Lynch syndrome (LS), synonymous with hereditary non-polyposis colorectal cancer (HNPCC), is caused by germline pathogenic variants in MLH1, MSH2, MSH6 or PMS2, which confer an elevated lifetime risk of colorectal cancer (CRC). Since the early 2000s, colonoscopic surveillance has been recommended to reduce CRC incidence via polypectomy and mortality via early detection, with intervals now being tailored by gene. Early non-randomised studies suggested that surveillance imparted reductions in both CRC incidence and mortality. However, more recent prospective registry data, including the Prospective Lynch Syndrome Database (PLSD), consistently report high CRC incidence, despite regular colonoscopy. Nevertheless, mortality from CRC is low in individuals under surveillance, indicative of a beneficial effect of early cancer detection, likely through detection at a less advanced tumour stage. The apparent discrepancies between historical and recent studies regarding incidence reduction may reflect methodological issues (selection, confounding, overdiagnosis, immortal-time bias). However, LS tumourigenesis often follows an accelerated or alternative pathway (DNA mismatch repair (MMR)-deficient adenomas and MMR-deficient crypt foci) that may bypass conventional, easily detected precursor lesions. This may limit the impact of surveillance on incidence but preserve the mortality benefit through earlier-stage detection. Adherence, procedure quality and surveillance interval further influence outcomes. When weighting the evidence, large prospective consortium studies do not provide evidence in support of a substantial reduction in CRC incidence with 1-2 yearly surveillance for carriers of pathogenic MLH1/MSH2 variants over longer intervals. However, smaller retrospective studies have suggested potential benefits. Less intensive schedules appear appropriate for carriers of pathogenic PMS2 variants due to their low penetrance and more conventional adenoma-carcinoma pathways. In short, the evidence is strong that colonoscopic surveillance in LS reliably reduces CRC mortality but incompletely prevents incidence, especially in carriers with pathogenic variants whose cancers arise through an accelerated pathway and without a visible precursor. Improving adherence and endoscopic quality, considering adjunctive techniques (eg, faecal immunochemical testing between surveillance intervals, chromoendoscopy/AI (artificial intelligence) assistance), and exploring complementary strategies (eg, aspirin chemoprevention, biomarker-guided risk) are priorities. This narrative review synthesises current evidence, highlighting the need for robust future studies to optimise patient surveillance.

The presence of colonic adenomatous polyps is a risk factor for colorectal cancer. Australian Guidelines changed in 2019 so that the surveillance colonoscopy intervals and polyp risk stratification were changed to reflect evidence available. The purpose of this research was to understand compliance with the Guidelines and implications for the health system. Using routine hospital administrative datasets, all polyp surveillance colonoscopies performed from January 2018 to September 2020 in three government-funded hospitals in Central Queensland, Australia, were analysed. Colonoscopy intervals were calculated and compared with national recommendations. 'Early surveillance' was defined as greater than 6 months earlier than recommended. Logistic regression analyses were used to assess early surveillance or not, adjusted for potential confounding. Interval cancer and adenoma detection rates were also examined. Surveillance colonoscopies were performed for 294 patients with low-risk polyps, 20 with intermediate-risk polyps, 321 with high-risk polyps and 12 with very high-risk polyps during the study period (total n = 647). Early surveillance occurred in 566 (87.5%). The overall interval cancer rate was 0.9% (6/647), and adenoma detection rates were 62.2% (357/574) before the change of guidelines and 79.1% (53/67) after the change. No examined demographic or clinical factors were associated with early surveillance. Despite outstanding and high-quality colonoscopy services being provided, higher than recommended colonoscopy surveillance was identified in the regional public hospitals in Central Queensland. Hospital processes should be improved to ensure appropriate intervals between procedures to avoid using scarce healthcare resources.

How does linked color imaging (LCI) compare with conventional white-light imaging (WLI) colonoscopy for detection of colorectal polyps in adults requiring colonoscopy for screening, symptom assessment, or surveillance?

Background and study aims: First surveillance colonoscopy (SC1) following piecemeal endoscopic mucosal resection (pEMR) is recommended at 3 to 6 months. We aimed to investigate whether delayed SC1 is associated with increased risk of recurrence. Patients and methods: This was a retrospective analysis of a prospective cohort of patients undergoing pEMR for large non-pedunculated colorectal polyps (LNPCPs). Patients were categorized into standard SC1 (3-6 months) and delayed SC1 (> 6 months) groups. The primary endpoint was recurrence at SC1. Secondary outcomes included recurrence at second surveillance colonoscopy (SC2) and features of lesion recurrence. Subgroup analyses of very delayed SC1 and high-risk lesions were performed. Recurrence rates were also evaluated with propensity score matching (PSM). Results: We analyzed 577 lesions (standard: 407, delayed: 170) with a median polyp size of 30 mm (interquatile range [IQR] 25-40). Median time to SC1 was 5 months (IQR 5-6) in the standard versus 9 months (IQR 7-13) in the delayed group (P < 0.01). There were no significant differences in SC1 recurrence rates between groups (6.4% versus 6.5% in the standard and delayed respectively, <i>P</i> = 1). At SC2, recurrence rate was also similar between groups (3.8% versus 8.8% respectively, <i>P</i> = 0.43). Recurrence rates did not differ significantly among the analyzed subgroups. Recurrence rates did not differ significantly among the analyzed subgroups or in the PSM analyses. No advanced recurrences were detected at SC1 or SC2. <b>Conclusions:</b> Delayed SC1 is not associated with increased recurrence rates. Complete resection can be anticipated for most lesions and SC1 at 1-year post resection may be sufficient.

Microsimulation models use empirical evidence about cancer epidemiology and screening test performance to predict the long-term effectiveness of screening regimens and are essential for developing cancer screening guidelines. Colorectal cancer (CRC) provides a clear example. CRC arises through two pathways, the adenoma-carcinoma pathway and the serrated pathway. Sessile serrated lesions (SSLs) are the primary serrated precursor lesion. SSLs are more difficult to detect and remove than adenomas. We describe version 3.0 of the Colorectal Cancer Simulated Population model for Incidence and Natural history (CRC-SPIN), which adds new information about the serrated pathway and CRC risk in adults under 50, then estimate the effectiveness of decennial colonoscopy from 45 to 75 years old. The model was calibrated using a Bayesian approach to estimate 95% credible intervals (CIs) that reflect uncertainty in predictions. The model validated well to studies of the effect of one-time screening and outcomes from surveillance colonoscopy. In the absence of screening, SSLs accounted for 10.6% (95% CI: 3.3-21.6) of CRC, increasing to 23.5% (95% CI: 7.7%-46.0%) with screening due to selective removal of adenomas. Screening was predicted to prevent 93.9% (95% CI: 92.0%-94.3%) of CRC and 95.3% (95% CI: 93.8%-96.5%) of CRC mortality. Although SSLs are less common than adenomas, they likely make up a large fraction of CRC that arises in people who participate in screening. This points to the importance of improving the ability to detect SSLs, especially large SSLs, at colonoscopy.

Ulcerative colitis (UC)-associated colorectal neoplasia (UCAN) in patients with UC and primary sclerosing cholangitis (PSC) has not been studied well in Japan. This retrospective study examined the clinicopathological features and prognosis of UCAN in patients with PSC-UC. A total of 808 patients with UCAN were enrolled from 1983 to 2020 and categorized into PSC (PSC-UCAN, n = 26) and no PSC (UCAN-alone, n = 782) groups. Clinicopathological features were compared between the 2 groups, and the 10-year overall survival (OS) and cancer-specific survival (CSS) were analyzed. The PSC-UCAN group had a shorter UC duration before UCAN diagnosis (12.8 years vs. 16.9 years, P= 0.044), were younger at UCAN diagnosis (47.8 years vs. 53.3 years, P= 0.046), and developed UCAN more frequently in the right-sided colon (34.6% vs. 15.9%, P= 0.028) than the UCAN-alone group. The PSC-UCAN group showed a trend toward a lower proportion of high-grade dysplasia (19.2% vs. 30.7%) and a higher proportion of early-stage cancers (53.9% vs. 31.2%). The 10-year OS (64.6% vs. 79.3%, P=0.080) and CSS (80.8% vs. 83.9%, P=0.60) were comparable. Patients with PSC-UCAN showed earlier and younger development of UCAN than patients with only UCAN, with a high prevalence in the right-sided colon. Early-stage cancer was more frequently observed in the PSC-UCAN group, despite the shorter duration of UC. Patients with PSC-UC probably benefit from early initiation of surveillance colonoscopy.

Lynch syndrome (LS) is the most common hereditary colorectal cancer syndrome, caused by a germline pathogenic variant in one of the mismatch repair (MMR) genes. Among these, MSH6-associated LS represents a distinct subtype with unique molecular and clinical characteristics. Despite its relatively high prevalence (~1 in 758 individuals) compared with MLH1- (1 in 1946) and MSH2-associated LS (1 in 2841), MSH6-associated LS remains underrepresented in research and clinical guidelines. To bridge this knowledge gap, we reviewed current literature on molecular, biological, and clinical aspects of MSH6-associated LS. From a biological perspective, loss of MSH6 function results in a relatively low degree of microsatellite instability and potentially slower tumor progression compared with other LS subtypes. Nevertheless, tumor immunogenicity of MSH6-associated colorectal cancers appears preserved, supporting responsiveness to immune checkpoint inhibitors. Clinically, pathogenic MSH6 (path_MSH6) variant carriers have a unique tumor spectrum, characterized by a relatively lower colorectal cancer penetrance (~8.1%-44%) compared with path_MLH1 and path_MSH2 carriers, but a relatively high endometrial cancer risk (~16%-44%), with a median age of onset approximately a decade later than that observed for path_MLH1 or path_MSH2 carriers. Phenotypic heterogeneity among path_MSH6 carriers may reflect contributions from modifier genes, environmental exposures, microbiome composition and/or the individual's HLA type. Recognition of the distinct biology of MSH6-associated LS and its clinical implications highlights the importance of gene-specific precision in clinical care, such as initiating colonoscopy surveillance at a later age (30-35 years) and performing it every 2-3 years.

Background and study aimsThe European Society for Gastrointestinal Endoscopy recommends Lynch syndrome patients be followed in centers that monitor compliance and measure endoscopic performance. It is unclear if this policy impacts neoplasia outcomes. We investigated whether neoplasia outcomes were better at a dedicated center vs. community-based endoscopy centers.Patients and methodsWe reviewed findings of surveillance colonoscopy in 129 Lynch patients according to whether the previous colonoscopy was performed at a community vs. dedicated center and compared detection rates of advanced lesions (cancers plus advanced precancerous lesions) at colonoscopy.ResultsThere were five cancers identified at a surveillance colonoscopy: one after a colonoscopy at the dedicated center at an interval of 137 months and four after community center colonoscopies at intervals of 12, 14, 26, and 77 months. Detection of advanced lesions (cancer plus advanced precancerous lesions) was higher after colonoscopy performed at community centers compared with the dedicated center (12.0% vs 4.1%; odds ratio [OR] 3.20; 95% confidence interval [CI] 1.30–7.90). The cancer detection rate after previous colonoscopy at community centers was 4.3%, compared with 0.4% after colonoscopy at the dedicated center (OR 12.23; 95% CI 1.4–107.2). The interval between previous and surveillance colonoscopy was longer if the previous colonoscopy was performed at a community center (934 +/- 1037 days vs. 589 +/- 445 days;P= 0.006).ConclusionsA dedicated center with consistently high colonoscopy performance measures and navigation to augment patient adherence provided superior neoplasia outcomes in Lynch syndrome patients compared with community colonoscopy centers.

High-quality colonoscopy requires accurate risk stratification for surveillance per the 2020 US Multi-Society Task Force (USMSTF) guidelines and adherence to 2024 ACG/ASGE quality benchmarks. Both are operationally challenging in clinical practice. We developed and validated Colon-Pilot, a large language model (LLM)--powered clinical decision support system (CDSS) using GPT-4o to automate and standardize both functions. The system was evaluated in two operational modes: (1) a human-in-the-loop clinical decision support validation of surveillance recommendations for 596 colonoscopies, comparing concordance with 2020 USMSTF guidelines against expert consensus; and (2) an automated administrative audit applying Colon-Pilot to 42,632 colonoscopies across the Mayo Clinic Health System to calculate 2024 ACG/ASGE priority quality indicators. Recommendations were auto-generated unless predefined safety criteria triggered manual review. Colon-Pilot issued recommendations for 522/596 cases (87.6%) and flagged 12.4% for manual review. For automated cases, guideline-concordant accuracy was 97.5% (Cohen's κ = 0.970) versus 69.7% (κ = 0.781) for original endoscopist recommendations. Discordant AI cases (n=13) most often recommended longer-than-appropriate intervals (62%). Applied to the enterprise dataset, Colon-Pilot calculated performance exceeding 2024 targets: Adenoma Detection Rate 49.8% (≥35%), Sessile Serrated Lesion Detection Rate 17.7% (≥6%), bowel preparation adequacy 91.8% (≥90%), and cecal intubation rate 97.4% (≥95%). Colon-Pilot demonstrated high fidelity in applying surveillance guidelines and automated quality benchmarking, outperforming unassisted endoscopists in guideline adherence. By combining safety protocols with large-scale automated reporting, it offers a scalable solution for improving both efficiency and quality in colorectal cancer prevention.

ABSTRACTIntroductionIndividuals at elevated risk of developing colorectal cancer (CRC) benefit from regular surveillance colonoscopies. However, many countries lack well‐managed recall processes, leading to either excessive or insufficient colonoscopy use, both of which have significant consequences. A nurse‐coordinated surveillance program has been shown to improve compliance with surveillance guidelines but is associated with a costly administration burden. This study aims to create a multicenter, stepped‐wedge cluster trial that will integrate digital processes into this model to optimise colonoscopy management, reduce resource burden and ensure equitable service delivery across multiple healthcare sites.MethodsData from colonoscopy and pathology reports will be extracted into a clinical registry and natural language processing will be used to structure the data. Rule‐based algorithms (based on the Australian colonoscopy surveillance guidelines (but adaptable to other international standards), and with version control) will assess the need for future surveillance colonoscopies and recommend appropriate follow‐up intervals. The accuracy of the recommendations will be evaluated by nurse coordinators, with adherence to the guidelines assessed both at baseline and 6 months post‐implementation. Patient‐reported measures will be collected before and during trial implementation to assess satisfaction with the surveillance processes. Outcome measures will include evaluation of guideline compliance, key performance indicators for the quality of endoscopic services and cost‐effectiveness.DiscussionThis trial will establish the performance, acceptability and cost‐effectiveness of a digital health approach to managing surveillance colonoscopy. This will improve healthcare delivery by providing a cost‐effective way to manage colonoscopy demand and to mitigate risk for CRC.

Follow-up of 35 appendiceal orifice neoplasms resected by endoscopic full-thickness resection.

Abstract Background Endoscopic resection has revolutionized the management of large (≥ 20 mm) non-pedunculated colonic polyps (LNPCPs) with international data demonstrating its efficacy, safety and cost-effectiveness. Canadian outcome data from tertiary resection programs remains limited Aims Evaluate the outcomes of endoscopic resection of LNPCPs in a Canadian tertiary referral program. Methods Consecutive adult patients referred for the management of a LNPCP were enrolled in a prospective multi-centre cohort (ClinicalTrials.gov identifier: NCT05402696). Endoscopic modality selection (endoscopic mucosal resection [EMR], cold snare resection [CSR], or endoscopic submucosal dissection [ESD]) was at the discretion of the endoscopist. The primary outcome was technical success (removal of all polypoid tissue at index resection). Secondary outcomes included peri-procedural adverse events (intra-procedural perforation [IPP], clinically significant post-endoscopic resection bleeding [CSPEB], delayed perforation), and recurrence at first surveillance colonoscopy (SC1). Results From 06/2022 – 10/2025, 1138 large colorectal lesions were enrolled; 38 did not undergo endoscopic resection and 97 were located in the rectum. Ultimately 1003 LNPCPs were included for analysis. Median patient age was 68 years (IQR 61-73 years), and 45.4% of patients were female. Median lesion size was 25 mm (IQR 20-35mm) with 46.9% located in the cecum/ascending colon. The predominant morphology was Paris 0-IIA (66.1%) with 44.8% demonstrating granular topography. On histopathology, 62.5% were adenomas and 30.6% were sessile serrated lesions. Overall cancer frequency was 3.4%. Predominant resection modalities included piecemeal EMR (55.4%), CSR (26.3%), and ESD (9.5%). Technical success was achieved in 98.3%. Intraprocedural perforation occurred in 3.0% and CSPEB occurred in 4.7% with no delayed perforations. Hospital admission was required in 7.5% of patients, primarily due to CSPEB. Recurrence at SC1 was identified in 2.3%. Conclusions Our findings support that tertiary tissue resection programs demonstrate high performance in minimally invasive endoscopic resection for LNPCPs. Funding Agencies None

Abstract Background Colorectal cancer (CRC) is a leading cause of cancer-related death in older adults, particularly those with a history of colon polyps. However, surveillance guidance beyond age 75 is lacking. As a result, many individuals aged 75–84 with prior polyps continue to undergo colonoscopies despite uncertain benefit. The Fecal Immunochemical Test (FIT) may provide a safer alternative for surveillance in this population. Determining whether FIT can reliably exclude advanced neoplasia could reduce unnecessary colonoscopies and optimize the use of endoscopy resources. Aims This interim report evaluates the feasibility of FIT kit collection among older adults undergoing surveillance colonoscopy and provides preliminary data on the negative predictive value (NPV) of FIT for high-risk polyps (HRP) or CRC in this population. Methods This study is a prospective study aiming to recruit 417 patients aged 75–84 with a history of prior polypectomy who are already scheduled for surveillance colonoscopy at London Health Sciences Centre and St. Joseph’s Health Care London. Participants are asked to complete a FIT prior to their scheduled colonoscopy. FIT results do not influence clinical care, and all participants undergo colonoscopy as planned. The primary outcome is the NPV of FIT for detecting CRC or HRP, defined as polyps ≥10 mm, ≥3 adenomas, tubulovillous adenoma, high-grade dysplasia, or sessile serrated polyps. Results To date, 82 patients have been recruited, of whom 1 has passed away. The FIT kit return rate was 69.1% (56/81), with 6.2% testing positive (5/81). Among these 56 participants, 38 have completed colonoscopies with pathology results available; none were found to have CRC. Of these 38 participants, 30 had negative FIT results with no HRP identified on colonoscopy, while 5 had negative FIT results but were found to have HRP, yielding a preliminary NPV of 85.7% for FIT in detecting HRP. One participant had a positive FIT with HRP confirmed, and two had positive FIT results without HRP on colonoscopy. Stratifying by history, 14 participants had a history of HRP and 24 had a history of low-risk polyps (LRP). Among those with prior HRP, the NPV was 72.7% (8 with FIT-/HRP- and 3 with FIT-/HRP+). Among those with prior LRP, the NPV was 90.9% (20 with FIT-/HRP- and 2 with FIT-/HRP+). No serious adverse events have been reported to date. Conclusions Preliminary data demonstrate that FIT kit collection is feasible in older adults undergoing surveillance colonoscopy and suggest a high NPV of FIT, particularly among those with a history of low-risk polyps. These findings support FIT as a reasonable alternative to colonoscopy for guiding surveillance in this population. Continued recruitment will allow for more precise estimates and further assessment of its clinical implementation. Funding Agencies None

Safety and efficacy of margin and base ablation after endoscopic mucosal resection of large nonpedunculated colorectal polyps: a prospective multicenter study.

In Australia, the number of colonoscopies performed each year is increasing, placing stress on the resources of the health system. Our aim is to assess the diagnostic yield of repeat colonoscopies performed within 3 years of a prior colonoscopy and adherence to the National Health and Medical Research Council (NHMRC) surveillance colonoscopy guidelines. We performed a retrospective analysis of colonoscopies performed in 2021, repeated within 3 years of the previous colonoscopy at a tertiary hospital in Western Australia. We extracted data from index and repeat colonoscopies regarding patient demographics, referrer, indications, histopathology, colonoscopy findings, proceduralist specialty and recommendations. We sought associations between indications and diagnostic yield and adherence to NHMRC surveillance guidelines. Out of the 5838 total colonoscopies performed, 951 (16.3%) were repeats within 3 years. For polyp surveillance, 56.2% were adherent to the guidelines. Colonoscopies performed for poor bowel preparation or colorectal cancer syndromes mostly occurred within the recommended time frame (>80%). Considering all repeat colonoscopy indications, high-risk conventional adenomas were detected in 84 (8.8%), advanced sessile serrated lesions (SSLs) in three (0.32%) but no cancer was identified. Adherence to NHMRC surveillance colonoscopy guidelines after polypectomy is inadequate, with almost half of colonoscopies being performed outside of the recommended surveillance interval. The diagnostic yield for advanced adenomas, SSLs or colorectal cancer from repeat colonoscopies within 3 years of the previous one for all indications was low. Therefore, we recommend increased scrutiny of the appropriateness of repeat colonoscopy referrals within 3 years of the previous one.

While the association between metabolic factors and risk of colorectal cancer (CRC) in the general population is well established, their effect on precancerous polyps among individuals undergoing surveillance colonoscopy is not well understood. Additionally, most guidelines do not consider metabolic factors when determining surveillance colonoscopy intervals. This systematic review and meta-analysis summarizes current evidence for this association in individuals at above-average risk for CRC. Relevant studies published from 2010 through 2023 were identified using seven databases. Two independent reviewers performed abstract and full-text screening and quality assessment. Effect estimates were reported using a pooled odds ratio (POR) or pooled hazard ratio (PHR) based on the primary studies measurement with 95% confidence intervals and heterogeneity was reported as I2. 15,486 studies were screened, with 24 meeting the inclusion criteria. General obesity (POR = 1.31, 95% CI 1.09-1.57, I2 = 67%), central obesity (POR = 1.31, 95% CI 1.16-1.49, I2 = 0%), hypertension (POR = 1.22, 95% CI 1.02-1.44, I2 = 57%), high triglyceride (POR = 1.39, 95% CI 1.06-1.83, I2 = 0%), and metabolic syndrome (PHR = 1.24, 95% CI 1.01-1.51, I2 = 24%) were significant risk factors for the development of any precancerous polyp. The association between diabetes and nonalcoholic fatty liver disease and overall precancerous polyps was inconsistent. General obesity (PHR = 3.04, 95% CI 2.01-4.60, I2 = 0%) but not diabetes (PHR = 1.07, 95% CI 0.72-1.57, I2 = 0%) was significantly associated with the risk of advanced precancerous polyps. Metabolic factors should be considered when recommending surveillance colonoscopy intervals, which in most guidelines are mainly determined based on the findings at colonoscopy, the significance of family history of CRC and genetic predispositions.

Abstract Colorectal cancer incidence and mortality have declined over time, due in part to high-quality screening and surveillance colonoscopy. Nevertheless, postcolonoscopy colorectal cancer (PCCRC) occurs in up to 7% of cases and is inversely related to examination quality. Artificial intelligence-assisted colonoscopy aims to improve performance metrics and, ultimately, patient outcomes. Multiple randomized trials show that computer-aided polyp detection (CADe) increases adenoma detection, predominantly for diminutive lesions (≤5 mm). Computer-aided polyp characterization (CADx) enables real-time optical diagnosis, potentially shifting management of diminutive polyps by supporting resect-and-discard and diagnose-and-leave in situ strategies. Computer-aided quality assessment (CAQ) systems monitor key metrics—including cecal intubation rate, withdrawal time, speed, and mucosal exposure. Whether CADe alone leads to a reduction in PCCRC or cancer-related mortality remains to be determined; in the near term, a combined approach using CADe, CADx, and CAQ is most likely to deliver the greatest improvements in patient outcomes.

Surveillance colonoscopy is recommended for follow up of colorectal cancer and polyps. It has, however, a low yield in this setting and presents a significant strain on endoscopy capacity. Colon capsule endoscopy (CCE) is an alternative diagnostic. We aimed to determine the utility of this test in surveillance patients. A retrospective analysis of a prospectively collated service evaluation data was conducted looking at all surveillance CCE patients in NHS Highland. The primary outcomes were the need for follow up endoscopy and capacity saved. Secondary outcomes included the CCE completion rate, and patient specific factors that contribute to an unsuccessful CCE or the need for a follow up endoscopy. One hundred forty-six patients underwent surveillance CCE between May 2023 and January 2025. Ninety-three (63.7%) required follow up endoscopy. Capacity saved was up to 35.2% of the time slots that would have otherwise been used if all had undergone colonoscopy. Opiate use was associated with CCE failure. Polyp, as opposed to cancer, surveillance and a history of multiple polyps on previous endoscopy were associated with increased follow up rate. CCE resulted in endoscopy capacity savings in this surveillance cohort, but it should be used selectively in view of the high follow up investigation rate. The benefit may be improved with careful patient selection and the exclusion of patients on opiates, tricyclic antidepresants, or who have a history of polyposis.

Increasing timely colonoscopy surveillance for patients with high-risk colorectal polyps: Protocol for a cluster randomized trial.

Abstract Background Patients with inflammatory bowel disease (IBD) are at 1.4-1.7 times increased risk of developing colorectal cancer (CRC) compared with the non-IBD population. Clinical guidelines recommend regular colonoscopic surveillance to detect and manage colitis-associated dysplasia or early-stage CRC.1 Despite its importance, colonoscopy ranks low in acceptability among IBD patients when compared to other disease monitoring procedures.2 Adherence to surveillance varies3 and patients’ experiences are poorly understood. This study aimed to address the question: “What are the experiences of adult patients with IBD regarding colonoscopic surveillance programmes for colitis-associated dysplasia and CRC?”. The objectives were to explore patients’ experiences of surveillance and identify barriers and motivators influencing participation. Methods This mixed-methods systematic review (MMSR) was conducted in alignment with the Joanna Briggs Institute methodology, using a convergent segregated mixed-methods design. The PRISMA diagram (Figure 1) summarises the search and studies selection. Data were extracted using a standardised tool and appraised with Critical Appraisal Skills Programme checklists. Quantitative findings were synthesised descriptively, and qualitative findings underwent thematic synthesis before final integration. Results Three studies met the inclusion criteria (two cross-sectional surveys and one qualitative interview study), performed in the UK (n = 1) and the USA (n = 2). Key qualitative and quantitative findings are summarised in Table 1. The barriers to surveillance spanned 5 themes: 1) bowel preparation difficulties, 2) understanding the procedure’s purpose, 3) poor clinician communication, 4) emotional responses, e.g. anxiety, and 5) logistical constraints. Motivating factors included clear explanations from clinicians, reassurance about disease status, and confidence in the benefits of surveillance. Conclusion This review provides a deeper understanding of how patients experience and interpret the surveillance process, highlighting modifiable factors that could enhance engagement. The five identified themes raise awareness that many barriers are easily remediable. Measures to remove barriers may improve the patient experience and thereby increase the uptake of surveillance to mitigate the risk of CRC. This MMSR demonstrates that research in this area remains limited and highlights the need for further research.