Colorectal Polyps Research Articles

Impact of margin thermal ablation after endoscopic mucosal resection of large (≥20 mm) non-pedunculated colonic polyps on long-term recurrence

Background and aimsThe efficacy of colorectal endoscopic mucosal resection (EMR) is limited by recurrence and the necessity for conservative surveillance. Margin thermal ablation (MTA) after EMR has reduced the incidence...

Qingchang suppository ameliorates mucosal inflammation in ulcerative colitis by inhibiting the differentiation and effector functions of Th1 and Th17 cells

Ethnopharmacological relevanceQing Chang Suppository (QCS), a traditional Chinese medicine formula, has been shown to effectively alleviate mucosal inflammation in patients with ulcerative colitis (UC). While the mechanism of QCS appears to be related to the regulation of CD4+T cell subset responses, direct evidence demonstrating that QCS inhibits Th1 and Th17 cell activation in UC (particularly based on human data) remains lacking. Additionally, the precise mechanisms through which QCS affects these cells have yet to be fully elucidated. Aim of studyThis study aimed to investigate the effects of QCS on Th1 and Th17 cell responses in UC and to explore the underlying mechanisms. Materials and methodsTwenty-eight patients with mild-to-moderate UC were recruited and treated with QCS for 12 weeks. Symptoms were assessed every two weeks, with sigmoidoscopies performed at baseline and at week 12. Intestinal mucosal biopsies and peripheral blood (PB) were collected at these time points. At the end of the trial, patients were categorized into responder and non-responder groups based on a modified Mayo disease activity index score. Healthy controls (HCs) were defined as subjects without IBD or colorectal carcinoma but with colon polyps. The frequencies of IFN-γ+CD4+T cells and IL-17A+CD4+T cells in PB and colonic mucosa were measured using flow cytometry. The expression levels and localization of T-bet, RORγT, IFN-γ, TNF-α, and IL-17A were determined via immunofluorescence, and JNK signaling activation was assessed through immunoblotting and immunohistochemistry. All parameters were compared across the three groups. ResultsAt week 12, responders showed a significant reduction in colonic mucosal inflammation compared to baseline, accompanied by decreased frequencies of IFN-γ+CD4+T and IL-17A+CD4+ T cells in both PB and the colonic epithelial layer. Notably, Th1 and Th17 cell activity around intestinal epithelial cells (IECs) was nearly undetectable, as evidenced by the diminished expression of T-bet, RORγT, IFN-γ, TNF-α, and IL-17A. Additionally, JNK phosphorylation in these cells was significantly reduced. In contrast, non-responders exhibited no meaningful improvement; colonic pathology remained unchanged, and elevated levels of IFN-γ+CD4+T and IL-17A+CD 4+T cells persisted in both the PB and colonic epithelial layer. The presence of Th1 and Th17 cells and their associated cytokines around IECs remained substantial, and there was no significant change in JNK activation. ConclusionQCS attenuates mucosal inflammation in UC patients by inhibiting the differentiation and effector functions of Th1 and Th17 cells, primarily through the regulation of the JNK signaling pathway.

NA-segformer: A multi-level transformer model based on neighborhood attention for colonoscopic polyp segmentation

In various countries worldwide, the incidence of colon cancer-related deaths has been on the rise in recent years. Early detection of symptoms and identification of intestinal polyps are crucial for improving the cure rate of colon cancer patients. Automated computer-aided diagnosis (CAD) has emerged as a solution to the low efficiency of traditional methods relying on manual diagnosis by physicians. Deep learning is the latest direction of CAD development and has shown promise for colonoscopic polyp segmentation. In this paper, we present a multi-level encoder-decoder architecture for polyp segmentation based on the Transformer architecture, termed NA-SegFormer. To improve the performance of existing Transformer-based segmentation algorithms for edge segmentation on colon polyps, we propose a patch merging module with a neighbor attention mechanism based on overlap patch merging. Since colon tract polyps vary greatly in size and different datasets have different sample sizes, we used a unified focal loss to solve the problem of category imbalance in colon tract polyp data. To assess the effectiveness of our proposed method, we utilized video capsule endoscopy and typical colonoscopy polyp datasets, as well as a dataset containing surgical equipment. On the datasets Kvasir-SEG, Kvasir-Instrument and KvasirCapsule-SEG, the Dice score of our proposed model reached 94.30%, 94.59% and 82.73%, with an accuracy of 98.26%, 99.02% and 81.84% respectively. The proposed method achieved inference speed with an Frame-per-second (FPS) of 125.01. The results demonstrated that our suggested model effectively segmented polyps better than several well-known and latest models. In addition, the proposed method has advantages in trade-off between inference speed and accuracy, and it will be of great significance to real-time colonoscopic polyp segmentation. The code is available at https://github.com/promisedong/NAFormer.

Survival and Endoscopic/Clinical Features of Patients with Colorectal Cancer Resected by Cold Snare Polypectomy: The Importance of Chronic Kidney Disease.

Colorectal polyps resected by cold snare polypectomy (CSP) are rarely diagnosed as colorectal cancer (CRC). We aimed to investigate the prevalence, clinical features, and prognosis of patients with CRC resected by CSP. Patients with colorectal polyps treated with CSP between 2018 and 2022 were enrolled and regularly followed up (median observation period: 30.6 months). Logistic regression analysis and decision tree analysis were employed to investigate the clinical features of the patients. A total of 5,064 colorectal polyps from 2,530 patients were resected by CSP. Of these, 0.24% were diagnosed as CRC; however, no patients died due to CRC. eGFR was an independent risk factor for the presence of CRC (unit 10, OR 0.716, 95%CI 0.525-0.973, P=0.0323) and its optimal cut-off value was 59.9 mL/min/1.73 m2. The decision-tree analysis revealed that 2.03% of patients with creatinine ≥ 1.0 mg/dL had CRC. CRC was diagnosed in 0.24% of the polyps; however, no patients died due to CRC. eGFR <60 mL/min/1.73 m2 and creatinine >1.0 mg/dL were associated with CRC. Thus, colorectal polyps should be carefully examined in patients with chronic kidney disease.

BCL-Former: Localized Transformer Fusion with Balanced Constraint for polyp image segmentation

Polyp segmentation remains challenging for two reasons: (a) the size and shape of colon polyps are variable and diverse; (b) the distinction between polyps and mucosa is not obvious. To solve the above two challenging problems and enhance the generalization ability of segmentation method, we propose the Localized Transformer Fusion with Balanced Constraint (BCL-Former) for Polyp Segmentation. In BCL-Former, the Strip Local Enhancement module (SLE module) is proposed to capture the enhanced local features. The Progressive Feature Fusion module (PFF module) is presented to make the feature aggregation smoother and eliminate the difference between high-level and low-level features. Moreover, the Tversky-based Appropriate Constrained Loss (TacLoss) is proposed to achieve the balance and constraint between True Positives and False Negatives, improving the ability to generalize across datasets. Extensive experiments are conducted on four benchmark datasets. Results show that our proposed method achieves state-of-the-art performance in both segmentation precision and generalization ability. Also, the proposed method is 5%–8% faster than the benchmark method in training and inference. The code is available at: https://github.com/sjc-lbj/BCL-Former.

How to "pick up" colorectal serrated lesions and polyps in daily histopathology practice: From terminologies to diagnostic pitfalls.

Over the last decade, our knowledge of colorectal serrated polyps and lesions has significantly improved due to numerous studies on this group of precursor lesions. Serrated lesions were misleading as benign before 2010, but they are currently reclassified as precancerous lesions that contribute to 30% of colorectal cancer through the serrated neoplasia pathway. The World Health Organization updated the classification for serrated lesions and polyps of the colon and rectum in 2019, which is more concise and applicable in daily practice. The responsible authors prescribe that "colorectal serrated lesions and polyps are characterized by a serrated (sawtooth or stellate) architecture of the epithelium." From a clinical standpoint, sessile serrated lesion (SSL) and SSL with dysplasia (SSLD) are the two most significant entities. Despite these advancements, the precise diagnosis of SSL and SSLD based mainly on histopathology remains challenging due to various difficulties. This review describes the nomenclature and the terminology of colorectal serrated polyps and lesions and highlights the diagnostic criteria and obstacles encountered in the histopathological diagnosis of SSL and SSLD.

Evaluation of Multigene Methylation for Blood-Based Detection of Colorectal Cancer.

Background: Early screening for colorectal cancer (CRC) has the potential to improve patient prognosis, but current screening methods are limited. In this prospective study, we aimed to evaluate the multigene (Septin9, SDC2, KCNQ5, and IKZF1) detection in patient plasma for CRC diagnosis. Methods: Overall, 67 participants were enrolled, including 31 patients with CRC, 17 patients with colorectal polyp, and 19 normal controls who underwent colonoscopy. Carcinoembryonic antigen (CEA) and Septin9, SDC2, KCNQ5, and IKZF1 methylation tests were performed. Sensitivity, specificity, and the area under the receiver operating characteristic (ROC) curve were used to evaluate the diagnostic value of each biomarker. The association between positive rates of methylated Septin9, SDC2, KCNQ5, and IKZF1 and the clinicopathological characteristics of CRC was also analyzed. Results: The positive rate of multigene methylation detection was 87.1% (27/31) in patients with CRC, which was higher than single indicators: CEA (51.61%, 16/31), Septin9 (41.94%, 13/31), SDC2 (41.94%, 13/31), KCNQ5 (58.06%, 18/31), and IKZF1 (32.26%, 10/31). In the colorectal polyp group, the rate of multigene methylation detection is 88.24% (15/17), which was also higher than single indicator: CEA (17.65%, 3/17), Septin9 (11.76%, 2/17), SDC2 (64.71%, 11/17), KCNQ5 (58.82%, 10/17), and IKZF1 (35.29%, 6/17). The ROC curves further showed better diagnostic value of the multigene test for CRC than any single gene. Correlation analysis found that the positive rate of the test was not affected by patients' clinicopathologic characteristics. Conclusion: The combination of methylated Septin9, SDC2, KCNQ5, and IKZF1 tests is preferable to individual gene tests for patients with CRC and polyp.

Real-life experience of colonic polyps’ detection rate and adenoma detection rate with their characteristics in a cohort of Egyptian patients

BackgroundData on the prevalence of colonic polyps and adenomas in the Egyptian population are scarce. This study aimed to determine the prevalence of colonic polyps among Egyptian patients aged 50 years and older who underwent colonoscopy for a variety of reasons.Patients and methodsThis study is a retrospective one that was conducted with the use of an endoscopic reporting database of patients presenting at Cairo University Hospital. The considered variables were age, gender, clinical presentation, polyps’ characteristics, and diagnosis. Polyps were retrieved and sent for histopathological examination.ResultsAmong 4861 patients whose clinical presentation necessitated colonoscopic examination between 2012 and 2019, 850 consecutive patients aged 50 years and older were enrolled in this study. The median age was 65 ± 9 SD. The male gender was slightly predominant (50.8%). The polyp detection rate was 23.1%, while the adenoma detection rate was 14.7%, and they were mostly encountered on the left side of the colon. By regression analysis, the most important predictors of adenoma were age ≥ 65 years, diabetes, and the presence of a polyp in the right colon. Diabetics and older people (≥ 65 years) had two times increased risk for adenoma, while patients with polyps in the right side of the colon had 30 times increased risk of adenoma.ConclusionPDR and ADR among the Egyptian population are matched to the target ADR set by the ASGE. We recommend ADR and PDR as key quality indicators of colonoscopy quality.

Risk factors for unclear margin in cold snare polypectomy for colorectal polyp.

Cold snare polypectomy (CSP) is a common, simple, and safe procedure; however, it has a high rate of unclear margins. We analyzed the risk factors for unclear margins of colorectal polyp. We retrospectively investigated colorectal polyps treated with CSP between July 2021 and July 2022, excluding those that could not be retrieved or pathologically nonneoplastic and hyperplastic polyps without margin evaluation. The clinicopathological features and risk factors for unclear margins were analyzed. Furthermore, the polyps were divided into two groups: those resected by experts and those resected by trainees. A 1 : 1 propensity score matching was performed. After matching, the risk factors for unclear margins in each group were analyzed as secondary outcomes. We analyzed 237 patients with 572 polyps; the margins were negative in 58.6% (negative group) and unclear in 41.4% (unclear group). The unclear margin was significantly higher at straddling folds (P = 0.0001), flexure points (P = 0.005), and in the procedures performed by trainees (P < 0.0001). Altogether, 198 propensity score matched pairs were explored for secondary outcomes. There were no significant differences in risk factors for unclear margins in the expert group, while in the trainee group, the unclear margin was significantly higher at the straddling folds (P = 0.0004) and flexure points (P = 0.005). We demonstrated that straddling folds, flexure points, and procedures performed by the trainees were significant risk factors for unclear margins, and we hypothesized that the rate of unclear margins will reduce as the trainees accumulate experience at difficult sites.

The Natural HASPIN Inhibitor Coumestrol Suppresses Intestinal Polyp Development, Cachexia, and Hypogonadism in a Mouse Model of Familial Adenomatous Polyposis (ApcMin/+).

(1) Background: HASPIN kinase is involved in regulating spindle function and chromosome segregation, as well as phosphorylating histone H3 at Thr3 in mitotic cells. Several HASPIN inhibitors suppress cancer cell proliferation. It was recently reported that coumestrol from bean sprouts inhibits HASPIN, and a cultivation method for bean sprouts containing large amounts of coumestrol has been established. Here, we showed the effects of bean sprout ingestion on intestinal polyp development, cachexia, and hypogonadism in a mouse model of familial adenomatous polyposis (ApcMin/+). (2) Methods: ApcMin/+ mice were randomized into control and treatment groups. Mice in the control group were given the standard diet, while those in the treatment group were given the same standard diet with the addition of 15% bean sprouts. Treatments were commenced at 7 weeks old and analyses were performed at 12 weeks old. (3) Results: ingesting bean sprouts suppressed the development of intestinal polyps, cachexia, and hypogonadism, and also increased serum levels of testosterone in male wild-type and ApcMin/+ mice. (4) Conclusions: ingesting bean sprouts helps prevent cancer and increases serum levels of testosterone in a mouse model. These results are expected to be applicable to humans.

Association of late eating with colorectal adenomas: a cross-sectional study.

Colorectal cancer (CRC) is linked to lifestyle exposures. However, changes in the CRC rates among younger populations remain poorly understood and suggest the existence of yet unidentified factor(s) that may contribute to colon carcinogenesis. Here, we investigated the potential role of time of eating in the risk of pre-cancerous colonic neoplasms (tubular adenoma: TA). We enrolled 663 participants undergoing screening colonoscopies. Data on food timing, dietary intake, sleep/wake patterns, and chronotype were collected through structured questionnaires. Late eating was defined as the consumption of food or snack within a 3-hour window of sleep onset for at least four days a week. Pathology reports confirmed the histology of colonic polyps, and adenomas were further classified into risk categories. A total of 644 patients met criteria for our study. There were 270 (42.2%) participants classified as late eaters. Compared to non-late eaters, the odds of TA were higher in late eaters (OR = 1.46, 95% CI = 1.05-2.03, p = 0.023), an association which was strengthened after adjusting for multiple confounders (OR 1.98, 95% CI 1.19-3.28, p = 0.008). Late eating remained an independent risk factor for high-risk as well as multiple TAs. This study proposes late eating as a risk factor for colon tubular adenomas and underscores the potential role of less studied forms of circadian disruption imposed by time of eating in the development of colon neoplastic formation.

Computer-aided diagnosis for the resect-and-discard strategy for colorectal polyps: a systematic review and meta-analysis

The resect-and-discard strategy allows endoscopists to replace post-polypectomy pathology with real-time prediction of polyp histology during colonoscopy (optical diagnosis). We aimed to investigate the benefits and harms of implementing computer-aided diagnosis (CADx) for polyp pathology into the resect-and-discard strategy. In this systematic review and meta-analysis, we searched MEDLINE, Embase, and Scopus from database inception to June 5, 2024, without language restrictions, for diagnostic accuracy studies that assessed the performance of real-time CADx systems, compared with histology, for the optical diagnosis of diminutive polyps (≤5 mm) in the entire colon. We synthesised data for three strategies: CADx-alone, CADx-unassisted, and CADx-assisted; when the endoscopist was involved in the optical diagnosis, we synthesised data exclusively from diagnoses for which confidence in the prediction was reported as high. The primary outcomes were the proportion of polyps that would have avoided pathological assessment (ie, the proportion optically diagnosed with high confidence; main benefit) and the proportion of polyps incorrectly predicted due to false positives and false negatives (main harm), directly compared between CADx-assisted and CADx-unassisted strategies. We used DerSimonian and Laird's random-effects model to calculate all outcomes. We used Higgins I2 to assess heterogeneity, the Grading of Recommendations, Assessment, Development, and Evaluation approach to rate certainty, and funnel plots and Egger's test to examine publication bias. This study is registered with PROSPERO, CRD42024508440. We found 1019 studies, of which 11 (7400 diminutive polyps, 3769 patients, and 185 endoscopists) were included in the final meta-analysis. Three studies (1817 patients and 4086 polyps [2148 neoplastic and 1938 non-neoplastic]) provided data to directly compare the primary outcome measures between the CADx-unassisted and CADx-assisted strategies. We found no significant difference between the CADx-assisted and CADx-unassisted strategies for the proportion of polyps that would have avoided pathological assessment (90% [88-93], 3653 [89·4%] of 4086 polyps diagnosed with high confidence vs 90% [95% CI 85-94], 3588 [87·8%] of 4086 polyps diagnosed with high confidence; risk ratio 1·01 [95% CI 0·99-1·04; I2=53·49%; low-certainty evidence; Egger's test p=0·18). The proportion of incorrectly predicted polyps was lower with the CADx-assisted strategy than with the CADx-unassisted strategy (12% [95% CI 7-17], 523 [14·3%] of 3653 polyps incorrectly predicted with a CADx-assisted strategy vs 13% [6-20], 582 [16·2%] of 3588 polyps incorrectly diagnosed with a CADx-unassisted strategy; risk ratio 0·88 [95% CI 0·79-0·98]; I2=0·00%; low-certainty evidence; Egger's test p=0·18). CADx did not produce benefit nor harm for the resect-and-discard strategy, questioning its value in clinical practice. Improving the accuracy and explainability of CADx is desired. European Commission (Horizon Europe), the Japan Society of Promotion of Science, and Associazione Italiana per la Ricerca sul Cancro.

Pseudoinvasion and squamous metaplasia/morules in colorectal adenomatous polyp: a case report and literature review

BackgroundSubmucosal pseudoinvasion and squamous metaplasia (SM) are incidental and special morphological findings in colorectal adenomas, and both can mimic invasive carcinoma. The coexistence of these two findings further increases the risk of misdiagnosis, posing a great diagnostic challenge to pathologists. From 1979 to 2022, only 8 cases have been reported, which was extremely rare. In this report, we presented a case of sigmoid colon adenoma accompanied by pseudoinvasion and SM. Additionally, relevant literature was analyzed to summarize the clinical and pathological characteristics.Case presentationA 51-year-old Chinese male patient presented with fresh blood after defecation. Electronic colonoscopy revealed multiple polyps, which were removed using a snare and subjected to high-frequency electrocoagulation resection. The largest polyp, located in the sigmoid colon, was a thick pedunculated and lobulated polyp with a maximum diameter of 2.8 cm. The surface of the polyp showed slight ruggedness and redness, and it was sent for pathological examination. Grossly, the polyp had a lobulated and slightly rough surface. Microscopically, it showed a tubulovillous adenoma with focal high-grade dysplasia and mucosal muscle hyperplasia. Glandular elements were observed in the submucosal layer, forming a well-defined lobular structure. Some of the glands displayed cystic change, and focal SM could be seen within the adenoma. SM could manifest as discrete solid cell nests of varying sizes or cribriform-morular-like structures. Immunohistochemical staining showed that SM cells were diffusely positive for cytokeratin 5/6 (CK5/6); p40, p63, and cytokeratin 20 (CK20) were negative; while caudal type homeobox 2 (CDX2) was weakly positive. β-catenin showed abnormal nuclear expression, and an extremely low Ki67 proliferation index was observed.ConclusionsCoexistence of SM and pseudoinvasion in colorectal adenomas is highly rare. It is more commonly observed in males and tends to occur in the sigmoid colon. It primarily manifests in tubulovillous adenoma and tubular adenoma, with a majority of cases exhibiting a pedicle. Histologically, it is similar to invasive lesions. The cystic dilation of the submucosal glands, hemosiderin deposition, and the presence of a lamina propria around the submucosal glands without adjacent desmoplastic reaction, suggest pseudoinvasion rather than cancer. The bland cytological morphology and Immunohistochemical markers play a crucial role in distinguishing SM from true invasive lesions.

Performance of Computer-Aided Detection and Quality of Bowel Preparation: A Comprehensive Analysis of Colonoscopy Outcomes

BackgroundArtificial intelligence (AI) has emerged as a promising tool for detecting and characterizing colorectal polyps during colonoscopy, offering potential enhancements in traditional colonoscopy procedures to improve outcomes in patients with inadequate bowel preparation.AimsThis study aimed to assess the impact of an AI tool on computer-aided detection (CADe) assistance during colonoscopy in this population.MethodsThis case–control study utilized propensity score matching (PSM) for age, sex, race, and colonoscopy indication to analyze a database of patients who underwent colonoscopy at a single tertiary referral center between 2017 and 2023. Patients were excluded if the procedure was incomplete or aborted owing to poor preparation. The patients were categorized based on the use of AI during colonoscopy. Data on patient demographics and colonoscopy performance metrics were collected. Univariate and multivariate logistic regression models were used to compare the groups.ResultsAfter PSM patients with adequately prepped colonoscopies (n = 1466), the likelihood of detecting hyperplastic polyps (OR = 2.0, 95%CI 1.7–2.5, p < 0.001), adenomas (OR = 1.47, 95%CI 1.19–1.81, p < 0.001), and sessile serrated polyps (OR = 1.90, 95%CI 1.20–3.03, p = 0.007) significantly increased with the inclusion of CADe. In inadequately prepped patients (n = 160), CADe exhibited a more pronounced impact on the polyp detection rate (OR = 4.34, 95%CI 1.6–6.16, p = 0.049) and adenomas (OR = 2.9, 95%CI 2.20–8.57, p < 0.001), with a marginal increase in withdrawal and procedure times.ConclusionThis study highlights the significant improvement in detecting diminutive polyps (< 5 mm) and sessile polyps using CADe, although notably, this benefit was only seen in patients with adequate bowel preparation. In conclusion, the integration of AI in colonoscopy, driven by artificial intelligence, promises to significantly enhance lesion detection and diagnosis, revolutionize the procedure’s effectiveness, and improve patient outcomes.

Colorectal polyp size measurement: can we trust our own eyes?

Colorectal polyp size measurement: can we trust our own eyes?

Will Transformers change gastrointestinal endoscopic image analysis? A comparative analysis between CNNs and Transformers, in terms of performance, robustness and generalization

Gastrointestinal endoscopic image analysis presents significant challenges, such as considerable variations in quality due to the challenging in-body imaging environment, the often-subtle nature of abnormalities with low interobserver agreement, and the need for real-time processing. These challenges pose strong requirements on the performance, generalization, robustness and complexity of deep learning-based techniques in such safety–critical applications. While Convolutional Neural Networks (CNNs) have been the go-to architecture for endoscopic image analysis, recent successes of the Transformer architecture in computer vision raise the possibility to update this conclusion. To this end, we evaluate and compare clinically relevant performance, generalization and robustness of state-of-the-art CNNs and Transformers for neoplasia detection in Barrett’s esophagus. We have trained and validated several top-performing CNNs and Transformers on a total of 10,208 images (2,079 patients), and tested on a total of 7,118 images (998 patients) across multiple test sets, including a high-quality test set, two internal and two external generalization test sets, and a robustness test set. Furthermore, to expand the scope of the study, we have conducted the performance and robustness comparisons for colonic polyp segmentation (Kvasir-SEG) and angiodysplasia detection (Giana). The results obtained for featured models across a wide range of training set sizes demonstrate that Transformers achieve comparable performance as CNNs on various applications, show comparable or slightly improved generalization capabilities and offer equally strong resilience and robustness against common image corruptions and perturbations. These findings confirm the viability of the Transformer architecture, particularly suited to the dynamic nature of endoscopic video analysis, characterized by fluctuating image quality, appearance and equipment configurations in transition from hospital to hospital. The code is made publicly available at: https://github.com/BONS-AI-VCA-AMC/Endoscopy-CNNs-vs-Transformers.

The Diagnostic Accuracy of Colon Capsule Endoscopy in Inflammatory Bowel Disease-A Systematic Review and Meta-Analysis.

Colon capsule endoscopy (CCE) has regained popularity for lower gastrointestinal investigations since the COVID-19 pandemic. While there have been systematic reviews and meta-analyses on colonic polyp detection using CCE, there is a lack of comprehensive evidence concerning colonic inflammation. Therefore, this systematic review and meta-analysis aimed to assess the diagnostic accuracy of CCE for colonic inflammation, predominantly ulcerative colitis (UC) and Crohn's disease (CD). Methods: We systematically searched electronic databases (EMBASE, MEDLINE, PubMed Central, and Cochrane Library) for studies comparing the diagnostic accuracy between CCE and optical endoscopy as the standard reference. A bivariate random effect model was used for the meta-analysis. Results: From 3797 publications, 23 studies involving 1353 patients were included. Nine studies focused on UC, and ten focused on CD. For UC, CCE showed a pooled sensitivity of 92% (95% CI, 88-95%), a specificity of 71% (95% CI, 35-92%), and an AUC of 0.93 (95% CI, 0.89-0.97). For CD, the pooled sensitivity was 92% (95% CI, 89-95%), and the specificity was 88% (95% CI, 84-92%), with an AUC of 0.87 (95% CI, 0.76-0.98). Overall, for inflammatory bowel disease, the pooled sensitivity, specificity, and AUC were 90% (95% CI, 85-93%), 76% (95% CI, 56-90%), and 0.92 (95% CI, 0.94-0.97), respectively. Conclusions: Despite the challenges around standardised disease scoring and the lack of histological confirmation, CCE performs well in diagnosing inflammatory bowel disease. It demonstrates high sensitivity in both UC and Crohn's terminal ileitis and colitis and high specificity in Crohn's disease. Further studies are needed to evaluate the diagnostic accuracy of other colonic inflammatory conditions.

UMF-Net: A UNet-based multi-branch feature fusion network for colon polyp segmentation

The early diagnosis of colorectal cancer heavily relies on colonoscopy, but clinical examinations often face challenges in detecting polyps due to various influencing factors. Polyp segmentation models can be categorized into two architectures: those based on convolutional neural networks (CNNs), which specialize in local modeling, and those based on Transformers, which excel at capturing global context. However, existing methods that combine these architectures often do so simply without addressing the large parameter size of Transformer architectures and the fixed weights problem of convolutional networks. In our study, we propose a Transformer-to-CNNs block by combining advanced components from Transformers with deformable convolutions (DCN) to replace the Transformer block. Deformable convolutions (DCN) enable learning offsets to capture long-range dependencies, apply adaptive weights, and select only a fixed number of pixels, thereby reducing the parameter size effectively. Based on approach, we introduce a novel architecture called UMF-Net (UNet-based Multi-Branch Feature Fusion Network), which adopts a multi-branch architecture and a unique feature fusion strategy to aggregate features from these branches. Additionally, we incorporate a Residual Coarse-to-Fine block to enhance the model’s learning capabilities further. In our evaluation process, we assess the performance of our proposed method using metrics such as mDice, mIoU, Fβω, Sα, mEξ, and MAE on four widely used benchmark datasets. The experimental results demonstrate that UMF-Net outperforms other state-of-the-art methods while effectively improving colon polyp segmentation accuracy.

Prevalence of colorectal polyps in patients undergoing colonoscopy in Sulaimaniyah gastroenterology center: a retrospective study

Background &amp; objectives: Colorectal cancers are believed to develop primarily through an adenoma-carcinoma sequence, with adenomatous polyps beginning as the primary precursor lesions. Thus, this study aimed to assess the prevalence of colorectal polyps with their characteristics and relation to age/gender and to aid in establishing a screening program to detect polyps and colorectal cancer in the early stages. Methods: In this retrospective study, the data of 2698 patients who underwent colonoscopy in Sulaimani Gastroenterology Center, Sulaimaniyah, Iraq, for various complaints and asymptomatic patients from January 2019 to February 2021 were studied regarding colorectal polyps. Patients sociodemographic data (age, gender, and residency), presented symptoms, surveillance rate for colon cancer and polyps, and disease follow-up were studied. Briefly, patients were given bowel preparation solutions the day before the colonoscopy, and the process was performed under conscious sedation. Results: The mean±SD age of patients was 52.0±17.59 years, and most were females (55.1%)(p=0.000) and from urban areas (62.12%) (p?0.05). Among the studied patients, 14.3% were diagnosed with polyps, of which 17.1% were males and 12.1% were females. The high prevalence rate was found in patients aged &gt;60 years (23.8%), followed by 50-60 years (17.71%), and then 40-49 years (13.07%). Conclusion: Colorectal polyp was common among patients undergoing colonoscopy for several gastrointestinal symptoms, especially after the age of forty.

Application of linaclotide in bowel preparation for colonoscopy in patients with constipation: A prospective randomized controlled study.

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 3days) 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.