Prevention of late complications with coverage agents in endoscopic resection of colorectal lesions: Current landscape in gastrointestinal endoscopy

Endoscopic removal of large(≥20 mm)non-pedunculated colorectal lesions(LNPCLs)may result in major adverse events,such as delayed bleeding(DB)and delayed perforation(DP),despite closure of the mucosal defects with clips.Topical application of a coverage agent refers to the creation of a shield with a biocompatible medical device(tissue or hydrogel)with proven bioactive properties.Coverage of the eschar after endoscopic resection provides shielding protection to prevent delayed complications.The aim of the present review was to systematically collect and review the currently available literature regarding the prevention of DB and DP with coverage agents after endoscopic mucosal resection or endoscopic submucosal dissection of LNPCLs.

Prevention of late complications of endoscopic resection of colorectal lesions with a coverage agent:Current status of gastrointestinal endoscopy

Endoscopic ectomy of large nonpedunculated colorectal lesions(≥20 mm)might cause significant adverse incidents,such as delayed perforation and delayed bleeding,despite the closure of mucosal lesions with clips.The conventional utilization of prophylactic clipping has not decreased the risk of postprocedural delayed adverse events,and additional outcomes and cost-effectiveness research is needed for patients with proximal lesions≥20 mm,in whom prophylactic clipping might be useful.Coverage of the wound after endoscopic excision offers shield protection against delayed concomitant diseases.

From advanced diagnosis to advanced resection in early neoplastic colorectal lesions:Never-ending and trending topics in the 2020s

Colonoscopy represents the most widespread and effective tool for the prevention and treatment of early stage preneoplastic and neoplastic lesions in the panorama of cancer screening.In the world there are different approaches to the topic of colorectal cancer prevention and screening:different starting ages(45-50 years);different initial screening tools such as fecal occult blood with immunohistochemical or immune-enzymatic tests;recto-sigmoidoscopy;and colonoscopy.The key aspects of this scenario are composed of a proper bowel preparation that ensures a valid diagnostic examination,experienced endoscopist in detection of preneoplastic and early neoplastic lesions and open-minded to upcoming artificial intelligence-aided examination,knowledge in the field of resection of these lesions(from cold-snaring,through endoscopic mucosal resection and endoscopic submucosal dissection,up to advanced tools),and management of complications.

Deep learning driven colorectal lesion detection in gastrointestinal endoscopic and pathological imaging

Colorectal cancer has the second highest incidence of malignant tumors and is the fourth leading cause of cancer deaths in China.Early diagnosis and treatment of colorectal cancer will lead to an improvement in the 5-year survival rate,which will reduce medical costs.The current diagnostic methods for early colorectal cancer include excreta,blood,endoscopy,and computer-aided endoscopy.In this paper,research on image analysis and prediction of colorectal cancer lesions based on deep learning is reviewed with the goal of providing a reference for the early diagnosis of colorectal cancer lesions by combining computer technology,3D modeling,5G remote technology,endoscopic robot technology,and surgical navigation technology.The findings will supplement the research and provide insights to improve the cure rate and reduce the mortality of colorectal cancer.

Prediction of the severity of colorectal lesion by fecal hemoglobin concentration observed during previous test in the French screening program

BACKGROUND The rate of positive tests using fecal immunochemical test(FIT)does not decrease with subsequent campaigns,but the positive predictive value of advanced neoplasia significantly decreases in subsequent campaign after a first negative test.A relationship between the fecal hemoglobin concentration(Fhb)and the opportunity to detect a colorectal cancer in subsequent campaign has been shown.AIM To predict the severity of colorectal lesions based on Fhb measured during previous colorectal cancer screening campaign.METHODS This etiological study included 293750 patients aged 50-74,living in Auvergne-Rhone-Alpes(France).These patients completed at least two FIT[test_((-1))and test_((0))]between June 2015 and December 2019.Delay between test_((-1))and test_((0))was>1year and test_((-1))result was negative(<150 ngHb/mL).The severity of colorectal lesions diagnosed at test_((0))was described according to Fhb measured at test_((-1))[Fhb_((-1))].The relationship between the severity classified in seven ordinal categories and the predictive factors was analyzed in an ordered multivariate polytomous regression model.RESULTS The test_((0))positive rate was 4.0%,and the colonoscopy completion rate was 97.1%in 11594 patients who showed a positive test_((0)).The colonoscopy detection rate was 77.7%in those 11254 patients who underwent a colonoscopy.A total of 8748 colorectal lesions were detected(including 2182 low-risk-polyps,2400 high-riskpolyp,and 502 colorectal cancer).The colonoscopy detection rate varied significantly with Fhb_((-1))[0 ngHb/mL:75.6%,(0-50 ngHb/mL):77.3%,(50-100 ngHb/mL):88.7%,(100-150 ngHb/mL):90.3%;P=0.001].People with a Fhb_((-1))within(100-150 ngHb/mL)(P=0.001)were 2.6(2.2;3.0)times more likely to have a high severity level compared to those having a Fhb_((-1))value of zero.This risk was reduced by 20%in patients aged 55-59 compared to those aged<55[adjusted odds ratio:0.8(0.6;1.0)].CONCLUSION The study showed that higher Fhb_((-1))is correlated to an increased risk of severity of colorectal lesions.This risk of severity increased among first-time participants(age<55)and the elderly(≥70).To avoid the loss of chance in these age groups,the FIT positivity threshold should be reduced to 100 ngHb/mL.The other alternative would be to reduce the time between the two tests in these age groups from the current 2 years to 1 year.