homocysteine(Hcy)levels are associated with increased risk of colorectal cancer(CRC),particularly in patients with systemic inflammation or AIM To evaluate serum Hcy levels as a predictive marker of lesion risk and CRC to prioritize patients undergoing diagnostic colonoscopy.METHODS We conducted a prospective cohort study of 301 fecal occult blood test-positive patients at San Agustín University Hospital in Asturias,Spain.Plasma Hcy levels were measured prior to the colonoscopy and classified into three thresholds:≤12,12-15,and>15μmol/L.Colonoscopy and histopathology determined the presence of low-risk,high-risk polyps or adenocarcinoma.Predictive performance of serum Hcy to detect lesions was assessed using logistic regression and diagnostic accuracy measures,including models adjusted for age and sex.RESULTS Median Hcy levels rose progressively with lesion severity,reaching 15.3μmol/L in adenocarcinoma(P<0.001).Higher levels were also observed in men and individuals aged 65 or older.A threshold above 15μmol/L showed good sensitivity(76.6%)and positive predictive value(87.2%)for detecting adenocarcinoma.When combined with age and sex,predictive accuracy improved(area under the receiver operating characteristic curve=0.706).Based on these findings,we propose a three-tier triage system:Green(≤12μmol/L in both sexes,colonoscopy within three months),Yellow(>12-15μmol/L in men,intervention within one month and red(≥15 in either sex or>12μmol/L in women,immediate colonoscopy).CONCLUSION Serum Hcy is a clinically useful biomarker for identifying high-risk colorectal lesions and cancer,particularly when interpreted in combination with age and sex.This composite model improves predictive accuracy and enables a structured three-tiered triage system that supports faster colonoscopy scheduling for at-risk groups.The traffic light approach offers a low cost,scalable strategy to reduce delays and optimize resource use in CRC screening,especially in public health systems with limited endoscopic capacity.
