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Colorectal polyps are structural abnormalities of the gastrointestinal tract that can potentially become cancerous in some cases. The study introduces a novel framework for colorectal polyp segmentation named the Multi-Scale and Multi-Path Cascaded Convolution Network (MMCC-Net), aimed at addressing the limitations of existing models, such as inadequate spatial dependence representation and the absence of multi-level feature integration during the decoding stage by integrating multi-scale and multi-path cascaded convolutional techniques and enhances feature aggregation through dual attention modules, skip connections, and a feature enhancer. MMCC-Net achieves superior performance in identifying polyp areas at the pixel level. The Proposed MMCC-Net was tested across six public datasets and compared against eight SOTA models to demonstrate its efficiency in polyp segmentation. The MMCC-Net's performance shows Dice scores with confidence interval ranging between 77.43 ± 0.12, (77.08, 77.56) and 94.45 ± 0.12, (94.19, 94.71) and Mean Intersection over Union (MIoU) scores with confidence interval ranging from 72.71 ± 0.19, (72.20, 73.00) to 90.16 ± 0.16, (89.69, 90.53) on the six databases. These results highlight the model's potential as a powerful tool for accurate and efficient polyp segmentation, contributing to early detection and prevention strategies in colorectal cancer. [ABSTRACT FROM AUTHOR]

Colonoscopy is widely recognized as the most effective method for the detection of colon polyps, which is crucial for early screening of colorectal cancer. Polyp identification and segmentation in colonoscopy images require specialized medical knowledge and are often labor-intensive and expensive. Deep learning provides an intelligent and efficient approach for polyp segmentation. However, the variability in polyp size and the heterogeneity of polyp boundaries and interiors pose challenges for accurate segmentation. Currently, Transformer-based methods have become a mainstream trend for polyp segmentation. However, these methods tend to overlook local details due to the inherent characteristics of Transformer, leading to inferior results. Moreover, the computational burden brought by self-attention mechanisms hinders the practical application of these models. To address these issues, we propose a novel CNN-Transformer hybrid model for polyp segmentation (CTHP). CTHP combines the strengths of CNN, which excels at modeling local information, and Transformer, which excels at modeling global semantics, to enhance segmentation accuracy. We transform the self-attention computation over the entire feature map into the width and height directions, significantly improving computational efficiency. Additionally, we design a new information propagation module and introduce additional positional bias coefficients during the attention computation process, which reduces the dispersal of information introduced by deep and mixed feature fusion in the Transformer. Extensive experimental results demonstrate that our proposed model achieves state-of-the-art performance on multiple benchmark datasets for polyp segmentation. Furthermore, cross-domain generalization experiments show that our model exhibits excellent generalization performance. [ABSTRACT FROM AUTHOR]

Background: Artificial intelligence (AI) has emerged as a promising tool for detecting and characterizing colorectal polyps during colonoscopy, offering potential enhancements in traditional colonoscopy procedures to improve outcomes in patients with inadequate bowel preparation. Aims: This study aimed to assess the impact of an AI tool on computer-aided detection (CADe) assistance during colonoscopy in this population. Methods: This case–control study utilized propensity score matching (PSM) for age, sex, race, and colonoscopy indication to analyze a database of patients who underwent colonoscopy at a single tertiary referral center between 2017 and 2023. Patients were excluded if the procedure was incomplete or aborted owing to poor preparation. The patients were categorized based on the use of AI during colonoscopy. Data on patient demographics and colonoscopy performance metrics were collected. Univariate and multivariate logistic regression models were used to compare the groups. Results: After PSM patients with adequately prepped colonoscopies (n = 1466), the likelihood of detecting hyperplastic polyps (OR = 2.0, 95%CI 1.7–2.5, p < 0.001), adenomas (OR = 1.47, 95%CI 1.19–1.81, p < 0.001), and sessile serrated polyps (OR = 1.90, 95%CI 1.20–3.03, p = 0.007) significantly increased with the inclusion of CADe. In inadequately prepped patients (n = 160), CADe exhibited a more pronounced impact on the polyp detection rate (OR = 4.34, 95%CI 1.6–6.16, p = 0.049) and adenomas (OR = 2.9, 95%CI 2.20–8.57, p < 0.001), with a marginal increase in withdrawal and procedure times. Conclusion: This study highlights the significant improvement in detecting diminutive polyps (< 5 mm) and sessile polyps using CADe, although notably, this benefit was only seen in patients with adequate bowel preparation. In conclusion, the integration of AI in colonoscopy, driven by artificial intelligence, promises to significantly enhance lesion detection and diagnosis, revolutionize the procedure's effectiveness, and improve patient outcomes. [ABSTRACT FROM AUTHOR]

Gastrointestinal stromal tumors (GIST) are rare mesenchymal neoplasms of the gastrointestinal tract, most commonly occurring in the stomach. The concurrence of GIST with another malignancy is an uncommon phenomenon, with few works of literature reported. We report a rare synchronous giant gastric GIST with a malignant colonic polyp. A 70-year-old woman presented with an upper abdominal mass. There were no changes in bowel habits. CEA level was normal. Contrasted computed tomography of the abdomen revealed a huge gastric mass with incidental findings of a suspicious mass in the sigmoid colon. Esophagogastroduodenoscopy revealed extrinsic compression with normal overlying mucosa, suggesting a submucosal mass. Colonoscopy revealed a large polypoidal mass in the sigmoid colon, and initial biopsy revealed tubulovillous adenoma with highgrade dysplasia. Wide local excision of the gastric tumor and table snare polypectomy were performed. The base of the polyp was also taken for biopsy. The patient had an uneventful recovery and was discharged home well. Postoperative histopathological examination showed gastric GIST and adenocarcinoma of the sigmoid polyp. The polyp base showed no malignancy. The patient was started on imatinib 400 mg once a day. GIST and colon malignant polyps are two distinct types of neoplasms that can occur synchronously. GIST tumours arise from the interstitial cells of Cajal and are characterized by mutations in KIT/PDGFRA genes. Conversely, malignant polyps are epithelial tumours that arise from the colonic mucosa classically because of alterations in the APC tumour suppressor gene, resulting in overactivation of the Wnt/ß-catenin signaling pathway. Synchronous GISTs and malignant colon polyps are rare, and their molecular basis is distinct. However, it is crucial to consider the possibility of genetic predisposition in patients with such tumors. In a case of GIST, the surgeon should recognize the possibility of another tumor with a different histological origin. High clinical analysis needed during laparotomy for GIST to detect a synchronous tumor. Due to its rare occurrence and limited literature further GIST with another synchronous tumor must be conducted to help surgeons optimize patient management. [ABSTRACT FROM AUTHOR]

Background and Aim: Few studies have evaluated the adenoma detection rate (ADR) of colonoscopy with texture and color enhancement imaging (TXI), a novel image‐enhancing technology. This study compares the detection of colorectal polyps using TXI to that using white light imaging (WLI). Methods: This single‐center retrospective study used propensity‐matched scoring based on the patients' baseline characteristics (age, sex, indication, bowel preparation, endoscopist, colonoscope type, and withdrawal time) to compare the results of patients who underwent chromoendoscopy using WLI or TXI at the Toyoshima Endoscopy Clinic. The differences in polyp detection rates and the mean number of detected polyps per colonoscopy were determined between the TXI and WLI groups. Results: After propensity score matching, 1970 patients were enrolled into each imaging modality group. The mean patient age was 57.2 ± 12.5 years, and 44.5% of the cohort were men. The ADR was higher in the TXI group than in the WLI group (55.0% vs 49.4%, odds ratio: 1.25). High‐risk ADR were more common in the TXI group than in the WLI group (17.6% vs 12.8%; OR: 1.45). The mean number of adenomas per colonoscopy (APC) was higher in the TXI group than in the WLI group (1.187 vs 0.943, OR: 1.12). APC with a flat morphology (1.093 vs 0.848, OR: 1.14) and APC of <6 mm (0.992 vs 0.757, OR: 1.16) were higher in the TXI group than in the WLI group. Conclusion: Compared to WLI, TXI improved the ADR in patients who underwent chromoendoscopy based on actual clinical data. [ABSTRACT FROM AUTHOR]

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

Aims Materials and methods Results Conclusions To create and validate a weakly supervised artificial intelligence (AI) model for detection of abnormal colorectal histology, including dysplasia and cancer, and prioritise biopsies according to clinical significance (severity of diagnosis).Triagnexia Colorectal, a weakly supervised deep learning model, was developed for the classification of colorectal samples from haematoxylin and eosin (H&E)‐stained whole slide images. The model was trained on 24 983 digitised images and assessed by multiple pathologists in a simulated digital pathology environment. The AI application was implemented as part of a point and click graphical user interface to streamline decision‐making. Pathologists assessed the accuracy of the AI tool, its value, ease of use and integration into the digital pathology workflow.Validation of the model was conducted on two cohorts: the first, on 100 single‐slide cases, achieved micro‐average model specificity of 0.984, micro‐average model sensitivity of 0.949 and micro‐average model F1 score of 0.949 across all classes. A secondary multi‐institutional validation cohort, of 101 single‐slide cases, achieved micro‐average model specificity of 0.978, micro‐average model sensitivity of 0.931 and micro‐average model F1 score of 0.931 across all classes. Pathologists reflected their positive impressions on the overall accuracy of the AI in detecting colorectal pathology abnormalities.We have developed a high‐performing colorectal biopsy AI triage model that can be integrated into a routine digital pathology workflow to assist pathologists in prioritising cases and identifying cases with dysplasia/cancer versus non‐neoplastic biopsies. [ABSTRACT FROM AUTHOR]

Background: The Paris classification categorises colorectal polyp morphology. Interobserver agreement for Paris classification has been assessed at optical colonoscopy (OC) but not CT colonography (CTC). We aimed to determine the following: (1) interobserver agreement for the Paris classification using CTC between radiologists; (2) if radiologist experience influenced classification, gross polyp morphology, or polyp size; and (3) the extent to which radiologist classifications agreed with (a) colonoscopy and (b) a combined reference standard. Methods: Following ethical approval for this non-randomised prospective cohort study, seven radiologists from three hospitals classified 52 colonic polyps using the Paris system. We calculated interobserver agreement using Fleiss kappa and mean pairwise agreement (MPA). Absolute agreement was calculated between radiologists; between CTC and OC; and between CTC and a combined reference standard using all available imaging, colonoscopic, and histopathological data. Results: Overall interobserver agreement between the seven readers was fair (Fleiss kappa 0.33; 95% CI 0.30–0.37; MPA 49.7%). Readers with < 1500 CTC experience had higher interobserver agreement (0.42 (95% CI 0.35–0.48) vs. 0.33 (95% CI 0.25–0.42)) and MPA (69.2% vs 50.6%) than readers with ≥ 1500 experience. There was substantial overall agreement for flat vs protuberant polyps (0.62 (95% CI 0.56–0.68)) with a MPA of 87.9%. Agreement between CTC and OC classifications was only 44%, and CTC agreement with the combined reference standard was 56%. Conclusion: Radiologist agreement when using the Paris classification at CT colonography is low, and radiologist classification agrees poorly with colonoscopy. Using the full Paris classification in routine CTC reporting is of questionable value. Clinical relevance statement: Interobserver agreement for radiologists using the Paris classification to categorise colorectal polyp morphology is only fair; routine use of the full Paris classification at CT colonography is questionable. Key Points: • Overall interobserver agreement for the Paris classification at CT colonography (CTC) was only fair, and lower than for colonoscopy. • Agreement was higher for radiologists with < 1500 CTC experience and for larger polyps. There was substantial agreement when classifying polyps as protuberant vs flat. • Agreement between CTC and colonoscopic polyp classification was low (44%). [ABSTRACT FROM AUTHOR]

In various countries worldwide, the incidence of colon cancer-related deaths has been on the rise in recent years. Early detection of symptoms and identification of intestinal polyps are crucial for improving the cure rate of colon cancer patients. Automated computer-aided diagnosis (CAD) has emerged as a solution to the low efficiency of traditional methods relying on manual diagnosis by physicians. Deep learning is the latest direction of CAD development and has shown promise for colonoscopic polyp segmentation. In this paper, we present a multi-level encoder-decoder architecture for polyp segmentation based on the Transformer architecture, termed NA-SegFormer. To improve the performance of existing Transformer-based segmentation algorithms for edge segmentation on colon polyps, we propose a patch merging module with a neighbor attention mechanism based on overlap patch merging. Since colon tract polyps vary greatly in size and different datasets have different sample sizes, we used a unified focal loss to solve the problem of category imbalance in colon tract polyp data. To assess the effectiveness of our proposed method, we utilized video capsule endoscopy and typical colonoscopy polyp datasets, as well as a dataset containing surgical equipment. On the datasets Kvasir-SEG, Kvasir-Instrument and KvasirCapsule-SEG, the Dice score of our proposed model reached 94.30%, 94.59% and 82.73%, with an accuracy of 98.26%, 99.02% and 81.84% respectively. The proposed method achieved inference speed with an Frame-per-second (FPS) of 125.01. The results demonstrated that our suggested model effectively segmented polyps better than several well-known and latest models. In addition, the proposed method has advantages in trade-off between inference speed and accuracy, and it will be of great significance to real-time colonoscopic polyp segmentation. The code is available at https://github.com/promisedong/NAFormer. [ABSTRACT FROM AUTHOR]

Background: Previous research has demonstrated an association between gut microbiota and immune status with the development of several diseases. However, whether these factors contribute to polyps remains unclear. This study aims to use Mendelian randomization (MR) to investigate the causal relationship between gut microbiota and 4 types of polyps (nasal, gallbladder, colon, and gastric polyps), as well as to analyze the mediating role of immune traits. Methods: This study utilized large-scale GWAS meta-analyses of gut microbiota (MiBioGen Consortium), 731 immune traits, and 4 types of polyps (one from the FinnGen Consortium and three from the NBDC Human Database). Univariate MR with the inverse variance weighted (IVW) estimation method was employed as the primary analytical approach. A two-step MR analysis was performed to identify potential mediating immune traits. Additionally, multivariable MR approach based on Bayesian model averaging (MR-BMA) was employed to further prioritize gut microbiota and immune traits associated with polyp development. Results: Based on IVW method in univariate MR analysis, we identified 39 gut microbial taxa and 135 immune traits significantly causally associated with at least one type of polyp. For nasal polyps, 13 microbial taxa and 61 immune traits were causally associated. After false discovery rate (FDR) correction, CD3 on Central Memory CD8+ T cells and CD3 on CD4 regulatory T cells remained significant. MR-BMA identified 4 gut microbial taxa and 4 immune traits as high priority. For gallbladder polyps, 9 microbial taxa and 30 immune traits were causally associated. MR-BMA identified 8 microbial taxa and 6 immune traits as higher importance. For colon polyps, 6 microbial taxa and 21 immune traits were causally associated. MR-BMA identified 4 microbial taxa and 3 immune traits as higher importance. For gastric polyps, 12 microbial taxa and 33 immune traits were causally associated. Actinobacteria remained significant after FDR correction, and MR-BMA identified 7 gut microbial taxa and 6 immune traits as high priority. We identified 16 causal pathways with mediator directions consistent with the direction of gut microbiome-polyp association. Of these, 6 pathways were associated with the mechanism of nasal polyps, 1 with gallbladder polyps, 2 with colon polyps, and 7 with gastric polyps. Conclusions: Our findings shed light on the causal relationships between gut microbiota, immune traits, and polyp development, underscoring the crucial roles of gut microbiota and immune status in polypogenesis. Furthermore, these findings suggest potential applications in polyp prevention, early screening, and the development of effective strategies to reduce polyp risk. [ABSTRACT FROM AUTHOR]

One of the most severe cancers worldwide is Colorectal Cancer (CRC), which has the third-highest incidence of cancer cases and the second-highest rate of cancer mortality. Early diagnosis and treatment are receiving much attention globally due to the increasing incidence and death rates. Colonoscopy is acknowledged as the gold standard for screening CRC. Despite early screening, doctors miss approximately 25% of polyps during a colonoscopy examination because the diagnosis varies from expert to expert. After a few years, this missing polyp may develop into cancer. This study is focused on addressing such diagnostic challenges, aiming to minimize the risk of misdiagnosis and enhance the overall accuracy of diagnostic procedures. Thus, we propose an efficient deep learning method, DeepCPD, combining transformer architecture and Linear Multihead Self-Attention (LMSA) mechanism with data augmentation to classify colonoscopy images into two categories: polyp versus non-polyp and hyperplastic versus adenoma based on the dataset. The experiments are conducted on four benchmark datasets: PolypsSet, CP-CHILD-A, CP-CHILD-B, and Kvasir V2. The proposed model demonstrated superior performance compared to the existing state-of-the-art methods with an accuracy above 98.05%, precision above 97.71%, and recall above 98.10%. Notably, the model exhibited a training time improvement of over 1.2x across all datasets. The strong performance of the recall metric shows the ability of DeepCPD to detect polyps by minimizing the false negative rate. These results indicate that this model can be used effectively to create a diagnostic tool with computer assistance that can be highly helpful to clinicians during the diagnosing process. [ABSTRACT FROM AUTHOR]

Background: Data on the prevalence of colonic polyps and adenomas in the Egyptian population are scarce. This study aimed to determine the prevalence of colonic polyps among Egyptian patients aged 50 years and older who underwent colonoscopy for a variety of reasons. Patients and methods: This study is a retrospective one that was conducted with the use of an endoscopic reporting database of patients presenting at Cairo University Hospital. The considered variables were age, gender, clinical presentation, polyps' characteristics, and diagnosis. Polyps were retrieved and sent for histopathological examination. Results: Among 4861 patients whose clinical presentation necessitated colonoscopic examination between 2012 and 2019, 850 consecutive patients aged 50 years and older were enrolled in this study. The median age was 65 ± 9 SD. The male gender was slightly predominant (50.8%). The polyp detection rate was 23.1%, while the adenoma detection rate was 14.7%, and they were mostly encountered on the left side of the colon. By regression analysis, the most important predictors of adenoma were age ≥ 65 years, diabetes, and the presence of a polyp in the right colon. Diabetics and older people (≥ 65 years) had two times increased risk for adenoma, while patients with polyps in the right side of the colon had 30 times increased risk of adenoma. Conclusion: PDR and ADR among the Egyptian population are matched to the target ADR set by the ASGE. We recommend ADR and PDR as key quality indicators of colonoscopy quality. [ABSTRACT FROM AUTHOR]

Polyp segmentation in colorectal images is the most effective and necessary tool for the early detection of colorectal cancer, and deep learning has become popular for efficiently segmenting polyps. The complex morphological characteristics of polyps, such as the unclear boundary between polyps and mucosa, and the lack of training data could cause great difficulties in network fitting. Transformer-based semantic segmentation networks have achieved more promising performance than traditional convolutional neural networks. However, the dispersion of self-attention and the less accurate local feature recognition limit the further development and applications of Transformer-based networks. This paper proposes a novel Stepwise Attention Emphasis module to refocus self-attention for Transformer-based polyp segmentation in colorectal images, where a reverse fuse module is used to better fuse different levels of features. Furthermore, a new decoder network, called the densely smooth fusion decoder, is also proposed to enhance local details and provide more useful information from deep features to shallow features. Experimental comparisons are conducted, and result analysis shows that the proposed network achieves promising performance in both learning and generalization ability on public datasets. [ABSTRACT FROM AUTHOR]

Background and Aims: The resect‐and‐discard strategy for colorectal polyps based on accurate optical diagnosis remains challenges. Our aim was to investigate the feasibility of hyperspectral imaging (HSI) for identifying colorectal polyp properties and diagnosis of colorectal cancer in fresh tissues during colonoscopy. Methods: 144,900 two dimensional images generated from 161 hyperspectral images of colorectal polyp tissues were prospectively obtained from patients undergoing colonoscopy. A residual neural network model was trained with transfer learning to automatically differentiate colorectal polyps, validated by histopathologic diagnosis. The diagnostic performances of the HSI‐AI model and endoscopists were calculated respectively, and the auxiliary efficiency of the model was evaluated after a 2‐week interval. Results: Quantitative HSI revealed histological differences in colorectal polyps. The HSI‐AI model showed considerable efficacy in differentiating nonneoplastic polyps, non‐advanced adenomas, and advanced neoplasia in vitro, with sensitivities of 96.0%, 94.0%, and 99.0% and specificities of 99.0%, 99.0%, and 96.5%, respectively. With the assistance of the model, the median negative predictive value of neoplastic polyps increased from 50.0% to 88.2% (p = 0.013) in novices. Conclusion: This study demonstrated the feasibility of using HSI as a diagnostic tool to differentiate neoplastic colorectal polyps in vitro and the potential of AI‐assisted diagnosis synchronized with colonoscopy. The tool may improve the diagnostic performance of novices and facilitate the application of resect‐and‐discard strategy to decrease the cost. [ABSTRACT FROM AUTHOR]

Background: Submucosal pseudoinvasion and squamous metaplasia (SM) are incidental and special morphological findings in colorectal adenomas, and both can mimic invasive carcinoma. The coexistence of these two findings further increases the risk of misdiagnosis, posing a great diagnostic challenge to pathologists. From 1979 to 2022, only 8 cases have been reported, which was extremely rare. In this report, we presented a case of sigmoid colon adenoma accompanied by pseudoinvasion and SM. Additionally, relevant literature was analyzed to summarize the clinical and pathological characteristics. Case presentation: A 51-year-old Chinese male patient presented with fresh blood after defecation. Electronic colonoscopy revealed multiple polyps, which were removed using a snare and subjected to high-frequency electrocoagulation resection. The largest polyp, located in the sigmoid colon, was a thick pedunculated and lobulated polyp with a maximum diameter of 2.8 cm. The surface of the polyp showed slight ruggedness and redness, and it was sent for pathological examination. Grossly, the polyp had a lobulated and slightly rough surface. Microscopically, it showed a tubulovillous adenoma with focal high-grade dysplasia and mucosal muscle hyperplasia. Glandular elements were observed in the submucosal layer, forming a well-defined lobular structure. Some of the glands displayed cystic change, and focal SM could be seen within the adenoma. SM could manifest as discrete solid cell nests of varying sizes or cribriform-morular-like structures. Immunohistochemical staining showed that SM cells were diffusely positive for cytokeratin 5/6 (CK5/6); p40, p63, and cytokeratin 20 (CK20) were negative; while caudal type homeobox 2 (CDX2) was weakly positive. β-catenin showed abnormal nuclear expression, and an extremely low Ki67 proliferation index was observed. Conclusions: Coexistence of SM and pseudoinvasion in colorectal adenomas is highly rare. It is more commonly observed in males and tends to occur in the sigmoid colon. It primarily manifests in tubulovillous adenoma and tubular adenoma, with a majority of cases exhibiting a pedicle. Histologically, it is similar to invasive lesions. The cystic dilation of the submucosal glands, hemosiderin deposition, and the presence of a lamina propria around the submucosal glands without adjacent desmoplastic reaction, suggest pseudoinvasion rather than cancer. The bland cytological morphology and Immunohistochemical markers play a crucial role in distinguishing SM from true invasive lesions. [ABSTRACT FROM AUTHOR]

Colon polyps represent a common gastrointestinal form. In order to effectively treat and prevent complications arising from colon polyps, colon polypectomy has become a commonly used therapeutic approach. Accurately segmenting polyps from colonoscopy images can provide valuable information for early diagnosis and treatment. Due to challenges posed by illumination and contrast variations, noise and artifacts, as well as variations in polyp size and blurred boundaries in polyp images, the robustness of segmentation algorithms is a significant concern. To address these issues, this paper proposes a Double Loss Guided Residual Attention and Feature Enhancement Network (DLGRAFE-Net) for polyp segmentation. Firstly, a newly designed Semantic and Spatial Information Aggregation (SSIA) module is used to extract and fuse edge information from low-level feature graphs and semantic information from high-level feature graphs, generating local loss-guided training for the segmentation network. Secondly, newly designed Deep Supervision Feature Fusion (DSFF) modules are utilized to fuse local loss feature graphs with multi-level features from the encoder, addressing the negative impact of background imbalance caused by varying polyp sizes. Finally, Efficient Feature Extraction (EFE) decoding modules are used to extract spatial information at different scales, establishing longer-distance spatial channel dependencies to enhance the overall network performance. Extensive experiments conducted on the CVC-ClinicDB and Kvasir-SEG datasets demonstrate that the proposed network outperforms all mainstream networks and state-of-the-art networks, exhibiting superior performance and stronger generalization capabilities. [ABSTRACT FROM AUTHOR]

This article provides a summary of various studies related to gastrointestinal cancer. The studies cover a range of topics, including predicting the likelihood of hepatocellular carcinoma recurrence after surgery, using patient-derived organoid culture for personalized chemotherapy, identifying carriers of a rare genetic disorder that predisposes individuals to colorectal cancer, investigating extreme elevation of a tumor marker caused by a specific type of neoplasm, evaluating the value of performing same-day upper and lower endoscopies for colonoscopy referrals, screening strategies for Barrett's esophagus, the effects of butyrate on polyp burden in individuals with familial adenomatous polyposis, the influence of a genetic mutation on the gastric microbiota and inflammation in relation to gastric cancer, and the impact of diverticulosis and polypectomy on the risk of developing metachronous colorectal cancer. These studies provide valuable insights into various aspects of gastrointestinal cancer and can inform future research and treatment approaches. [Extracted from the article]

Incomplete resection rates vary among endoscopists performing cold snare polypectomy. Cold snare endoscopic mucosal resection (CS-EMR) is the technique of cold resection after submucosal injection to reduce incomplete resection. This study aimed to evaluate the efficacy and safety of CS-EMR for small colorectal polyps compared to hot snare endoscopic mucosal resection (HS-EMR). Preplanned sample size required 70 polyps to CS-EMR group or HS-EMR group, respectively. Patients with polyps sized 6–9 mm were randomly allocated to either the CS-EMR or the HS-EMR group. The primary outcome was residual or recurrent adenoma (RAA) rate. A total of 70 and 68 polyps were resected using CS-EMR and HS-EMR, respectively. In the intention-to-treat population, the RAA rate was 0% in the CS-EMR group and 1.5% in the HS-EMR group (risk difference [RD], − 1.47; 95% confidence interval [CI] − 4.34 to 1.39). En bloc resection rate was 98.6% and 98.5% (RD, − 0.04; 95% CI − 4.12 to 4.02); the R0 resection rate was 55.7% and 82.4% (RD, − 27.80; 95% CI − 42.50 to − 13.10). The total procedure time was 172 s (IQR, 158–189) in the CS-EMR group and 186 s (IQR, 147–216) in the HS-EMR group (median difference, − 14; 95% CI − 32 to 2). Delayed bleeding was 2.9% vs 1.5% (RD, 1.37; 95% CI − 3.47 to 6.21) in both groups, respectively. CS-EMR was non-inferior to HS-EMR for the treatment of small colorectal polyps. CS-EMR can be considered one of the standard methods for the removal of colorectal polyps sized 6–9 mm. [ABSTRACT FROM AUTHOR]

Background and Aim: Hot snare excision using electrocautery is widely used for large colorectal polyps (>10 mm); however, adverse events occur due to deep thermal injury. Colorectal polyps measuring 10–14 mm rarely include invasive cancer. Therefore, less invasive therapeutic options for this size category are demanding. We have developed hot snare polypectomy with low‐power pure‐cut current (LPPC HSP), which is expected to contribute to less deep thermal damage and lower risk of adverse events. This study aimed to evaluate the efficacy and safety of LPPC HSP for 10–14 mm colorectal polyps, compared with conventional endoscopic mucosal resection (EMR). Methods: In this multicenter, retrospective, observational study, clinical outcomes of EMR and LPPC HSP for 10–14 mm nonpedunculated colorectal polyps between January 2021 and March 2022 were compared using propensity score matching. Results: We identified 203 EMR and 208 LPPC HSP cases. After propensity score matching, the baseline characteristics between the groups were comparable, with 120 pairs. The en bloc and R0 resection rates were not significantly different between EMR and LPPC HSP groups (95.8% vs 97.5%, P = 0.72; 90.0% vs 91.7%, P = 0.82). The rates of delayed bleeding and perforation did not differ between the groups. Conclusions: Compared with conventional EMR, LPPC HSP showed a similar resection ability without an increase in adverse events. These results suggest that LPPC HSP is a safe and effective treatment for 10–14 mm nonpedunculated colorectal polyps. [ABSTRACT FROM AUTHOR]

Objective: To analyze the relationship between multiple relapses and clinicopathological features in patients with colorectal polyps after resection. Methods: A retrospective study was conducted. 300 patients who underwent colorectal polypectomy at Shanxi Provincial Cancer Hospital from January 2018 to December 2022 were enrolled in this study. They were grouped based on 1-year postoperative follow-up outcomes. Among the patients with relapses, those with 3 or more recurrence polyps were included in the multiple relapses group (25 cases), while those with fewer than 3 recurrence polyps were included in the control group (142 cases). Baseline data and initial pathological features of the two groups of patients were comparatively analyzed. The correlation between multiple relapses and pathological features in patients with colorectal polyps after resection was discussed. Results: There were statistically significant differences in the diameter, number, and pathological type of polyps between the two groups (P<0.05). There was no statistically significant difference between the two groups in terms of polyp location, polyp color, polyp morphology, and resection method (P>0.05). Logistic regression analysis results showed that polyps in large diameter, increased number of polyps, and adenomatous polyps were independent risk factors for multiple relapses in patients with colorectal polyps after resection (P<0.05). Pearson analysis results showed that multiple relapses in patients with colorectal polyps after resection were positively correlated with polyp diameter, number of polyps, and adenomatous polyps (P<0.05). Conclusion: There is a significant correlation between multiple relapses and polyp diameter, number of polyps, adenomatous polyps in patients with colorectal polyps after resection. [ABSTRACT FROM AUTHOR]

This document is a compilation of various studies and articles related to colonoscopy procedures and their outcomes. The references cover topics such as quality indicators for colonoscopy, the detection rates of adenomas and neoplasia, and the management and surveillance of colorectal polyps. The studies also discuss factors that can affect the quality of colonoscopy procedures, such as withdrawal time and technique. The document provides a comprehensive list of resources for library patrons conducting research on colonoscopy and related topics. [Extracted from the article]

Background: Polyps are the predominant precursors of colorectal cancer. In the past three decades, the incidence and mortality rates of colorectal cancer have been increasing in adults younger than 50 years. Aims: The aim of this clinical audit was to evaluate the prevalence, characteristics and clinical associations of polyps in adults aged 18–49 years presenting to an established private gastroenterology clinic in the Toowoomba Darling Downs region. Methods: The audit included data from 353 patient records held by the Toowoomba Gastroenterology Clinic. Data extracted from patient medical records through the Medical Director program software contained structured endoscopy/colonoscopy and histology reports of excised lesions of patients presenting to the clinic. The extract involved identifying all patients aged 18–49 years in the database from January 2019 to March 2022. Patients were screened based on audit inclusion and exclusion criteria. Patients were risk stratified for recommended surveillance intervals as per Australian Clinical Guidelines. Results: Of the sample population, 33.4% were identified with polyps and 22.4% were identified with neoplastic polyps (NPs). A total of 6.7% of 18‐ to 29‐year‐old patients were identified with intermediate risk for colorectal cancer (CRC) screening, and 19.8% and 19.3% of 30‐ to 39‐year‐old and 40‐ to 49‐year‐old patients identified with intermediate or high risk for CRC screening respectively. Increased age, greater size of polyps and surveillance of previous polyps were associated with increased NP prevalence. Conclusions: Data from this audit supported the temporal trend of increasing prevalence of polyps in adults younger than 50 years. Patient cohorts aged 30–39 and 40–49 years may benefit from earlier first colonoscopies. Findings could be the impetus for future research in young adults presenting for colonoscopy. [ABSTRACT FROM AUTHOR]

Background: Sedation increases colonoscopy risks and prolongs recovery time. We examined whether virtual reality (VR) can substitute for sedation. The primary outcome was the overall satisfaction of patients who underwent colonoscopy with VR headset compared with patients who underwent standard sedation. Pain during the procedure, polyp detection rate (PDR), colonoscopy duration, post-colonoscopy adverse events, post-colonoscopy recovery, time-to-return to daily functions, and turnaround time at the endoscopy unit were secondary outcomes. Methods: The study was approved by Sheba Medical Center's ethics committee IRB number 21-8177-SMC. Sixty patients were sequentially enrolled in a 1:1 ratio to either standard sedated colonoscopy or VR-unsedated procedure, and all patients signed a written informed consent. 28/30 patients successfully completed the colonoscopy using VR headset. Overall satisfaction score was comparable between the groups. Results: There was no difference between VR and controls in colonoscopy duration, or PDR. VR patients had numerically lower rate of post-colonoscopy adverse events than controls. The proportion of VR patients who reported resuming daily activities on the day of the procedure was significantly higher than in the control group. The VR group patients spent significantly less time in the hospital compared to the control group. Conclusions: VR technology can provide adequate substitution for sedation for most patients undergoing colonoscopy and offers comparable patient satisfaction and faster return to daily activities. [ABSTRACT FROM AUTHOR]

To investigate the role of body mass index (BMI), serum lipid profile molecules and their derivative indexes in colorectal polyps. A total of 352 individuals who underwent colonoscopy at our center were included in this retrospective analysis. Of these, 247 patients without evident abnormalities (control group), while 105 patients diagnosed with colorectal polyps (patient group). Serum lipid profile molecules and their derivative indexes were then compared between the two groups. The patient group exhibited significantly higher levels of total cholesterol (TC) and apolipoprotein B (ApoB) compared to the control group (p<0.05). In males, the patient group displayed elevated levels of ApoB and ApoB/ApoA1 ratio compared to the control group (p<0.05). Additionally, the triglycerides (TG) and TG/high-density lipoprotein-cholesterol (HDL-C) ratios were significantly higher in the multiple polyps group than in the single polyp group (p<0.05). Furthermore, the HDL-C and HDL-C/ApoA1 ratio levels were higher in the adenomatous polyp group when compared to the non-adenomatous polyp group (p<0.05). Multiple logistic regression analysis indicated that total cholesterol (TC), TG, low-density lipoprotein-cholesterol (LDL-C), TC/HDL-C ratio, TG/HDL-C ratio and LDL-C/HDL-C ratio were risk factors for the occurrence of colorectal polyps (p<0.05). ROC curve analyses revealed that TC, ApoB, and ApoB/ApoA1 ratio were associated with colorectal polyps. No significant difference in BMI between the two groups (p>0.05). The incidence and progression of colorectal polyps are linked to serum lipid molecules and their derivative indexes. Dyslipidemia may increase the risk of colorectal polyps, potentially leading to colorectal cancer (CRC). [ABSTRACT FROM AUTHOR]

Background. The large number of lesions detected via high-definition (HD) imaging during colonoscopy calls for the reliable real-time histological characterization of polyps, especially diminutive and small ones, to permit tailored management based on the neoplastic risk, such as a "resect-and-discard" or a "diagnose-and-leave" strategy for low-risk adenomas and hyperplastic polyps (HPs). The Kudo classification of glandular pit pattern is currently used for predicting polyp histology. Aim. The aim in this study was to assess whether Kudo's glandular pit pattern, assessed via HD digital chromoendoscopy (i-Scan) without magnification and optical enhancement, reliably predicts polyp histology and differentiates neoplastic lesions (NLs) from non-neoplastic lesions (non-NLs) during routine colonoscopy. Methods. Consecutive colorectal lesions recorded in a database over 12 months, with Kudo's glandular pit pattern classification, were retrospectively compared with histology. The diagnostic accuracy and negative predictive value (NPV) for adenomatous histology of Kudo's pit patterns were assessed separately for diminutive (≤5 mm) and small (6–9 mm) polyps, accordingly to the American Society for Gastrointestinal Endoscopy (ASGE) Preservation and Incorporation of Valuable Endoscopic Innovations (PIVI), and in large (≥10 mm) lesions. Results. A total of 2230 lesions were recorded: 898 diminutive, 704 small, and 628 large. Kudo's type II pit pattern was prevalent in diminutive polyps and recognized mostly in HPs (83.27%); it was also found in 38.8% of adenomas. In the right colon, Kudo's type II pit pattern was prevalent in adenomas (70.04% vs. 20.74% in HPs); among the serrated lesions, it was evenly distributed between HPs and adenomas. Kudo's type IIIL/IIIs/IV pit pattern was prevalent in NLs (61% vs. 8.37% of non-NLs) in diminutive polyps, evenly distributed between non-NLs and NLs in small polyps, and found only in NLs in large polyps. Kudo's type Vi/Vn pit pattern correctly identified all but one adenocarcinoma. The NPV for adenomatous histology did not reach the recommended 90% PIVI threshold for differentiation between NLs and non-NLs in diminutive polyps showing Kudo's type II pit pattern and in small polyps showing type IIIL/IIIs/IV pit pattern. Conclusions. Kudo's pit pattern classification carried out with digital chromoendoscopy (i-Scan) during routine colonoscopy does not allow the reliable differentiation between non-NLs and NLs in diminutive and small polyps, so a "diagnose-and-leave" strategy for diminutive polyps may leave undetected adenomas, while a "resect-and-discard" strategy could miss lesions requiring closer follow-up. [ABSTRACT FROM AUTHOR]

The implementation of screening colonoscopy with polyp removal has significantly decreased mortality rates associated with colorectal cancer (CRC), although it remains a major cause of cancer-related deaths globally. CRC typically originates from adenomatous polyps, and increased removal of these growths has led to reduced CRC incidence and mortality. Endoscopic polypectomy techniques, including hot and cold snare polypectomy, play a pivotal role in this process. While both methods are effective for small polyps (10 mm), particularly those with advanced features, pose increased cancer risks and often require meticulous assessment and advanced endoscopic techniques, including endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), for resection.This chapter also provides a practical overview of endoscopic techniques for managing colonic obstructions and pericolonic fluid collections, detailing their indications, advantages, disadvantages, and complications. The goal is to improve understanding and application in clinical practice. Additionally, we provide a summary of endoscopic closure techniques that have revolutionized the management of perforations and fistulas, offering safe and effective alternatives to surgery.

Colon polyps have become a focal point of research due to their heightened potential to develop into appendiceal cancer, which has the highest mortality rate globally. Although numerous colon polyp segmentation methods have been developed using public polyp datasets, they tend to underperform on private datasets due to inconsistencies in data distribution and the difficulty of fine-tuning without annotations. In this paper, we propose a Self-Adaptive Teacher-Student (SATS) framework to segment colon polyps from unannotated private data by utilizing multiple publicly annotated datasets. The SATS trains multiple teacher networks on public datasets and then generates pseudo-labels on private data to assist in training a student network. To enhance the reliability of the pseudo-labels from the teacher networks, the SATS includes a newly proposed Uncertainty and Distance Fusion (UDFusion) strategy. UDFusion dynamically adjusts the pseudo-label weights based on a novel reconstruction similarity measure, innovatively bridging the gap between private and public data distributions. To ensure accurate identification and segmentation of colon polyps, the SATS also incorporates a Granular Attention Network (GANet) architecture for both teacher and student networks. GANet first identifies polyps roughly from a global perspective by encoding long-range anatomical dependencies and then refines this identification to remove false-positive areas through multi-scale background-foreground attention. The SATS framework was validated using three public datasets and one private dataset, achieving 76.30% on IoU, 86.00% on Recall, and 7.01 pixels on HD. These results outperform the existing five methods, indicating the effectiveness of this approach for colon polyp segmentation. [ABSTRACT FROM AUTHOR]

This study aims to analyze the risk factors associated with delayed postoperative bleeding (DPPB) following colorectal polyp surgery, develop a dynamic nomogram and evaluate the model efficacy, provide a reference for clinicians to identify the patients at high risk of DPPB. Retrospective study was done on patients who underwent endoscopic colorectal polypectomy at the First Hospital of Lanzhou University from January 2020 to March 2023. Differences between the group with and without DPPB were compared, and independent risk factors for DPPB occurrence were identified through univariate analysis and combination LASSO and logistic regression. A dynamic nomogram was constructed based on multiple logistic regression to predict DPPB following colorectal polyp surgery. Model evaluation included receiver operating characteristic (ROC), Calibration curve, Decision curve analysis (DCA). DPPB occurred in 38 of the 1544 patients included. multivariate analysis showed that direct oral anticoagulants (DOACs), polyp location in the right hemi colon, polyp diameter, drink, and prophylactic hemoclips were the independent risk factors for DPPB and dynamic nomogram were established. Model validation indicated area under the ROC curve values of 0.936, 0.796, and 0.865 for the training set, validation set, and full set, respectively. The calibration curve demonstrated a strong alignment between the predictions of the column-line diagram model and actual observations. The decision curve analysis (DCA) displayed a significant net clinical benefit across the threshold probability range of 0–100%. The dynamic nomogram aids clinicians in identifying high-risk patients, enabling personalized diagnosis and treatment. [ABSTRACT FROM AUTHOR]

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

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

Astragaloside IV (AS-IV), a natural triterpenoid isolated from Astragalus membranaceus, has been used traditionally in Chinese medicine. Previous studies have highlighted its benefits against carcinoma, but its interaction with the gut microbiota and effects on adenomatous polyps are not well understood. This present study investigates the effects of AS-IV on colonic adenomatous polyp (CAP) development in high-fat-diet (HFD) fed A p c Min ∕ + mice. A p c Min ∕ + mice were fed an HFD with or without AS-IV or Naringin for 8 weeks. The study assessed CAP proliferation and employed 16S DNA-sequencing and untargeted metabolomics to explore correlations between microbiome and metabolome in CAP development. AS-IV was more effective than Naringin in reducing CAP development, inhibiting colonic proinflammatory cytokines (IL-1β, IL-6, and TNF-α), tumor associated biomarkers (c-Myc, Cyclin D1), and Wnt/β-catenin pathway proteins (Wnt3a, β-catenin). AS-IV also inhibited the proliferative capabilities of human colon cancer cells (HT29, HCT116, and SW620). Multiomics analysis revealed AS-IV increased the abundance of beneficial genera such as Bifidobacteriumpseudolongum and significantly modulated serum levels of certain metabolites including linoleate and 2-trans,6-trans-farnesal, which were significantly correlated with the number of CAP. Finally, the anti-adenoma efficacy of AS-IV alone was significantly suppressed post pseudoaseptic intervention in HFD-fed A p c Min ∕ + mice but could be reinstated following a combined with Bifidobacteriumpseudolongum transplant. AS-IV attenuates CAP development in HFD-fed A p c Min ∕ + mice by regulating gut microbiota and metabolomics, impacting the Wnt3a/β-catenin signaling pathway. This suggests a potential new strategy for the prevention of colorectal cancer, emphasizing the role of gut microbiota in AS-IV's antitumor effects. [ABSTRACT FROM AUTHOR]

Background: Colorectal cancer ranks third among the most common cancer of male. Globally colorectal adenocarcinoma accounts for approximately 1.2 million new cases, and 600,000 deaths each year1. In India, the incidence of colorectal cancer is 4.3 and 3.4 per 100,000 male and female respectively2. Colorectal carcinoma (CRC) is considered as the most preventable cancers because it arises from benign neoplasms, called polyps which evolve into colorectal carcinomas over many years. The aim of the study is to study the age, sex, site and clinical presentation of various colorectal neoplasm, to study expression of beta catenin in benign, premalignant and malignant tumors of colorectum and correlate the level of expression of beta catenin in various histological grades of colorectal carcinoma. Materials and Methods: Paraffin blocks from 23 cases has been selected which includes both polyps and colorectal carcinoma. Colorectal carcinoma has been graded and staged according to the cap protocol. Polyps has been classified in to benign and premalignant, whereas colorectal carcinoma has been graded with respect to degree of differentiation. Betacatenin immuno-histochemistry has been done. Scoring has done with respect to the localization of beta-catenin in membrane, cytoplasm and nucleus. Result: Normal colorectal mucosa and benign polyps shows predominant membranous expression. Premalignant polyp shows predominantly increased cytoplasmic expression with focal nuclear positivity and the colorectal carcinoma shows raised nuclear expression and loss of membranous expression. This proves the gradual translocation of beta catenin from membrane to nucleus in adenomacarcinoma sequence. Beta-catenin expression has been significantly correlated with depth of invasion (T), nodal metastasis (N) and thereby to the stage of the carcinoma. Beta-catenin expression has been statistically correlated with degree of differentiation (tumor grade). Both recurrence and death were equally distributed in our study, through this observation the morbidity and mortality were greatly correlated with grade of beta-catenin expression. Hence beta-catenin can be used as a marker to identify the malignant potential of premalignant dysplastic polyps which helps in early management. It is used to assess the prognosis of the patients who were in post-colectomy status hence this marker can be used as an additional prognostic marker. [ABSTRACT FROM AUTHOR]

Purpose: The available evidence regarding the role of fruit and vegetable consumption in the development of colorectal polyps remains inconclusive, and there is a lack of data on different histopathologic features of polyps. We aimed to evaluate the associations of fruit and vegetable consumption with the prevalence of colorectal polyps and its subtypes in a high-risk population in China. Methods: We included 6783 Chinese participants aged 40–80 years who were at high risk of colorectal cancer (CRC) in the Lanxi Pre-colorectal Cancer Cohort (LP3C). Dietary information was obtained through a validated food-frequency questionnaire (FFQ), and colonoscopy screening was used to detect colorectal polyps. Dose–response associations of fruit and vegetable intake with the prevalence of polyps were calculated using multivariate-adjusted regression models, which was reported as odds ratios (ORs) with 95% confidence intervals (CIs). Results: 2064 cases of colorectal polyps were ascertained in the LP3C during 2018–2019. Upon multivariable adjustments, including the diet quality, fruit consumption was inversely associated with the prevalence of polyps (P trend = 0.02). Participants in the highest tertile of fruit intake had a 25% lower risk (OR: 0.75; 95% CI 0.62‒0.92) compared to non-consumers, while vegetable consumption had no significant association with polyp prevalence (P trend = 0.86). In terms of colorectal histopathology and multiplicity, higher fruit intake was correlated with 24, 23, and 33% lower prevalence of small polyps (OR: 0.76; 95% CI 0.62‒0.94; P trend = 0.05), single polyp (OR: 0.77; 95% CI 0.62‒0.96; P trend = 0.04), and distal colon polyps (OR: 0.67; 95% CI 0.51‒0.87; P trend = 0.003), respectively. Conclusions: Fresh fruit is suggested as a protective factor to prevent colorectal polyps in individuals at high risk of CRC, and should be underscored in dietary recommendations, particularly for high-risk populations. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Colonoscopy surveillance guidelines categorize individuals as high or low risk for future colorectal cancer (CRC) based primarily on their prior polyp characteristics, but this approach is imprecise, and consideration of other risk factors may improve postpolypectomy risk stratification. METHODS: Among patients who underwent a baseline colonoscopy with removal of a conventional adenoma in 2004-2016, we compared the performance for postpolypectomy CRC risk prediction (through 2020) of a comprehensive model featuring patient age, diabetes diagnosis, and baseline colonoscopy indication and prior polyp findings (i.e., adenoma with advanced histology, polyp size ≥10 mm, and sessile serrated adenoma or traditional serrated adenoma) with a polyp model featuring only polyp findings. Models were developed using Cox regression. Performance was assessed using area under the receiver operating characteristic curve (AUC) and calibration by the Hosmer-Lemeshow goodness-of-fit test. RESULTS: Among 95,001 patients randomly divided 70:30 into model development (n = 66,500) and internal validation cohorts (n = 28,501), 495 CRC were subsequently diagnosed; 354 in the development cohort and 141 in the validation cohort. Models demonstrated adequate calibration, and the comprehensive model demonstrated superior predictive performance to the polyp model in the development cohort (AUC 0.71, 95% confidence interval [CI] 0.68-0.74 vs AUC 0.61, 95% CI 0.58-0.64, respectively) and validation cohort (AUC 0.70, 95% CI 0.65-0.75 vs AUC 0.62, 95% CI 0.57-0.67, respectively). DISCUSSION: A comprehensive CRC risk prediction model featuring patient age, diabetes diagnosis, and baseline colonoscopy indication and polyp findings was more accurate at predicting postpolypectomy CRC diagnosis than a model based on polyp findings alone. [ABSTRACT FROM AUTHOR]

Background: In Isfahan, the fecal immunochemical test (FIT) has been used since January 2016 as part of the Iran's Package of Essential Non-communicable Diseases (IraPEN) program for colorectal cancer (CRC) screening. The test is recommended for people who are 50-70 years old. Then, those with positive results would be referred for colonoscopy. This study aims to describe the uptake of the program and its outcome. Methods: A retrospective observational study was performed by collecting data from Isfahan Vice-Chancellor for Health database for this study purpose. The number of participators, the number of positive FIT, and the number of detected polyps or cancers were determined. Results: Between 2016 and 2019, the number of participants in the program reached 345 207 individuals (nearly 40% of the eligible population of 874 674). Totally, 21 264 participants (6.1%) had positive tests, of whom about 20% underwent the recommended colonoscopy with available reports, and 971 (24%) and 110 (3%) patients were diagnosed with polyps and CRC, respectively. Conclusion: Over four years of screening with FIT in Isfahan, 40% of the eligible population participated. Among those with positive FIT results, 20% underwent colonoscopy, and approximately 26% of these individuals were identified as having polyps or cancer. This study provides valuable insights into the uptake and outcomes of a population-based CRC screening program in Isfahan, Iran. The findings highlight the need for targeted interventions to increase participation rates and improve the detection of polyps and CRC cases. [ABSTRACT FROM AUTHOR]

Colorectal cancer, a type of colon or bowel cancer, poses a major challenge in the treatment of colorectal lesions. Colorectal endoscopic mucosal resection (EMR) is a minimally invasive technique, but the risk of wound infections remains a significant concern. These infections can impede the healing process, affecting daily activities and patient satisfaction. To mitigate the risk of wound infections, various prophylactic measures have been explored, including medication, vaccines, lifestyle adjustments and hygiene practices. This study aims to investigate the prevention of wound infections through prophylactic measures in colorectal EMR. A comprehensive literature review was conducted to identify prophylactic measures that can prevent wound infections. A systematic literature search was conducted using both free words and search terms. The data extraction was performed after a comprehensive literature screening. The meta‐analysis was performed using the metabin function of the meta library in R to evaluate the infection incidences in intervention and control groups. A total of 599 infection incidences were considered, with 267 in intervention and 332 in the control group. The results of meta analysis demonstrated significant reduction of wound incidences following the prophylactic measures (risk ratio [RR] = 0.77, 95% confidence interval [CI]: 0.6747; 0.9016, I2 = 78.5%, p < 0.01). The wound infection ratio analysis also exhibited an approximate 6.6% less infection rate in the intervention group, demonstrating significantly less wound infection following the implementation of prophylactic measures. This study highlights the crucial significance of prevention of wound infections by prophylactic measures in colorectal EMR. [ABSTRACT FROM AUTHOR]

Background: This study was designed to compare the diagnostic efficacy of mSEPT9 to four blood markers (CEA, CA19-9, platelet-lymphocyte ratio (PLR) and neutrophil-lymphocyte ratio (NLR)). In addition, we aimed to determine the combined diagnostic efficacy of mSEPT9, CEA, CA19-9, PLR and NLR in colorectal cancer. Methods: A total of 567 participants were enrolled in the study, including 308 CRC patients, 61 colorectal polyp patients and 198 healthy subjects confirmed by colonoscopy and/or tissue biopsy. Plasma samples were collected for tests. Results: The positive rate of mSEPT9 in CRC (71.8%) was markedly higher than that in either the colorectal polyps group (27.9%) or the healthy controls (6.1%) (P < 0.001). The levels of CEA, CA19-9, NLR and PLR in the CRC group were significantly higher than those in the non-CRC groups (P < 0.05). ROC curves comparison analyses showed that the diagnostic efficacy of mSEPT9 alone in CRC was significantly higher than CEA, CA19-9, NLR and PLR alone. The combination of mSEPT9 with CEA, CA19-9 and PLR showed superior diagnostic value. In addition, binary logistic regression was also used to build a better model for clinical diagnosis of CRC. On univariable analyses, age, mSEPT9, CEA, CA 19–9, PLR and NLR were independent predictors of CRC. When these covariates were fitted in multivariable models, the ones with positive detection of mSEPT9, CEA, CA 19–9 and PLR were more likely to have CRC. Conclusions: This research revealed a significant association between mSEPT9 status and the clinicopathological characteristics of CRC patients, and the combination of mSEPT9, CEA, CA19-9 and PLR could significantly improve diagnostic efficacy in CRC. [ABSTRACT FROM AUTHOR]

The development of premalignant colorectal polyps is significantly influenced by various lifestyle and modifiable risk factors. In our study, we used a large cohort of 9025 patients, who underwent screening colonoscopies at a university hospital, to assess the risk factors associated with the development of three different colorectal cancer precursor lesions: non-advanced adenomas (NAs), advanced adenomatous lesions (ADLs), and sessile serrated lesions (SSLs). Among the participants, 3641 had NAs, 836 had ADLs, and 533 had SSLs. We identified obesity, current smoking, and appendicular skeletal muscle mass as modifiable lifestyle risk factors that increase the development of NAs and ADLs (all P < 0.05). Furthermore, we found a positive correlation between the degree of obesity and an increased risk of developing NAs and ADLs (all P for trend < 0.001), while non-smoking was associated with a decreased risk (P for trend < 0.001 and 0.003, respectively). Smoking was the only modifiable risk factor for developing SSLs (adjusted odds ratio [aOR] 1.58; 95% confidence interval [CI] 1.20–2.07), and the risk was even higher in patients with metabolic syndrome (aOR 1.71; 95% CI 1.05–2.77). Addressing modifiable lifestyle factors such as smoking and obesity could play an important role in reducing the risk of both non-advanced and advanced adenomatous lesions. Smoking cessation is especially important as it is a significant modifiable risk factor for sessile serrated lesions. [ABSTRACT FROM AUTHOR]

Purpose: The fragmentation of polyps affects complete resection confirmation. The primary aim of this study was to assess the feasibility of a novel polyp retrieval bag for reducing the fragmentation rate of colon polyps. Methods: Patients with a 5–15 mm colon polyp were recruited and randomized into two groups at a 1:1 ratio. After polyp resection, polyps obtained from patients in the treatment group were extracted via a novel polyp retrieval bag without traversing the instrument channel, whereas polyps obtained from patients in the control group were collected through the instrument channel, attaching the polyp trap to the instrument channel port, and applying suction. Results: From January to July 2022, 225 patients were assessed for eligibility. The study participants included 204 patients, and seven patients whose samples were not retrieved were excluded. Polyp fragmentation was significantly lower in the treatment group than in the control group (3.0% [3/100] vs. 17.5% [17/97], P = 0.001). The retrieval failure rates in the treatment group and control group were not significantly different (2.0% [2/102] vs. 4.9% [5/102], P = 0.442). There were fewer colonoscope insertions in the treatment group than in the control group (102 vs. 110), but a significant difference was not present (P = 0.065). No significant adverse events were observed during the follow-up. Conclusions: This study demonstrated that the polyp retrieval bag was safe and feasible for reducing the fragmentation rate of retrieved polyps. Trial registration: The study was registered at ClinicalTrials.gov (NCT05189912, 1/12/2021). [ABSTRACT FROM AUTHOR]

Background: Delayed bleeding (DB) is a serious complication after cold snare polypectomy (CSP) for polyps in the colon. The present study aimed to investigate the incidence and risk factors of DB after CSP and to develop a risk-scoring model for predicting DB. Methods: A retrospective study was conducted in four Chinese medical institutions. 10650 patients underwent CSP from June 2019 to May 2023. The study analyzed the rate of DB and extracted the general clinical information and polyp-related information of patients with postoperative DB. As a control, non-DB patients who received CSP at the same 4 hospitals were analyzed. A multivariate Cox regression analysis was performed to develop the prediction model. The model was further validated using a Kaplan–Meier log-rank analysis, receiver operating characteristic curve (ROC) plot and risk plot. Results: In our study, we found a 0.24% rate of DB and the risk factors were history of hypertension, hyperlipidemia, antithrombotics use, antiplatelet use, anticoagulant use, abdominal operation, sigmoid colon lesion, hematoma, cold snare defect protrusion, polyp size, wound size, the grade of wound bleeding, and morphology of Ip. These factors were incorporated into the prediction model for DB after CSP. For 1, 3, and 5 days of bleeding, the AUC of the ROC curve was 0.912, 0.939, and 0.923, respectively. The Kaplan–Meier analysis indicated that the high-risk group had a significantly higher risk of DB than the low-risk group. Conclusions: This study screened the risk factors and established a prediction model of DB after CSP. The results may help preventing and reducing the DB rate after CSP of colorectal polyps. [ABSTRACT FROM AUTHOR]

Aim: A systematic review was conducted to summarize the methylated circulating tumor DNA (ctDNA) markers reported over the last decade for early detection of colorectal cancer (CRC) and to identify the main technical challenges that are impeding their clinical implementation. Background: CRC is a major cause of cancer deaths worldwide, but early detection is key for successful treatment. Non-invasive methods such as methylated ctDNA testing show promise for improving detection and monitoring of CRC. Methods: A comprehensive search was performed using Web of Science, PubMed, and Scopus up to December 30, 2023, limited to articles published in the last 10 years (after 2012), while including advanced adenoma/stage 0 or stage I/II samples in biomarker validation. Results: After identifying 694 articles, removing duplicates and screening titles, abstracts, and full texts, a total of 62 articles were found to meet the inclusion criteria. Among the single biomarkers, MYO1 -G, SEPT9, SDC2, and JAM3 revealed the highest sensitivity for polyps and stage I/II CRC. For multi-biomarkers with suitable sensitivity, combinations of SFRP1, SFRP2, SDC2, PRIMA1, or ALX4, BMP3, NPTX2, RARB, SDC2, SEPT9, VIM or ZFHX4, ZNF334, ELOVL2, UNC5C, LOC146880, SFMBT2, GFRA1 were identified for polyps and stage I/II CRC. Conclusion: Enhancing sensitivity and specificity of molecular screening methods is crucial for improving CRC detection. Identifying a select few valuable biomarkers is key to reducing costs, despite challenges posed by low ctDNA levels in plasma, particularly in early-stage cancers. [ABSTRACT FROM AUTHOR]

Introduction: We investigated coexisting lesion types in patients with invasive colorectal cancer (CRC) in a multinational study for comprehending the adenoma-carcinoma and serrated pathway about the development of CRC. Methods: We retrospectively reviewed 3,050 patients enrolled in the international randomized controlled trial (ATLAS study) to evaluate the colorectal polyp detection performance of image-enhanced endoscopy in 11 institutions in four Asian countries/regions. In the current study, as a subgroup analysis of the ATLAS study, 92 CRC patients were extracted and compared to 2,958 patients without CRC to examine the effects of age, sex, and coexisting lesion types (high-grade adenoma [HGA], low-grade adenoma with villous component [LGAV], 10 adenomas, adenoma ≥10 mm, sessile serrated lesions [SSLs], and SSLs with dysplasia [SSLD]). Additional analyses of coexisting lesion types were performed according to sex and location of CRC (right- or left-sided). Results: A multivariate analysis showed that HGA (odds ratio [95% confidence interval] 4.29 [2.16–8.18]; p < 0.01), LGAV (3.02 [1.16–7.83], p = 0.02), and age (1.04 [1.01–1.06], p = 0.01) were independently associated with CRC. According to sex, the coexisting lesion types significantly associated with CRC were LGAV (5.58 [1.94–16.0], p < 0.01) and HGA (4.46 [1.95–10.20], p < 0.01) in males and HGA (4.82 [1.47–15.80], p < 0.01) in females. Regarding the location of CRC, SSLD (21.9 [1.31–365.0], p = 0.03) was significant for right-sided CRC, and HGA (5.22 [2.39–11.4], p < 0.01) and LGAV (3.46 [1.13–10.6], p = 0.02) were significant for left-sided CRC. Conclusions: The significant coexisting lesions in CRC differed according to sex and location. These findings may contribute to comprehending the pathogenesis of CRC. [ABSTRACT FROM AUTHOR]

Background The wide range of R0 resection rates (R0RR) and incomplete resection rates (IRR) observed with conventional cold snare polypectomy (CCSP) emphasizes the necessity for technique enhancement. The COLDWATER study aimed to compare underwater cold snare polypectomy (UCSP) to CCSP for 5-10-mm colorectal polyps, focusing on comprehensive histopathological evaluation, efficacy, and safety. Methods This was a randomized, single-blind, controlled trial comparing UCSP to CCSP for nonpedunculated colorectal polyps of size 5-10 mm. The primary outcome was to report differences in the muscularis mucosa resection ratio. The secondary outcomes focused on differences in depth of excision, R0-RR, IRR, en bloc resection rate, adverse events, and recurrence rate. Results The COLDWATER study found higher muscularis mucosa resection in UCSP (81.72±62.81% vs. CCSP: 72.33±22.33%, P=0.003) with comparable submucosa presence (UCSP: 16.6%, CCSP: 12.5%, P=0.25). UCSP showed better outcomes regarding IRR (3.5% vs. 8.5%, P=0.05) and en bloc resection (98% vs. 93.5%, P=0.04). In CCSP, expert endoscopists achieved higher R0RR than nonexperts, while UCSP showed no significant difference in R0RR across endoscopist's experience levels. Conclusions UCSP achieves a more extensive excision of the muscularis mucosa compared to CCSP, even though it does not attain a deeper excision. Additionally, UCSP shows a higher en bloc resection rate, with lower rates of IRR, and emerges as a promising technique for training inexperienced endoscopists in polypectomy, given its experience-independent success in achieving R0 resection. [ABSTRACT FROM AUTHOR]

Background Hybrid approaches combining endoscopic full-thickness resection (EFTR) with conventional techniques (endoscopic mucosal resection [EMR], endoscopic submucosal dissection [ESD]) have enabled the resection of difficult fibrotic colorectal adenomas exhibiting a "non-lifting" sign, and polyps in difficult positions. We present our cohort treated with either EMR+EFTR or ESD+EFTR as salvage hybrid endoscopic approaches for complex colorectal polyps not amenable to conventional techniques. Methods Retrospective analysis included technical success, histological confirmation of marginfree resection, assessment of adverse events and follow up with histological assessment. All patients underwent follow-up endoscopy at least 6 and 12 months post-resection. Results Fourteen patients underwent hybrid EFTR procedures (11 EMR+EFTR and 3 ESD+EFTR). Technical success was achieved in all cases where the full-thickness resection device (FTRD) was advanced to the site of the resection (100%). In 2 cases, the FTRD system could not be passed through the sigmoid colon because of severe chronic diverticulitis, subsequent fibrosis and stiffness. The mean lesion size in the EMR+EFTR group (41.7 mm; range 20-50 mm) was larger than the ESD+EFTR group (31.7 mm; range 30-35 mm). Six patients (42.9%) were histologically diagnosed with T1 carcinoma. The mean duration of hospitalization was 1.4 days. Follow-up endoscopy was available in all patients and no recurrence was observed with histological confirmation during a mean follow-up period of 15.4 months. Conclusion Hybrid procedures appear to be safe and effective treatments for complex colorectal lesions not amenable to EMR, ESD or EFTR alone, because of the lesion size, positive non-lifting sign, and difficult positions. [ABSTRACT FROM AUTHOR]

Objective: In recent decades, there has been an increase in early-onset colorectal cancer, the need to screen individuals younger than 50 years of age, and the presence of histopathological differences remains unclear. The objective of this study was to explore the occurrence of polyps in both young adults and older individuals and to examine their potential correlation with colorectal cancer. Methods: In this retrospective study conducted between July 1, 2018, and October 5, 2022, in the Pathology Laboratory, we designed a study based on the histopathological features of colorectal polyps evaluated by an experienced gastrointestinal pathologist based on the WHO 2019 classification. Results: We evaluated 735 consecutive patients who underwent colonoscopic polypectomy between July 2018 and October 2022. The prevalence of cases under the age of 50 was 13.9%, and adults over the age of 50 was 86.1%. A total of 1269 polyps were detected, 1215 (95.7%) were epithelial polyps and 145 (11.9%) were epithelial polyps under the age of 50. One hundred four conventional adenomas and four intramucosal carcinomas were detected in cases younger than 50 years. The patients in the low-risk adenoma group was 57%, and the rate of patients in the high-risk adenoma group was 14.9%. Overall, polyps were most common in the sigmoid colon and there was a statistically significant difference between detecting tubular adenomas in the sigmoid colon (P=0.04). Conclusions: Our current results confirm the detection of sporadic colorectal adenomas and advanced neoplasia in young adults.It is important to establish professional community guidelines for surveillance colonoscopy in these age groups. [ABSTRACT FROM AUTHOR]

Extracellular vesicles (EVs) are a heterogeneous population of membrane-bound nanoparticles (< 1 µm in size) secreted by various cell types. Most of EVs circulating in human blood are derived from platelets, leukocytes, erythrocytes, and endotheliocytes. The composition of circulating adipocyte-derived EVs under various pathological conditions has been virtually unknown. Small EVs were isolated by ultrafiltration and double ultracentrifugation from blood plasma of patients with colorectal cancer (CRC) and colonic polyps with obesity or metabolic syndrome. The composition of adipocyte-derived EVs was analyzed by immunoprecipitation combined with Western blotting and flow cytometry. EVs fractions (FABP4- and CD11b-immunoprecipitated EVs, as well as EVs contained in the supernatant after removal of CD11b-positive EVs) contained a complex of adipocyte markers (FABP4, PPAR-γ, perilipin 1). In CRC patients without obesity, monocyte/macrophage-derived EVs precipitated on CD11b-coated particles were characterized by a combined overexpression of FABP4 and perilipin 1, while such an overexpression was not typical for CRC patients with metabolic syndrome or obesity. The fraction of true adipocyte-derived EVs (supernatant after removal of CD11b-positive EVs) was characterized by the presence of a complex of adipocyte markers with a predominant expression of FABP4 in all patients both with metabolic syndrome/metabolically healthy obesity and without metabolic disorders. To correctly characterize circulating EVs in patients without obesity, it is necessary first to remove the fraction of CD11b-positive monocyte/macrophage-derived EVs from EV preparations by immunoprecipitation or similar methods, and then, after removal/sorption of precipitated EVs, to analyze the composition of adipocyte-derived EVs in the supernatant using a set of above-mentioned adipocyte markers. Moreover, in patients with metabolic disorders, given the insignificant FABP4 expression in CD11b-immunoprecipitated EVs, the pre-depletion of EV preparations does not appear to be that necessary. [ABSTRACT FROM AUTHOR]

Combined endoscopic mucosal resection (EMR) with endoscopic Full thickness resection (EFTR) is an emerging technique that has been developed to target colorectal polyps larger than 2 cm. We performed a systematic review and meta-analysis to evaluate this technique for the resection of large colorectal lesions. We conducted a comprehensive search of multiple electronic databases from inception through August 2023, to identify studies that reported on hybrid FTR. A random-effects model was employed to calculate the overall pooled technical success, macroscopic complete resection, free vertical margins resection rate, adverse events, and recurrence on follow up. A total of 8 Study arms with 244 patients (30% women) were included in the analysis. The pooled technical success rate was 97% (95% CI 88%-100%, I2 = 79.93%). The pooled rate of macroscopic complete resection was achieved in 95% (95% CI 90%-99%, I2 = 49.98) with a free vertical margins resection rate 88% (95% CI, 78%-96%, I2 = 63.32). The overall adverse events rate was 2% (95% CI 0%-5%, I2 = 11.64) and recurrence rate of 6% (95% CI 2%-12%, I2=20.32). Combined EMR with EFTR is effective and safe for resecting large, and complex colorectal adenomas, offering a good alternative for high surgical risk patients. Regional heterogeneity was observed, indicating that outcomes may be impacted by differences in operator expertise and industry training certification across regions. Comparative studies that directly compare combined EMR with EFTR against alternative methods such as ESD and surgical resection are needed. [ABSTRACT FROM AUTHOR]

Background: Patients with end-stage renal disease (ESRD) who undergo polypectomy may experience postpolypectomy bleeding. To reduce the risk of delayed postpolypectomy bleeding among the general population, cold snare polypectomy (CSP) is recommended for removing colon polyps smaller than 1 cm. Nevertheless, only few studies have examined the effect of CSP on patients with ESRD. Methods: We retrospectively analyzed the data of patients with ESRD who underwent colonoscopic polypectomy for polyps larger than 5 mm at a Taiwanese university hospital from January 2014 to January 2023. The main outcome was delayed postpolypectomy bleeding within 30 days. Multivariate analysis was conducted to adjust for major confounders. Results: A total of 557 patients with ESRD underwent colonoscopic polypectomy during the study period: 201 underwent CSP and 356 underwent hot snare polypectomy (HSP). Delayed postpolypectomy bleeding occurred in 27 patients (4.8%). The rate of delayed postpolypectomy bleeding was lower in patients with ESRD who underwent CSP than in those who underwent HSP (1.9% vs. 6.4%, P = 0.022). The percentage of patients who did not experience postpolypectomy bleeding within 30 days after CSP remained lower than that observed after HSP (P = 0.019, log-rank test). Multivariate analysis demonstrated immediate postpolypectomy bleeding and HSP to be independent risk factors for delayed postpolypectomy bleeding. A nomogram prognostic model was used to predict the potential of delayed postpolypectomy bleeding within 30 days in patients with ESRD. Conclusions: Compared with HSP, CSP is more effective in mitigating the risk of delayed postpolypectomy bleeding in patients with ESRD. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Adenoma per colonoscopy (APC) has recently been proposed as a quality measure for colonoscopy. We evaluated the impact of a novel artificial intelligence (AI) system, compared with standard high-definition colonoscopy, for APC measurement. METHODS: This was a US-based, multicenter, prospective randomized trial examining a novel AI detection system (EW10-EC02) that enables a real-time colorectal polyp detection enabled with the colonoscope (CAD-EYE). Eligible average-risk subjects (45 years or older) undergoing screening or surveillance colonoscopy were randomized to undergo either CAD-EYE-assisted colonoscopy (CAC) or conventional colonoscopy (CC). Modified intention-to-treat analysis was performed for all patients who completed colonoscopy with the primary outcome of APC. Secondary outcomes included positive predictive value (total number of adenomas divided by total polyps removed) and adenoma detection rate. RESULTS: In modified intention-to-treat analysis, of 1,031 subjects (age: 59.1 6 9.8 years; 49.9% male), 510 underwent CAC vs 523 underwent CC with no significant differences in age, gender, ethnicity, or colonoscopy indication between the 2 groups. CAC led to a significantly higher APC compared with CC: 0.9961.6 vs 0.8561.5, P50.02, incidence rate ratio 1.17 (1.03-1.33, P50.02) with no significant difference in the withdrawal time: 11.28 6 4.59 minutes vs 10.8 6 4.81 minutes; P50.11 between the 2 groups. Difference in positive predictive value of a polyp being an adenoma among CAC and CC was less than 10% threshold established: 48.6% vs 54%, 95% CI 29.56% to 21.48%. There were no significant differences in adenoma detection rate (46.9% vs 42.8%), advanced adenoma (6.5% vs 6.3%), sessile serrated lesion detection rate (12.9% vs 10.1%), and polyp detection rate (63.9% vs 59.3%) between the 2 groups. There was a higher polyp per colonoscopy with CAC compared with CC: 1.68 6 2.1 vs 1.33 6 1.8 (incidence rate ratio 1.27; 1.15-1.4; P < 0.01). DISCUSSION: Use of a novel AI detection system showed to a significantly higher number of adenomas per colonoscopy compared with conventional high-definition colonoscopy without any increase in colonoscopy withdrawal time, thus supporting the use of AI-assisted colonoscopy to improve colonoscopy quality (ClinicalTrials. gov NCT04979962). [ABSTRACT FROM AUTHOR]