Endoscopic resection of colorectal polyps is fundamental to colorectal cancer prevention and is a core competency for all colonoscopists. With improved detection through national screening and advances in imaging, endoscopists are increasingly required to manage these lesions effectively. This review provides a structured, evidence-based framework for contemporary colorectal polypectomy, emphasising practical application, lesion assessment and technique selection. High-quality polypectomy begins before the procedure with optimal bowel preparation, equipment readiness and accurate optical evaluation to guide management. Consistent use of validated classification systems facilitates the distinction between benign, dysplastic and invasive lesions, ensuring appropriate referral of complex cases to expert centres. Piecemeal endoscopic mucosal resection remains the mainstay for large non-pedunculated colorectal polyps, with recent refinements significantly improving safety and efficacy. Endoscopic submucosal dissection enables en bloc curative resection of early cancers. Emerging innovations, including endoscopic intermuscular dissection and full-thickness resection, offer potential to extend organ-preserving therapy to increasingly complex and advanced lesions. A tailored approach balancing safety, oncological outcomes, patient-reported outcomes and healthcare resources is advocated.

Background and study aimsDuring the COVID-19 pandemic the National Health Service introduced colon capsule endoscopy (CCE) as an alternative to colonoscopy in patients awaiting 3-year post-polypectomy surveillance. We determined the safety, diagnostic accuracy, and utility of CCE in this clinical setting.Patients and methodsConsenting patients awaiting 3-year post-polypectomy surveillance underwent CCE or colonoscopy. For those having CCE, risk-based guidance was developed directing to: 1) immediate colorectal endoscopic intervention; 2) deferred intervention; or 3) discharge. The safety, comparative and paired diagnostic accuracy, and colonoscopy capacity spared by CCE were determined.ResultsThere were 464 CCE and 78 colonoscopy patients recruited. CCE patients were younger (mean 62 years versus 68 years). CCE was safely tolerated in 99% of patients. More ≥ 10 mm and 6- to 9-mm polyps were detected in the CCE cohort than the colonoscopy comparator cohort. This was on an intention to investigate basis and in those who had complete and adequately prepared examinations. Two hundred and five CCE patients had an urgent colonoscopy or flexible sigmoidoscopy and their paired findings were matched. Per patient sensitivities for ≥ 10 mm and 6- to 9-mm polyps were 92% and 90%, respectively. Two-thirds of patients entered a modified management pathway after CCE with 25% being discharged and 27% having a procedure deferral for up to 3 years. CCE completion and bowel preparation adequacy rates were 78% and 73% respectively. No colorectal cancer was detected.ConclusionsCCE is a safe diagnostic of colorectal polyps. In surveillance, its "filter function" complements existing colorectal diagnostic services by providing capacity and choice.

Adequate bowel preparation is crucial for high-quality colonoscopy; however, assessing preparation adequacy can be burdensome for both healthcare providers and patients. In this study, we aimed to develop artificial intelligence (AI) models for the automated identification of bowel PREParation for cOlonoscOpy (AI-PREPOO). On the day of colonoscopy, participants were instructed to use smartphones to photograph their stool in the toilet after each bowel movement following initiation of polyethylene glycol solution and upload the images to a secure web server. All images were labeled as "ready" or "not ready" for colonoscopy based on clarity and the absence of solid content. Using these labeled images, four image-recognition models based on different deep learning architectures (AI-PREPOO 1-4) were developed using transfer learning to classify stool status as "ready" or "not ready." A total of 282 stool images were collected from 37 patients, with 141 images labeled as "ready" and 141 as "not ready." These images were divided into training (224 images) and test (58 images) sets, and the training set was augmented to 2240 images. All models trained on the augmented dataset achieved high performance, with area under the curve (AUC) values exceeding 0.90. AI-PREPOO 1, based on MobileNetV3-Small, demonstrated the most balanced sensitivity-specificity profile (AUC, 0.95; sensitivity, 0.93; specificity, 0.86). We developed AI-based models capable of accurately assessing bowel preparation adequacy. AI-PREPOO 1 showed a well-balanced diagnostic performance, suggesting its potential to facilitate bowel preparation assessment and reduce the burden on healthcare providers and patients.

Intraoperative transvaginal ultrasound to refine surgical strategy in rectosigmoid endometriosis.

To assess whether sports drinks as polyethylene glycol (PEG) solvent improve compliance, bowel preparation, and acceptability in children with autism spectrum disorder (ASD). In this randomized trial, 60 ASD children (30 per group) received PEG in sports drinks (experimental) or water (control). Outcomes included compliance, Boston Bowel Preparation Scale (BBPS) scores, need for enemas, safety (glucose and electrolytes), adverse events, and caregiver-reported tolerance. The sports drink group had higher compliance (83.3% vs. 60.0%, relative risk [RR]:1.39, 95% confidence interval [CI]: 1.00-1.94, p = 0.045), reaching borderline statistical significance, as well as better BBPS (7.5 ± 0.8 vs. 6.0 ± 1.0, p < 0.05), and more adequate preparation (96.7% vs. 66.7%, RR: 1.45, 95% CI: 1.12-1.88, p = 0.003). They required fewer enemas (6.7% vs. 26.7%, RR: 0.25, 95% CI: 0.06-1.08, p = 0.038) and had fewer adverse events (10.0% vs. 33.3%, RR: 0.30, 95% CI: 0.09-0.98, p = 0.028). No concerning side effects were observed, and blood glucose and electrolyte levels remained within normal ranges. Caregiver tolerance scores were higher (median 8 vs. 6, p < 0.001). Sports drinks as PEG solvent significantly enhance compliance, bowel preparation, and acceptability in ASD children without safety concerns, offering a practical child-friendly strategy.

Colonoscopy is a widely used diagnostic and therapeutic procedure with a low risk of serious adverse events. Acute bilateral lower-limb paralysis following colonoscopy is extremely rare. Acute limb ischemia due to thromboembolism from abdominal aortic aneurysm (AAA) is a vascular emergency that requires prompt diagnosis and intervention. This is the report of a unique case of acute limb ischemia due to thromboembolism associated with infrarenal AAA following colonoscopy. This case report aims to raise clinical awareness of the potential risk of thromboembolic complications after colonoscopy. Further, this case suggests a potential mechanism in which hemodynamic alterations or periprocedural factors, such as dehydration associated with bowel preparation, may have contributed to thrombus dislodgement and subsequent embolization. A 67-year-old man with acute paraplegia was referred to our emergency department following colonoscopy. The patient was diagnosed with acute thromboembolism associated with an infrarenal AAA, resulting in paraplegia following colonoscopy, as confirmed by computed tomography angiography. The patient underwent emergent aorto-bifemoral bypass, bilateral lower extremity thrombectomy, and left femoral artery-to-distal superficial femoral artery bypass surgery. Although revascularization was technically successful, the patient died of massive reperfusion injury. Acute paraplegia caused by thromboembolism from an infrarenal AAA following colonoscopy is extremely rare but potentially fatal. Awareness of this potential adverse event after colonoscopy is critical to avoid severe outcomes and improve patient prognoses.

ResumenIntroducción:el cáncer de próstata (CaP) es la neoplasia más común en hombres. La biopsia de próstata transrectal es el estándar para diagnosticar el CaP, pero presenta complicaciones. La biopsia transperineal ha ganado popularidad debido a sus mejores tasas de detección y menores complicaciones.Objetivo:comparar la eficiencia y la tasa de complicaciones entre la biopsia prostática transperineal de un punto de acceso único (BTPP) y la biopsia prostática transrectal (BTRP), guiadas por ultrasonido en pacientes con sospecha de CaP.Material y métodos:se recolectó y analizó información de 241 pacientes con sospecha de CaP, divididos en dos grupos: 171 en el de BTPP y 70 en el de BTRP. Se recolectaron los resultados de patología y se identificaron las complicaciones.Resultados:de los 241 pacientes, 132 tuvieron biopsia positiva (54.77%) y 109 negativa (45.22%). La BTPP fue positiva en 60.2% en comparación con 41.4% de la BTRP (p = 0.008). Las complicaciones en BTPP fueron hematuria (53.8%), dolor (6.4%), hemospermia (6.4%) y retención aguda de orina (2.3%). La BTPP mostró ser un factor protector para complicaciones (odds ratio [OR] 0.028, intervalo de confianza del 95% [IC 95%] 0.009-0.9; p < 0.001), en comparación con la técnica de la BTRP (OR 35.5, IC 95% 10.7-117.6; p < 0.001).Conclusiones:la BTPP ofrece una mejor tasa para detección del CaP y debe adoptarse como método de primera elección para el diagnóstico del CaP, dado que tiene menor tasa de complicaciones y puede realizarse sin necesidad de preparación intestinal ni profilaxis antibiótica.

A Retrospective Analysis of Glucagon-like Peptide-1 Receptor Agonists on Bowel Preparation Efficacy in Colonoscopies.

Objective: To summarize the perioperative nursing strategies of a patient undergoing laparoscopic retrieval and partial gastrectomy because of the gastric migration of an intrauterine device. Methods: The following individualized care strategies were implemented: preoperative psychological optimization using cognitive-behavioral counseling, modified bowel preparation, accelerated postoperative recovery through early ambulation and stepwise nutritional advancement, strict condition monitoring of the patient, multimodal step analgesia, early tube removal, integration of medical and nursing checkups, and nursing measures using traditional Chinese medicine. Results: The patient was discharged from the hospital smoothly after 8 days. A follow-up visit was conducted one-week post-discharge, during which the patient’s general condition was assessed as good, and no complications were reported. Conclusion: The use of individualized nursing strategies has aided in the smooth postoperative recovery of patients with ectopic intrauterine devices while improving the quality and safety of nursing.

Background and Objectives: Colorectal cancer caused over 1.9 million new cases and 0.9 million deaths in 2020, ranking third in incidence and second in cancer mortality worldwide. Poor bowel preparation may hide adenomas, increasing the colorectal cancer risk. This retrospective study aims to identify differences and associations in bowel preparation quality in relation to gender, age, timing of preparation, and the type of cleansing agent used. Materials and Methods: We analyzed the quality of bowel preparation in a total of 4609 colonoscopies performed between June 2019 and April 2022. We used t-tests and ANOVA to assess differences in bowel preparation quality according to participants’ characteristics. The multivariable linear and logistic regression analyses were used to evaluate the association between bowel preparation quality, withdrawal time, adequate bowel preparation, and total colonoscopy. Results: 70.9% of patients had adequate bowel preparation quality. Enema (β = −0.20, p &lt; 0.001), bisacodyl (β = −0.16, p &lt; 0.001), and senna solution (β = −0.03, p = 0.012) were linked to poorer bowel preparation quality in comparison with polyethylene glycol. Older age was associated with a slight decrease in the probability of adequate bowel preparation (adjusted OR 0.98 per year, p &lt; 0.001), whereas female gender was associated with an increase in this probability (OR 1.18, p = 0.038). Bowel preparation in winter is associated with a lower likelihood of adequate preparation compared to summer (OR 0.74, p = 0.004). The type of bowel preparation agent affected outcomes, with enema (OR 0.22, p &lt; 0.001) and bisacodyl (OR 0.35, p &lt; 0.001) associated with the less clean bowels. Longer withdrawal time was inversely associated with adequate preparation (OR 0.94, p &lt; 0.001). For total colonoscopy, the strongest predictor was adequate bowel preparation (OR 23.6, p &lt; 0.001), with gender, ulcerative colitis, and polyps also influencing the outcome. Conclusions: Age, gender, season, medications, withdrawal time, and the type of colorectal lesions influence bowel preparation quality. Personalized approaches, including patient education and targeted interventions, might contribute to improved bowel preparation, especially in older patients, and should be evaluated in future studies.

BackgroundColorectal cancer (CRC) remains a global health concern, underscoring the importance of effective bowel preparation for diagnostic procedures such as colonoscopy. This randomized controlled trial was designed to compare the efficacy and tolerability of orally administered mannitol and polyethylene glycol (PEG) solutions for repeat colonoscopy in patients with inadequate bowel preparation.MethodsThis prospective, open-label, noninferiority, blinded end point, randomized controlled clinical trial enrolled patients from two centers. Participants aged 18–75 years with Boston Bowel Preparation Scale (BBPS) scores ≤ 1 in any colon segment were included. The study employed a 1-L mannitol or PEG solution, with primary outcomes assessed using BBPS scores. The secondary outcomes included adverse events, taste preferences, and patient satisfaction. A simple randomization strategy was employed, and both intention-to-treat (ITT) and per-protocol (PP) analyses were conducted.ResultsA total of 134 patients were included in the study, and the trial demonstrated the noninferiority of mannitol compared to PEG in achieving adequate bowel preparation (difference 3.0%, 95% confidence interval − 5.0 to 11.0%). Mannitol exhibited favorable trends in BBPS scores, highlighting its effectiveness. The safety profiles of the two solutions were comparable, with a low incidence of adverse events (17.9% vs. 19.4%, P = 0.825). Notably, mannitol outperformed PEG in terms of patient satisfaction and a greater inclination for reuse.ConclusionThe findings suggest that orally administered mannitol is not inferior to orally administered PEG in patients with inadequate bowel preparation.Registration numberClinicalTrials.gov, NCT05912114. Registered on 12/6/2023.

Background: Patients with inflammatory bowel disease (IBD) frequently undergo colonoscopy, each requiring bowel preparation. ESGE 2019 guidelines recommended high or low volume polyethylene glycol (PEG)-based bowel prep for IBD patients; however other non-PEG-based preparations (sulphate and picosulphate-based) have now been studied in IBD. Methods: We searched CENTRAL, ClinicalTrials.gov, Embase, MEDLINE, and WHO ICTPR for randomised controlled trials (RCTs) up to December 2024. Primary outcome was bowel prep success; secondary outcomes included tolerability, acceptability, caecal intubation rates (CIR) and safety. Pooled estimates used risk ratio (RR) and GRADE to assess evidence certainty. Results: Ten RCTs (1479 IBD patients) were included. There was no difference in prep success (RR 0.98, 95%CI 0.88-1.09; I2=33%, 2 RCTs; moderate certainty evidence) between 2L vs. 4L PEG, but higher acceptability for 2L (RR 0.69, 95%CI 0.59-0.80; I2=18%,2 RCTs; high certainty evidence). Low-volume non-PEG vs. PEG, are probably similar for prep success (RR 0.96,95%CI:0.90-1.01; I2=6%,3 RCTs; moderate certainty evidence). The evidence on tolerability and acceptability was very uncertain. Sub-group analysis revealed comparable effectiveness of picosulphate-based (RR 0.89, 95%CI 0.78-1.01; I2=0%,1 RCT) and sulphate-based preps (RR 0.98, 95% CI: 0.91-1.05; I2=28%, 2 RCTs) compared to low-volume PEG. Safety data were inconsistently reported. Conclusion: High-certainty evidence supports low-volume PEG as comparably successful to high-volume PEG, with higher acceptability. Moderate-certainty evidence indicates similar success between non-PEG and PEG-based preps. Both low-volume PEG and non-PEG-based preps are supported for use in IBD, broadening options beyond current ESGE guidelines.

Colonoscopy plays a key role in colorectal cancer (CRC) screening. It is effective in reducing morbidity and mortality from CRC. To optimize quality of colonoscopy, performance measures (PM) have been identified and published by major international societies. While adenoma detection rate (ADR) is an imperative quality measure, the sessile serrated lesion detection rate (SSLDR) is not currently a quality indicator for screening colonoscopy. Objective — to determine the trend of polyp detection rate (PDR), ADR, and SSLDR in participants in different age groups. Materials and methods. We performed a retrospective observational study of patients who underwent colonoscopy at Olymed, Kyiv, Ukraine from April 2021 through December 2023. We calculated the polyp detection rate (PDR), ADR, and SSLDR for all colonoscopies performed during the specified period, taking into account the exclusion criteria (non-total colonoscopy (not reaching the blind bowel or &lt; 6 on the Boston Bowel Preparation Scale (BBPS), CRC or inflammatory bowel disease). Patients were stratified into 10 main and 2 additional age groups. Particular attention is paid to the analysis of the prevalence of serrated lesions on a broad basis among young people, which is important for understanding the potential role of these lesions in the pathogenesis of colorectal cancer. Statistical analysis was performed using Stata 17 (StataCorp LLC, USA). Comparisons between independent groups were conducted using Pearson’s chi-squared test. Differences were considered statistically significant at p &lt; 0.05. Results. The initial sample included 2676 patients, with 2402 examinations analyzed after applying exclusion criteria. The largest age group was 50 — 54 years (13.9%, n=335). Two key subgroups were analyzed: 45 — 49 years (n=323) and ≥ 50 years (n=1216). There was a clear trend of increasing PDR and ADR with age. The highest ADR was observed in patients aged ≥ 75 years (88.2%). SSLDR showed a nonlinear pattern, peaking at 31.3% in the 60 — 64 age group. Compared to the ≥ 50 group, patients aged 45 — 49 had significantly lower ADR (44.9% vs. 66.8%; p &lt; 0.001) and PDR (66.8% vs. 80.9%; p &lt; 0.001), while SSLDR was similar (26.7% vs. 26.6%; p=0.893), indicating notable SSL prevalence among younger individuals. Conclusions. The findings highlight the importance of recognizing SSLs as potential CRC risk markers, especially in younger adults. Further research is necessary to establish optimal SSLDR benchmarks and appropriate detection targets for endoscopists.

Background: Bowel preparation is essential for high-quality colonoscopy, enabling accurate mucosal visualization and reducing missed lesions. Inadequate cleansing compromises diagnostic reliability, increases procedural risks, and necessitates repeat examinations. Aim: To review nursing roles in bowel preparation, focusing on assessment, patient education, and evidence-based perioperative management to optimize outcomes. Methods: This narrative review synthesizes current evidence on bowel preparation regimens, contraindications, risk factors, and nursing interventions. It examines pharmacologic classifications (isosmotic, hypoosmotic, hyperosmotic), dosing strategies, and interprofessional collaboration. Results: High-volume polyethylene glycol (PEG) remains the safest option for complex patients, while low-volume PEG with ascorbic acid improves tolerability but requires caution in G6PD deficiency. Sulfate-free PEG enhances palatability without compromising efficacy. Hyperosmotic agents (magnesium citrate, sodium sulfate) and sodium phosphate carry significant risks, particularly in renal impairment and electrolyte imbalance. Split-dose regimens consistently outperform single-dose schedules in cleansing quality and adenoma detection. Nursing interventions—risk assessment, education reinforcement, hydration monitoring, and early escalation for intolerance—are pivotal for success. Conclusion: Effective bowel preparation is a structured, team-based process integrating individualized regimen selection, patient-centered education, and vigilant nursing oversight. Optimizing preparation quality improves diagnostic accuracy, reduces repeat procedures, and enhances patient safety.

Colorectal cancer (CRC) is a leading cause of cancer-related death, and timely and accurate recognition of endoluminal pathology is crucial. While CT colonography (CTC) is validated for luminal assessment with a sensitivity concordant to endoscopy, most radiology referrals to the tumor board are based on unprepared CT abdominal studies without bowel preparation or fecal tagging. The diagnostic yield of these routine unprepared CT scans and the influence of radiologist subspecialty, remain uncertain. This study evaluated the positive predictive value of CTC and unprepared CT for suspected endoluminal pathology and examined the impact of gastrointestinal (GI) subspeciality reporting. We reviewed colorectal tumor board outcomes from 2022 at St George's Hospital, London, United Kingdom. Patients referred to the tumor board by radiology were identified and analyzed through patient records. Radiological and endoscopic concordance was assessed using composite endpoints. Of the 106 radiology-initiated referrals to the tumor board in 2022, 61 (58%) were for suspected endoluminal pathology. Overall positive predictive value (PPV) was 79% (42 true positives and 11 false positives). The PPV was 91% for CTC and 70% for unprepared CT. GI subspecialist reporters identified 44% more endoluminal lesions on unprepared CT than non-specialist reports (p < 0.0001), but without a significant difference in PPV (67% vs. 78%, p = 0.543). No significant difference in colorectal cancer detection was observed between CTC and unprepared CT (p = 0.8). Unprepared CT demonstrates a good PPV (70%) for detecting endoluminal pathology, with over half of identified lesions being malignant. Although PPV is comparable between GI and non-GI radiologists, GI subspecialists refer significantly more cases for further evaluation, emphasizing the importance of subspeciality expertise. Radiologists should confidently raise suspicion of endoluminal pathology to ensure timely referral for direct visualization and tumor board discussion.

Clostridioides difficile infection (CDI) is a major cause of nosocomial diarrhea worldwide, and limitations of standard antibiotic therapy have driven the adoption of fecal microbiota transplantation (FMT) as an alternative therapeutic approach. Although FMT achieves clinical success in most patients, treatment failure still occurs in a considerable proportion of cases. Existing literature has examined overall FMT efficacy, yet no review has comprehensively synthesized the multifactorial determinants of FMT failure while incorporating age-related considerations. This narrative review provides an integrative overview of factors contributing to FMT failure in adults with CDI. A literature search of PubMed and Google Scholar identified original research articles published between 2015 and 2025. Evidence indicates that FMT failure is influenced by host-related factors such as comorbidities, immune function, and nutritional status; disease-related characteristics, including CDI severity and recurrence history; technical aspects, such as bowel preparation, donor type, and route of administration; and pharmacological factors, including antibiotic exposure before or after the procedure. These factors collectively affect donor microbiota engraftment and increase the risk of therapeutic failure. Age-related physiological and microbiome changes may additionally modify treatment responses. This review highlights the need for comprehensive patient assessment, standardized procedural protocols, and careful post-FMT monitoring. Addressing current evidence gaps and improving clinical guidance will be essential for optimizing the safety and effectiveness of FMT across different adult age groups.

Background: Colorectal cancer (CRC) remains a major contributor to cancer-related mortality globally, with a concerning increase in early-onset cases. Although colonoscopy is the established gold standard for CRC screening, its effectiveness is constrained by operator variability, inconsistent bowel preparation, and disparities in access. Artificial intelligence (AI) has emerged as a promising adjunct across the CRC care continuum, offering potential enhancements in screening, diagnosis, and risk stratification. This review aims to examine the current applications of AI in CRC screening and diagnosis, with particular emphasis on AI-assisted endoscopy, non-invasive screening modalities, and digital pathology. Key implementation challenges are also discussed. Methods: This narrative review synthesizes evidence from randomized controlled trials, prospective cohort studies, meta-analyses, and emerging translational research. It evaluates AI-based computer-aided detection (CADe) and computer-aided diagnosis (CADx) systems in colonoscopy, machine learning–driven risk prediction models and biomarker integration for non-invasive screening, and deep learning applications in whole-slide histopathology for CRC. Results and Discussion: AI-assisted colonoscopy has demonstrated consistent improvements in adenoma detection rates, particularly through enhanced identification of diminutive lesions. Several multicenter trials have also reported increased detection of advanced adenomas. CADx systems employing enhanced imaging modalities have achieved optical diagnostic performance comparable to expert endoscopists and may facilitate cost-saving strategies such as “resect-and-discard” or “diagnose-and-leave.” Beyond the endoscopy suite, AI and machine learning algorithms can integrate multimodal data, including demographic, dietary, biomarker, and circulating cell-free DNA (cfDNA) profiles, to identify individuals at elevated risk and strengthen non-invasive screening approaches. In pathology, AI-powered systems have shown promise in reducing interobserver variability, detecting subtle morphologic and molecular features (e.g., microsatellite instability), and informing treatment planning. Despite these advances, translation into routine clinical practice remains limited by several factors: heterogeneity in training datasets, potential algorithmic bias, insufficient real-world validation, substantial infrastructure requirements, and the need for interpretable outputs that clinicians can trust. Addressing these barriers will be essential to ensure safe, and effective integration of AI into CRC care. Conclusion: Artificial intelligence holds substantial promise for enhancing the accuracy, scalability, and personalization of CRC screening and diagnosis. Realizing this potential will require rigorous multicenter prospective validation, standardization of datasets and reporting frameworks, and the development of clinical workflows that preserve provider judgment and promote equitable access to care.

Irritable bowel syndrome (IBS) is a prevalent functional gastrointestinal (FGITD) disorder, the diagnosis is based on Rome Criteria and other subjective tools. Because IBS overlaps with other FGITD and organic diseases, and the subjective tools do not apply to patients with cognitive decline, objective diagnostic tools are important in this category of patients. To discuss the role of imaging in IBS diagnosis. We systematically searched three databases for articles published in the English language with no limitation to a specific period. The literature search was conducted in June and July 2024. The keywords used are IBS and functional bowel disorders, computed tomography, Magnetic Resonance Imaging, functional brain magnetic resonance imaging (MRI), and static brain MRI, and were linked with the terms "AND" and "OR". Out of the 679 articles, 578 remained after duplication removal. However, 50 full texts were used in the review. Magnetic resonance imaging is superior due to its sensitivity, lack of radiation exposure, and lack of need for bowel preparation. Patients with IBS had smaller colonic and rectal volumes compared to healthy controls and functional constipation. Dynamic and static Magnetic Resonance Imaging of the brain showed increased activity, thinning, and increased volumes in specific areas of pain modulation. The above abnormalities are not uniform and vary significantly according to the type of IBS, the duration and intensity of symptoms, gender, and culture. Magnetic resonance imaging shows smaller colonic and rectal volumes, and increased activity, thinning, and increased volumes in specific areas of pain modulation. Large trials incorporating all above limitations are needed.

Background and Aims: Colon capsule endoscopy (CCE) provides a non-invasive alternative to traditional colonoscopy. This study evaluated the feasibility, safety, diagnostic yield (DY), and patient satisfaction of the OMOM CC100 CCE system, with special focus on fully remote (n = 30) and partially remote (n = 89) administration across four centres to advance decentralised models. Methods: This prospective, investigator-initiated, international multicentre feasibility study enrolled 119 patients aged 18–75 years at centres in Denmark, Sweden, Portugal, and Poland from July 2024 to May 2025. Indications included rectal bleeding, iron-deficiency anaemia, a positive faecal immunochemical test, changes in bowel habit, suspected inflammatory bowel disease (IBD), post-polypectomy or colorectal cancer (CRC) surgery surveillance, and a family history of CRC. The OMOM CC100 capsule was employed with a standardised bowel preparation regimen. Administration was fully remote in Denmark using the IntelliGI™ platform and partially remote (clinic ingestion, home completion) at the other sites. Primary outcomes encompassed procedure feasibility, completion rate (capsule excretion or anal verge visualisation), bowel cleanliness (Leighton-Rex scale ≥ 3), diagnostic yield, and patient satisfaction. Secondary measures included transit times, adverse events, and technical failures. Results: Median age was 55.7 years (65 males, 54 females). Overall completion rate was 79%, varying by centre: Sweden (90%), Portugal (81%), Denmark (80%), and Poland (63%). Adequate bowel cleanliness was achieved in 71% of cases. Diagnostic findings included polyps (25 patients), angioectasia (20), diverticulosis (17), and mucosal inflammation (17); 42% were normal. Fully remote administration yielded 80% completion and 89.7% satisfaction. No serious adverse events occurred; overall satisfaction was 81%, with 87% preferring home-based procedures. Conclusions: The OMOM CC100 CCE system is feasible, safe, with DY comparable to established systems. IntelliGI™-enabled remote administration promotes decentralised care, enhancing accessibility.

Optimal bowel preparation is critical for high-quality colonoscopy and the effective prevention of colorectal cancer. Although traditional high-volume polyethylene glycol (PEG) electrolyte lavage solutions are effective and safe, they are frequently limited by poor patient tolerability. To improve adherence, several low- and ultralow-volume PEG-based regimens, particularly 2 L and 1 L PEG plus ascorbate, have demonstrated noninferior efficacy and better patient compliance. Hyperosmotic alternatives, including oral sulfate solution and sodium picosulfate with magnesium citrate, provide comparable bowel-cleansing efficacy and are often favored for their improved palatability and tolerability. The recent introduction of oral sulfate tablets offers the convenience of a tablet form while maintaining efficacy similar to that of PEG-based regimens and significantly enhancing tolerability. However, a few cases of gastric mucosal irritation have been reported. Adjunctive simethicone also improves mucosal visibility by reducing intraluminal bubbles. With the growing diversity of bowel preparation options, regimen selection should be tailored to individual patient characteristics, including age, comorbidities, prior experiences, and personal preferences. A personalized evidence-based approach, guided by patient-specific factors and supported by emerging clinical data, can improve adherence, ensure adequate bowel cleansing, and enhance the diagnostic yield and procedural efficiency of colonoscopy.