Efficacy of cap-assisted colonoscopy according to lesion location and endoscopist training level

AIM: To evaluate the efficacy of cap-assisted colonoscopy(CAC) for detection of colorectal polyps and adenomas according to the lesion location and endoscopist training level.METHODS: Patients 20 years or older, who underwent their first screening colonoscopy in a single tertiary center from May 2011 to December 2012 were enrolled in this study. All patients underwent either CAC or standard colonoscopy(SC), and all of the procedures were performed by 11 endoscopists(8 trainees and 3 experts). All procedures were performed with highdefinition colonoscopes and narrow band imaging. The eight trainees had experiences of performing 150 to 500 colonoscopies, and the three experts had experiences of performing more than 3000 colonoscopies. A 4-mmlong transparent cap was attached to the end of a colonoscope in the CAC group. We retrospectively evaluated the number of polyps and adenomas, polyp detection rate(PDR), and the number of adenomas and adenoma detection rate(ADR) according to the lesion location and endoscopist training level between CAC and SC. We also evaluated the number of polyps and adenomas according to their size between CAC and SC.RESULTS: Overall, PDR and ADR using CAC were significantly higher than those using SC for both whole colon(48.5% vs 40.7%, P = 0.012; 35.7% vs 28.3%, P = 0.012) and right-side colon(35.3% vs 26.6%, P = 0.002; 27.0% vs 16.9%, P < 0.001). The number of polyps and adenomas per patient using CAC was significantly higher than that using SC for both the whole colon(1.07 ± 1.59 vs 0.82 ± 1.31, P = 0.008; 0.72 ± 1.32 vs 0.50 ± 1.01, P = 0.003) and right-side colon(0.66 ± 1.18 vs 0.41 ± 0.83, P < 0.001; 0.46 ± 0.97 vs 0.25 ± 0.67, P < 0.001). In the trainee group, the PDR and ADR using CAC were significantly higher than those using SC for both the whole colon(46.7% vs 39.7%, P = 0.040; 33.9% vs 26.0%, P =0.012) and right-side colon(34.2% vs 26.5%, P = 0.015; 25.3% vs 15.9%, P = 0.001). In the expert group, the PDR and ADR using CAC were significantly higher than those using SC only for the right-side colon(42.1% vs 27.0%, P =0.035; 36.8% vs 21.0%, P = 0.020).CONCLUSION: CAC is more effective than SC for detection of colorectal polyps and adenomas, especially when performed by trainees and when the lesions are located in the right-side colon.

Prospective randomized controlled trial evaluating cap-assisted colonoscopy vs standard colonoscopy

AIM: To study the significance of cap-fitted colonoscopy in improving cecal intubation time and polyp detection rate. METHODS: This study was a prospective randomized controlled trial conducted from March 2008 to February 2009 in a tertiary referral hospital at Sydney. The primary end point was cecal intubation time and the secondary endpoint was polyp detection rate. Consecutive cases of total colonoscopy over a 1-year period were recruited. Randomization into either standard colonoscopy (SC) or cap-assisted colonoscopy (CAC) was performed after consent was obtained. For cases randomized to CAC, one of the three sizes of cap was used: D-201-15004 (with a diameter of 15.3 mm), D-201-14304 (14.6 mm) and D-201-12704 (13.0 mm). All of these caps were produced by Olympus Medical Systems, Japan. Independent predictors for faster cecal time and better polyp detection rate were also determined from this study. RESULTS: There were 200 cases in each group. There was no signif icant difference in terms of demographic characteristics between the two groups. CAC, when compared to the SC group, had no signif icant difference in terms of cecal intubation rate (96.0% vs 97.0%, P = 0.40) and time (9.94 ± 7.05 min vs 10.34 ± 6.82 min, P = 0.21), or polyp detection rate (32.8% vs 31.3%, P = 0.75). On the subgroup analysis, there was no significant difference in terms of cecal intubation time by trainees (88.1% vs 84.8%, P = 0.40), ileal intubation rate (82.5% vs 79.0%, P = 0.38) or total colonoscopy time (23.24 ± 13.95 min vs 22.56 ± 9.94 min, P = 0.88). On multivariate analysis, the independent determinants of faster cecal time were consultant-performed procedures (P < 0.001), male patients (P < 0.001), non-usage of hyoscine (P < 0.001) and better bowel preparation (P = 0.01). The determinants of better polyp detection rate were older age (P < 0.001), no history of previous abdominal surgery (P = 0.04), patients not having esophagogastroduodenoscopy in the same setting (P = 0.003), trainee-performed procedures (P = 0.01), usage of hyoscine (P = 0.01) and procedures performed for polyp follow-up (P = 0.01). The limitations of the study were that it was a single-center experience, no blinding was possible, and there were a large number of endoscopists. CONCLUSION: CAC did not signif icantly different from SC in term of cecal intubation time and polyp detection rate.

Impact of cap-assisted colonoscopy during transendoscopic enteral tubing:A randomized controlled trial

BACKGROUND Colonic transendoscopic enteral tubing(TET)requires double cecal intubation,raising a common concern of how to save cecal intubation time and make the tube stable.We hypothesized that cap-assisted colonoscopy(CC)might reduce the second cecal intubation time and bring potential benefits during the TET procedure.AIM To investigate if CC can decrease the second cecal intubation time compared with regular colonoscopy(RC).METHODS This prospective multicenter,randomized controlled trial was performed at four centers.Subjects≥7 years needing colonic TET were recruited from August 2018 to January 2020.All subjects were randomly assigned to two groups.The primary outcome was the second cecal intubation time.Secondary outcomes included success rate,insertion pain score,single clip fixation time,purpose and retention time of TET tube,length of TET tube inserted into the colon,and all procedurerelated(serious)adverse events.RESULTS A total of 331 subjects were randomized to the RC(n=165)or CC(n=166)group.The median time of the second cecal intubation was significantly shorter for CC than RC(2.2 min vs 2.8 min,P<0.001).In patients with constipation,the median time of second cecal intubation in the CC group(n=50)was shorter than that in the RC group(n=43)(2.6 min vs 3.8 min,P=0.004).However,no difference was observed in the CC(n=42)and RC(n=46)groups of ulcerative colitis patients(2.0 min vs 2.5 min,P=0.152).The insertion pain score during the procedure in CC(n=14)was lower than that in RC(n=19)in unsedated colonoscopy(3.8±1.7 vs 5.4±1.9;P=0.015).Multivariate analysis revealed that only CC(odds ratio[OR]:2.250,95%confidence interval[CI]:1.161-4.360;P=0.016)was an independent factor affecting the second cecal intubation time in difficult colonoscopy.CC did not affect the colonic TET tube’s retention time and length of the tube inserted into the colon.Moreover,multivariate analysis found that only endoscopic clip number(OR:2.201,95%CI:1.541-3.143;P<0.001)was an independent factor affecting the retention time.Multiple regression analysis showed that height(OR:1.144,95%CI:1.027-1.275;P=0.014)was the only independent factor influencing the length of TET tube inserted into the colon in adults.CONCLUSION CC for colonic TET procedure is a safe and less painful technique,which can reduce cecal intubation time.

Trauma to the solid abdominal organs:The missed dark box of colonoscopy

Colonoscopy is an integral part of the lower bowel care and is generally considered a potentially safe diagnostic and therapeutic procedure performed as a daycare outpatient procedure.Colonoscopy is associated with different complications that are not limited to adverse events related to the bowel preparation solutions used,the sedatives used,but to the procedure related as well including bleeding and perforation.Injuries to the extra-luminal abdominal organs during colonoscopy are uncommon,however,serious complications related to the procedure have been reported infrequently in the literature.Life threatening injuries to the spleen,liver,pancreas,mesentery,and urinary bladder have been reported as early as in mid-1970s.These injuries should not be overlooked by clinicians and endoscopists.Steadily increasing abdominal pain,abdominal distension,and hemodynamic instability in absence of rectal bleeding should raise the possibility of severe organ injury.Splenic and hepatic injury following colonoscopy are usually serious and may be life threatening.Although conservative management may help,yet they usually need interventional radiology or surgical intervention.Acute pancreatitis following colonoscopy is usually mild and is mostly managed conservatively.The mechanism of abdominal organ injuries during colonoscopy is not fully understood,however many risk factors have been identified,which can be classified as-organ related,procedure related,and local abdominal factors.Difficult colonoscopy and prior intra-abdominal adhesions are probably the most relevant risk factors for these injuries.Left lateral position,avoidance of looping and excessive force during the procedure would probably reduce the risk of such injuries.

Colonoscopy plays an important role in detecting colorectal neoplasms in patients with gastric neoplasms

BACKGROUND Gastric cancer(GC)and colorectal cancer(CRC)are the fifth and third most common cancer worldwide,respectively.Nowadays,GC is reported to have a potential predictive value for CRC,especially for advanced CRC.AIM To evaluate the necessity of colonoscopy for gastric neoplasm(GN)patients.METHODS Four databases,including PubMed,EMBASE,the Cochrane Library,and Ovid,were used to perform the search strategy on May 2,2023.The prevalence of colorectal neoplasms(CRN)and baseline characteristics were compared between the neoplasm group and the control group.Continuous variables are expressed as the mean difference and standard deviation.Relationships of categorical variables in the two groups are expressed as odds ratios(OR)and 95%confidence intervals(95%CIs).Subgroup analysis according to different kinds of GNs was conducted for more in-depth analysis.The results of this study are represented by forest plots.Publication bias was evaluated by a funnel plot.All data analyses were performed by STATA SE 16.0 software.RESULTS A total of 3018 patients with GNs and 3905 healthy controls(age and sex matched)were enrolled for analysis.After comparing the prevalence of CRNs between the two groups,CRNs were detected significantly more frequently in GN patients than in controls(OR=1.69,95%CI=1.28 to 2.23,I^(2)=85.12%,P=0.00),especially in patients with GC(OR=1.80,95%CI=1.49 to 2.18,I^(2)=25.55%,P<0.1).Moreover,other risk factors including age(OR=1.08,95%CI=1.00 to 1.17,I^(2)=90.13%,P=0.00)and male sex(OR=2.31,95%CI=1.26 to 4.22,I^(2)=87.35%,P=0.00),were related to the prevalence of CRNs.For patients in the GN group,body mass index(BMI,OR=0.88,95%CI=0.80 to 0.98,I^(2)=0.00%,P=0.92)and smoking(OR=1.03,95%CI=1.01 to 1.05,I^(2)=0.00%,P=0.57)were protective and risk factors for CRNs,respectively.CONCLUSION Patients are recommended to undergo colonoscopy when diagnosed with GNs,especially GC patients with a low BMI and a history of smoking.

Importance of diet and intestinal microbiota in the prevention of colorectal cancer-colonoscopy early screening diagnosis

Colorectal cancer is a term used to describe colon and rectal cancer,which is the third most common type of cancer.A MEDLINE and PubMed search resulted in the inclusion of manuscripts written in the last 10 years,using keywords relevant to the topic of the manuscript.By analyzing the aim of the searched studies and manuscripts,adequate articles were included that described the stated problem.The frequency of colorectal cancer varies with climate,nutrition,and many other factors,primarily endogenous,hereditary,intestinal microbiome,as well as external factors,such as exposure of the individual to stress,and bad eating habits.Colon cancer and rectal cancer or colorectal cancer in general in the early stages of the disease,may not show symptoms or are barely noticeable.Colorectal cancer symptoms will most often not develop until the disease has progressed to stage 2 or beyond.Regular screening tests for colon or rectal cancer,especially colonoscopy,are recommended as part of a regular checkup for people aged 50 years or younger who are at high risk due to a family history of the disease or other cancers.Diet and colonoscopy as an early screening method play an important role in the prevention of colorectal cancer.

Research Progress of Bowel Preparation for Colonoscopy

Colorectal cancer ranks third in the global cancer data in 2020. Colorectal scope is the most effective method to diagnose colorectal diseases such as benign and malignant colorectal tumors. The poor quality of intestinal preparation causes an increased rate of missed diagnosis of colorectal tumors, reduces the rate of cecal intubation for colorectal examination, increases the discomfort, and reduces the compliance of re-examination. Therefore, we should try our best to improve the quality of intestinal preparation. This study reviewed the latest advances related to the preoperative preparation for colonoscopy. Recent research shows that smartphone apps can provide more detailed education and guidance on bowel preparation;Pre-packaged foods are more suitable as a way to eat before colonoscopy. The use of smaller doses, better taste of cathartic agents, and some auxiliary measures, combined with the patient’s situation to provide personalized intestinal preparation measures to improve the quality of intestinal preparation. Starting from the quality of colonoscopy bowel preparation, continuous improvement of patients’ tolerance to bowel preparation, continuous improvement of bowel preparation plan based on individual factors’ needs, and better communication with examined subjects by using existing scientific information technology, may be the hot spot of colonoscopy bowel preparation research in the next few years.

Colo-colonic intussusception as a rare complication of colonoscopy with polypectomy: Two case reports

BACKGROUND Colonoscopy is the most frequently used diagnostic and therapeutic tool for the treatment of colorectal diseases.Although the complication rate is low,it can be potentially serious.Intussusception is a rare and severe complication often associated with polypectomy.Only a handful of post-colonoscopy intussusception cases have been reported,making this study a valuable addition to the medical literature.CASE SUMMARY Case 1:A 61-year-old man underwent colonoscopy with polypectomy for chronic abdominal pain.The patient experienced abdominal pain 11 hours later but was still discharged after pain management.He was readmitted due to recurring pain.Computed tomography(CT)showed colo-colonic intussusception.Initial conservative management and attempts at endoscopic reduction failed;therefore,laparoscopic right hemicolectomy was performed.Histopathological examination revealed tubular adenomas in the polyps and inflammation in the resected specimens.Case 2:A 59-year-old woman underwent colonoscopy with polypectomy for a polyp in the transverse colon.She experienced upper abdominal pain,fever,nausea,and vomiting 9 hours after the procedure.Emergency CT and blood tests revealed a colo-colonic intussusception near the hepatic flexure and an elevated white blood cell count.Initial attempts at endoscopic reduction failed and conservative treatment showed no improvement.She underwent successful laparoscopic reduction and recovered uneventfully.Histopathological examination of the resected polyp revealed hyperplasia.CONCLUSION Post-colonoscopy intussusception in adults is rare,and polypectomy may contribute to its occurrence.Early diagnosis is crucial,with prompt CT examination serving as key.After excluding malignancies,conservative management and reduction of intussusception should be considered before surgical bowel resection.

Vomiting-induced pharyngeal perforation during bowel preparation for colonoscopy:A case report

BACKGROUND Effective bowel cleansing is essential for a successful colonoscopy.Laxatives,such as polyethylene glycol,are commonly used for bowel preparation.Vomiting is a frequent complication during bowel preparation,and forceful vomiting can potentially lead to esophageal perforation,as reported in several previous cases.However,pharyngeal perforation during bowel preparation has not been previously documented.Here,we present a case of pharyngeal perforation induced by forceful vomiting during bowel preparation.CASE SUMMARY A 38-year-old man with a history of hypertension,dyslipidemia,diabetes mellitus,and end-stage renal disease on hemodialysis was admitted for evaluation of recurrent abdominal pain.The patient complained of sudden pain in the neck,throat,and anterior chest following forceful vomiting during bowel preparation.Physical examination revealed crepitus under the skin of the neck and anterior chest on palpation,and upper gastrointestinal endoscopy revealed pharyngeal perforation.The perforation site was located above the upper esophageal sphincter,which distinguished it from Boerhaave’s syndrome.Conservative medical management was chosen after consultation with a thoracic surgeon and an otolaryngologist,considering the patient's mild symptoms,stable vital signs,and the small size of the lesion;the perforation resolved without endoscopic or surgical intervention.The patient was discharged from hospital two weeks after the perforation.CONCLUSION Despite its rarity,pharyngeal perforation should be considered a potential complication of bowel preparation for colonoscopy.

Previously undiagnosed Morgagni hernia with bowel perforation detected during repeat screening colonoscopy: A case report

BACKGROUND Morgagni hernia(MH)is a form of congenital diaphragmatic hernia(CDH)characterized by an incomplete formation of diaphragm,resulting in the protru-sion of abdominal organs into the thoracic cavity.The estimated incidence of CDH is between 1 in 2000 and 1 in 5000 live births,although the true incidence is unknown.MH typically presents in childhood and can be diagnosed either pre-natally or postnatally.However,it can also be asymptomatic and carry the risk of developing into a life-threatening condition in adulthood.CASE SUMMARY A 76-year-old female with no history of prior abdominal surgeries presented for an elective colonoscopy for polyp surveillance.During the procedure,when approaching the hepatic flexure,the scope could not be advanced further despite multiple attempts.The patient experienced mild abdominal discomfort,leading to the abortion of the procedure.While in the recovery area,she developed increa-sing abdominal pains and hypotension.Urgent abdominal imaging revealed her-niation of the proximal transverse colon through a MH into the chest with evi-dence of perforation.The patient underwent laparoscopic urgent colonic resection and primary hernia repair and was discharged uneventfully 2 d later.CONCLUSION A MH is a rare condition in adults that can present as a life-threatening compli-cation of colonoscopy,even in patients with a history of uneventful colonoscopies.This case highlights the importance of considering congenital and internal hernias when faced with sudden and unexplained difficulties during colonoscopy.If there is a suspicion of MH,the endoscopist should halt the procedure and immediately obtain abdominal imaging to confirm the diagnosis.

Trends in colorectal cancer incidence according to an increase in the number of colonoscopy cases in Korea

BACKGROUND The incidence of colorectal cancer(CRC)and preinvasive CRC(e.g.,early colon cancer and advanced adenoma)is gradually increasing in several countries.AIM To evaluate the trend in incidence of CRC and preinvasive CRC according to the increase in the number of colonoscopies performed in Korea.METHODS This retrospective cohort study enrolled Korean patients from 2002 to 2020 to evaluate the incidence of CRC and preinvasive CRC,and assess the numbers of diagnostic colonoscopies and colonoscopic polypectomies.Colonoscopy-related complications by age group were also determined.RESULTS The incidence of CRC showed a rapid increase,then decreased after 2012 in the 50-75 year-age group.During the study period,the rate of incidence of preinvasive CRC increased at a similar level in patients under 50 and 50-75 years of age.Since 2009,the increase has been rapid,showing a pattern similar to the increase in colonoscopies.The rate of colonoscopic polypectomy in patients aged under 50 was similar to the rate in patients over 75 years of age after 2007.The rate of complications after colonoscopy and related deaths within 3 mo was high for those over 75 years of age.CONCLUSION The diagnosis of preinvasive CRC increased with the increase in the number of colonoscopies performed.As the risk of colonoscopy-related hospitalization and death is high in the elderly,if early lesions at risk of developing CRC are diagnosed and treated under or at the age of 75,colonoscopy-related complications can be reduced for those aged 76 years or over.

Colonoscopy-assisted removal of an impaction foreign body at the rectosigmoid junction: A case report

BACKGROUND When an anorectal foreign body is found,its composition and shape should be evaluated,and a timely and effective treatment plan should be developed based on the patient's symptoms to avoid serious complications such as intestinal perforation caused by displacement of the foreign body.CASE SUMMARY A 54-year-old male was admitted to our outpatient clinic on June 3,2023,due to a rectal foreign body that had been embedded for more than 24 h.The patient reported using a glass electrode tube to assist in the recovery of prolapsed hemorrhoids,however,the electrode tube was inadvertently inserted into the anus and could not be removed by the patient.During hospitalization,the patient underwent surgery,and the foreign body was dragged into the rectum with the aid of colonoscopy.The anus was dilated with a comb-type pulling hook and an anal fistula pulling hook to widen the anus and remove the foreign body,and the local anal symptoms were then relieved with topical drugs.The patient was allowed to eat and drink,and an entire abdominal Computed tomography(CT)and colonoscopy were reviewed 3 d after surgery.CT revealed no foreign body residue and colonoscopy showed no metal or other residues in the colon and rectum,and no apparent intestinal tract damage.CONCLUSION The timeliness and rationality of the surgical and therapeutic options for this patient were based on a literature review of the clinical signs and conceivable conditions in such cases.The type,material and the potential risks of rectal foreign bodies should be considered.

Colonoscopy in the diagnosis and management of appendiceal disease

In this editorial,we comment on the article published in the recent issue of the World Journal of Gastrointestinal Endoscopy.We focused on the understanding of appendiceal disease,and the various options for diagnosis and treatment via endoscopy.Some factors affecting the diagnosis and management of appendiceal diseases are also discussed.The existence of any organ has its natural rationality,and the appendix is such a magical organ.A growing number of experts and scholars have gradually come to a consensus that the appendix is not a useless evolutionary relic.There are many lymphocytes and lymph nodes in the appendix wall,which has a strong immune function,and this function is particularly important for children and adolescents.Many intestinal probiotics in the appendix are very helpful for maintaining the balance of the intestinal flora.With the continuous progress of endoscopic technology,endoscopic treatment involving preservation of the appendix has shown great advantages over surgery.In the diagnosis of appendiceal inflammation and neoplasms,colonoscopy,endoscopic retrograde appendicography and choledochoscopy help assess conditions of the appendix.Endoscopic retrograde appendicitis therapy,abscess drainage under colonoscopy,fenestration of abscess under colonoscopy,and endoscopic or natural orifice transluminal endoscopic surgery resection of appendiceal neoplasms are safe and effective endoscopic treatments for appendiceal disease.New breakthroughs in the application of endoscopy in the appendix are expected to occur in the near future.

Constipation and colonoscopy

Constipation is a significant sociomedical problem,which can be caused by various reasons.In the diagnostic approach to patients with constipation,the following data are usually sufficient:History,complete physical examination(including rectal examination),and additional diagnostic tests.A colonoscopy is not a necessary diagnostic method for all patients with constipation.However,if patients have alarm symptoms/signs,that suggest an organic reason for constipation,a colonoscopy is necessary.The most important alarm symptoms/signs are age>50 years,gastrointestinal bleeding,new-onset constipation,a palpable mass in the abdomen and rectum,weight loss,anemia,inflammatory bowel disease,and family history positive for colorectal cancer.Most endoscopists do not like to deal with patients with constipation.There are two reasons for this,namely the difficulty of endoscopy and the adequacy of preparation.Both are adversely affected by constipation.To improve the quality of colonoscopy in these patients,good examination techniques and often more extensive preparation are necessary.Good colonoscopy technique implies adequate psychological preparation of the patient,careful insertion of the endoscope with minimal insufflation,and early detection and resolution of loops.Bowel preparation for colonoscopy often requires prolonged preparation and sometimes the addition of other laxatives.

Bowel preparation experiences and needs before follow-up colonoscopy in older adult postoperative colorectal cancer patients: A qualitative study

BACKGROUND The bowel preparation process prior to colonoscopy determines the quality of the bowel preparation,which in turn affects the quality of the colonoscopy.Colono-scopy is an essential procedure for postoperative follow-up monitoring of colorec-tal cancer(CRC)patients.Previous studies have shown that advanced age and a history of colorectal resection are both risk factors for inadequate bowel prepara-tion.However,little attention has been paid to the bowel preparation experiences and needs of predominantly older adult postoperative CRC patients.AIM To explore the experiences and needs of older adult postoperative CRC patients during bowel preparation for follow-up colonoscopy.METHODS Fifteen older adult postoperative CRC patients who underwent follow-up colonoscopy at a tertiary hospital in Shanghai were selected using purposive sampling from August 2023 to November 2023.The phenomenological method in qualitative research was employed to construct an interview outline and conduct semi-structured interviews with the patients.Colaizzi's seven-step analysis was utilized to organize,code,categorize,summarize,and verify the interview data.RESULTS The results of this study were summarized into four themes and eight sub-themes:(1)Inadequate knowledge about bowel preparation;(2)Decreased physiological comfort during bowel preparation(gastrointestinal discomfort and sleep deprivation caused by bowel cleansing agents,and hunger caused by dietary restrictions);(3)Psychological changes during different stages of bowel preparation(pre-preparation:Fear and resistance due to previous experiences;during preparation:Irritation and helplessness caused by taking bowel cleansing agents,and post-preparation:Anxiety and worry while waiting for the colonoscopy);and(4)Needs related to bowel preparation(detailed instructions from healthcare professionals;more ideal bowel cleansing agents;and shortened waiting times for colonoscopy).CONCLUSION Older adult postoperative CRC patients'knowledge of bowel preparation is not adequate,and they may encounter numerous difficulties and challenges during the process.Healthcare professionals should place great emphasis on providing instruction for their bowel preparation.

Long-term impact of artificial intelligence on colorectal adenoma detection in high-risk colonoscopy

BACKGROUND Improved adenoma detection rate(ADR)has been demonstrated with artificial intelligence(AI)-assisted colonoscopy.However,data on the real-world appli-cation of AI and its effect on colorectal cancer(CRC)screening outcomes is limited.AIM To analyze the long-term impact of AI on a diverse at-risk patient population undergoing diagnostic colonoscopy for positive CRC screening tests or sympt-oms.METHODS AI software(GI Genius,Medtronic)was implemented into the standard proced-ure protocol in November 2022.Data was collected on patient demographics,procedure indication,polyp size,location,and pathology.CRC screening outcomes were evaluated before and at different intervals after AI introduction with one year of follow-up.RESULTS We evaluated 1008 colonoscopies(278 pre-AI,255 early post-AI,285 established post-AI,and 190 late post-AI).The ADR was 38.1%pre-AI,42.0%early post-AI(P=0.77),40.0%established post-AI(P=0.44),and 39.5%late post-AI(P=0.77).There were no significant differences in polyp detection rate(PDR,baseline 59.7%),advanced ADR(baseline 16.2%),and non-neoplastic PDR(baseline 30.0%)before and after AI introduction.CONCLUSION In patients with an increased pre-test probability of having an abnormal colonoscopy,the current generation of AI did not yield enhanced CRC screening metrics over high-quality colonoscopy.Although the potential of AI in colonoscopy is undisputed,current AI technology may not universally elevate screening metrics across all situations and patient populations.Future studies that analyze different AI systems across various patient populations are needed to determine the most effective role of AI in optimizing CRC screening in clinical practice.

Effectiveness of colonoscopy,immune fecal occult blood testing,and risk-graded screening strategies in colorectal cancer screening

BACKGROUND Colorectal cancer(CRC)is one of the most common malignant tumors,and early screening is crucial to improving the survival rate of patients.The combination of colonoscopy and immune fecal occult blood detection has garnered significant attention as a novel method for CRC screening.Colonoscopy and fecal occult blood tests,when combined,can improve screening accuracy and early detection rates,thereby facilitating early intervention and treatment.However,certain risks and costs accompany it,making the establishment of a risk classification model crucial for accurate classification and management of screened subjects.AIM To evaluate the feasibility and effectiveness of colonoscopy,immune fecal occult blood test(FIT),and risk-graded screening strategies in CRC screening.METHODS Based on the randomized controlled trial of CRC screening in the population conducted by our hospital May 2020 to May 2023,participants who met the requirements were randomly assigned to a colonoscopy group,an FIT group,or a graded screening group at a ratio of 1:2:2(after risk assessment,the high-risk group received colonoscopy,the low-risk group received an FIT test,and the FITpositive group received colonoscopy).The three groups received CRC screening with different protocols,among which the colonoscopy group only received baseline screening,and the FIT group and the graded screening group received annual follow-up screening based on baseline screening.The primary outcome was the detection rate of advanced tumors,including CRC and advanced adenoma.The population participation rate,advanced tumor detection rate,and colonoscopy load of the three screening programs were compared.RESULTS A total of 19373 subjects who met the inclusion and exclusion criteria were enrolled,including 8082 males(41.7%)and 11291 females(58.3%).The mean age was 60.05±6.5 years.Among them,3883 patients were enrolled in the colonoscopy group,7793 in the FIT group,and 7697 in the graded screening group.Two rounds of follow-up screening were completed in the FIT group and the graded screening group.The graded screening group(89.2%)and the colonoscopy group(42.3%)had the lowest overall screening participation rates,while the FIT group had the highest(99.3%).The results of the intentional analysis showed that the detection rate of advanced tumors in the colonoscopy group was greater than that of the FIT group[2.76%vs 2.17%,odds ratio(OR)=1.30,95%confidence interval(CI):1.01-1.65,P=0.037].There was no significant difference in the detection rate of advanced tumors between the colonoscopy group and the graded screening group(2.76%vs 2.35%,OR=1.9,95%CI:0.93-1.51,P=0.156),as well as between the graded screening group and the FIT group(2.35%vs 2.17%,OR=1.09%,95%CI:0.88-1.34,P=0.440).The number of colonoscopy examinations required for each patient with advanced tumors was used as an index to evaluate the colonoscopy load during population screening.The graded screening group had the highest colonoscopy load(15.4 times),followed by the colonoscopy group(10.2 times),and the FIT group had the lowest(7.8 times).CONCLUSION A hierarchical screening strategy based on CRC risk assessment is feasible for screening for CRC in the population.It can be used as an effective supplement to traditional colonoscopy and FIT screening programs.

Delivering a high-quality colonoscopy service fit for the 21st century

Colorectal cancer(CRC)is the third most prevalent cancer globally.There is a concerning increase in its incidence among younger individuals.Colonoscopy remains the gold standard for CRC diagnosis.With the introduction of population-based bowel screening and increased public awareness,there has been a significant rise in referrals for colonoscopy.Healthcare providers worldwide will need to strategically evaluate how to allocate resources to adequately train the next generation of colonoscopists who will need to provide accurate endoscopic assessment and treatment for premalignant polyps and early CRC.This review outlines the current workload challenges faced by colonoscopists whilst exploring emerging technologies such as artificial intelligence for adenoma detection.Additionally,advanced endoscopic surgical techniques like endoscopic submucosal dissection are discussed.

The applications and challenges of artificial intelligence in colonoscopy

It has been widely acknowledged that colonoscopy is the most effective method of preventing colorectal cancer because it can detect and remove precursor lesions,thereby reducing both incidence and mortality.Among these approaches,standardized colonoscopy stands out as the most efficacious method for early-stage colorectal cancer identification.Artificial intelligence is a rapidly expanding field in gastrointestinal endoscopy.This article presents a comprehensive review of the advantages and clinical evidence supporting the application of artificial intelligence in colonoscopy while also discussing prospects for utilizing artificial intelligence-assisted endoscopy in diagnosing colorectal cancer.

Cap-assisted endoscopic sclerotherapy for hemorrhoids: Methods, feasibility and efficacy

AIM: To evaluate the methodology, feasibility, safety and efficacy of a novel method called cap-assisted endoscopic sclerotherapy(CAES) for internal hemorrhoids.METHODS: A pilot study on CAES for grade Ⅰ to Ⅲ internal hemorrhoids was performed. Colon and terminal ileum examination by colonoscopy was performed for all patients before starting CAES. Polypectomy and excision of anal papilla fibroma were performed if polyps or anal papilla fibroma were found and assessed to be suitable for resection under endoscopy. CAES was performed based on the requirement of the cap, endoscope, disposable endoscopic long injection needle, enough insufflated air and sclerosing agent.RESULTS: A total of 30 patients with grade Ⅰ to Ⅲ internal hemorrhoids was included. The follow-up was more than four weeks. No bleeding was observed after CAES. One(3.33%) patient claimed mild tenesmus within four days after CAES in that an endoscopist performed this procedure for the first time. One hundred percent of patients were satisfied with this novel procedure, especially for those patients who underwent CAES in conjunction with polypectomy or excision of anal papilla fibroma.CONCLUSION: CAES as a novel endoscopic sclerotherapy should be a convenient, safe and effective flexible endoscopic therapy for internal hemorrhoids.