A high adenoma detection rate in screening colonoscopy is associated with decreased rates of post-colonoscopy colorectal cancer. The use of artificial intelligence has emerged to assist with the identification of adenomas. This study aimed to evaluate whether adopting artificial intelligence-powered computer-aided detection systems in colonoscopy will increase the adenoma detection rate. The greatest increase was expected among low-volume and junior endoscopists. A retrospective review compared the adenoma detection rate before and after computer-aided detection in a single-center, high-volume endoscopy practice, including both colorectal surgeons and gastroenterologists with a wide variety of experience. Single tertiary referral institution between April 2023 and August 2023, and April 2024 and August 2024. Endoscopists board certified in colorectal surgery or gastroenterology participated in this study. Incorporation of computer-aided detection software into colonoscopy equipment. Adenoma detection rate. Data from 9 colorectal surgeons and 15 gastroenterologists were included. A total of 2327 colonoscopies were performed during the 10 months-1285 pre-computer-aided detection and 1042 post-computer-aided detection. The overall mean adenoma detection rate significantly increased from 53.9% to 61.3% ( p = 0.02). Colorectal surgeons had a statistically significant increase in adenoma detection rate from 49% to 62% ( p = 0.02), but gastroenterologists did not (56.9% to 60.8%, p = 0.15). Of 12 senior and 12 junior endoscopists, the seniors had a statistically significant increase ( p = 0.02) from 51.7% to 59.6%, whereas juniors did not (56.2% to 62.9%, p = 0.12). When comparing 12 high-volume and 12 low-volume endoscopists, the high-volume group had a statistically significant increase (51.3% to 59.4%, p = 0.01), whereas the low-volume group did not (56.5% to 63.1%, p = 0.13). The study has the following limitations: single institution and limited time of study to show whether increased adenoma detection rate will impact overall colorectal cancer incidence. Computer-aided detection in colonoscopy correlated with an increased adenoma detection rate for experienced endoscopists. See Video Abstract . ANTECEDENTES:Una tasa elevada de detección de adenomas en la colonoscopia de cribado se asocia con una disminución en las tasas de cáncer colorrectal posterior a la colonoscopia. El uso de inteligencia artificial ha surgido como una herramienta de apoyo para la identificación de adenomas.OBJETIVO:Evaluar si la adopción de sistemas de detección asistida por computadora, impulsados por inteligencia artificial, en la colonoscopia aumentará la tasa de detección de adenomas, observándose el mayor incremento entre los endoscopistas de bajo volumen y los de menor experiencia.DISEÑO:Una revisión retrospectiva comparó la tasa de detección de adenomas antes y después de la implementación de la detección asistida por computadora en una práctica endoscópica de alto volumen y de centro único, incluyendo tanto a cirujanos colorrectales como a gastroenterólogos con una amplia variedad de niveles de experiencia.ENTORNO:Institución única de referencia de nivel terciario, entre abril de 2023 y agosto de 2023, y entre abril de 2024 y agosto de 2024.PACIENTES:Endoscopistas certificados por la junta en cirugía colorrectal o gastroenterología.INTERVENCIÓN:Incorporación de software de detección asistida por computadora al equipo de colonoscopia.MEDIDA DE RESULTADO PRINCIPAL:Tasa de detección de adenomas.RESULTADOS:Se incluyeron datos de 9 cirujanos colorrectales y 15 gastroenterólogos. Se realizaron un total de 2.327 colonoscopias a lo largo de los 10 meses: 1.285 antes de la detección asistida por computadora y 1.042 después de la misma. La tasa media global de detección de adenomas aumentó de manera significativa, pasando del 53,9% al 61,3% ( p = 0,02). Los cirujanos colorrectales experimentaron un aumento estadísticamente significativo en la tasa de detección de adenomas, del 49% al 62% ( p = 0,02); sin embargo, los gastroenterólogos no mostraron tal aumento (del 56,9% al 60,8%; p = 0,15). De los 12 endoscopistas sénior y los 12 júnior, los sénior mostraron un aumento estadísticamente significativo ( p = 0,02), pasando del 51,7% al 59,6%, mientras que los júnior no lo mostraron (del 56,2% al 62,9%; p = 0,12). De 12 endoscopistas de alto volumen y 12 de bajo volumen, el grupo de alto volumen presentó un aumento estadísticamente significativo (del 51,3% al 59,4 %; p = 0,01), mientras que el grupo de bajo volumen no lo presentó (del 56,5 % al 63,1 %; p = 0,13).LIMITACIONES:Estudio realizado en una sola institución; duración limitada del estudio para determinar si el aumento en la tasa de detección de adenomas repercutirá en la incidencia global del cáncer colorrectal.CONCLUSIONES:La detección asistida por computadora en la colonoscopia se correlacionó con un aumento en la tasa de detección de adenomas en endoscopistas experimentados. ( AI-generated translation ).

Spectrum of Colopathy and Severe Polyposis Associated With Pentosan Polysulfate Sodium Maculopathy: A Retrospective Case Series.

Colorectal cancer (CRC) is the third most diagnosed cancer and the second leading cause of cancer death globally. Early identification of precancerous lesions and early-stage cancers can substantially reduce CRC incidence and improve survival. Hong Kong launched an organized colorectal cancer screening program (CRCSP) for the population in 2016. To assess the association of the CRCSP with the health equity of cancer screening participation among different socioeconomic groups over a 9-year period. Individual-level data from adults aged 50 to 75 years were analyzed from 3 repeated territory-wide population surveys in Hong Kong, China, between December 2014 to January 2022 to track trends in fecal test and colonoscopy participation. Disparities in screening uptake by socioeconomic status and income were assessed by concentration curves and indices. Survey-weighted generalized logistic regression models were used to assess the association between screening participation and socioeconomic factors. Data were analyzed from January 2025 to March 2026. Colorectal cancer screening utilization, specifically having ever undergone (1) a fecal test without symptoms and (2) a colonoscopy without symptoms. This study analyzed 14 602 adults aged 50 to 75 years (mean [SD] age, 60.62 [7.03] years; 7716 female individuals [52.84%]). Participation in fecal testing increased from 19.88% (95% CI, 18.70-21.05) from 2014 to 2015 to 27.15% (95% CI, 26.12%-28.18%) from 2020 to 2022, and colonoscopy uptake rose from 17.65% (95% CI, 16.53%-18.77%) to 27.28% (95% CI, 26.24%-28.31%). Socioeconomic disparities narrowed after the CRCSP, with the concentration indices declining (fecal test participation, 0.11 from 2014-2015 to 0.02 from 2020-2022). Similar improvements were found for colonoscopy screening and across income groups. Screening participation was significantly associated with older age, higher education level, marital status, private housing, income, and socioeconomic status. In this cross-sectional study, following the implementation of an organized population screening program, colorectal cancer screening participation increased and socioeconomic disparities narrowed over time. Overall uptake in Hong Kong remains low, and some disparities persist in younger age groups (age 50-59 years), single households, individuals with a primary and secondary school education, lower-income groups, and public housing residents. Efforts to increase participation are needed in certain groups to ensure health equity.

Removal of an Incidental Appendicolith Impacting the Appendiceal Orifice During Colonoscopy Screening

The incidence of early-onset colorectal cancer is rising globally. While metabolic dysregulation is a known risk, the specific contribution of lipid profiles to colorectal carcinogenesis in young adults remains unclear. Remnant cholesterol (RC) has emerged as a significant cardiovascular risk factor, but its association with young-onset colorectal neoplasia is not fully elucidated. We conducted a retrospective, cross-sectional study of 4,100 asymptomatic individuals under 50 years of age undergoing screening colonoscopy. RC was calculated as total cholesterol minus high-density lipoprotein cholesterol and low-density lipoprotein cholesterol. We used multivariate logistic regression to assess the independent association between RC levels and the presence of young-onset adenoma (YOA) and advanced YOA. Patients with YOA had significantly higher RC levels than controls (17.65 ± 14.52 mg/dL vs. 14.69 ± 11.14 mg/dL; P< 0.001). In adjusted multivariate analysis, RC was independently associated with YOA risk (odds ratio [OR], 1.011; 95% confidence interval [CI], 1.003-1.019; P= 0.005). Notably, for advanced YOA, RC remained the only lipid parameter that retained statistical significance in the multivariable model (OR, 1.021; 95% CI, 1.004-1.038; P= 0.015), whereas traditional lipid markers were not significant. Higher RC levels were independently associated with YOA and advanced YOA in this cohort of asymptomatic individuals under 50 years of age. Among the lipid parameters examined, RC remained statistically significant in the multivariable model for advanced YOA.

Pragmatic colorectal cancer (CRC) screening trials compare colonoscopy with faecal immunochemical testing (FIT), but differences in adherence complicate interpretation of comparative outcomes. To compare 10-year risks of CRC mortality, CRC incidence and all-cause mortality under one-time colonoscopy versus sustained FIT strategies in the COLONPREV Trial. We conducted a post hoc per-protocol analysis of 17 270 screening initiators aged 50-69 years in eight Spanish regions, using inverse probability weighting to adjust for observed confounding and informative protocol deviations. Weighted 10-year risks were similar for CRC incidence (0.80% FIT vs 0.86% colonoscopy; risk difference (RD) 0.06%, 95% CI -0.25% to 0.37%) and all-cause mortality (4.02% vs 4.09%; RD 0.07%, 95% CI -0.76% to 0.84%). CRC mortality was lower with colonoscopy (0.072% FIT vs 0.042% colonoscopy; RD -0.03%, 95% CI -0.12% to 0.06%), but estimates were imprecise. Sustained colonoscopy and FIT showed similar 10-year outcomes overall, highlighting the importance of adherence pathways in pragmatic screening trials. ClinicalTrials.gov: NCT00906997.

ABSTRACTA 59‐year‐old man with a history of colorectal polypectomy underwent a screening colonoscopy. A 5‐mm reddish lesion was identified in the sigmoid colon. The lesion had a smooth surface without erosion or ulceration and appeared slightly elevated with well‐demarcated margins. Magnifying narrow‐band imaging revealed dilated round pits, reduced crypt density, and arborizing vessels in the central area. Cold snare polypectomy was performed for diagnostic and therapeutic purposes. Histopathological examination demonstrated proliferation of bland spindle cells with oval nuclei in the lamina propria. Immunohistochemistry showed positivity for vimentin and GLUT‐1, weak epithelial membrane antigen expression, and negativity for S‐100, SMA, c‐kit, and CD34, with a Ki‐67 index of <1%. These findings were consistent with colonic perineurioma, a rare benign peripheral nerve sheath tumor composed of perineurial cells. This case highlights that colonic perineurioma should be considered in the differential diagnosis of small subepithelial lesions detected during colonoscopy. Reduced crypt density and arborizing vessels may provide subtle clues; however, definitive diagnosis requires histopathological and immunohistochemical evaluation.

To evaluate lung cancer screening eligibility and use among U.S. adults undergoing breast and colorectal cancer screening. Participants in the 2024 Behavioral Risk Factor Surveillance System were identified. Females aged 50 to 74 up-to-date on screening mammography were included in the breast cancer screening cohort. Males and females aged 50 to 75 up-to-date on screening colonoscopy or sigmoidoscopy were included in the colorectal cancer screening cohort. In each cohort, lung cancer screening eligibility (according to the 2021 U.S. Preventive Services Task Force criteria) and use were evaluated. BRFSS survey weights were applied to obtain national estimates of screening eligibility and use. In the breast cancer screening cohort, 9.9% (weighted number 3.6 million) were eligible for lung cancer screening. In the colorectal cancer screening cohort, 11.8% (weighted number: 7.4 million) were eligible for lung cancer screening. Together, 8.4 million adults up-to-date on breast or colorectal cancer screening were eligible for lung cancer screening. However, lung cancer screening use among eligible adults in the breast and colorectal cancer screening cohorts was only 28.7% and 27.7%, respectively. If all eligible adults up-to-date on breast or colorectal cancer screening underwent lung cancer screening in 2024, overall lung cancer screening uptake in the U.S. would increase from 22.7% to 70.5%. In this national analysis, there were 8.4 million adults up-to-date on breast or colorectal cancer screening who were eligible for lung cancer screening; if these adults had undergone lung cancer screening in 2024, lung cancer screening uptake in the U.S. would increase 3-fold to 71%.

A multi-center study of non-invasive colorectal cancer evaluation in cystic fibrosis (NICE-CF).

Colorectal cancer (CRC) screening uptake in Türkiye remains suboptimal, despite the presence of a national screening program. Understanding whether barriers arise primarily from patient-related factors or system-level constraints is essential for effective policy planning. This study aimed to evaluate barriers to CRC screening across the screening pathway using patient, procedural, and provider perspectives. A descriptive cross-sectional study was conducted between January and June 2025 at a tertiary training and research hospital. Three distinct groups were surveyed: 100 screening-naïve outpatients aged 50-70 years, 100 patients undergoing diagnostic or screening colonoscopy, and 50 general surgeons performing or referring for colonoscopy. Study-specific questionnaires, pilot-tested for clarity but not formally validated, were used to assess screening awareness, attitudes, perceived barriers, and strategies for improvement. The data were analyzed descriptively. Among screening-naïve outpatients, 54% had no prior awareness of CRC screening, and only 28% had received a physician recommendation for screening. Fear of a serious diagnosis (45%) and pain or discomfort (40%) were commonly reported concerns; however, most respondents indicated that these would not deter screening. Among patients undergoing colonoscopy, 77% underwent the procedure for symptoms rather than preventive screening, while post-procedure satisfaction was high. Surgeons predominantly identified system-level barriers, particularly long waiting times (90%) and an insufficient number of trained endoscopists (92%), as major limitations in effective screening delivery. The primary perceived barrier to CRC screening in Türkiye appears to be limited system capacity rather than patient reluctance. Improving screening uptake will likely require coordinated public awareness efforts, structured national reminder systems, and expansion of the number of adequately trained endoscopists, alongside endoscopy infrastructure.

Spatial computer vision techniques have the potential to improve the diagnostic performance of colonoscopy. However, the lack of 3D colonoscopy datasets for training and validation hinders their development. This paper introduces C3VDv2, the second version (v2) of the high-definition Colonoscopy 3D Video Dataset, featuring enhanced realism designed to facilitate the quantitative evaluation of 3D colon reconstruction algorithms. 192 video sequences totaling 169,371 frames were captured by imaging 60 unique, high-fidelity silicone colon phantom segments. Ground truth depth, surface normals, optical flow, occlusion, diffuse maps, six-degree-of-freedom pose, coverage map, and 3D models are provided for 169 colonoscopy videos. Eight simulated screening colonoscopy videos acquired by a gastroenterologist are provided with ground truth poses. Lastly, the dataset includes 15 videos with colon deformations for qualitative assessment. C3VDv2 emulates diverse and challenging scenarios for 3D reconstruction algorithms, including fecal debris, mucous pools, blood, debris obscuring the colonoscope lens, en-face views, and fast camera motion. The enhanced realism of C3VDv2 will allow for more robust and representative development and evaluation of 3D reconstruction algorithms.

Rural barriers to colonoscopy screening identified through patient navigation.

Barriers and facilitators to colonoscopy adherence among populations with high risk of being diagnosed with colorectal cancer: A qualitative study using the Theoretical Domains Framework and COM-B model.

Colorectal cancer (CRC) screening remains below national targets among US women. Primary care providers (PCPs) play an important role in promoting CRC screening adherence. Many US women see an obstetrician/gynecologist (OB/GYN) as their PCP. We evaluated adherence among US women to multi-target stool DNA (mt-sDNA) testing and follow-up colonoscopy ordered by OB/GYNs. We linked Exact Sciences Laboratories (ESL) orders with a national multi-payer claims database (2016-2022). Eligible participants were average-risk women aged 45-75 years with continuous health plan enrollment (- 180 to 0 days baseline; 0-365 days to assess mt-sDNA adherence; and, after a positive mt-sDNA result, 0-365 days to assess colonoscopy). Primary outcomes were mt-sDNA completion within 365 days of kit shipment and colonoscopy completion within 365 days of a positive mt-sDNA test. Logistic regression evaluated factors associated with mt-sDNA adherence. Of 160,068 women with OB/GYN-ordered mt-sDNA, 71.4% (n = 114,360/160,068) completed testing within 365 days. Test positivity was 8.6% (n = 9773/114,360). Among those with positive results, 71.3% (n = 6971/9773) completed colonoscopy within 365 days. Test adherence increased with age (45-49 years, 67.1%; 50-64 years, 71.8%; 65-75 years, 76.7%), was higher in non-metropolitan areas, and rose with higher ZIP code median household income. Test adherence was higher among individuals with traditional Medicare (85.2%) and Medicare Advantage (77.3%) than commercial insurance (71.3%) and Medicaid (61.7%). In routine practice, more than 70% of women completed OB/GYN-ordered mt-sDNA testing and, after a positive result, more than 70% completed colonoscopy within 1year. OB/GYN clinicians may play a key role in improving CRC screening adherence, with opportunities to address gaps by payer, income, and race/ethnicity.

Characteristics and Effectiveness of Patient Navigation Programs on Colorectal Cancer Screening and Follow-Up Colonoscopy Uptake: A Systematic Review.

We report the case of a 52-year-old man undergoing routine screening colonoscopy who was found to have a 3-cm submucosal mass in the sigmoid colon. Initial biopsy demonstrated S100 positivity, raising suspicion for ganglioneuroma (GN). Endoscopic ultrasound revealed a large hypoechoic submucosal lesion, and due to concern for possible gastrointestinal stromal tumor, size, and partial obstruction, the patient underwent partial colectomy. Surgical pathology confirmed a polypoid GN without atypia. Colonic GNs are rare, benign tumors derived from neural crest cells that may mimic other subepithelial lesions. Complete excision is typically curative, and though recurrence is uncommon, some experts advise follow-up imaging to monitor.

Despite the availability of multiple screening options, rates of colorectal cancer (CRC) screening remain suboptimal. With recent approval of a blood test for CRC screening, there is an urgent need to understand screening preferences of populations with low screening rates. Between October 2023 and June 2024, we conducted a survey on preferences for CRC screening modalities of stool test, blood test and colonoscopy among adults aged 45-75 at ambulatory primary care clinics across multiple community health centers and federally qualified healthcare centers across the city as well as in community settings regardless of prior screening. A total of 1,014 individuals completed the survey. Respondents were 12.8% Black/African American, 51.6% White, 23.4% Hispanic, 15.8% South Asian, and 4.2% Asian. Overall, the highest test preference was for screening colonoscopy (45.5%) followed by blood test (29.9%). Colonoscopy was preferred by individuals under age 70 (47.5%), while stool-based (20.2%) and blood-based (31.9%) tests were the most preferred among above 70 years (p = 0.0429. Whites (54.6%), Blacks (44.6%), and Hispanics (35.9%, p < 0.001) preferred colonoscopy, while Asians (37.2%) and South Asians (24.4%) favored blood tests. Factors associated with preference for a colonoscopy over other screening tests were younger age: respondents aged below 70years were more likely to prefer colonoscopy, compared to respondents aged above 70years (OR 1.72, 95% CI [1.20-2.47], p = 0.003); Nonsmoker compared to former/current smokers (OR 2.04, 95% CI [1.10-3.94], p = 0.028); Having undergone a prior colonoscopy (OR 6.83, 95% CI [4.52-10.6], p = < 0.001) or not having a prior stool test (OR 1.56, 95% CI [1.52-2.11], p = < 0.001). Factors associated with preference for a blood test over other screening tests were education level: respondents without any college experience were more likely to prefer blood test compared to respondents with college experience (OR 1.46, 95% CI 1.02-2.07, p = 0.038); Nonsmoker compared to former/current smokers (OR 1.73, 95% CI [1.00-2.99], p = 0.048); Never undergone a prior colonoscopy (OR 1.76, 95% CI [1.23-2.51], p = 0.002). Factors associated with preference for a stool test over other screening tests were: age over 80years compared to respondents aged below 80 (OR 3.34, 95% CI 1.67-6.55, p < 0.001); respondents with college experience were more likely to prefer blood test compared to respondents without college experience (OR 1.62, 95% CI 1.02-2.66, p = 0.048). Colonoscopy was the preferred test option, followed by blood test. Preferences for screening test varied by age, race, ethnicity, education and prior screening. The study underscores importance of patient preference in deciding which tests to offer based on the patient characteristics. Nonsmokers, those without any college education and those without prior screening preferred blood test for screening.

An association between higher adenoma detection rate (ADR) at index screening colonoscopy and lower risk of metachronous advanced neoplasia (AN, defined as colorectal cancer [CRC] or advanced adenoma [AA]) has been reported. However, the relationship between ADR at both index and surveillance colonoscopy and subsequent AN is unknown. We examined the association between ADR and withdrawal time (WT) at index and surveillance colonoscopy and risk of metachronous AN at surveillance colonoscopy. We used GIQuIC, a repository of colonoscopies across the United States. Each patient has a unique ID at a participating site. Endoscopist national provider identifiers are associated with each examination. We included patients with 2 colonoscopies at least 3 years apart (index and surveillance) between 2011 and 2022 and calculated the ADR and average WT for the endoscopist performing the index and surveillance colonoscopies, respectively. We built a multivariable logistic regression model with metachronous AN as the outcome and ADR and WT as independent variables, controlling for patient age, sex, and race. We included 768,274 patients and 3,425 endoscopists. Mean patient age was 61 years and 48% were men; 66% were White, and 3% were Hispanic. Indication for index colonoscopy were screening (43.4%), surveillance (39.0%), and diagnostic (17.6%). ADR quartiles were ≤29.7%, >29.7%-37.2%, >37.2%-45.0%, and >45%. WT quartiles were ≤7.1 minutes, >7.1-8.2 minutes, >8.2-9.7 minutes, and >9.7 minutes. AN detection was lowest when low ADR endoscopists performed both index and surveillance examinations (5.4%, Table 1) and high ADR index examinations were followed by low ADR surveillance examinations (4.0%). Compared with low ADR endoscopists for both index and surveillance examinations, advanced neoplasia detection was significantly higher when both examinations performed by a high ADR endoscopist (AA 7.4%; OR [odds ratio] for AN 1.10 [1.05-1.16]) or low ADR index examinations were followed by high ADR surveillance examinations (AA 13.3%; OR for AN 1.448 [1.37-1.51]). Compared with short WT endoscopists for both examinations (AA 7.2%; CRC 0.3%), AN detection was higher when both examinations were performed by a long WT endoscopist or short WT index examinations were followed by long WT surveillance examinations (AA 7.0% P = 0.53 and 9.9%, P < 0.001) but similar CRC detection of 0.2% and 0.2% ( P 0.14). Other factors associated with finding of metachronous AN were older age (76 years and older vs 45-55 years OR 1.64; 95% CI 1.48, 1.82), male sex (Male vs female OR 1.15; 95% CI 1.10-1.19), White race compared with non-White (OR 1.10; 95% CI 1.06, 1.14), 7-10 years between examinations compared with 3-5 years between examinations (OR 1.24; 95% CI 1.11, 1.37), indication of surveillance vs screening for the index examination (OR 1.1.7; 95% CI 1.13, 1.22), AA or sessile serrated lesion finding on the index examination (OR 2.08; 95% CI 1.97, 21.9 and OR 1.23; 95% CI 1.16, 1.30 respectively). Our findings show endoscopist ADR and WT for both index and surveillance colonoscopy are associated with risk of metachronous neoplasia. Future studies on metachronous neoplasia should include both sets of quality indicators.

Advanced colorectal neoplasia and colorectal cancer in metabolic dysfunction-associated steatotic liver disease.

It is often hypothesized that persons not participating in cancer screening are difficult to reach through the healthcare system. We aimed to investigate this hypothesis for non-participants in colorectal cancer (CRC) screening in Germany. Using health claims data covering ~20% of the German population, we included persons aged 59 years in 2020 who had undergone neither fecal occult blood testing nor screening colonoscopy by the age of 59 years. We assessed (preventive) healthcare contacts and utilization of (reimbursable) CRC screening counseling between the ages of 50 and 59 years. Among 71 575 included persons (38% female), 99% had at least one physician contact between 50 and 59 years (mean age at first contact: 50.3 years). A total of 87% of women and 80% of men utilized any other preventive measure such as the general health check-up; the latter was utilized by 71% of women and men. Counseling about CRC screening was coded in 38% of women (men: 34%). Non-participants in CRC screening in Germany are reachable through the healthcare system and the vast majority has preventive healthcare contacts. This suggests that new structures are not needed, but rather it should be investigated how existing structures could be better used for counseling about CRC screening.