Colonoscopy is a widely used diagnostic and therapeutic procedure. The impact of frailty on outcomes of hospitalized older patients undergoing colonoscopy is unclear. This study aims to evaluate associations between frailty and outcomes of hospitalized older adults undergoing colonoscopy.

Data were extracted from the Nationwide Inpatient Sample (NIS), 2016-2020. Hospitalized patients ≥ 65 years old who underwent colonoscopy were included. Frailty was assessed using a modified frailty index (mFI), and frail was defined as mFI ≥ 0.27. The primary outcomes were in-hospital mortality, nonroutine discharge, prolonged length of stay (LOS) (≥ 75th percentile), postprocedural dysrhythmia, and other postprocedural complications.

A total of 142 257 hospitalized older adults were included, with 29 558 categorized as frail. The mean age was 77 years, and 54% were males. Frail patients had significantly higher in-hospital mortality (2.7% vs. 1.7%), nonroutine discharge (27.8% vs. 19.6%), prolonged LOS (33.9% vs. 24.2%), and postprocedural dysrhythmia (46.3% vs. 29.2%) compared to nonfrail patients (all, p < 0.001). After adjusting for covariates, frailty remained significantly associated with increased risks of in-hospital mortality (odds ratio [OR] = 1.60), nonroutine discharge (OR = 1.62), prolonged LOS (OR = 1.62), and postprocedural dysrhythmia (OR = 2.12). Stratified analyses by sex and age obtained the same results across all subgroups.

Frailty is significantly associated with adverse outcomes in hospitalized older adults undergoing colonoscopy. These findings highlight the importance of increased periprocedural care for frail patients to improve clinical outcomes and optimize resource utilization.

Older patients with constipation are at an increased risk of inadequate bowel preparation.

To assess the effectiveness of an abdominal vibration combined with walking exercise (AVCWE) programme compared to walking exercise (WE) and standard preparation regimens for bowel preparation in older patients with constipation.

This three-arm randomised controlled trial involved 271 older patients with constipation scheduled for colonoscopy. Patients assigned to the AVCWE group were asked to walk independently for at least 5500 steps and received two cycles of moderate-intensity abdominal vibrations. Patients in the WE group were required to walk independently for at least 5500 steps, whereas patients in the control group received only the standard regimen. The primary outcome was the rate of adequate bowel preparation, defined as a total score of ≥ 6 on the Boston Bowel Preparation Scale.

The rate of adequate bowel preparation in the AVCWE group (92.2%) was significantly higher than in the WE group (78.9%) and the control group (60.4%) (p < 0.001). Additionally, the AVCWE group had statistically significant increases in adenoma detection rate (p = 0.003) and patient satisfaction (p < 0.001), and a reduced incidence of bloating (p = 0.016). Logistic regression analysis identified first colonoscopy (OR = 2.329), laxative use ≥ 3 times per week (OR = 2.675) and poor dietary compliance (OR = 2.249) as risk factors for inadequate preparation.

This provides empirical evidence suggesting that AVCWE may help improve bowel preparation quality among older patients with constipation.

Chinese Clinical Trial Registry, Number: ChiCTR2300067667.

Colorectal cancer (CRC) is the third most common cancer in the United States. Early detection through colonoscopy significantly improves survival rates. Detecting colon polyps depends on the quality of bowel preparation. However, inadequate bowel preparation remains a significant issue in clinical practice. Efforts to address this challenge have led to the development of bowel preparation regimens emphasizing efficacy, tolerability, and safety. Bowel preparation options can be categorized by their osmotic and volume properties. Isosmotic solutions based on polyethylene glycol-electrolyte lavage solutions (PEG-ELS) are available in both low-volume PEG-ELS with ascorbic acid (PEG-Asc) (e.g., MoviPrep, PLENVU) and high-volume formulations (e.g., GoLYTELY, CoLyte), as well as sulfate-free high-volume PEG-ELS formulations (SF-PEG-ELS). Hyperosmotic solutions include oral sulfate solution (OSS) (e.g., SUPREP), sodium phosphate tablets (NaP) (e.g., OsmoPrep), oral sulfate tablets (OST) (e.g., SUTAB), flavored PEG with sulfate salts (FPSS) (e.g., SUFLAVE), and magnesium citrate. Hypoosmotic solutions consist of PEG-sports drink (PEG-SD). In addition, combination solutions are available, such as sodium picosulfate with magnesium citrate (SPMC) with laxatives (e.g., CLENPIQ), and OSS with SF-PEG-ELS (Suclear). Each regimen differs in terms of cost, volume, taste, contraindications, and potential adverse effects. Therefore, clinicians must carefully evaluate each patient to determine the most suitable regimen for their patients.

This document is an update to the 2014 recommendations for optimizing the adequacy of bowel cleansing for colonoscopy from the US Multi-Society Task Force on Colorectal Cancer, which represents the American College of Gastroenterology, the American Gastroenterological Association, and the American Society for Gastrointestinal Endoscopy. The US Multi-Society Task Force developed consensus statements and key clinical concepts addressing important aspects of bowel preparation for colonoscopy. The majority of consensus statements focus on individuals at average risk for inadequate bowel preparation. However, statements addressing individuals at risk for inadequate bowel preparation quality are also provided. The quality of a bowel preparation is defined as adequate when standard screening or surveillance intervals can be assigned based on the findings of the colonoscopy. We recommend the use of a split-dose bowel preparation regimen and suggest that a 2 L regimen may be sufficient. A same-day regimen is recommended as an acceptable alternative for individuals undergoing afternoon colonoscopy, but we suggest that a same-day regimen is an inferior alternative for individuals undergoing morning colonoscopy. We recommend limiting dietary restrictions to the day before a colonoscopy, relying on either clear liquids or low-fiber/low-residue diets for the early and midday meals. We suggest the adjunctive use of oral simethicone for bowel preparation before colonoscopy. Routine tracking of the rate of adequate bowel preparations at the level of individual endoscopists and at the level of the endoscopy unit is also recommended, with a target of >90% for both rates.

This document is an update to the 2014 recommendations for optimizing the adequacy of bowel cleansing for colonoscopy from the US Multi-Society Task Force on Colorectal Cancer, which represents the American College of Gastroenterology, the American Gastroenterological Association, and the American Society for Gastrointestinal Endoscopy. The US Multi-Society Task Force developed consensus statements and key clinical concepts addressing important aspects of bowel preparation for colonoscopy. The majority of consensus statements focus on individuals at average risk for inadequate bowel preparation. However, statements addressing individuals at risk for inadequate bowel preparation quality are also provided. The quality of a bowel preparation is defined as adequate when standard screening or surveillance intervals can be assigned based on the findings of the colonoscopy. We recommend the use of a split-dose bowel preparation regimen and suggest that a 2 L regimen may be sufficient. A same-day regimen is recommended as an acceptable alternative for individuals undergoing afternoon colonoscopy, but we suggest that a same-day regimen is an inferior alternative for individuals undergoing morning colonoscopy. We recommend limiting dietary restrictions to the day before a colonoscopy, relying on either clear liquids or low-fiber/low-residue diets for the early and midday meals. We suggest the adjunctive use of oral simethicone for bowel preparation before colonoscopy. Routine tracking of the rate of adequate bowel preparations at the level of individual endoscopists and at the level of the endoscopy unit is also recommended, with a target of >90% for both rates.

Colonoscopy is the gold standard for early detection and monitoring of colorectal cancer. Procedural effectiveness is dependent on optimal bowel preparation. Traditional polyethylene glycol (PEG) solutions are difficult to tolerate, whereas newer low-volume alternatives, including PEG with ascorbic acid and oral sulfate solutions (OSS), offer improved efficacy and tolerability. The meta-analysis was performed to evaluate the efficacy and safety of OSS compared to PEG for bowel preparation in colonoscopy.

Studies were identified by searching PubMed, Embase, Cochrane CENTRAL, and clinicaltrials.gov from inception until June 2024. Only randomized controlled trials comparing OSS with PEG were included. Data was analyzed using R version 4.4.0 using a random effects model to calculate risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs).

Twenty-one studies with 6346 participants met the inclusion criteria. OSS significantly improved adenoma detection (RR, 1.13; 95% CI, 1.04-1.22; p-value <0.01; I2 = 0%) and polyp detection rates (RR, 1.16; 95% CI, 1.06-1.26; p-value <0.01; I2 = 0%), and had a higher Boston Bowel Preparation Scale (BBPS) score (MD, 0.31; 95% CI, 0.13-0.50; p-value <0.01; I2 = 81%). PEG was associated with more sleep disturbances (RR, 0.45; 95% CI, 0.25-0.82; p-value = 0.03; I2 = 0%). However, other adverse effects were similar between both solutions.

OSS demonstrated superior adenoma and polyp detection rates. When compared to PEG, patients utilizing OSS achieved higher BBPS scores. Data gleaned support enhanced cleansing efficacy and safety of OSS as a bowel preparation regimen.

This document is an update to the 2014 recommendations for optimizing the adequacy of bowel cleansing for colonoscopy from the US Multi-Society Task Force on Colorectal Cancer, which represents the American College of Gastroenterology and the American Society for Gastrointestinal Endoscopy. The US Multi-Society Task Force developed consensus statements and key clinical concepts addressing important aspects of bowel preparation for colonoscopy. The majority of consensus statements focus on individuals at average risk for inadequate bowel preparation. However, statements addressing individuals at risk for inadequate bowel preparation quality are also provided. The quality of a bowel preparation is defined as adequate when standard screening or surveillance intervals can be assigned based on the findings of the colonoscopy. We recommend the use of a split-dose bowel preparation regimen and suggest that a 2 L regimen may be sufficient. A same-day regimen is recommended as an acceptable alternative for individuals undergoing afternoon colonoscopy, but we suggest that a same-day regimen is an inferior alternative for individuals undergoing morning colonoscopy. We recommend limiting dietary restrictions to the day before a colonoscopy, relying on either clear liquids or low-fiber/low-residue diets for the early and midday meals. We suggest the adjunctive use of oral simethicone for bowel preparation before colonoscopy. Routine tracking of the rate of adequate bowel preparations at the level of individual endoscopists and at the level of the endoscopy unit is also recommended, with a target of >90% for both rates.

Background Colorectal cancer (CRC) is a leading cause of cancer-related mortality worldwide. Colonoscopy is the gold standard for CRC screening, but its effectiveness depends on bowel preparation quality. This study compares polyethylene glycol (PEG)-based MoviPrep (Norgine Limited, Hengoed, UK) and sodium picosulfate-based Picolax (Ferring GmbH, Kiel, Germany) in terms of bowel cleansing quality, caecal and ileal intubation rates, and adenoma detection rate (ADR). Methods This retrospective observational study analysed 6,921 colonoscopies performed at University Hospital Crosshouse between June 2020 and June 2023. Bowel preparation quality was assessed using the modified Ottawa Bowel Preparation Scale, categorised as Excellent, Good, Fair, or Inadequate. ADR was determined by histologically confirmed adenomas. Statistical comparisons between the two groups were performed using chi-square tests. Results MoviPrep was used in 6,219 (89.9%) of cases, while Picolax was used in 702 (10.1%) cases. MoviPrep was associated with a lower inadequate preparation rate (343 (5.5%) vs. 63 (9.0%)), a higher caecal intubation rate (3,675 (59.1%) vs. 307 (43.7%)) and ileal intubation rate (1,119 (18.0%) vs. 81 (11.5%)), and a higher ADR (2,295 (36.9%) vs. 167 (23.8%)). Conclusion MoviPrep demonstrated superior bowel cleansing, higher completion rates, and greater adenoma detection, supporting its use as a preferred bowel preparation method for colonoscopy in clinical practice.

This study aimed to evaluate the association between cholecystectomy and colonic bubble formation during colonoscopy, METHODS: A single-center retrospective cohort study was conducted at Staten Island University Hospital. Researchers reviewed 348 colonoscopy reports, comparing patients with (n = 56) and without (n = 292) a history of cholecystectomy. Colonic bubble formation was assessed using a 0-3 scale (0 = no bubbles, 3 = severe bubbles). Secondary endpoints included polyp and adenoma detection, withdrawal and procedure times, bowel preparation quality, and repeat procedures. Statistical analysis included t-tests, Mann-Whitney U tests, and χ2 tests.

Patients with prior cholecystectomy had significantly higher incidence of severe bubble formation (score 3; 28.6% vs. 12%, p = 0.001), longer withdrawal times (18 ± 8 vs. 15 ± 5 min, p = 0.024), and increased need for repeat colonoscopies (10.7% vs. 2.1%, p = 0.001). No significant differences were found in adenoma detection, polyp detection, or bowel preparation quality between the two groups.

Cholecystectomy is associated with increased colonic bubble formation during colonoscopy, leading to longer withdrawal times and higher rates of repeat procedures. While this study did not find a difference in adenoma detection rates, the impaired visualization caused by bubbles may necessitate tailored bowel preparation strategies for patients with a history of cholecystectomy to optimize colonoscopy effectiveness.

The risk of colorectal advanced adenomas (CAAs) and colorectal cancer (CRC) in siblings aged ≤ 50 of patients diagnosed with early-onset CAAs (E-CAAs), defined as having CAA at or below 50 years, is poorly understood. This study examined the risks of adenomas, CAA, and CRC in siblings aged ≤ 50 of patients diagnosed with E-CAA.

This case-control study was conducted at a tertiary hospital in Vietnam. The participants included 96 cases who were siblings aged ≤ 50 of patients diagnosed with E-CAA. Controls were randomly selected from consecutive patients aged ≤ 50 who did not have siblings diagnosed with E-CAA. Controls were matched to cases in a 2:1 ratio for age, sex, and smoking status.

The mean age was similar between cases (40.9 ± 6.0 years) and controls (41.1 ± 6.0 years). Except for indications for colonoscopy, there were no significant differences in the baseline demographics between the two groups. A heightened risk of CAA was documented in cases compared with controls (odds ratio [OR] 6.33; 95% confidence interval [CI] 1.43-43.8; P = 0.018). This increased risk was more pronounced in males (OR 13.7; 95% CI 1.23-262; P = 0.006). Cases had higher risks of colorectal adenomas (OR 2.43; 95% CI 1.27-4.67; P = 0.009) and colorectal neoplasia (OR 2.33; 95% CI 1.24-4.40; P = 0.011) than those in controls.

Siblings aged ≤ 50 of patients diagnosed with E-CAA have an increased risk of adenomas, CAA, and colorectal neoplasia. CRC screening should be initiated early in these high-risk individuals.

Background: This study aims to objectively evaluate the overall quality of colonoscopies using a specially trained deep learning-based semantic segmentation neural network. This represents a modern and valuable approach for the analysis of colonoscopy frames. Methods: We collected thousands of colonoscopy frames extracted from a set of video colonoscopy files. A color-based image processing method was used to extract color features from specific regions of each colonoscopy frame, namely, the intestinal mucosa, residues, artifacts, and lumen. With these features, we automatically annotated all the colonoscopy frames and then selected the best of them to train a semantic segmentation network. This trained network was used to classify the four region types in a different set of test colonoscopy frames and extract pixel statistics that are relevant to quality evaluation. The test colonoscopies were also evaluated by colonoscopy experts using the Boston scale. Results: The deep learning semantic segmentation method obtained good results, in terms of classifying the four key regions in colonoscopy frames, and produced pixel statistics that are efficient in terms of objective quality assessment. The Spearman correlation results were as follows: BBPS vs. pixel scores: 0.69; BBPS vs. mucosa pixel percentage: 0.63; BBPS vs. residue pixel percentage: -0.47; BBPS vs. Artifact Pixel Percentage: -0.65. The agreement analysis using Cohen's Kappa yielded a value of 0.28. The colonoscopy evaluation based on the extracted pixel statistics showed a fair level of compatibility with the experts' evaluations. Conclusions: Our proposed deep learning semantic segmentation approach is shown to be a promising tool for evaluating the overall quality of colonoscopies and goes beyond the Boston Bowel Preparation Scale in terms of assessing colonoscopy quality. In particular, while the Boston scale focuses solely on the amount of residual content, our method can identify and quantify the percentage of colonic mucosa, residues, and artifacts, providing a more comprehensive and objective evaluation.

Small bowel capsule endoscopy (SBCE) is crucial in diagnosing small bowel diseases, yet incomplete examinations often result from prolonged gastric transit time. This study aimed to assess the efficacy of orally administered peppermint oil solution as a prokinetic agent to improve SBCE completion rates in patients with delayed gastric transit risk factors.

Conducted as a single-center, prospective, open-label, non-inferiority trial, the study involved 132 patients identified as at risk for delayed gastric transit. Participants were divided into three groups: peppermint oil solution group (n = 57), real-time monitoring and intravenous prokinetics group (n = 75), and control group without risk factors (n = 193). Primary outcomes included SBCE completion rates, gastric transit time (GTT), small bowel transit time (SBTT), diagnostic yield, and bowel preparation quality.

Completion rates were high and comparable among groups, with 94.7% in the peppermint group, 90.7% in the real-time monitoring group, and 95.3% in the control group. The peppermint group exhibited a significantly shorter mean GTT of 42.3 minutes compared with 57.0 minutes in the real-time monitoring group ( P = 0.0423). However, SBTT was longer in the peppermint group at 246 minutes versus 193 minutes in the real-time monitoring group ( P = 0.0081), although similar to the control group at 228.3 minutes ( P = 0.2612). Diagnostic yield and bowel preparation quality were consistent across all groups.

Oral peppermint oil solution is a safe and effective alternative to traditional prokinetics, enhancing SBCE completion rates while reducing time and resource use in the endoscopy unit.

The UN General Assembly (UNGA) stated that the right-to-water entitles everyone to accessible and affordable water. People living with cancer (PLWC) need water for numerous reasons including hydration, personal hygiene and infection control. In 2023, reports emerged of PLWC in Lincolnshire (UK) disconnecting their water supply from cost fears. We report on innovative ways to ease financial burden and provide equitable and affordable access to clean water for PLWC in rural and coastal settings.

Quantitative data from secondary care and qualitative data from community-practitioners investigating PLWC's difficulties in accessing a clean and safe water supply were synthesised. A review of existing financial support identified no services directly addressing water. The Lincolnshire Living with Cancer Team approached water provider, Anglian Water sharing concerns, identifying common values, and confirming shared aims. A formal partnership was established to address these inequalities.

Initial data reviews showed completion of 25,858 Extra Care Assessments between Jan-Sept 2023 (12 % increase on previous year). This has enabled over 30,000 people with long-term conditions, including PLWC, to access clean and affordable water, a personalised support package for their water bill, including income maximisation, debt management, payment breaks, and bill reductions.

Impacts of cancer extend beyond physical health, with many PLWC reporting financial distress. Some PLWC have taken extreme measures to reduce their water consumption when they actually need increased water volumes. A partnership approach between health, voluntary and community sectors with a water provider can help address these inequalities.

The study addresses national policy (NHS Long Term Plan 2019) by demonstrating how personalisation can be achieved for PLWC in a rural and coastal county. Internationally, it aligns to The European Code of Cancer Practice and seeks to contribute to its implementation UNGA Resolution 64/292, the universal human right to water and sanitation.

Poor bowel preparation has been a great problem of endoscopists for a long time. Low-residue diet (LRD) is often recommended on the day before colonoscopy. However, the quality of bowel preparation with LRD alone is suboptimal. The aim of our study was to examine whether patients who consumed LRD with oral nutritional supplements (ONSs) had higher quality of bowel preparation than patients who consumed LRD alone before colonoscopy.

An endoscopist-blinded, randomized controlled trial was conducted in inpatients who scheduled for colonoscopy with sedation. Patients were randomized to the non-ONS group and the ONS group. The primary outcomes were the rates of adequate bowel preparation measured by the Boston Bowel Preparation Scale (BBPS), the Ottawa Bowel Preparation Scale (OBPS) and the Colon Endoscopic Bubble Scale (CEBuS). The secondary outcomes were the adenoma detection rate (ADR), polyp detection rate (PDR), intubation time, withdrawal time and rates of adverse events.

In both groups, 100 patients were analyzed. The rates of adequate bowel preparation measured by the BBPS and OBPS and PDR were significantly higher in the ONS group than in the non-ONS group (all P < 0.05). However, no significant differences were observed in the CEBuS scores, ADR, intubation time and rates of adverse events between the two groups (all P > 0.05). The withdrawal time was longer in the non-ONS group than the in the ONS group (P < 0.05).

LRD with ONSs helps increase the quality of bowel preparation. To help with colorectal cancer (CRC) screening, further studies are warrant.

[Chinese Clinical Trial Registry], [ChiCTR2400091660], [31/10/2024], [Retrospectively registered].

Acromegaly is associated with a possible increased risk of neoplasias, like colorectal cancer (CRC), although magnitude of this risk is unclear.

Evaluate frequency of colonic adenomatous polyps and CRC in patients with acromegaly at first and subsequent colonoscopies; correlate risk factors of CRC and disease activity of acromegaly with colonoscopy findings and analyze relationship of acromegaly as a risk factor for CRC and the best period for screening this neoplasia.

Patients ≥18 years-old with acromegaly were included. A questionnaire involving characteristics of follow-up of acromegaly and risk factors of CRC was created. Biochemical and colonoscopic data were collected through medical records. Only full-length colonoscopies with satisfactory colonic preparation were included.

123 patients (77 women) were included (mean age at diagnosis of 43.1 years and mean follow-up of 13.7 years). In baseline colonoscopy, 80.5% had non-neoplastic findings, 14.6% non-advanced adenomas, 3.3% advanced adenomas and 1.6% CRC. At end of the study, 3 (2.4%) patients were diagnosed with CRC. No patient under 50 years had a neoplastic lesion on colonoscopy. We observed a positive statistically significant relationship between smoking (p = 0.026), age at diagnosis of acromegaly (p < 0.001), age at baseline colonoscopy (p = 0.002), and risk of adenomas and/or CRC at initial colonoscopy.

Smoking and advanced age were positively related to a higher risk of developing premalignant/malignant colonic lesions. Age ( > 50 years) was the most robust variable. Our data suggest that screening age for CRC in acromegaly should be reviewed.

Post-colonoscopy colorectal cancer (PCCRC), defined as colorectal cancer (CRC) detected after a cancer-negative colonoscopy, represents a key quality indicator for CRC detection and prevention. While most PCCRC is attributed to missed lesions, few studies examine pathologic and molecular characteristics of PCCRC to assess for possible de novo cancer formation causing PCCRC.

The aim of this study was to identify cases of PCCRC where prior colonoscopy was adequate (A-PCCRC) versus inadequate (I-PCCRC) and compare both subtypes with spontaneous CRC (sCRC) in terms of patient factors, histopathology and molecular characteristics.

This was a 12-year retrospective population-based study using a data set from the Western Australian Cancer Registry between 2000 and 2011. A-PCCRCs were identified by excluding lesions likely missed due to procedural factors or incomplete prior resection at index colonoscopy performed within 3-36 months of cancer diagnosis. Histopathological review and next-generation sequencing were conducted on subsets of patients with A-PCCRC and sCRC. Statistical analysis included univariable and multivariable regression models and chi-squared and Wilcoxon rank sum tests.

A total of 524 (3.81%) cases of PCCRC were identified out of 13 757 cases of CRC; 272 were A-PCCRC (1.98%) and 252 I-PCCRC (1.83%). Female sex, older age and proximal location were associated with A-PCCRC. Mutations in the PIK3CA gene were less common in A-PCCRC compared to sCRC.

A significant percentage of PCCRC occurred despite adequate prior colonoscopy. Missed sessile serrated lesions may contribute to many of these cases; however, further studies are required to examine possible de novo cancer as a cause of PCCRC that may involve unique biological pathways.

The aim of this study is to compare the results of repeat colonoscopies performed on the same day and by appointment in patients with inadequate bowel cleansing.

The study was designed as a prospective randomized controlled study. Eighty patients with inadequate bowel cleansing detected in elective colonoscopies were included in the study. Patients were randomly divided into 2 groups: Group I: Same day group and Group II: Appointment day group. Same day colonoscopy group was given day hospitalization, sennoside A+B calcium was given and colonoscopy procedure was repeated. Patients in Group II were rescheduled and standard colonoscopy preparation protocol was applied. Boston bowel preparation scale (BBPS) was used for bowel preparation quality. Cecal intubation time, cecal intubation rate, procedure time, BBPS score and polyp detection rate were compared between the groups.

In the same-day group, 52.5% of the patients were female while 45.9% were female in the appointment group. There was no significant difference between the two groups in terms of age or gender (p>0.05). The rate of cecum intubation was higher in the same-day group than it was in the appointment group (p=0.022). The total BBPS score was 7.9±1.79 in the same-day group and 6.89±2.23 in the appointment group, and the difference was statistically significant (p=0.03). When the two groups were compared in terms of tolerability of the procedure, no difference was detected (p>0.05).

Same-day colonoscopy is an effective method and can be performed safely in patients with inadequate bowel cleansing.

Adenoma detection rate (ADR) is a key performance measure with variability among endoscopists. Artificial intelligence (AI) in colonoscopy could reduce this variability and has shown to improve ADR. This study assessed the impact of AI on ADR among Danish endoscopists of varying experience levels.

We conducted a prospective, quasi-randomized, controlled, multicenter trial involving patients aged 18 and older undergoing screening, surveillance, and diagnostic colonoscopy at four centers. Participants were assigned to AI-assisted colonoscopy (GI Genius, Medtronic) or conventional colonoscopy. Endoscopists were classified as experts (> 1000 colonoscopies) or non-experts (≤ 1000 colonoscopies). The primary outcome was ADR. We performed a subgroup analysis stratified on endoscopist experience and a subset analysis of the screening population.

A total of 795 patients were analyzed: 400 in the AI group and 395 in the control group. The AI group demonstrated a significantly higher ADR than the control group (59.1% vs. 46.6%, P < 0.001). The increase was significant among experts (59.9% vs. 47.3%, P < 0.002) but not among non-experts. AI assistance significantly improved ADR (74.4% vs. 58.1%, P = 0.003) in screening colonoscopies. Polyp detection rate (PDR) was also higher in the AI group (69.8% vs. 56.2%, P < 0.001). There was no significant difference in the non-neoplastic resection rate (NNRR) (15.1% vs. 17.1%, P = 0.542).

AI-assisted colonoscopy significantly increased ADR by 12.5% overall, with a notable 16.3% increase in the screening population. The unchanged NNRR indicates that the higher PDR was due to increased ADR, not unnecessary resections.

Adequate bowel preparation is indispensable for high-quality colonoscopy. We have developed an ultralow-volume (500 mL) polyethylene glycol (PEG) combined with other laxatives (sennoside, sodium picosulfate, and lactulose) and applied this regimen clinically to all patients with colonoscopy for 3 decades. This study aimed to assess the effectiveness of this ultralow-volume bowel preparation regimen.

This single-center, retrospective study analyzed data from consecutive outpatients who underwent colonoscopy between January 2022 and December 2022. All the patients took sennoside (24 mg) two nights before, sodium picosulfate (75 mg) one night before, and 500 mL of PEG with lactulose (58.5 g) on the day of examination. Cleaning efficacy was evaluated using the Boston Bowel Preparation Scale (BBPS). Adequate bowel preparation was defined as a total BBPS score ≥6, with all colon segments scoring ≥2.

Out of 862 patients with colonoscopy, 773 were eligible for this study, and the median age was 66 years. The adequate bowel preparation rate was 91.8% (710/773). Notably, the BBPS full score "9" was observed in 50.5% (390/773). The median cecal intubation time and examination time were 8 and 20 min, respectively. Only 3 patients vomited as a side effect. In the multivariate analysis, age ≥70 years, diabetes mellitus, and diverticula were significantly independent risk factors for inadequate bowel preparation.

Our established ultralow-volume (500 mL) PEG is safe and useful as a bowel preparation method.

Colonoscopy is the standard diagnostic method for colorectal cancer. Patients usually receive written and verbal instructions for bowel preparation (BP) before the procedure. Failure to understand the importance of BP can lead to inadequate BP in 25%-30% of patients. The quality of BP impacts the success of colonoscopy in diagnostic yield and adenoma detection. We developed the "ColonClean" mobile health (mHealth) app for Android devices. It incorporates visual representations of dietary guidelines, steps for using bowel cleansing agents, and observations of the last bowel movement. We used the Technology Acceptance Model to investigate whether the use of the ColonClean mHealth app can improve users' attitudes and behaviors toward BP.

This study aims to validate the effectiveness of the ColonClean app in enhancing user behavior and improving BP, providing safe and cost-effective outpatient colonoscopy guidance.

This study uses a structured questionnaire to assess perceived usefulness, perceived ease of use, and users' attitudes and behaviors toward BP regarding the ColonClean mHealth app. A total of 40 outpatients who were physically and mentally healthy and proficient in Chinese were randomly chosen for this study. The data were analyzed using SPSS 25.0, and we used Pearson product-moment correlation and simple regression analysis to predict the perception of ColonClean.

The results showed that 75% (30/40) of participants achieved an "excellent" or "good" level of BP according to the Aronchick Bowel Preparation Scale. Perceived usefulness and perceived ease of use of the ColonClean mHealth app were positively correlated with users' attitudes and behaviors (P<.05).

The ColonClean mHealth app serves as an educational reference and enhances the effectiveness of BP. Users expressed their willingness to use the app again in the future and recommend it to family and friends, highlighting its effectiveness as an educational guide for BP.

High-quality bowel preparation is paramount for a successful colonoscopy. This study aimed to explore the effect of artificial intelligence-driven smartphone software on the quality of bowel preparation.

Firstly, we utilized 3305 valid liquid dung images collected via mobile phones as training data. the most effective model was employed on mobile phones to evaluate the quality of bowel preparation. Secondly, From May 2023 to September 2023, colonoscopy patients were randomly assigned to two groups - the AI group (n = 116) and the control group (n = 116) - using a randomized, controlled, endoscopist-blinded method. We compared the two groups in terms of Boston Bowel Preparation Scale (BBPS) scores, polyp detection rate, adverse reaction rate, and factors related to bowel preparation quality. The primary endpoint was the percentage of patients who achieved a BBPS ≥6 among those who effectively utilized the smartphone software.

EfficientNetV2 exhibited the highest performance, with an accuracy of 87%, a sensitivity of 83%, and an AUC of 0.86. In the patient validation experiment, the AI group had higher BBPS scores than the control group (6.78 ± 1.41 vs. 5.35 ± 2.01, p = 0.001) and showed an improvement in the detection rate (71.55% vs. 56.90%, p = 0.020) for polyps. Multifactor logistic analysis indicated that compliance with enema solution usage rules (OR: 5.850, 95% confidence interval: 2.022-16.923), total water intake (OR: 1.001, 95% confidence interval: 1.001-1.002), and AI software reminders (OR: 2.316, 95% confidence interval: 1.096-4.893) were independently associated with BBPS scores ≥6.

Compared with traditional methods, the use of artificial intelligence combined with software to send reminders can lead to more accurate assessments of bowel preparation quality and an improved detection rate for polyps, thus demonstrating promising clinical value.

Segmental colitis associated with diverticulosis (SCAD) is characterized by a chronic inflammatory response involving the inter-diverticular colonic mucosa, sparing the rectum and the right colon.

to assess the prevalence of SCAD in a CRC screening program and to evaluate the differences in terms of oncological outcomes between SCAD and diverticulosis.

retrospective analysis from a prospectively-maintained database including all subjects undergoing first screening colonoscopy.

1518 patients were included (51.8 % male, mean age 63.48 ± 6.39). Adenomas were detected in 638 patients (ADR 42 %), CRC was diagnosed in 5.7 %. Diverticulosis was described in 37.5 %, while SCAD in 4.5 %. Among them, 69.6 % presented crescentic-fold disease, 20.3 % mild-to-moderate UC-like pattern, 8.7 % CD-like pattern and 1.4 % severe UC-like pattern. When SCAD was compared to uncomplicated/asymptomatic diverticulosis (501 patients), we found no differences in terms of gender (p = 0.46) or age (p = 0.47). Interestingly, the use of anticoagulant/antiplatelet (p = 0.79), anti-hypertensive (p = 0.89) or anti-hyperglycaemic drugs (p = 0.52) had no effect on SCAD onset as compared to diverticulosis. SCAD patients had significant lower rate of adenomas (ADR 31.9% vs 47.3 %, p = 0.018, OR 0.52, 95 %CI 0.31-0.89), and lower-but not significant-rate of CRC (1.4% vs 6.2 %, p = 0.14, OR 0.22, 95 %CI 0.02-1.66).

SCAD can be diagnosed in about 5 % of population undergoing screening colonoscopy and in 12 % of those with diverticulosis. SCAD seems to be associated with a reduced rate of adenomas or CRC as compared with diverticulosis.

Colonoscopy is widely used as a diagnostic and preventive procedure for colorectal diseases. The most recent guidelines advocate the use of a low-residue diet (LRD) for bowel preparation before colonoscopy. LRD duration varies considerably, with recommended 1-day and multiple-day regimens in clinical practice.

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched multiple databases for randomized controlled trials (RCTs) and analyzed the outcomes using a fixed-effects model.

Six RCTs with 2,469 subjects were included in this study. The rates of adequate bowel preparation for 1-day and >1-day were 87.2% and 87.1%, respectively. No statistically significant differences were observed between the 1-day and >1-day LRD in adequate bowel preparation (odds ratio [OR], 1.03; 95% confidence interval [CI], 0.76-1.41; p=0.84; I2=0%), polyp detection rate (OR, 0.91; 95% CI, 0.76-1.09; p=0.29; I2=16%), adenoma detection rate (OR, 0.87; 95% CI, 0.71-1.08; p=0.21; I2=0%), and withdrawal time (mean difference, -0.01; 95% CI, -0.25 to 0.24; p=0.97; I2=63%).

The efficacy of 1-day and multiple-day LRD is comparable in achieving satisfactory bowel preparation, highlighting their similar impact on the detection of polyps and adenomas during colonoscopy.

Colorectal cancer (CRC) causes substantial morbidity and mortality internationally. In Hungary, the incidence and mortality of CRC are among the world's highest. Fortunately, CRC is a highly preventable disease, since there is a long asymptomatic phase before neoplastic transformation. Numerous countries have instituted programs for CRC screening. However, Hungary did not implement population-based screening programs until December 2018, consisting of a voluntary 2-step screening program based on the fecal immunochemical test (FIT) and if positive, referral to colonoscopy. Asymptomatic individuals aged over 50 years were invited to participate in the 2-step program. This study aims to analyze the results of these colonoscopies and raise public awareness of the CRC disease process and prevention, especially in Hungary.

Various literature sources were reviewed, and external information was gathered and consolidated based on CRC etiopathogenesis, management options, screening options, cost, benefits, modalities, and quality control. Semmelweis University Department of Internal Medicine and Hematology's database was accessed for the cross-sectional study results of 168 screening colonoscopies within the 2-step program from 2019 to 2020. I quantified and compared the results obtained during the colonoscopies with that of said literature within Hungary and worldwide.

Colonoscopy was performed in 168 patients of average age 63.4 years. The incidence of CRCs in the population was 4.76%. Among the CRC cases, 75% were in the rectosigmoid area and 25% were in the remaining colon. The total adenoma detection rate (ADR) in the study was 57.1%, higher than the recommended 25% for adequate screening colonoscopy. The total number of resected polyps was 270; 8.1% were adenomas with high-grade dysplasia and 0.76% contained CRC. Out of the 185 resected adenomas, 141 were tubular, 34 were tubulovillous, and 10 were villous. Adenoma localizations included 14.6% rectum, 38.4% sigmoid, 11.9% descending colon, 8.6% transverse colon, 17.8% ascending colon, and 8.6% cecum. The average age of CRC patients was 63.9 years (range, 56-68 years) with a slight female predominance (5 females, 3 males). The ADR of the different endoscopists did not seem to correlate with experience. Optimal participation rate of the screening program would be >60%. Population outreach through mailed FIT is evidence-based and shown to increase CRC screening rates in underserved populations.

Hungary would benefit immensely in most aspects from mandatory, population-based CRC screening with this 2-step program. This alternative is proposed in lieu of 1-step screening, because of the limited capacity for colonoscopy in the country and the limited participation rates in the screened population. To reach maximum cost-benefit, the participation rate of the screened population must be >60%, with >80% of FIT positive test results being referred to colonoscopy. Consolidation and distribution of the screening program through population outreach will bring about substantial reductions in mortality from CRC. Further studies are warranted on the feasibility and sustainability of this 2-step program.

Colonoscopy plays a crucial role in the early diagnosis and treatment of colorectal cancer. Adequate bowel preparation is essential for clear visualization of the colonic mucosa and lesion detection. However, inadequate bowel preparation is common in patients with constipation, and there is no standardized preparation protocol for these patients. This study aimed to explore the effectiveness and tolerability of a pre-colonoscopy combination regimen of linaclotide and polyethylene glycol (PEG).

In this prospective, single-center, randomized controlled trial, 322 participants were divided into two groups: a 3-L PEG + 870-μg linaclotide group (administered as a single dose for 3 days) and a 4-L PEG group. The primary endpoints were the Boston Bowel Preparation Scale (BBPS) score and the rate of adequate and excellent bowel preparation. Secondary endpoints were the rates of detection of colonic adenomas and polyps, cecal intubation rates, colonoscopy time, adverse reactions, patient satisfaction, and physician satisfaction.

The study included 319 patients. The 3-L PEG + linaclotide group showed significantly higher rates of adequate and excellent bowel preparation than the 4-L PEG group (89.4% vs 73.6% and 37.5% vs 25.3%, respectively; P < 0.05). The mean BBPS score for the right colon in the 3-L PEG + linaclotide group was significantly higher than that in the 4-L PEG group. There were no significant between-group differences regarding the detection rates of colonic polyps and adenomas (44.4% vs 37.7% and 23.1% vs 20.1%, respectively; P > 0.05). There were no significant between-group differences regarding cecal intubation rates, colonoscopy operation, and withdrawal times. However, patient tolerance and sleep quality were better in the 3-L PEG + linaclotide group.

The combination of 3-L PEG and 870-μg linaclotide, because of its lower volume of intake, can be considered as an alternative bowel preparation regimen for constipated patients undergoing colonoscopy, especially for the elderly.

Several randomized clinical trials comparing different bowel preparations (BP) have shown similar efficacy; however, there is a lack of real-world studies on this topic.

This study aims to identify the most effective BP regimen in a real-world setting and any predictors of inadequate BP.

A retrospective single-center study was conducted over 14 months at an academic hospital including outpatient colonoscopies in which adult patients did not teach on how to perform BP before colonoscopy. Colonoscopies with 1L-PEG, 2L-PEG and picosulphate mixtures were considered. A multivariable analysis for factors associated to poor BP was fitted.

Overall, 1779 patients (51 %F, 60±14) years were included. The 1L-PEG regimen provided a higher rate of BP adequacy at multivariate analysis (adjusted OR 2.30, 95 %CI 1.67-3.16,p < 0.001) and was associated with higher median Boston Bowel Preparation Scale score (p < 0.001), higher rate of right-colon cleansing (p < 0.001) and exam completion (p = 0.04). Furthermore, we identified male sex, history of constipation, active smoking, previous pelvic surgery, concomitant psychiatric/neurological or chronic kidney diseases as predictors of inadequate BP.

This is the largest real-world study comparing 1L-PEG to other BP regimens. Our results suggest 1L-PEG provides better BP in a non-controlled setting, improving clinical practice quality and minimizing the need for repeated colonoscopies and saving healthcare resources.

Colorectal cancer is the third most common cancer in the United States, with colonoscopy being the preferred screening method. Up to 25% of colonoscopies are associated with poor preparation which leads to prolonged procedure time, repeat colonoscopies, and decreased adenoma detection. Artificial intelligence (AI) is being increasingly used in medicine, assessing medical school exam questions, and writing medical reports. Its use in gastroenterology has been used to educate patients with cirrhosis and hepatocellular carcinoma, answer patient questions about colonoscopy and provide correct colonoscopy screening intervals, having the ability to augment the patient-provider relationship. This study aims at assessing the accuracy of a ChatGPT-generated precolonoscopy bowel preparation prompt.

A nonrandomized cross-sectional study assessing the perceptions of an AI-generated colonoscopy preparation prompt was conducted in a large multisite quaternary health-care institution in the northeast United States. All practicing gastroenterologists in the health system were surveyed, with 208 having a valid email address and were included in the study. A Research Electronic Data Capture survey was then distributed to all participants and analyzed using descriptive statistics.

Overall, 91% of gastroenterologist physicians determined the prompt easy to understand, 95% thought the prompt was scientifically accurate and 66% were comfortable giving the prompt to their patients. Sixty four percent of reviewers correctly identified the ChatGPT-generated prompt, but only 32% were confident in their answer.

The ability of ChatGPT to create a sufficient bowel preparation prompt highlights how physicians can incorporate AI into clinical practice to improve ease and efficiency of communication with patients when it comes to bowel preparation.

The performance of bowel preparation (BP) in patients with Crohn's disease (CD) is unknown.

To evaluate the operating properties of instruments used to assess BP quality in patients with CD.

We used the Boston Bowel Preparation Scale, modified Boston Bowel Preparation Scale, Harefield Cleansing Scale, Food and Drug Administration Bowel Cleansing Assessment Scale (BCAS), and a 100-mm visual analogue scale of bowel cleanliness to assess BP quality in 50 videos from 40 patients with CD. We assessed endoscopic activity with the Simple Endoscopic Score for CD (SES-CD). Assessments were on endoscope insertion and withdrawal. Reliability was quantified using the intraclass correlation coefficient (ICC). We assessed validity by within-patient correlation between instruments and the visual analogue scale using mixed-effect models. The correlation between BP quality and SES-SD scores was assessed using Spearman's rho.

Inter- and intra-rater reliability for all BP quality instruments was substantial (ICC ≥0.61) except for the Food and Drug Administration BCAS on insertion (inter-rater reliability ICC ≥0.41). The visual analogue scale had substantial inter- and almost perfect (ICC ≥0.81) intra-rater reliability. Correlation coefficients for the validity of the instruments exceeded 0.58. BP quality and endoscopic disease activity scores in the colon were negatively correlated.

Most existing instruments reliably assess BP quality in patients with CD. These results support the use of these instruments in clinical practice, provide a framework for scoring BP quality in CD clinical trials, and support evaluation of novel BP agents in patients with CD.

Magnetic resonance enterography (MRE) has become a routine intestinal imaging examination for Crohn's disease (CD). Sufficient bowel preparation is fundamental for MRE.

To compare the efficacy and compliance of bowel preparation between through a mid-gut tube and oral administration for MRE in CD.

This was an open-label, prospective, multicenter, randomized controlled trial.

Eligible patients were randomized at a 1:1 ratio into an oral group (bowel preparation by oral administration) and a tubing group (bowel preparation through a mid-gut tube). Bowel preparation for MRE included bowel cleaning and bowel distention. The primary outcomes were the degree of discomfort and grade of bowel distention. The secondary outcomes were diagnostic accuracy rate through MRE, mental stress, and bowel preparation method preference.

A total of 95 CD patients were included in the final analysis. Subjects in the tubing group complained of less vomiting during bowel preparation than those in the oral group (p < 0.05). The degree of nausea and bloating during bowel cleaning for MRE was lower in the tubing group than in the oral group (all p < 0.05). The distention grade was higher in the tubing group compared to the oral group in the splenic flexure of the colon and rectosigmoid colon. The tubing group demonstrated a higher overall diagnostic sensitivity in ulcers compared to the oral group (p = 0.048). Additionally, bowel preparation via the mid-gut tube ameliorated mental stress (p = 0.020) and increased bowel preparation preference (p < 0.001).

Bowel preparation through the mid-gut tube enhanced the efficacy and compliance for MRE in CD. This study highlighted the concept of physician-patient satisfaction using mid-gut tube for proper bowel preparation for MRE, enteral nutrition and microbial therapy.

ClinicalTrials.gov, NCT03541733, registered 5 May 2018.

Colonoscopy is a key procedure for the early detection of colorectal cancer. Despite its importance, the discomfort associated with colonoscopy often requires sedation, and the ideal sedation regimen remains to be determined. In this prospective randomized controlled trial, patients scheduled for colonoscopy were randomly assigned to two different sedation protocols. Group A received a combination of midazolam and propofol, while group B was given midazolam and pethidine. The study analyzed data from 51 patients, with 23 in group A and 28 in group B. The incidence of adverse events was similar across both groups. Additionally, no significant differences were observed in cecal intubation times or total procedure durations. Notably, group A had a lower frequency of required postural changes (1.0±.7 vs. 1.5±0.7, p=0.02) and a reduced rate of manual compression (52.2% vs. 82.1%, p=0.02). There were no significant differences between the groups regarding subjective pain or overall satisfaction. Both sedation regimens were found to be safe and effective. The midazolam and propofol combination was associated with a smoother procedure, evidenced by fewer postural adjustments and less manual compression needed during colonoscopy.

Colonoscopy is an essential method for diagnosing and treating colorectal cancer, relying on effective bowel preparation to thoroughly examine the large intestinal mucosa. Traditional education involves printed instructions and verbal explanations but does not guarantee clear patient understanding. Poor bowel preparation can obscure mucosal visibility, delaying cancer diagnosis and treatment. A mobile medical model using Android devices for bowel preparation education was tested in a single-blind, randomized trial. This trial enrolled outpatients undergoing colonoscopy at the Endoscopy Center for Diagnostic and Treatment between 27 October 2021 and 31 December 2022. This study introduced the ColonClean app alongside traditional methods. After examination, endoscopists rated the preparation quality using the Aronchick scale. A data analysis was conducted using SPSS 25.0 to determine if there was a significant improvement in bowel preparation quality between the control group (traditional method) and the experimental group (traditional method plus the ColonClean app). Forty patients were recruited in each group. In the experimental group, all ratings were "fair", with 75% receiving an "excellent" or "good" rating, showing statistical significance (p = 0.016). The ColonClean app improves bowel preparation quality more effectively than traditional care instructions.

This study aimed to compare the accuracy of polyp size measurements using a virtual scale endoscope (VSE) with an integrated laser-based adaptive scale function and visual assessment (VA) during colonoscopies.

We conducted a single-blinded, prospective randomized controlled trial. Eligible patients (aged 45-80 years) undergoing screening, surveillance, or diagnostic colonoscopies were randomly assigned (1:1) into 2 groups. In the intervention group, all detected polyps were measured for size using VSE; in the control group, all polyps were measured using VA. Size measurements were compared with a reference standard of digital caliper measurement immediately post polypectomy. The primary outcome was the relative accuracy of real-time VSE measurement compared with VA. Secondary outcomes included the mean differences and the correlations between VSE or VA sizes and the reference standard of measurement.

Overall, 230 patients were enrolled and randomized. The relative size measurement accuracy of VSE was 84% in 118 polyps, which was significantly higher than that of VA (105 polyps; 68.4%, P < 0.001). VSE resulted in a significantly higher percentage of size measurements within 25% of true size compared with VA (81.4% vs 41%, P < 0.001). VSE had a significantly lower percentage for >5-mm polyps incorrectly sized as 1-5 mm compared with VA (13.5% vs 57.1%; P < 0.001) and a significantly lower percentage for >3-mm polyps incorrectly sized as 1-3 mm compared with VA (11.3% vs 56.5%; P < 0.001).

VSE significantly improves the size measurement accuracy of colorectal polyps during colonoscopies compared with VA and results in fewer misclassifications at relevant decision-making size thresholds.

Cancer remains a formidable adversary, challenging medical advancements with its dismal prognosis, low cure rates and high mortality rates. Within this intricate landscape, long non‑coding RNAs (lncRNAs) emerge as pivotal players, orchestrating proliferation and migration of cancer cells. Harnessing the potential of lncRNAs as therapeutic targets and prognostic markers holds immense promise. The present comprehensive review delved into the molecular mechanisms underlying the involvement of lncRNAs in the onset and progression of the top five types of cancer. By meticulously examining lncRNAs across diverse types of cancer, it also uncovered their distinctive roles, highlighting their exclusive oncogenic effects or tumor suppressor properties. Notably, certain lncRNAs demonstrate diverse functions across different cancers, confounding the conventional understanding of their roles. Furthermore, the present study identified lncRNAs exhibiting aberrant expression patterns in numerous types of cancer, presenting them as potential indicators for cancer screening and diagnosis. Conversely, a subset of lncRNAs manifests tissue‑specific expression, hinting at their specialized nature and untapped significance in diagnosing and treating specific types of cancer. The present comprehensive review not only shed light on the intricate network of lncRNAs but also paved the way for further research and clinical applications. The unraveled molecular mechanisms offer a promising avenue for targeted therapeutics and personalized medicine, combating cancer proliferation, invasion and metastasis.

The incidence of colonic adenomas and colorectal cancer has been on the rise among young patients. In this study, we aimed to describe the characteristics of young patients (<50 years) with adenomatous polyps and to characterize those polyps. We also aimed to determine appropriate surveillance intervals for young patients.

We performed a retrospective chart review of patients <50 years of age who had polypectomy of 1 or more adenomatous polyps on colonoscopy between 2008 and 2021. Patient demographics, colonoscopy indication and polyp characteristics were obtained from the chart. Timing and findings on surveillance colonoscopies were recorded.

A total of 610 patients were included: mean age 42.9±5.9 years, 61% males, body mass index 27.5±4.7 kg/m2, and over 50% smokers. The most common indications were abdominal pain (23.3%), rectal bleeding (22.3%), and change in bowel habits (17.6%). Almost half of the patients who had adenomas (299) were younger than 45 years. Tubular adenoma was the most frequently encountered type of polyp (571; 93.6%). Mean polyp size was 1.1±0.9 cm. The most common location of adenomas was the sigmoid colon (41%). Of patients with adenomas, 156 (26%) had surveillance colonoscopy within 2.9±2.3 years; 74 patients (47.4%) were found to have new adenomas.

Patients aged <50 years with colonic adenomas were mostly males, overweight, and smokers. Further adenomas were found in 47% of surveillance colonoscopies, and most were encountered within 5 years. High rates of recurrent adenomas in people <50 years of age may warrant frequent surveillance.

Bowel preparation is considered as major obstacle before colonoscopy, and it is often reported as the most feared part of the procedure. The aim of this study is to determine the difference in efficacy between a split dose of PEG and the previous day regimen in cleaning the colon, using Boston bowel preparation scale. In addition, also to evaluate patient satisfaction regarding the modality of preparation.

The study included 200 hospitalized patients undergoing colonoscopy at Beirut hospitals between 2021 and 2023. One of the two regimens will be prescribed randomly to the patients before colonoscopy: 98 (49%) in Group A (patients treated with PEG preparation as a split dose for 2 days), and 102 (51%) in Group B (patients taking PEG preparation as a whole dose). Data was analyzed using SPSS version 25.

Patients were distributed between 105 (52.5%) males and 95 (47.5%) females. The top two indications for colonoscopy were bleeding (34%), change in bowel habits (constipation/diarrhea) (32%). Patients experienced adverse events noting cramps (48.5%), stomach ache (32%), headache (31%), vomiting (53%), nausea (53%), sleep disturbance (27%), bloating (26.5%), and malaise (26%). A statistically significant difference (p = 0.040) was detected in sleep disturbance: 20.4% of patients in group A and 33.3% of patients in group B. The average satisfaction score was 3.02 ± 1.03 over 4 (Group A) and 3.04 ± 0.99 over 4 (Group B) (p = 0.896). The average BBPS was 8.07 ± 1.14 (Group A) and 8.28 ± 1.0 (Group B) (p = 0.162).

The two administrations were almost similar in term of satisfaction and BBPS. As multiple factors like age, sexe, comorbidities may contribute in altering how much a given drug is safe and efficace, more research is needed to choose the best 3regimen for each patient.

With the development of endoscopic technology, endoscopic submucosal dissection (ESD) has been widely used in the treatment of gastrointestinal tumors. It is necessary to evaluate the depth of tumor invasion before the application of ESD. The convolution neural network (CNN) is a type of artificial intelligence that has the potential to assist in the classification of the depth of invasion in endoscopic images. This meta-analysis aimed to evaluate the performance of CNN in determining the depth of invasion of gastrointestinal tumors.

A search on PubMed, Web of Science, and SinoMed was performed to collect the original publications about the use of CNN in determining the depth of invasion of gastrointestinal neoplasms. Pooled sensitivity and specificity were calculated using an exact binominal rendition of the bivariate mixed-effects regression model. I2 was used for the evaluation of heterogeneity.

A total of 17 articles were included; the pooled sensitivity was 84% (95% CI, 0.81-0.88), specificity was 91% (95% CI, 0.85-0.94), and the area under the curve (AUC) was 0.93 (95% CI, 0.90-0.95). The performance of CNN was significantly better than that of endoscopists (AUC: 0.93 vs 0.83, respectively; P = .0005).

Our review revealed that CNN is one of the most effective methods of endoscopy to evaluate the depth of invasion of early gastrointestinal tumors, which has the potential to work as a remarkable tool for clinical endoscopists to make decisions on whether the lesion is feasible for endoscopic treatment.

The purpose of this study is to evaluate the safety and efficacy of linaclotide and polyethylene glycol (PEG) electrolyte powder in patients with chronic constipation undergoing colonoscopy preparation.

We included 260 patients with chronic constipation who were scheduled to undergo a colonoscopy. They were equally divided into 4 groups using a random number table: 4L PEG, 3L PEG, 3L PEG+L, and 2L PEG+L. The 4 groups were compared based on their scores on the Boston Bowel Preparation Scale (BBPS) and Ottawa Bowel Preparation Quality Scale (OBPQS), adverse reactions during the bowel preparation procedure, colonoscope insertion time, colonoscope withdrawal time, detection rate of adenomas, and their willingness to repeat bowel preparation.

In terms of the score of the right half of the colon, the score of the transverse colon, the total score using BBPS, and the total score using OBPQS, the 3L PEG (polyethylene glycol)+L group was superior to groups 3L PEG and 2L PEG+L ( P <0.05), but comparable to the 4L PEG group ( P >0.05). The incidence rate of vomiting was higher in the 4L PEG group than in the 2L PEG+L group ( P <0.05). There was no statistically significant difference in the insertion time of the colonoscope between the 4 groups. The colonoscope withdrawal time in the 3L PEG+L group was shorter than in groups 4L PEG and 3L PEG ( P <0.05) and comparable to that in the 4L PEG group ( P >0.05). There was no statistically significant difference in the rate of adenoma detection among the 4 groups ( P >0.05). The 4L PEG group was the least willing of the 4 groups to undergo repeated bowel preparation ( P <0.05).

The 3L PEG+L is optimal among the 4 procedures. It can facilitate high-quality bowel preparation, reduce the incidence of nausea during the bowel preparation procedure, and encourage patients to undertake repeated bowel preparation.

BACKGROUND Body mass index (BMI) and endoscopists' experiences can be associated with cecal intubation time (CIT), but such associations are controversial. This study aimed to clarify the association between BMI and CIT during unsedated colonoscopy at 3 learning stages of a single endoscopist. MATERIAL AND METHODS A total of 1500 consecutive patients undergoing unsedated colonoscopy by 1 endoscopist at our department from December 11, 2020, to August 21, 2022, were reviewed. They were divided into 3 learning stages according to the number of colonoscopies performed by 1 endoscopist, including intermediate (501-1000 colonoscopies), experienced (1001-1500 colonoscopies), and senior stages (1501-2000 colonoscopies). Variables that significantly correlated with CIT were identified by Spearman rank correlation analyses and then included in multiple linear regression analysis. RESULTS Overall, 1233 patients were included. Among them, 392, 420, and 421 patients were divided into intermediate, experienced, and senior stages, respectively. Median CIT was 7.83, 6.38, and 5.58 min at intermediate, experienced, and senior stages, respectively (P.