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.

• Colonoscopy
• Colorectal cancer
• Bowel screening
• Polyps
• Adenoma

• Colonoscopia
• Colonoscopy
• Edada avanzada
• Elderly
• Frail patient
• Paciente con fragilidad

• Humans
• Aged
• Frailty/diagnosis
• Frail Elderly
• Colonoscopy/methods
• Risk Assessment

• Adult
• Humans
• Cathartics
• Artificial Intelligence
• Colonoscopy/methods
• Polyethylene Glycols
• Colorectal Neoplasms/diagnosis

• Adenoma detection rate
• Bowel preparation
• Colonoscopy
• Colorectal cancer
• Polyethylene glycol

• Humans
• Aged
• Cathartics/adverse effects
• Colonoscopy/methods
• Polyethylene Glycols/adverse effects
• Colon
• Ascorbic Acid

This study aimed to clarify the association of the risk of atrial fibrillation (AF) with bowel preparation and subsequent colonoscopy through population-based case-crossover analysis. Patients who developed new-onset AF after undergoing colonoscopy following bowel preparation were included. For each patient, one hazard period and four control periods were matched at specified time windows. Among 189,613 patients with AF, 84 patients (mean age: 72.4 years) finally met the inclusion criteria. Most patients used polyethylene glycol (PEG)-based solutions (2 L PEG + ascorbic acid (n = 56), 4 L PEG (n = 21)) as purgatives and had hypertension (n = 75). A significant association of bowel preparation and colonoscopy with AF occurrence was found in all time windows. The proportion of patients with bowel preparation and colonoscopy was higher during the hazard period than during the control periods. In the 1-, 2-, 4-, 8-, and 12-week time windows, the proportions were 11.9% vs. 4.2%, 13.1% vs. 4.8%, 16.7% vs. 6.3%, 28.6% vs. 11.9%, and 29.8% vs. 14.0%, and the odd ratios (ORs) were 3.11, 3.01, 3.00, 2.96, and 2.61, respectively. Bowel preparation and undergoing colonoscopy was associated with the risk of AF and this examination need to be performed with caution especially in elderly patients with hypertension.

• Polyethylene glycol with ascorbic acid
• Sodium picosulfate

Adequate bowel preparation is important for successful colonoscopic examination. Several effective colonic cleansing agents are available and routinely prescribed, but each carries its own limitations and benefits from particular dosing regimens. The most frequently prescribed colonic cleansing agent, the polyethylene glycol (PEG) cathartic solution, suffers from low patient compliance in general, due to its unpalatable taste and smell coupled with the large ingested volumes required. However, PEG is preferred over other cathartics for use in individuals of advanced age, sufferers of chronic kidney disease, heart failure and inflammatory bowel disease, and women who are pregnant or lactating. The laxative agents sodium phosphate (NaP) and sodium picosulfate plus magnesium citrate have been applied and have improved patient compliance and tolerance. NaP, however, should be avoided in individuals with impaired renal function or plasma clearance, such as those with chronic kidney disease, who are taking drugs that affect renal function, or who suffer from heart failure. Other special conditions that may affect an individual’s tolerance of the cathartic agent or ability to complete the administration routine include stroke, severe constipation, hematochezia, suspicious lower gastrointestinal bleeding, and mental disorders such as dementia. All ingestible bowel preparation solutions can be instilled into the stomach and duodenum through nasogastric tube or esophagogastroduodenoscope with the aid of a water irrigation pump for patients with difficulties swallowing or ingesting the large volumes of fluid required. In addition, dietary regimens based on clear liquids and low-residue foods for 1-4 d prior to the colonoscopy may be supplemental bowel preparation strategies. Achieving an effective and safe cleansing of the bowel is important for successful colonoscopy in all patients, so full knowledge of the individual’s condition and capabilities is necessary to select the most appropriate colonic cleansing agent and delivery regimen.

• Colonoscopy
• Preparation
• Polyethylene glycols
• Special conditions
• Cathartic agent

• Cathartics
• Chronic Disease
• Colonoscopy
• Humans

• Colonoscopy
• Metrics
• Outcome
• Quality assurance
• Standards

Acute lower gastrointestinal bleeding (LGIB) is a frequent gastrointestinal cause of hospitalization, particularly in the elderly, and its incidence appears to be on the rise. Endoscopic and radiographic measures are available for the evaluation and treatment of LGIB including flexible sigmoidoscopy, colonoscopy, angiography, radionuclide scintigraphy and multi-detector row computed tomography. Although no modality has emerged as the gold standard in the management of LGIB, colonoscopy is the current preferred initial test for the majority of the patients presenting with hematochezia felt to be from a colon source. Colonoscopy has the ability to diagnose all sources of bleeding from the colon and, unlike the radiologic modalities, does not require active bleeding at the time of the examination. In addition, therapeutic interventions such as cautery and endoclips can be applied to achieve hemostasis and prevent recurrent bleeding. Studies suggest that colonoscopy, particularly when performed early in the hospitalization, can decrease hospital length of stay, rebleeding and the need for surgery. However, results from available small trials are conflicting and larger, multicenter studies are needed. Compared to other management options, colonoscopy is a safe procedure with complications reported in less than 2% of patients, including those undergoing urgent examinations. The requirement of bowel preparation (typically 4 or more liters of polyethylene glycol), the logistical complexity of coordinating after-hours colonoscopy, and the low prevalence of stigmata of hemorrhage complicate the use of colonoscopy for LGIB, particularly in urgent situations. This review discusses the above advantages and disadvantages of colonoscopy in the management of acute lower gastrointestinal bleeding in further detail.

• Colonoscopy
• Acute lower gastrointestinal bleeding
• Management
• Diagnostic yield
• Therapeutic intervention
• Outcomes
• Colon preparation
• Stigmata of hemorrhage