Kolon

Kolon

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Evidence for Variation in the Number of Colonoscopies Required To Achieve a Clear Colon

Ideally, patients presenting for colonoscopy should have a complete examination and identification and resection of all precancerous polyps in a well-prepared colon, followed by assignment

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Metabolic Syndrome Increases All-Cause and Disease-Specific Mortality in Colorectal Cancer

Metabolic syndrome (MS), diabetes mellitus, and obesity are all associated with an increased prevalence of precancerous colorectal polyps and incidence of colorectal cancer (CRC). This

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Snare Tip Soft Coagulation Reduced Recurrence After EMR in Routine Practice

Thermal treatment of endoscopic mucosal resection (EMR) margin defects after complete resection of large (≥20 mm) nonpedunculated colorectal polyps has reduced the recurrence rate at

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U.S. GI Societies Announce Strategic Plan to Promote and Support Sustainable Digestive Health Care

As a subspecialty, GI medicine is typically ranked in the top 3 for its high carbon footprint and production of plastic waste. The 4 U.S. GI

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Randomized Controlled Trial Finds Lower Recurrence Rate With Underwater Versus Conventional Colorectal EMR

In a randomized controlled trial (RCT) performed in Brazil, 120 colorectal lesions with a mean size of 17.5 mm were randomized to underwater endoscopic mucosal

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Colonoscopist Adenoma Detection Rate Predicts Advanced Neoplasia Risk After Polypectomy

Investigators evaluated 30,897 individuals with baseline polypectomy and at least 1 surveillance colonoscopy between 2004 and 2016 across 73 Veterans Administration sites in the U.S.,

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Study Shows Margin Treatment Was Good but Not Perfect for Colorectal Laterally Spreading Lesions 40 mm or Larger

Thermal treatment of the margin after piecemeal endoscopic mucosal resection (EMR) of laterally spreading lesions (LSLs) ≥20 mm is now considered standard of care because

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GI Patients Like Telehealth

This is a survey of 5134 patients who participated in a telehealth visit in 1 year across 105 practices in the Digestive Health Physicians Association. 

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Prediagnosis Obesity Eliminates Survival Advantage Associated With Aspirin Use in Stage IV Colorectal Cancer

This study divided 656 participants with stage IV colorectal cancer (CRC) into groups according to their prediagnosis body mass index (BMI): normal (38.3%), overweight (36.3%),

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More on Withdrawal Time in Colonoscopy

Current recommendations are that minimum withdrawal times in screening colonoscopy that are negative should average at least 6 minutes.  In an analysis of a previously

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Combining CADe and a Mucosal Exposure Device Provides Best Detection During Colonoscopy

In a randomized controlled trial, 1245 participants aged 50 to 75 years were randomized to standard colonoscopy, standard colonoscopy plus an artificial intelligence (AI) detection

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Large Tandem Study Shows 9-Minute Withdrawal Time Better Than 6 Minutes

In a randomized tandem study from China, 2 study arms compared the standard colonoscopy withdrawal time of 6 minutes versus 9 minutes. The colon was

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Treat Traditional Serrated Adenomas as Advanced Lesions

Traditional serrated adenomas (TSAs) are rare lesions. They are predominantly in the left side of the colon, and unlike sessile serrated lesions, they can be

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Fifteen-Year Benefits of Screening Sigmoidoscopy, Based on Pooled Results of 4 Randomized Controlled Trials

This is a pooled analysis of 4 randomized controlled trials of one-time sigmoidoscopy screening in patients aged 55 to 64 years. The trials were conducted

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ADR Works in FIT-Positive Populations: Target ADR Must Be Substantially Higher Than Primary Screening ADR

It is well known that the prevalence of adenomas is higher in patients with a positive result from a stool test, including both the fecal

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Review Indicates Colorectal Cancer Screening Guidelines Have Inadequate Reporting and Discussion of Screening Harms

Cancer screening can lead to patient-level harms from screening tests, diagnostic follow-up, and cancer treatment. This review examined U.S. screening guidelines on breast, cervical, colorectal,

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Increasing Distance From Treatment Centers Associated With Advanced Stage Colorectal Cancer

In a study of the National Cancer Database, the distance of patients from their medical facility was found to be associated with a risk of

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Wide Geographic Variation in Colorectal Cancer Screening Rates in the U.S. Associated With CDC’s Social Vulnerability Index

The Centers for Disease Control and Prevention (CDC) quantifies social vulnerability in the U.S. at the county level. The Social Vulnerability Index (SVI) reflects infrastructure,

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The Impact of Different Bowel Preparation Approaches on Nocturnal Awakenings, Sleep Loss, and Travel Interruption

This is a subinvestigation of a randomized bowel preparation trial in 10 Canadian centers. Patients were divided into 2 groups and underwent colonoscopy either in

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Kolon

Rare Causes of Abdominal Pain

Gastroenterologists commonly evaluate unexplained chronic or recurrent abdominal pain. In a review of overlooked causes of recurrent abdominal pain, some key points were: Chronic abdominal

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Expert Endoscopists (>1000 Procedures) Can Generally Assess Their Own Competency Accurately; Those With Less Experience Can’t

This systematic review and meta-analysis identified 13 qualitative studies of the accuracy of GI endoscopist self-assessment and 3 studies for individual patient data meta-analysis. These

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First Randomized Controlled Trial Comparing Colonoscopy With No Screening Finds Less Benefit Than Expected for Colonoscopy

In the first report of incidence and mortality results from a randomized controlled trial (RCT) comparing colonoscopy with no screening, 84,585 previously unscreened persons aged

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GI Reimbursement Being Hammered by Medicare: 15-Year Trends

This study looked at reimbursement from Medicare for 10 commonly used EGD and colonoscopy codes as well as several inpatient and outpatient services over a

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Postcolonoscopy Symptoms Are Related to Gender, Mood, Prior Somatic Symptoms

There are few prospective, detailed studies on factors such as time lost from work and symptoms after colonoscopy. This study prospectively measured postcolonoscopy symptoms in

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Dutch Describe Impact of Their National Biennial Fecal Immunochemical Test Screening Program

In 2014, the Netherlands instituted a national program of every-other-year fecal immunochemical test (FIT) screening for colorectal cancer (CRC). Since the start of screening, within

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Risk-Stratified CRC Screening Using Fecal Immunochemical Test and Stool DNA

This is a post hoc analysis of a risk-stratification screening strategy based on the Asia-Pacific Colorectal Screening (APCS) scoring system. This score ranks patients as

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Substantial Risk of Advanced Adenomas but No Colorectal Cancer in a Cohort of Patients With CDH1 Mutations

CDH1 mutations are associated with a very high risk of gastric cancer, early age of onset of gastric cancer, and a high risk of breast cancer

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Global Trends in Colorectal Cancer

Data on colorectal cancer (CRC) incidence and deaths were extracted from the GLOBOCAN database for 2020, and projections were made for 2040. Some of the

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Metachronous Adenomas Occur More Often in the Same Segment or a Proximal Segment Than in a Distal Segment

It is well-known that some clustering of adenomas occurs in the colorectum. In a single-center study in patients each with a single index adenoma, 61%

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Second-Generation Endocuff Again Found to Be Effective in New Randomized Controlled Trial

The second-generation Endocuff (Olympus America, Center Valley, Penn, USA) is called Endocuff Vision (ECV). It differs from the original Endocuff by having only a single

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Adherence to Low-Risk Adenoma Recommendations From 2020 U.S. Multi-Society Task Force Postpolypectomy Guideline Has Not Yet Caught On

The U.S. Multi-Society Task Force on Colorectal Cancer (USMSTF) creates postpolypectomy surveillance interval recommendations for the U.S. The main change to the 2020 guideline was

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Artificial Intelligence Increased Fraction of Colonoscopy Patients Needing 3-Year Surveillance: Relative Increase of 35% and Absolute Increase of 2.9%

This study examined the fraction of patients undergoing colonoscopy with versus without artificial intelligence (AI) in 9 randomized controlled trials (6 parallel and 3 tandem)

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Review Your Bowel Preparation Program Regularly

In an article published by Gastrointestinal Endoscopy in its new Top Tips section, Shaukat reviews methods to improve bowel preparation in the endoscopy unit: Map the bowel

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Interval Cancers Are More Deadly Than Screen-Detected Cancers but Are Not Different in Molecular Features

Previous studies have found that interval or postcolonoscopy cancers have molecular profiles that differ somewhat from those of cancers detected at a baseline colonoscopy, including

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Do Patients With Young-Onset Colorectal Cancer Require More Frequent Surveillance Colonoscopy?

Current recommendations for sporadic colorectal cancer (CRC) are to perform surveillance colonoscopy 1 year after surgical resection, then at 3 years, and then at 5-year

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Deaths From GI Cancers Declined in the U.S. From 2003 to 2019 but Less So in Rural Areas

Based on the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiological Research database, nationwide GI cancer age-adjusted mortality rates (AAMRs) per 100,000

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Colonoscopy Every 10 Years Starting at Age 40 Modeled as Cost-Effective for Men With Body Mass Index ≥35

Obesity is a known risk factor for colorectal cancer (CRC) in both men and women. A previously developed decision analytic was used to model the

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Steps To Consider in Deciding Whether To Incorporate a New Endoscopic Technique Into Your Practice

This interesting opinion piece provides advice regarding a process for deciding whether to incorporate a new endoscopic technique into your practice. The authors suggest you

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Endoscopy Units Should Establish a Management Algorithm for Acute Iatrogenic Endoscopic Perforations

In this single-center study, 8 gastroenterology fellows and 20 practicing gastroenterologists answered a 10-question pretest regarding acute iatrogenic endoscopic perforation (AIEP) diagnosis and management. This

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Observational Study Indicates Early Colonoscopy, Within 24 Hours of Admission, Benefits Patients With Shock Index ≥1, Performance Status ≥3

Randomized controlled trials of early versus late colonoscopy in acute lower GI bleeding suggest no or limited benefit from early colonoscopy, but some of these

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Artificial Intelligence Increased Adenoma and Advanced Adenoma Detection Rates in Multicenter Randomized Controlled Trial

Artificial intelligence (AI) has been shown to increase adenoma detection rates (ADRs) by an average of about 10% in randomized controlled trials (RCTs). Meta-analyses of

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Double Right-Sided Colon Examination Effective No Matter How You Do It

This study identified 5 randomized controlled trials that addressed the value of a second right-sided colon examination in the forward view versus no second examination.

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ESGE and ESGENA Issue Position Statement on the Environmental Footprint of Endoscopy

Endoscopists interested in reducing their carbon and plastic footprints will find this set of recommendations from the European Society of Gastrointestinal Endoscopy and the European

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Predicting Residual Neoplasia Risk After “Noncurative” Endoscopic Submucosal Dissection for Malignant Colorectal Lesions

This is a retrospective study from 15 Western centers performing colorectal endoscopic submucosal dissection (ESD) in Europe and Australia.  A curative resection was defined as

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Liquid Biopsy Shows Promise for Early-Onset Colorectal Cancer

Early-onset colorectal cancer (EOCRC), or CRC occurring before age 50, is associated with advanced tumor stage at diagnosis, distal colon location, and signet ring histology.

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New Recommendations on Anticoagulant and Antiplatelet Management During Acute GI Bleeding and the Periendoscopic Period

A new GRADE guideline from the American College of Gastroenterology and Canadian Association of Gastroenterology includes recommendations for the periendoscopic management of anticoagulants and antiplatelets

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Impact of Preresection Biopsy on Subsequent Endoscopic Mucosal Resection

We often hear that physician-identified large nonpedunculated colorectal polyps (LNPCPs) that warrant referral to an advanced endoscopist for endoscopic mucosal resection (EMR) or endoscopic submucosal

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Risk of Ileoanal Pouch Cancer Is Greater in Familial Adenomatous Polyposis Than in Ulcerative Colitis

This report identified 46 studies that included 19,964 patients with ulcerative colitis (UC) in whom 73 cases of pouch cancer occurred and 3741 patients with

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Breath Test for Colon Cancer Shows Promise

Patients with certain cancers expel volatile organic compounds (VOCs). VOCs are the basis of previous reports in which dogs were trained to identify patients with

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Randomized Trial Finds Tip-In (Anchoring) EMR Superior to Conventional EMR for 10- to 25-mm Nonpedunculated Colorectal Polyps

“Tip-in” or “anchoring” endoscopic mucosal resection (A-EMR) involves submucosal injection followed by a small incision on the proximal side of the injection mound. The snare

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Tip-in EMR Compared With ESD for 20- to 30-mm Nonpedunculated Colorectal Neoplasms

Tip-in endoscopic mucosal resection (EMR) involves submucosal injection, followed by an incision on the proximal side of the injection mound using a snare tip with

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Cap-Assisted EMR Produced Faster Resection Times and Lower Recurrence Rates Compared to Traditional EMR

Cap-assisted EMR (EMR-C) involves submucosal injection followed by resection using a stiff Olympus cap (MH-597, Olympus Optical Co, Ltd, Tokyo, Japan) with an outer diameter

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Gender, Mood Among Factors Predicting Severe Symptoms With Bowel Preparation

In a study performed in 10 Italian centers, 1137 colonoscopy patients completed validated questionnaires prior to colonoscopy and had symptoms from bowel preparation tracked. Overall,

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Ketogenic Diets and ß-Hydroxybutyrate May Suppress Colorectal Cancer

High-sugar diets and hyperglycemia have been associated with colorectal cancer (CRC). In this study, investigators showed that ketogenic diets both prevented and treated CRC induced

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Serrated Polyp Detection Predicted Interval Cancer Independent of Adenoma Detection Rate

The adenoma detection rate (ADR) is currently the recommended measure of the quality of mucosal inspection during colonoscopy. ADR does not include sessile serrated lesions

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Hybrid Argon Plasma Coagulation Endorsed to Reduce Recurrence Rate After Colorectal EMR

Thermal coagulation of the normal-appearing margin using snare tip soft coagulation (STSC) treatment after endoscopic mucosal resection (EMR) has been shown to reduce recurrence rates

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Badge Sign-in Plus Report Cards Increased First Case On-time Starts

At a single U.S. academic center with 20 endoscopists, including 13 academic and 7 voluntary, there were initial baseline measurements of first case on-time starts

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Treating High-Grade Squamous Intraepithelial Lesions in HIV Prevents Anal Cancer

Anal cancer is 10 times more common in HIV-positive men than cervical cancer is in women in the general population; however, women with HIV are

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Pilot Study Finds Submucosal Thickness Is Greater With Colorectal EMR Than ESD

Discussions of colorectal endoscopic mucosal resection (EMR) versus endoscopic submucosal dissection (ESD) usually focus on en bloc resection and recurrence rates. Little is known about

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12 of 12 Patients With Mismatch Repair-Deficient, Locally Advanced Rectal Cancer Had Complete Response to Dostarlimab Alone

It is well known that mismatch repair-deficient colorectal cancer (CRC), also called microsatellite instability (MSI)-high CRC, fails to respond to traditional fluorouracil-based chemotherapy but has

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Systematic Review and Meta-analysis Indicates Snare Tip Soft Coagulation of EMR Margins Is Likely Better Than Argon Plasma Coagulation

Thermal treatment of the margin of piecemeal endoscopic mucosal resection (EMR) defects is now considered an effective treatment for reducing recurrences. Some practitioners have adopted

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Motorized Spiral Enteroscopy Effective for Previous Incomplete Colonoscopies Related to Redundant Colon

The motorized spiral enteroscope has been shown to be safe and effective for deep enteroscopy.  This study from a single center included 36 patients who

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Liquid Biopsy After Resection of Stage II Colon Cancer Reduced the Need for Adjuvant Chemotherapy

Patients with stage III (node-positive) colorectal cancer (CRC) benefit from adjuvant chemotherapy. Patients with stage II (invading muscularis propia or deeper and node-negative) CRC typically

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Median Thickness of Submucosa in the Resected Specimen Is Less With Underwater Than Conventional EMR for Polyps <20 mm

The thickness of submucosal tissue resection can be important for predicting whether the resection margin and submucosal assessment will be adequate when there is suspicion

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Adenoma Detection Rate Says It All in FIT-Positive Patients

This is a study of detection indicators in 13,067 fecal immunochemical test (FIT)-positive colonoscopies performed by 80 community gastroenterologists. The cutoff for FIT positivity was

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Actual Impact of COVID-19 on CRC (8.7% Reduction) and Advanced Adenoma (26.9% Reduction) Diagnoses in a U.S. Health Care System

This study utilized the Kaiser Permanente Northern California (KPNC) health care system to evaluate the actual impact of the COVID-19 pandemic on colorectal cancer (CRC).

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Again, No Need To Adjust Adenoma Detection Rate After Inclusion of 45- To 49-Year-Olds

This study looked at a large health care system’s first-time screening colonoscopies from the period October 2017 through December 2018, prior to the American Cancer

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Fully Covered Metal Stents Are the Most Cost-Effective Option for Benign Biliary Strictures in Chronic Pancreatitis

Benign distal biliary strictures (BBS) are common sequelae of chronic pancreatitis. The usual treatment involves prolonged maximal-caliber stenting, using either serial exchange of multiple plastic

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Computer-Aided Detection Improves Adenoma Detection Rate and Adenomas Per Colonoscopy in Fecal Immunochemical Test-Positive Patients

In parallel-arm randomized trials involving mostly primary screening and surveillance colonoscopy patients, computer-aided detection (CADe) has increased the adenoma detection rate (ADR) by about 10%.

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ORISE Associated With Submucosal Fullness and Distortion at Follow-Up EMR

ORISE (Boston Scientific, Marlborough, Mass, USA) is a viscous gel for submucosal injection. When ORISE is used for endoscopic mucosal resection (EMR) or endoscopic submucosal

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Gastroenterology Fellows Need More Training in Detection of Sessile Serrated Lesions

Detection skills by gastroenterology fellows are difficult to quantitate. One way to measure detection is to have the fellow perform a complete colonoscopy and clear

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CADx Program Met PIVI Thresholds for Diminutive Rectosigmoid Polyps but Not in Proximal Colon

A computer-assisted diagnosis (CADx) program is artificial intelligence (AI) software that predicts histology. In a prospective evaluation of the Fujifilm CADx program (CAD EYE, Fujifilm

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For Resection Without Injection, Histologic Study Indicates Underwater Gives Most Complete Resection

Previous studies have indicated that cold snare polypectomy effectively removes colorectal lesions up to 15 mm in size but cuts more superficially than hot snare

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Complications of Colonoscopy Remain Stable During Surveillance in VA Cooperative Study 380

Most studies of colonoscopy complications examine adverse event rates at a single time point. The Department of Veterans Affairs Cooperative Study #380 was one of

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More on Recurrence After Endoscopic Resection of T1 Colorectal Cancer: In Large Study, Only Rectal Location Predicted Recurrence

Widely accepted predictors of local recurrence after endoscopic resection of T1 cancers include rectal location, positive resection margin, poor differentiation (PD), lymphovascular invasion (LVI), high-grade

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New Study Suggests T2 Colorectal Cancers Could Be Resected Endoscopically and Analyzed for Risk of Lymph Node Metastases Before Surgical Resection

T2 colorectal cancers (CRCs) are almost invariably treated by surgical resection, but only 25% have lymph node metastases (LNM). An alternative approach in selected cases

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New Distal Attachment Combines Hood and Finger Features

Distal attachments that utilize fingers include the Endocuff Vision (Olympus America, Center Valley, Penn, USA) and AmplifEYE (Medivators Inc, Minneapolis, Minn, USA). An alternative approach

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Multi-Society Task Force Issues New Recommendations for Management of Hamartomatous Polyposis Syndromes

The hamartomatous polyposis syndromes include Peutz-Jeghers syndrome, juvenile polyposis syndrome, PTEN hamartoma tumor syndrome (Cowden’s and Bannayan-Riley-Ruvalcaba syndromes), and hereditary mixed polyposis syndrome. This document is a

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Randomized Controlled Trial Finds Cold Forceps Are Equally Effective and Faster Than Cold Snare for Colorectal Polyps ≤3 mm

Previous studies have found that a cold snare is more effective than cold forceps for polypectomy of polyps ≥4 mm in size, but data are

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Cold Snare Polypectomy of Pedunculated Polyps ≤10 mm: Choking Stalk for ≥10 Seconds Before Resection Reduces Immediate Bleeding

Cold snare polypectomy is now accepted as safer than hot resection of lesions ≤10 mm in size, though it is still widely believed that electrocautery

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T1 Colorectal Cancer With Free Resection Margins Between 0.1 and 1 mm: High-Grade Tumor Budding Makes the Difference in Recurrence Risk

A free resection margin, often interpreted as >1 mm between cancer and the resection line, is an independent predictor of low risk for recurrent cancer

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Large Japanese Real-World Experience Suggests Self-Expandable Metal Stents Are Beneficial in Obstructive Colorectal Cancer

Randomized controlled trials (RCT) of emergency surgery versus colonic stent placement using self-expandable metal stents (SEMS) have mostly suggested limited or no benefits from SEMS.

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Hang Some Pictures of Sessile Serrated Lesions in Your Endoscopy Unit

The first requirement in detecting subtle colorectal lesions during colonoscopy is to know what they look like. In this study from Minneapolis, a poster with

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Systematic Review and Meta-analysis of Adenoma Detection Rates in FIT-positive Patients

The U.S. Multi-Society Task Force on Colorectal Cancer recommends minimally acceptable adenoma detection rates (ADRs) in primary screening colonoscopy of 30% in men and 20%

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Artificial Intelligence Detection Program Assessment by a High Detector: Improved Adenoma Detection Rate, but Some Misses of Large, Flat Lesions

Artificial intelligence (AI) programs for computer-aided detection (CADe) of colorectal polyps have increased adenoma detection rates (ADR) by about 10% in parallel randomized trials and

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Prophylactic Clipping to Prevent Postpolypectomy Bleeding After Oral Anticoagulants

Prophylactic clipping is generally considered effective for endoscopic mucosal resection (EMR) defects of lesions ≥20 mm removed with electrocautery and proximal to the splenic flexure. 

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Endoscopic Submucosal Dissection of Lesions at the Dentate Line Compared With Rectal Lesions Above the Dentate Line

This systematic review and meta-analysis sought to quantify the differences in outcomes after endoscopic submucosal dissection (ESD) of rectal lesions at the dentate line versus

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Linked Color Imaging Improves Sessile Serrated Lesion Detection

Linked color imaging (LCI) emphasizes red color and is available on Fujinon endoscopes (Fujifilm Corp, Tokyo, Japan). Previous studies found LCI improved adenoma detection and

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Real-world Efficacy of Fecal Microbiota Transplantation for All C difficile Infection Subtypes: 81% for Recurrent, 78% for Refractory, 71% for Severe

This report describes a 4-year prospective, observational assessment of fecal microbiota transplantation (FMT) performed in 681 health care facilities across 50 U.S. states and 7

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Smartphone Apps on Bowel Preparation for Colonoscopy Improve Bowel Prep and Increase Adenoma Detection Rate

This is a meta-analysis of 12 eligible randomized controlled trials with a total of 4165 patients that compared the effect of education using a smartphone

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Continuing Clopidogrel Increases Intraprocedural Bleeding and Clip Use After Cold Snare Polypectomy, but Not Delayed Bleeding

Guidelines have often recommended the continuation of clopidogrel for diagnostic colonoscopy but discontinuation for polypectomy, which is impractical because polypectomy rates are so high during

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Advanced Adenoma Findings at Screening Colonoscopy Associated With Noncolorectal Cancer Mortality

This study used the VA Cooperative Screening Colonoscopy Study, one of the pivotal trials that led to federal legislation directing the Centers for Medicare and

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Declining Colectomy Rates for Benign Colorectal Polyps in an Integrated Health Care System in the U.S.

Population-based studies have found no decline in colectomy rates for benign colorectal polyps over the past 10 to 15 years, even though a recent study

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Chronic Physical and Mental Comorbidities Decrease Colonoscopy Uptake After Positive Fecal Blood Test

This study evaluated 168,701 individuals with a positive fecal occult blood test (FOBT) result, of whom 80.5% underwent colonoscopy within 12 months. Compared with patients

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American Gastroenterological Association Updates Diet Recommendations for Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) can be managed with a variety of treatments but commonly with diet and medications. This document from the American Gastroenterological Association

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Detection Measures Other Than Adenoma Detection Rate Predict Postcolonoscopy Cancer

The adenoma detection rate (ADR) predicts the incidence of interval cancer after colonoscopy. Although ADR correlates in retrospective studies with other detection measures, it is

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CMS Reduction in RVU Payment for Endoscopy With Anesthesia Slowed but Did Not Stop Growth in Anesthesia Use

In 2017, the Centers for Medicare and Medicaid Services (CMS) instituted a small relative value unit (RVU) reduction in the professional fee payment for endoscopy

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Cold Snaring Effective for Colorectal Lesions Up to 15 mm

Cold snare resection is well established as comparably effective to and safer than hot snare resection for lesions ≤10 mm in size.  In a study

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Randomized Tandem Study Shows Artificial Intelligence Decreases Adenoma Miss Rate

In a randomized tandem study of 230 patients, the adenoma miss rate (AMR) was lower at 15.5% when colonoscopy with artificial intelligence (AI) was performed

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Prospective Comparison of Needle Knives With Scissor Knives for Colorectal Endoscopic Submucosal Dissection

This is a post-hoc propensity score-matched analysis of 2498 colorectal lesions removed with needle-type or scissor-type knives for endoscopic submucosal dissection (ESD) in 11 Japanese

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Salvage Endoscopic Submucosal Dissection After Chemoradiation for Locally Advanced Rectal Cancer

Patients with locally advanced rectal cancer who undergo neoadjuvant chemoradiation sometimes have remarkable responses to treatment. These may include evidence of no residual disease or

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Green Tea Does Not Prevent Recurrent Adenomas in Females, but It Might in Males

Green tea contains catechins, which have anticancer properties and reduce the incidence of polyps in mouse models with a mutation in the Adenomatous polyposis coli gene.  In

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The Veterans Health Administration Instituted a National Policy Converting Screening Colonoscopy to FIT During the COVID Pandemic: Was the Policy Followed?

During the COVID-19 pandemic, the Veterans Health Administration (VHA) instituted a national policy converting screening colonoscopy to fecal immunochemical testing (FIT) to manage reduced access

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Small Tubular Adenomas Plus Small Serrated Polyps Equals Higher Risk of Metachronous Advanced Neoplasms

Recent studies have added complexity to our understanding of postpolypectomy surveillance risk, such as the risk of metachronous advanced neoplasia is higher with 6- to

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Frequency of Splenic Injury in U.S. Inpatients

A previous study of U.S. inpatients suggested that the frequency of splenic injury was about 1 in 6000.  The current study utilized 2012-2018 data from

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Rectal Lesions Really Are, Well, Different

Previous studies have indicated that the rectosigmoid colon location is an independent risk factor for cancer in large nonpedunculated colorectal polyps. Surgical procedures for cancer

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Adenoma Detection Rate in 45- to 49-year-olds in the GIQuIC Registry

According to 2014-2020 data from the GI Quality Improvement Consortium (GIQuIC) Registry, 2.81 million screening colonoscopies were performed by 814 endoscopists in patients aged 45

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Hemorrhoids Are Associated With Diverticulosis Not Constipation or Dietary Fiber Intake

This was a case-control study of patients undergoing screening colonoscopy between 2013 and 2015. Patients completed a detailed diet and bowel habit questionnaire, and a

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Endoscopic Intermuscular Dissection for Deep Submucosal Invasion in Rectal Cancer

Endoscopic submucosal dissection (ESD) for T1 rectal cancer can leave positive margins, particularly for lesions invasive to the middle or deep thirds of the submucosa.

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Impact of Simethicone During Bowel Preparation on Colonoscopy Quality: Systematic Review and Meta-analysis of 38 Randomized Controlled Trials

Many endoscopists utilize simethicone (SIM) in their bowel preparations for colonoscopy. This systematic review and meta-analysis identified 38 randomized controlled trials relevant to SIM impact

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Formal Training in Endoscope Handling and Care Reduces Repair Costs

In the current study, a medical center in Thailand instituted a formal educational program focused on personal awareness of endoscope handling and manipulation, the correct

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Stopping Direct Oral Anticoagulants on the Day of Colonoscopy Was Enough to Prevent Bleeding After Cold Snare Polypectomy

Direct oral anticoagulants (DOACs) are often stopped a couple of days before colonoscopy and resumed one or more days after the procedure, depending on thromboembolism

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Colonoscopy Without Bowel Preparation for Acute Lower GI Bleeding

Colonoscopy for acute lower GI bleeding is usually performed after bowel purge. In a retrospective study with clinical diverticular bleeding, 266 patients received bowel preparation

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Endoscopic Submucosal Dissection for Early Colorectal Cancer and High-Risk Surgery: Okay to Not Operate

This study investigated outcomes in patients who underwent endoscopic submucosal dissection (ESD) for T1 colorectal cancer (CRC) and then had adverse histologic features that predict

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Cold Snare Polypectomy Failed to Achieve Complete Resection in 11% of 4- to 9-mm Polyps

In a randomized controlled trial (RCT) performed at 8 hospitals in 4 countries, patients with nonpedunculated polyps ranging in size from 4 to 9 mm

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Oral Microbiome Therapy Made of Purified Firmicutes Spores Effective for Treatment of Recurrent C difficile Infection

This study was a double-blind, randomized, placebo-controlled trial. It included patients with ≥3 episodes of C difficile infection (CDI) within 12 months, including the qualifying acute episode.

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American College of Physicians Endorses No Antibiotics for Most Uncomplicated Acute Diverticulitis

The American College of Physicians (ACP) has issued a clinical guideline regarding acute left-sided diverticulitis. There are 3 recommendations, which were developed using the GRADE

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American College of Physicians Issues Guideline on Colonoscopy and Interventions to Prevent Recurrence After Acute Left-sided Diverticulitis

This guideline from the American College of Physicians appears with a summary of the supporting literature review and has 3 recommendations: Colonoscopy should be performed

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Clip Closure Did Not Reduce Delayed Hemorrhage After Resection of Large Sessile Serrated Lesions Using Electrocautery, Even From the Proximal Colon

Recent large randomized controlled trials have demonstrated that clip closure reduces the risk of delayed hemorrhage after endoscopic mucosal resection (EMR) using electrocautery if the

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Proving What We All Know: Hot Snare Polypectomy Causes More Delayed Bleeding Than Cold Snare

This was a retrospective analysis of bleeding after cold snare polypectomy (CSP) and hot snare polypectomy (HSP) for colorectal lesions with a diameter <10 mm.

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Artificial Intelligence False Positives in Colonoscopy Are Not Time Consuming

Computer-aided detection (CADe), or artificial intelligence (AI), programs are now commercially available and have been shown to increase the adenoma detection rate. These AI programs

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Kolon

Cutting Plane Between Underwater and Conventional EMR Is Similar

Randomized controlled trials (RCT) show that underwater EMR (UEMR) is more likely than conventional EMR (CEMR) to result in en bloc and R0 resection for

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Second-Generation Endocuff Versus Distal Cap Versus Standard High-Definition White-Light: No Overall Difference but More Detected Adenomas and Shorter Withdrawal Times in Screening Exams With Endocuff

This study from 3 U.S. centers is the first to compare the second-generation Endocuff Vision (Olympus America, Center Valley, Penn, USA) to distal cap (Reveal;

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Cancer Risk in Serrated Polyposis Syndrome and Sporadic Sessile Serrated Lesion Patients and Their Relatives

This study used the Utah Cancer Registry to examine cancer risk in patients with serrated polyposis syndrome (SPS) and their relatives as well as patients

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A Way Forward for Side-Viewing Colonoscopy?

Previous attempts to improve polyp detection during colonoscopy using extreme wide-angle or side-viewing optics have been unsuccessful, largely because of issues with diminished image resolution

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Exploring Panendoscopy With a Colon Capsule: Issues of Bowel Preparation, Transit, Completion, Acceptance

This study looked at issues of technical success and acceptance of panendoscopy with a colon capsule in 451 generally healthy adults aged 50 to 75

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Dye-based Chromoendoscopy Added Nothing to Prediction of Cancer in Colorectal Nonpedunculated Lesions

In a prospective study, 2 experts independently assessed the surfaces of 400 large, laterally spreading colorectal lesions (median size, 35 mm) for predictors of submucosal

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Epinephrine Caused Increased Postprocedural Pain When Used for Colorectal EMR

Including epinephrine in the submucosal injectate for endoscopic mucosal resection (EMR) varies among endoscopists – some endoscopists prefer epinephrine, whereas others do not. Of those

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Rivaroxaban Again Shown to Cause More GI Bleeding Than Other Direct Oral Anticoagulants

In a study from Iceland, investigators compared GI bleeding rates among 3217 patients receiving rivaroxaban, 2157 receiving apixaban, and 494 receiving dabigatran. Patients were excluded

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Impact of Colonoscopy on Patients’ Work Productivity

The impact of colonoscopy on work productivity was assessed prospectively in 1137 employed patients in 10 Italian centers, utilizing a diary for 7 days after

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Asking Patients With Colorectal Cancer to Help Get Their Siblings Screened Is Not That Helpful

We often tell our patients with colorectal cancer (CRC) or advanced adenomas that guidelines indicate their siblings are at increased risk of developing CRC or

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Should We Mark the Margins Before EMR?

One approach sometimes used in endoscopic mucosal resection (EMR) to improve complete resection is to use cautery to mark the normal tissue at the margins

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Transferring Endoscopic Submucosal Dissection Skills From Hands-on to Human Cases

This report from The Netherlands describes the results of a survey of 118 participants in an endoscopic submucosal dissection (ESD) training workshop using live porcine

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Study Suggests Computer-Aided Quality Assurance More Important Than Computer-Aided Detection in Polyp Detection

Artificial intelligence (AI) that highlights lesions seen at endoscopy is called computer-aided detection (CADe) or detection software. Computer-aided quality (CAQ) programs assess the completeness of

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Too Much Forceps Removal of Small Polyps, but It Could Be Modified

Anecdotally, many colonoscopists still use forceps to remove small and diminutive colorectal polyps that are more effectively and efficiently removed by snare polypectomy. In 2

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Randomized Controlled Trial of Thin Versus Thick Cold Snare Polypectomy for Small Polyps: Not Much Difference

Cold snare polypectomy is now considered the resection method of choice for colorectal lesions ≤10 mm in size. Dedicated snares with a wire diameter about

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Randomized Controlled Trial Confirms Clipping Is Effective in Prevention of Right-Sided Colon Bleeding After EMR With Electrocautery

Previous randomized controlled trials (RCTs) have indicated that prophylactic clip closure is effective in preventing delayed hemorrhage after EMR of colonic lesions that are ≥20

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Evacuation Problems? Check the RED Test

The balloon expulsion test (BET) is a screening tool for rectal evacuation disorders. BET is often performed in conjunction with anorectal manometry. In this report,

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Gluten Intake Not Associated With GI Cancer Risk

Gluten exposure triggers an immune reaction in celiac disease that is associated with an increased risk of GI cancers. In this study, the effect of

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U.S. Multi-Society Task Force Endorses Colorectal Cancer Screening in Average-Risk Persons at Age 45

In a recommendation characterized as “weak recommendation; low-quality evidence,” the U.S. Multi-Society Task Force on Colorectal Cancer (MSTF) now recommends initiating screening for colorectal cancer

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Laterally Spreading Lesions With Focus of T1 Cancer Treated by Hybrid EMR and EFTR

Patients with laterally spreading lesions and endoscopic evidence of T1 cancer (usually of morphologic change combined with NBI International Colorectal Endoscopic classification 3 or Kudo

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Management of Large Polyps in a French Colorectal Cancer Screening Program Using Fecal Immunochemical Testing Suboptimal, With Widely Varying Endoscopic Resection Rates

In a study of fecal immunochemical test-positive patients in France, 1256 large polyps (LPs), defined as polyps ≥20 mm, were detected by 102 community gastroenterologists.

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Predicting Diverticulitis and Surgery for Diverticulitis Based on Endoscopic and Clinical Features: DICA and CODA Scoring

The Diverticular Inflammation and Complication Assessment (DICA) endoscopic scale is a scoring system that predicts diverticulitis and related surgery. Briefly, this scale takes into account

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There Are Now 5 Randomized Controlled Trials of Flexible Sigmoidoscopy Screening, and They All Show It Works

Four previous randomized controlled trials of flexible sigmoidoscopy (FS) have shown reductions in at least distal colorectal cancer (CRC) incidence and mortality after FS screening. 

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European Society of Gastrointestinal Endoscopy Issues Guideline on Lower GI Tract Endoscopic Tissue Sampling

These evidence-based recommendations from the European Society of Gastrointestinal Endoscopy (ESGE) cover principles of tissue sampling and removal in the lower GI tract. Some points

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Endocuff Vision Effective in “Real-World” Experience

Endocuff Vision (ECV; Olympus America, Center Valley, Pa) has produced adenoma detection rate (ADR) gains in randomized controlled trials, but it has not received widespread

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Do We Keep Measuring and Measuring and Measuring Adenoma Detection Rate?

The adenoma detection rate (ADR), first recommended by the U.S. Multi-Society Task Force on Colorectal Cancer in 2002, is a validated predictor of colorectal cancer

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U.S. GI Endoscopy Volumes: Biggest Change Is Increases in Upper Endoscopic Ultrasound

This article uses data from multiple sources to estimate gastrointestinal, liver, and pancreatic health care expenditures, ambulatory visits, and hospitalizations, as well as endoscopic procedural

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Birth Cohort Effects in Colorectal Cancer Impacting 50- to 54-Year-Olds

As birth cohorts younger than age 50 become progressively younger, the relative increase in colorectal cancer (CRC) risk compared to past decades becomes progressively greater.

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Constipation Is Not a Risk Factor for Colorectal Cancer

Patients are often concerned that chronic constipation will put them at risk for colorectal cancer (CRC), and previous data on this topic have been mixed.

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Systematic Review and Meta-Analysis Finds That 9-Minute Withdrawal Is Indeed Better Than 6 Minutes

Very large retrospective studies of withdrawal time and colonoscopy yield have indicated that interval cancer prevention levels out with a withdrawal time of 8 to

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Meta-Analysis of Full-Thickness Resection in the Colorectum

In a meta-analysis of 14 studies of colorectal endoscopic full-thickness resection (EFTR) involving 1936 patients, 76% of lesions were in the colon and the remainder

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World Gastroenterology Organisation Reports on Gastroenterology, Climate Change, and Nonrecyclable Waste

This report from the World Gastroenterology Organisation (WGO) reviews the potential health impact of climate change on GI disease, but it also calls on gastroenterology

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Predictors of Endoscopy Procedure Volume During Fellowship: Male Gender and Private (vs Academic) Program

The American Society for Gastrointestinal Endoscopy recommends that gastroenterology fellows complete a minimum of 130 EGDs and 275 colonoscopies before assessing competency.  In a survey

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Genetic Testing for Everyone With 10 or More Adenomas? It’s Low Yield

Germline genetic testing for inherited colorectal cancer syndromes often is recommended in patients with ≥10 cumulative adenomas. However, the evidence to support this recommendation is

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Oral Sulfate Solution and 2-Liter Polyethylene Glycol-Ascorbic Acid Are Both Safe and Effective in Older Patients

In a trial of 199 patients aged 65 to 80 years, standard oral sulfate solution (OSS) was compared with 2-L polyethylene glycol with ascorbic acid

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Current Rates of Colorectal Cancer in Average-Risk Screening Are About 1 in 500

Older studies have suggested that the prevalence of cancer detected with average-risk screening colonoscopy is 0.5% to 1% or about 1 cancer per 100 to

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Multi-Society Task Force Said to Repeat Colonoscopy Within One Year for Inadequate Preparation, but a Lot of Colonoscopists Aren’t

In 2015, the U.S. Multi-Society Task Force (MSTF) on Colorectal Cancer, composed of members of the 3 luminal GI societies, recommended that patients with inadequate

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Cap-Assisted Endoscopic Mucosal Resection Effective for Flat and Fibrotic Colorectal Polyps

Everyone performing EMR in the colorectum encounters flat or fibrotic polyp tissue that resists standard snaring.  In a multicenter European study, 70 nonlifting polyps with

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How Much Will Screening 45- to 49-Year-Olds Affect ADR?

With the advent of screening average-risk persons beginning at age 45, many are wondering whether minimum acceptable adenoma detection rate (ADR) thresholds will need adjustment,

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Endoscopic Full-Thickness Resection for T1 Colorectal Cancers: Update on Short-Term Outcomes

Endoscopic full-thickness resection (eFTR) can be used for lesions <30 mm in size, and when used for early colorectal cancer (CRC), it provides a histologic

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Perioperative Antibiotics Did Not Prevent Postendoscopic Submucosal Dissection Coagulation Syndrome in Study

Postendoscopic coagulation syndrome (PECS) is common after endoscopic submucosal dissection (ESD), and prior data have indicated that perioperative antibiotics reduced the syndrome.  In this Japanese

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Artificial Intelligence for Detection During Colonoscopy Works in the U.S. Too

Artificial intelligence programs that detect lesions are called computer-aided detection (CADe) systems. Randomized controlled trials of CADe for colonoscopy have, thus far, mostly been performed

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Pericolonoscopy Antibiotics Associated With Postcolonoscopy Irritable Bowel Syndrome

Experienced colonoscopists have seen occasional patients date the onset of irritable bowel syndrome (IBS) to colonoscopy (and, occasionally, patients who date improvement of digestive symptoms

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ASGE Journal Scan | Kolon

Problems With Colorectal EMR Training for Some GI Fellows

In a 2019-2020 academic year survey of all 1730 GI fellows in the U.S. regarding endoscopic mucosal resection (EMR) training and knowledge, the response rate

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ASGE Journal Scan | Kolon

Maternal Obesity and Pregnancy Weight Gain and Colorectal Cancer Risk in Offspring

This study utilized a database of women and their prenatal care between 1959 and 1966, involving 18,751 live births and 14,507 mothers. Sixty-eight offspring developed

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Cold Snare Polypectomy Without Submucosal Injection May Be the Treatment of Choice for Sessile Serrated Lesions 10 mm or Larger

In a multicenter, multinational study, retrospectively obtained data for 379 patients showed 615 sessile serrated lesions ≥10 mm in size resected by cold snare polypectomy

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Kolon

Are Gastroenterologists Better at Colonoscopy Than Other Specialists? Yep

Numerous studies have found that colonoscopies performed by nongastroenterologists are associated with lower rates of polyp detection and higher rates of interval cancer than colonoscopies

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Endo-SPONGE Analysis Shows Device Effective in Treating Colorectal Anastomotic Leaks

Anastomotic leak after low anterior resection is a dreaded complication. Patients with generalized peritonitis must undergo surgery, and treatment of localized walled-off leaks is not

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ASGE Journal Scan | Kolon

Sessile Serrated Lesions, Unspecified Serrated Polyps, and Colorectal Cancer Risk

This study examined the risk of colorectal cancer (CRC) associated with serrated polyp subtypes in patients undergoing their first colonoscopy between 2006 and 2016. There

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ASGE Journal Scan | Kolon

Updated Guideline on Endoscopy and Antiplatelet or Anticoagulant Therapy From British and European Gastroenterology Organizations

This guideline from the British Society of Gastroenterology and the European Society of Gastrointestinal Endoscopy relies on the traditional division of procedures into low risk

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Does Better Sleep Prevent Colon Cancer?

In this study from Sweden, 58,657 persons aged 50 years and older prescribed melatonin were matched with 175,971 nonusers of melatonin. The adjusted hazard ratio

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Underwater EMR Outperforms Conventional EMR for 20- to 40-mm Nonpedunculated Polyps in Randomized Controlled Trial

In a single-center randomized controlled trial from Germany, 148 nonpedunculated lesions 20 to 40 mm in size were included in a per-protocol analysis and randomized

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ASGE Journal Scan | Kolon

Incompletely Resected Polyps Associated With Subsequent Neoplasia and Advanced Neoplasia in Observational Study

Interval cancers are thought to result primarily from missed lesions, with a smaller component in the 10% to 30% range arising from incomplete polyp resection.

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ASGE Journal Scan | Kolon

Summary of Evidence: Overweight and Obesity Are Both Associated With Early-Onset Colorectal Cancer Incidence

Intense ongoing investigation has suggested a number of risk factors for early-onset colorectal cancer (EOCRC), defined as CRC in persons younger than aged 50 years

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Computer-Based Measurement of Polyp Size Getting Closer

Polyp size measurements by endoscopists during colonoscopy are notoriously inaccurate, with both over-measurements and under-measurements. Computerized assessments of polyp size are promising for more accurate

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Tip-In EMR Increases En Bloc Resection Rate for 15- to 25-mm Colorectal Lesions

Tip-in EMR is a method of anchoring the snare tip in the submucosa before snare resection. First, a mound of submucosal injection is created. Then,

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Is a Second Right-Side Colon Examination Needed When Using Mucosal Exposure Devices? Yes

Double right-sided colon examination has been advocated as a way to reduce interval cancers, which are more common in the proximal colon. Mucosal exposure devices,

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ASGE Journal Scan | Kolon

Patients Live a Healthier Lifestyle After Endoscopic Screening

Previous studies have been inconclusive as to whether endoscopic screening contributes to patients leading a healthier or unhealthier lifestyle. For example, patients with normal examinations

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ASGE Journal Scan | Kolon

Protein Assays Added to the Fecal Immunochemical Test Improve Sensitivity for Advanced Adenomas

The fecal immunochemical test (FIT) is widely chosen by organized colorectal cancer (CRC) screening programs as the screening test of choice. FIT detects about 80%

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New Data Indicate That Surgery Rates for Benign Polyps Might Be Finally Declining

Several recent studies have collectively reported that surgery rates for benign colorectal polyps in the U.S. have continued to increase even though surgery results in

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Low Vitamin D Intake Associated With Early Onset Colorectal Cancer in Nurses’ Health Study

Many investigators are trying to understand the increasing risk of colorectal cancer (CRC) developing before age 50, or so-called early-onset CRC.  The Nurses’ Health Study

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Diet High in Processed Meats and Low in Mixed Vegetables and Legumes Associated With Early-Onset Adenomas

This study utilized the Nurses’ Health Study II data to evaluate a sulfur microbial diet (high intake of processed meats and low intake of vegetables

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No Increase in Adenomas in Microscopic Colitis

Although ulcerative colitis and Crohn’s colitis are associated with an increased risk of colorectal cancer (CRC), chronic inflammation associated with microscopic colitis (MC) has not

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ASGE Journal Scan | Kolon

Practice Patterns for Stopping Surveillance in Older Patients Are Highly Variable Among Endoscopists

The U.S. Multi-Society Task Force on Colorectal Cancer recommends individualizing the decision to stop surveillance colonoscopy in patients aged 75 years and older.  This is

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ASGE Journal Scan | Kolon

Randomized Controlled Trial in Patients With Failed Bowel Preparation

When a patient is compliant with bowel preparation instructions, but the preparation is inadequate, there are little data from controlled trials to guide the bowel

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ASGE Journal Scan | Kolon

Artificial Intelligence Improves Detection, Regardless of Endoscopist Experience

Five randomized controlled trials (4 from China and 1 from Europe and the U.S.) have demonstrated that artificial intelligence (AI) increases the adenoma detection rate

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ASGE Journal Scan | Kolon

Strong Evidence That Long-Term Proton Pump Inhibitor Use Increases Colorectal Cancer Risk

Data vary regarding whether hypergastrinemia and proton pump inhibitor (PPI) use increase adenoma progression and risk of colorectal cancer (CRC).  The current study from the

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Amoxicillin-Clavulanate Favored Over Fluoroquinolone-Metronidazole for Outpatient Diverticulitis

A combination of fluoroquinolone (ciprofloxacin, levofloxacin) and metronidazole is the most commonly used antibiotic treatment for outpatient diverticulitis. However, the U.S. Food and Drug Administration

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Average U.S. Adenoma Detection Rate Hits 40%

Currently recommended minimum thresholds for adenoma detection rates (ADRs), defined as the fraction of patients undergoing first-time screening colonoscopy who have one or more conventional

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ASGE Journal Scan | Kolon

Skinny Scopes Better for Women Requesting Unsedated Colonoscopy

On average, colonoscope insertion is considered more difficult in women than men, and most colonoscopists meet patients, including women, who request an attempt at unsedated

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ASGE Journal Scan | Kolon

Is Leaving the Rectum in Place in Familial Adenomatous Polyposis Still Okay?

In this study from a French hospital, 296 patients with familial adenomatous polyposis (FAP) underwent either proctocolectomy with ileoanal anastomosis (IAA; 31.1%) or abdominal colectomy

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Microbiome Predicts Metachronous Colorectal Adenomas

This Chinese study examined 367 patients in a retrospective cohort and 238 in a prospective group for the amount of fecal Fusobacterium nucleatum, quantitated by

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ASGE Journal Scan | Kolon

Estimating Cancer Risk in Serrated Polyposis Syndrome

In a meta-analysis involving 36 studies and 2788 patients with serrated polyposis syndrome (SPS), the overall risk of colorectal cancer (CRC) was 19.9%. However, most

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ASGE Journal Scan | Kolon

Colorectal Cancer Rates Increasing in Younger People Since 1980: What About Before Then?

Many U.S. cancer registries extend back to only a few years before cancer incidence in younger people began to rise, but the Connecticut Tumor Registry

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ASGE Journal Scan | Kolon

New European Society of Gastrointestinal Endoscopy Guideline on Acute Lower GI Bleeding

These are highlights of the European Society of Gastrointestinal Endoscopy’s new guideline on the diagnosis and management of acute lower GI bleeding: In cases of

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ASGE Journal Scan | Kolon

Predicting Recurrence After Cold Endoscopic Mucosal Resection

Cold EMR is increasingly popular because of its low risk of complications. However, there do seem to be more recurrences after cold EMR.  In a

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Turn up the Lights During Colonoscopy

Traditionally, room lights are turned down quite low during endoscopy. In a single-center retrospective study, 498 colonoscopies were performed by 9 gastroenterologists in low light

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ASGE Journal Scan | Kolon

How Things Have Changed: Management of Colonoscopic Perforations

Fifteen years ago, tools to close acute perforations during colonoscopy became available, beginning with hemostatic clips, followed by over-the-scope clips and suturing.  To examine the

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ASGE Journal Scan | Kolon

Updated Colorectal Cancer Screening Recommendations From the U.S. Preventive Services Task Force: Some of the Details

The U.S. Preventive Services Task Force (USPSTF) recommendations are key for screening because they influence the policies of the Centers for Medicare and Medicaid Services

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ASGE Journal Scan | Kolon

Cancer Can Be Accurately Predicted Endoscopically in Flat Colorectal Lesions; Nodular and Bulky Lesions, Not so Much

Before endoscopic resection, large nonpedunculated colorectal lesions should be thoroughly inspected for evidence of submucosal invasive cancer (SMIC). The features to look for are disruption

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ASGE Journal Scan | Kolon

Surgery for Benign Colorectal Polyps

This report from the U.S. evaluated 144 patients undergoing surgical resection for benign colorectal polyps. There were 118 referred patients without an attempt at endoscopic

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ASGE Journal Scan | Kolon

Does Endoscopic Resection of High-Risk T1 Colorectal Cancer Cause Adverse Oncologic Outcomes?

High-risk T1 colorectal cancer means there are adverse histologic features associated with an increased risk of lymph node metastases (LNM). The features are typically deep

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ASGE Journal Scan | Kolon

Ileocecal Valve Lesions No Longer Defy Endoscopic Resection

Laterally spreading lesions on the ileocecal valve (ICV) have traditionally been among the most challenging to resect endoscopically, and some centers refer them for surgical

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ASGE Journal Scan | Kolon

Stalk Injection and Prophylactic Clipping of Pedunculated Polyps Increase Delayed Bleeding

In this Japanese study from 5 institutions, 1147 pedunculated (stalk length of ≥5 mm) colorectal polyps were evaluated for predictors of immediate bleeding after being

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ASGE Journal Scan | Kolon

Up to 4% of Colorectal Cancers Have Unexplained Positive Immunohistochemistry

Universal screening of colorectal cancers (CRCs) is recommended to increase the diagnosis of Lynch syndrome. Tumor screening can be done by microsatellite instability (MSI) testing,

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Colonoscopy More Effective Than the Fecal Immunochemical Test in Case-Control Study

Randomized controlled trials comparing the use of colonoscopy to the fecal immunochemical test (FIT) for colorectal cancer (CRC) screening are underway.   A case-control study from

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ASGE Journal Scan | Kolon

Using Family History to Guide Surveillance of “Other” Cancers in Lynch Syndrome: Does That Work?

The “other” cancers in Lynch syndrome include small-bowel, pancreatobiliary, urinary tract, and brain cancers, as well as sebaceous neoplasms. Routine screening for many of these

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Germline Testing for Cancer Genes in Everyone With Colorectal Cancer?

Current guidelines recommend universal screening of patients with newly diagnosed colorectal cancer (CRC) for tumor features of Lynch syndrome. This is usually done by immunohistocompatibility

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New Test for “Leaky Gut” Proposed

We often hear about the idea of “leaky gut,” which refers to intestinal permeability resulting from medications or certain diets, and that this condition may

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What Is the Prevalence of Sessile Serrated Lesions Anyway?

In a systematic review and meta-analysis of 280,370 screening colonoscopies in the literature, the pooled prevalence of sessile serrated lesion (SSL) detection was 2.5%. The

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Liquid Biopsy Assay Predicts Lymph Node Metastases in T1 Colorectal Cancer

When patients have T1 colorectal cancer (CRC) resected, histologic features, such as deep submucosal invasion, poor differentiation, lymphovascular invasion, and high-grade tumor budding, are used

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Tattoos Claimed Unnecessary for Finding EMR Scars

Referring physicians sometimes tattoo large nonpedunculated lesions before referral, and resectionists sometimes tattoo the resection site for easy identification of the scar later. Neither practice

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Modeling Suggests Later Starting Age and 3-Year Intervals for Colonoscopy in MSH6 and PMS2

Lynch syndrome is associated with increased cancer risk, particularly in the colorectum, as a result of germline mutations in any of 4 mismatch repair genes

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Cold EMR for Large Nonpedunculated Colon Polyps Dominates Hot EMR in Cost-Effectiveness Analysis

Cold EMR is becoming increasingly popular for large nonpedunculated colorectal lesions, particularly sessile lesions and adenomas without major 1s or pseudodepressed components. These researchers performed

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Multicenter International Study Confirms That Snare-Tip Soft Coagulation of EMR Margin Dramatically Lowers Recurrence Rate

A previous randomized controlled trial showed that thermal ablation of a normal-appearing EMR margin after complete polyp resection reduced the recurrence rate from 21% to

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Bad Outcomes for Patients Not Undergoing Colonoscopy After Positive Fecal Immunochemical Test

In an Italian study using a fecal immunochemical test (FIT)-positivity cutoff of 20 µg Hb/g feces, 88,013 FIT-positive patients (79%) underwent colonoscopy, and 23,410 (21%)

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Don’t Refer Large Nonpedunculated Colorectal Lesions to Surgeons After Failed EMR Attempts

In clinical practice, colonoscopists sometimes think that patients with large nonpedunculated colorectal lesions should be referred to surgery after one or two attempts at resection

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Adherence To Colonoscopy After Positive Fecal Immunochemical Testing Is Related To Patient Navigation and Distance From Center

In a comparison of colonoscopy adherence after positive fecal immunochemical testing (FIT) in 2017 without patient navigation (PN) versus 2018 with navigation, overall completion of

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Selective Serotonin Reuptake Inhibitors Reduce Colorectal Cancer Risk, and the Effect Is Additive to Aspirin

In a nationwide Swedish registry study, 24,786 colorectal cancer (CRC) cases and 74,358 randomly matched controls for birth year and sex were evaluated to determine

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Kolon

Brits Evaluate Their New Postpolypectomy Surveillance Guidelines

The UK revised its postpolypectomy surveillance guidelines to reduce the use of surveillance colonoscopy. According to the guidelines, patients considered to be high risk for

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“Step-Clipping” Technique Reported as Effective for Endoscopic Localization of Colonic Diverticular Bleed

Colonic diverticular bleeding (CDB) often stops spontaneously, and a meticulous colonoscopic search of the colon for the bleeding diverticulum is often unsuccessful. The “step-clipping” method

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Individual Patient Data Meta-Analysis of Randomized Trials Fails To Show Benefit of Chromoendoscopy in Lynch Syndrome

An individual patient data meta-analysis, which was performed for this study, utilizes the individual data from separate studies rather than summary data. However, this study

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Want To Take Out Polyps in Anticoagulated Patients? New Data Indicate Apixaban Is the Drug To Be On

This retrospective cohort study evaluated postpolypectomy bleeding and thromboembolism risks with warfarin, apixaban, dabigatran, and rivaroxaban use in Hong Kong public hospitals between January 2012

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Three Minutes of Verbal Instructions Improved Bowel Preparation in Mobile Inpatients

Clinicians everywhere struggle with colonoscopy bowel preparation in inpatients. In a randomized trial performed in 4 cities, 300 patients (180 mobile and 120 bedridden) received

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Adenoma Detection Rate Can Be Measured in Combined Screening, Surveillance, and Diagnostic Examinations

When the adenoma detection rate (ADR) was originally proposed as a quality measure in 2002, the recommendation did not constrain its indication to screening colonoscopies

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High Success Rates for Endoscopic Submucosal Dissection in Prospective North American Study

There are limited data on success rates of endoscopic submucosal dissection (ESD) in North America. In this study, 10 centers in the United States and

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Virtual Reality for Colonoscopy Sedation?

In this study, a virtual reality program playing nature and animal scenes was tested in 27 patients who had previously undergone moderate sedation for colonoscopy

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Endocuff Vision Raises Adenoma Detection Rate by 7% in Randomized Controlled Trial in FIT-Positive Patients

Recent analyses suggest that colonoscopy with the original Endocuff or newer Endocuff Vision (EV) is superior to standard colonoscopy but that Endocuff has a greater

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Europeans Report Japanese-Like en Bloc and R0 Colonic Endoscopic Submucosal Dissection Rates Using Double-Clip Traction

Colonic endoscopic submucosal dissection (ESD) is generally considered more challenging than esophageal, stomach, or rectal ESD.  The authors have previously described a double-clip traction (DCT)

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Off-Label Use of Multitarget Stool DNA Test Is Common in Primary Care

In a retrospective analysis of all multitarget stool DNA (mt-sDNA) tests ordered at a single center over one year by 62 primary care providers (50

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Cancer Incidence and Mortality Risk After Index Colonoscopies Showing Low-Risk Adenomas, High-Risk Adenomas, or No Adenomas

Postpolypectomy surveillance recommendations are based on observational studies, often using advanced adenomas at follow-up as their primary outcome.  A new meta-analysis focused on the risk

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Screening With Fecal Immunochemical Test More Impactful for Distal Than Proximal Cancers

In a nationwide biennial fecal immunochemical test (FIT) screening program in Taiwan, more than 5.4 million individuals were invited to undergo screening between 2004 and

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WASP Optical Classification Criteria Are Not So Good for Diminutive Sessile Serrated Lesions

The optical features of sessile serrated lesions (SSLs) identified in narrow-band imaging are a cloud-like surface, indistinct borders, irregular shape, and dark spots. In a

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Is Endocuff Vision As Good As the Original Endocuff?

The original Endocuff (EC) had two rows of fingers, whereas the currently marketed Endocuff Vision (ECV) has a single row of longer fingers. Although EC

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Colorectal cancer screening occurs broadly in two settings, termed “organized” and “opportunistic.” Organized programs are typically run by nations or health care systems and usually

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Colon Capsule Gives CT Colonography Another Drubbing

In a prospective randomized trial including 320 average-risk screenees, polyps ≥6 mm were found more often with colon capsule endoscopy than with CT colonography (CTC;

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Lower Back, Neck, and Left Thumb Injuries Most Common Types of Injuries Among Colonoscopists

In a survey of primarily UK endoscopists (72% of all respondents) that included endoscopists from 45 countries and had an overall 20.2% response rate, the

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Diverticulitis Not Associated With Constipation

In this study, researchers evaluated the Nurses’ Health Study (NHS) and Health Professional Follow-up Study (HPFS) databases to examine the association of diverticulitis with bowel

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Risks of Recurrence and Mortality After Local Endoscopic Resection of T1 Colorectal Cancer

In a meta-analysis of 71 studies involving 5167 endoscopically treated T1 colorectal cancers (CRCs), the cumulative recurrence rate was 3.3%, the local recurrence rate was

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Yes, Early Onset Colorectal Adenocarcinoma Rates Are Increasing, But Rectal Carcinoid Rates Are Increasing Faster

There is now widespread recognition that there are increasing rates of colorectal cancer in persons under age 50 (early-onset colorectal cancer), that most of the

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Depressed Lesions Are Different at a Histologic and Molecular Level

In a study from Japan, T1 colorectal cancers and adenomas were classified as “depressed,” “flat,” or “protruded” subtypes. Depressed lesions constituted only 1.2% of all

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Predicting Complete Closure of EMR Sites

Clip closure of endoscopic mucosal resection (EMR) defects ≥20 mm located proximal to the splenic flexure and removed by electrocautery is associated with a reduction

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Patients With Multifocal Cancer: Evidence for Intraluminal Spread of Tumor

In various series, 2% to 7% of patients with colorectal cancer (CRC) have either synchronous or metachronous second cancer. Second CRCs have generally been considered

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Hot Snare Polypectomy of 5-9 mm Polyps Leads To More Next-Day Abdominal Pain

Cold snare polypectomy is widely considered to be comparably effective and safer than hot snare polypectomy for colorectal polyps <10 mm. In a randomized trial

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New Expert Review From the American Gastroenterological Association on Managing Colonic Diverticulitis

The American Gastroenterological Association has issued a clinical practice update on the management of colonic diverticulitis. The recommendations are as follows: Physicians should order a

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Positive Incidental Colorectal PET/CT: Sometimes Serious Lesions, Sometimes Not

There is general agreement that when positron emission tomography (PET) incidentally lights up the colon, there is a substantial positive predictive value for cancer and

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Appendicitis Treatments: Large Randomized Controlled Trial Compares Antibiotics With Appendectomy

Antibiotic treatment is now widely recognized as an option for appendicitis therapy. In a nonblinded randomized trial of 1552 adults, including 414 with an appendicolith,

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When Is Clip Closure of EMR Defects Cost-Effective?

Randomized controlled trials demonstrate that prophylactic clip closure of endoscopic mucosal resection (EMR) defects of large (≥20 mm) nonpedunculated colorectal lesions effectively prevents delayed hemorrhage.

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Multi-Society Task Force Issues Malignant Polyp Management Recommendations

The U.S. Multi-Society Task Force on Colorectal Cancer, which consists of experts from the 3 luminal GI societies, has issued recommendations on the management of

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Oral Sulfate Tablets for Bowel Preparation Are Effective and Safe

This study compared a new formulation of oral sulfate in tablet form to polyethylene glycol with ascorbate (PEG-EA). Both types of preparation were given in

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Non-White Race and Low Socioeconomic Status Associated With Longer Wait for Treatment After Colorectal Cancer Diagnosis

The time between diagnosis of colorectal cancer (CRC) and initiation of treatment is associated with mortality. In this study of 330,988 CRC cases in the

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Sessile Serrated Lesions That Are 10 mm or Larger: No Need To Inject

Cold resection of sessile serrated lesions (SSLs) ≥10 mm in size is increasingly accepted as effective and, compared to electrocautery, is safer. Many experts prefer

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Poor Compliance With Antithrombotic Guidelines Associated With Bad Outcomes

Rates of polypectomy in colonoscopy are high for all indications; therefore, clinicians usually stop antiplatelet and antithrombotic agents other than aspirin prior to colonoscopy and

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Lynch Syndrome Colonoscopy: Quality Matters

In the U.S., colonoscopy is usually performed at 1- to 2-year intervals in Lynch syndrome. This multicenter study evaluated the relationship of adenoma detection and

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Colonoscopy Performance Produces Force Levels and Durations of Force Elevation That Are Associated With Upper Extremity Injury

Musculoskeletal injuries are common in endoscopists. This study used surface electromyography of wrist flexors and extensors as well as pressure transducers on the thumbs to

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Colon Capsule Endoscopy Scorches CT Colonography in Fecal Immunochemical Test-Positive Trial

Comparative trials in patients with prior incomplete colonoscopy suggest that colon capsule endoscopy (CCE) detects polyps with higher sensitivity than CT colonography (CTC). In the

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Postcolorectal Endoscopic Mucosal Resection Follow-up Is Essential

There is a well-known risk of adenoma recurrence after piecemeal endoscopic mucosal resection (EMR).  In a single-center study of 2411 nonpedunculated lesions ≥20 mm in

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Polish Study Calls for Using Adenoma Detection Rate to Stratify Screening and Surveillance Recommendations

In this study, the risk of interval cancer was compared between doctors with high (≥20%) versus low (<20%) adenoma detection rates (ADRs) in the Polish

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Anesthesia and Pathology Charges Lead to Surprise Billing in Commercially Insured Colonoscopy

This study reviewed colonoscopies identified in a claims database from a large national insurer in the United States. The database was queried for commercially insured

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Kaiser Achieved Greater Than 80% Screening Adherence; How Did They Do It?

Organized screening, in which a nation or health care system systematically offers colorectal cancer screening for eligible patients, usually by fecal immunochemical testing (FIT), is

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Symptoms are Common After Total Proctocolectomy With Ileal Pouch Creation in Patients With Familial Adenomatous Polyposis

Pouch symptoms are typically considered to occur less frequently after total proctocolectomy and ileal pouch-anal anastomosis (IPAA) for familial adenomatous polyposis (FAP) compared to after

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New Clinical Model Predicts Need for Screening Colonoscopy

A risk-stratified approach to colorectal cancer screening within the average-risk population is seldom used. In this approach, patients whose prescreening predicted prevalence of advanced neoplasia

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Which Rectal Neuroendocrine Tumors are Dangerous?

In this study of 309 rectal neuroendocrine tumors (NETs), often called rectal carcinoids in the past, endoscopic factors were studied to understand their association with

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Negative Colonoscopy for FIT-Positive Patients: Should We Keep Doing FIT?

In this study from Taiwan, patients with a negative colonoscopy after a positive fecal immunochemical test (FIT) during the interval 2004 through 2009 were followed

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Chemoprevention for Colorectal Cancer: What Works and What Doesn’t?

This was a systematic review of 80 meta-analyses of colorectal cancer prevention with medications, vitamins, supplements, and dietary factors.  Of the factors found to be

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Even Expert Pathologists Have Only Moderate Agreement Regarding Differentiating Sessile Serrated Lesions From Hyperplastic Polyps

Current recommendations for measurement of the adenoma detection rate (ADR) recommend that sessile serrated lesions (SSLs; also called sessile serrated adenomas and sessile serrated polyps)

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Artificial Intelligence System Outperforms Guideline Predictive Criteria for Lymph Node Metastasis in T1 Cancers

In a study from 7 centers in Japan, a deep learning artificial intelligence (AI) program trained on 3134 T1 colorectal cancers (CRCs) from 6 Japanese

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ESGE Issues Comprehensive Training Curriculum on Optical Diagnosis

The extent to which optical diagnosis is used in routine endoscopy in the United States to improve treatment decisions in endoscopy is virtually unknown.  The

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More Evidence That Negative Screening Colonoscopy Can Be Followed by Intervals of More Than 10 Years

This study compared the incidence of advanced neoplasms in 2456 German screening colonoscopy patients who had a previous colonoscopy without polyps to the results from

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Computerized Imaging of Vessels in EMR Defects Predicts Postprocedural Bleeding

Recent studies indicate that prophylactic clip closure of postendoscopic mucosal resection defects from colonic lesions >20 mm in size and proximal to the splenic flexure

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Monoallelic NTHL1 Loss of Function Not Associated With Colorectal Cancer

NTHL1 encodes endonuclease III-like protein 1, an enzyme involved in base-excision repair that identifies and removes oxidized pyrimidines. Biallelic loss-of-function mutations of base-excision repair genes, such

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Optical Character Recognition Combined With Natural Language Processing to Improve Extraction of Quality Parameters From Colonoscopy Reports

Measurement and improvement of colonoscopy quality measures, such as the adenoma detection rate (ADR), are critical to optimizing colorectal cancer prevention by colonoscopy. The process

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Most Primary Care Physicians Not Following the American Cancer Society’s Recommendation to Screen at Age 45

The American Cancer Society (ACS) recommended in 2018 that all Americans should undergo colorectal cancer (CRC) screening beginning at age 45. Thus far, other major

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American Gastroenterological Association Issues Guidelines on GI Evaluation of Iron Deficiency Anemia

The American Gastroenterological Association (AGA) has issued the following recommendations regarding GI evaluation of iron deficiency anemia (IDA): In patients with anemia, IDA should be

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What Are Cold Snare Protrusions and Are They a Bad Thing?

During cold snare polypectomy, removal of larger lesions and/or larger specimens sometimes results in a cold snare protrusion (CSP), appearing as a white cord in

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Hemostasis Peptide Reduces Need for Electrocoagulation of Bleeding Points During ESD

Bleeding is common during endoscopic submucosal dissection (ESD). It can obscure dissection planes and often requires electrocoagulation that could injure the muscularis propria. PuraStat (3D-Matrix,

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Risk of Death From Colonoscopy in the Italian FIT Screening Program

Organized fecal immunochemical test (FIT)-based screening programs offer the opportunity to prospectively assess adverse events of colonoscopy. A recent large study from the Netherlands found

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All That Time That Cannot Be Billed

Previous data found that primary care physicians and some specialists spend about an hour on electronic health records (EHRs) for each hour they are scheduled

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Risk of Death From Colonoscopy in a FIT-Positive Program

In any screening program, it is important to know the benefits and harms of screening. Patients who have a positive fecal immunochemical test (FIT) result

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Early Colorectal Cancer Screening in African Americans: High Uptake and High Yield

Recommendations from GI societies to screen African Americans for colorectal cancer (CRC) starting at age 45 were based largely on age-related incidence and mortality data

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Granular Laterally Spreading Tumors With Nodule: Rectal Location and at Least 4-cm Size Warrant en Bloc Resection

Granular laterally spreading tumors (G-LST) in the colorectum are more common than nongranular lesions, less likely to have cancer, and in general, easier to remove

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Acetic Acid and Blue Light Highlight Sessile Serrated Lesions

This case study demonstrates how acetic acid in combination with blue-light imaging (BLI), a relatively new mode of chromoendoscopy technology, highlights sessile serrated lesions (SSLs).

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Delayed Start Times Associated With Reduced Adenoma Detection

Previous studies have shown that the adenoma detection rate (ADR) is sometimes lower in colonoscopies performed in the afternoon versus the morning, though the results

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Surgery Not Needed After Complete Endoscopic Resection of Intramucosal Colorectal Cancer

Intramucosal cancer (IMC) refers to dysplasia in the lamina propria of the mucosa with or without invasion of the muscularis mucosa. Such lesions are usually

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Initial Experience With EndoRotor Tissue Resection Device

The EndoRotor nonthermal powered endoscopic debridement (PED) instrument (Interscope, Inc., Whitinsville, Mass) is a new tissue resection device that can be passed through endoscopes. There

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ESGE Expands the Postpolypectomy Cohort With No Recommended Surveillance

The European Society of Gastrointestinal Endoscopy (ESGE) has issued its first update of postpolypectomy surveillance recommendations since 2013. Key recommendations include the following: Patients with

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Adding Time for Inspection During Colonoscope Insertion Does Not Work

There remain occasional advocates of dedicated time during colonoscope insertion to look for polyps as a way of increasing detection. In this analysis of 7

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Prophylactic Clipping Ineffective for Polyps Less Than 20 mm in Size

Analyses of randomized trials indicate that prophylactic clipping of EMR sites ≥20 mm in size in the proximal colon reduces the risk of delayed hemorrhage.

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Dutch Endoscopic Full-Thickness Resection Experience in Colorectum

This report summarizes a prospectively acquired experience using the endoscopic full-thickness resection device (FTRD) in the colorectum. Among 367 procedures performed between July 2015 and

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Adenomas in the Young: What Do They Mean?

The incidence of colorectal cancer (CRC) is increasing in persons under age 50 in much of the world. Endoscopists commonly encounter sporadic adenomas when performing

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Sarcopenia (Loss of Skeletal Muscle Mass) Associated With Metachronous Adenomas

Sarcopenia is a progressive loss of skeletal muscle mass in relation to aging. Sarcopenia is associated with metabolic syndrome, diabetes, and nonalcoholic steatohepatitis and has

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Negative Colonoscopy Predicts Reduced Risk of Colon Cancer for 17 Years

Previous studies in symptomatic populations have found that a negative colonoscopy predicts a reduction in colorectal cancer (CRC) incidence for greater than 20 years. The

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Malpractice Trends in Colon Cancer

This study identified 240 malpractice cases related to colorectal cancer (CRC) between 1988 and 2018 by using a legal database called VerdictSearch. This database is

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Randomized Controlled Trial of Fellow Impact on Detection

There is widespread acceptance of a second-observer effect in improving adenoma detection in colonoscopy and general acceptance that this effect extends, in some regard, to

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Lynch Syndrome Testing on Preoperative Biopsy Specimens Is Accurate

In this study, there were 96 patients with matched preoperative and postoperative immunohistochemistry (IHC) and microsatellite instability testing results for Lynch syndrome. The concordance of

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No Correlation Between Detection and Optical Diagnosis in Colon Polyps

This is a Dutch multicenter study involving 24 colonoscopists who performed at least 50 colonoscopies in a fecal immunochemical test-positive population. All were high-performing colonoscopists

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Artificial Intelligence Program Increases Adenoma Detection Rate in Randomized Controlled Trial by 14%

In a randomized controlled trial conducted at 3 Italian centers with 6 experienced endoscopists and 685 patients with a mix of screening, surveillance, and fecal

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Meta-analysis Favors Low-Residue Diet Before Colonoscopy

This meta-analysis comparing a low-residue diet to a clear liquid diet the day before colonoscopy identified 20 relevant randomized controlled trials that were published between

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Collagenous Colitis Is a Genetic Disease

Collagenous colitis (CC) produces a watery diarrhea syndrome, occurs mostly in older women, and is associated with several drug classes. Recent studies show that patients

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Predicting CRC in Unscreened Populations by CBC

About one-third of the U.S. population is unscreened for colorectal cancer (CRC). One approach to early detection in this population is to screen health care

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Some GI Doctors May Not Understand Significance of Intramucosal Adenocarcinoma in the Colon

Several studies have found that rates of surgery for benign colorectal polyps continue to be high, despite clear evidence that endoscopic resection is safer and

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Meta-analysis for 6- to 9-mm Adenomas Shows Higher Risk of Subsequent Advanced Neoplasia Compared to 1 to 5 mm

Current surveillance recommendations classify patients with 1 or 2 tubular adenomas <10 mm in size and with low-grade dysplasia as low risk. Several studies have

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Randomized Colorectal Cancer Screening Trial Includes Risk-Stratified Arm

Colorectal cancer (CRC) screening can be offered to patients as a menu of screening options; sequential testing (colonoscopy offered first with another testing option offered

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Evidence for Routine Double Right-Sided Colon Examination

Double right-sided colon examination during colonoscopy is often recommended, and randomized controlled trials have compared a second examination of the right-sided colon in the forward

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Risks of Colonoscopy: Not Just Bleeding and Perforation

This French study evaluated 4,088,799 patients undergoing a first-time colonoscopy during a 6-year interval. Patients with inflammatory bowel disease, colorectal cancer, or complicated diverticular disease

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Quantitative Assignment of Ages to Start Screening Based on Family History

In a study from Sweden involving 12,829,251 persons who had family history information and were followed from 1958 to 2015, 173,796 developed colorectal cancer (CRC).

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No Benefit of Endocuff Vision in Screening Flexible Sigmoidoscopy

Endocuff Vision (EV) has well-established benefits in colonoscopy, both for improved detection and faster withdrawal without reduced detection.  EV has not been tested for its

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High-Volume Colonoscopy Predicts Higher Cecal Intubation Rates and Lower Perforation Risk, but Not Higher Detection or Cancer Prevention

Douglas K. Rex, MD, FASGE, reviewing Forbes N, et al. Clin Gastroenterol Hepatol 2020 Mar 20. In a systematic review and meta-analysis encompassing 27 studies

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Endocuff Vision Improves Detection in High Performers

In meta-analyses, Endocuff Vision (ECV) typically increases adenoma detection rates (ADRs) by about 7%. However, one meta-analysis found that the benefit was primarily in doctors

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Smartphone App for Bowel Prep Reduced Inadequate Preps and Improved ADR

Douglas K. Rex, MD, FASGE, reviewing Walter B, et al. Clin Gastroenterol Hepatol 2020 Mar 30. A variety of apps to assist in bowel preparation

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Pocket Method Beats Conventional Colorectal Endoscopic Submucosal Dissection in Randomized Controlled Trial

Douglas K. Rex, MD, FASGE, reviewing Yamashina T, et al. Gastrointest Endosc 2020 Feb 28. The conventional method (CM) of endoscopic submucosal dissection (ESD) involves

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Microprocessor-Controlled Endo Cut Versus Forced Coagulation: No Difference in Delayed Hemorrhage

Douglas K. Rex, MD, FASGE, reviewing Pohl H, et al. Gastroenterology 2020 Mar 12. Previous uncontrolled studies indicated that forced-coagulation (FC) current (the blue pedal)

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Molecular Markers Predict Prognosis in Colorectal Cancer

Douglas K. Rex, MD, FASGE, reviewing Phipps AI, et al. Gastroenterology 2020 Feb 20. Current recommendations from the U.S. Multi-Society Task Force recommend that all

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Two From the Ascending Colon and Two From the Descending Colon: Biopsies From Microscopic Colitis Simplified

Douglas K. Rex, MD, FASGE, reviewing Virine, B, et al. Clin Gastroenterol Hepatol 2020 Feb 25. Guidelines recommend that clinicians perform 8 biopsies total from

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Deciding on Surgery After Endoscopic Resection of T1-CRC? Repeat Colonoscopy and Biopsy Do Not Help

Douglas K. Rex, MD, FASGE, reviewing Gijsbers KM, et al. Gastrointest Endosc 2020 Feb 24. In general, when a flat or sessile T1 colorectal cancer

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Primary Care Physicians Order 88% of FIT-Fecal DNA Tests

Douglas K. Rex, MD, FASGE, reviewing Weiser E, et al. J Med Screen 2020 Feb 13. This industry-sponsored study examined adherence rates to the fecal

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Improving ADR Shown Again to Save Lives

Douglas K. Rex, MD, FASGE, reviewing Lam AY, et al. Gastrointest Endosc 2020 Feb 21. A 2017 study from the Polish screening colonoscopy program showed

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Radiographic Studies Unreliable for Polyp Detection in Patients With Incomplete Colonoscopy

Douglas K. Rex, MD, FASGE, reviewing Parsa N, et al. Gastrointest Endosc 2020 Feb 4. In a single U.S. center with a large experience performing

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Meta-analysis Associates Helicobacter pylori Infection With Colorectal Neoplasia

Douglas K. Rex, MD, FASGE, reviewing Choi DS, et al. Clin Transl Gastroenterol 2020 Feb. Helicobacter pylori (H. pylori) infection has been previously associated with colorectal

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Calculating Effect of Surveillance Colonoscopy on Colon Cancer Prevention

he U.S. Multi-Society Task Force on Colorectal Cancer recently presented new postpolypectomy surveillance recommendations. Perhaps the most impactful new recommendation is that patients with 1

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New Evidence Supports Surveillance Colonoscopy for Patients With Stage I Colon Cancer

Gastroenterologists may be surprised to learn that some guideline groups do not endorse surveillance colonoscopy after resection of stage I colon cancer because of a

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Vitamin D Supplementation Did Not Prevent Adenomas or Serrated Lesions

Douglas K. Rex, MD, FASGE, reviewing Song M, et al. Clin Gastroenterol Hepatol 2020 Feb 13. There is an association between vitamin D levels and

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Updated Postpolypectomy Surveillance Recommendations of the Multi-Society Task Force

Douglas K. Rex, MD, FASGE, reviewing Gupta S, et al. Gastroenterology 2020 Feb 7. The U.S. Multi-Society Task Force on Colorectal Cancer has updated its

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Considering Endoscopy in Iron Deficiency Anemia? Don’t Rely on Fecal Blood Testing to Decide

Douglas K. Rex, MD, FASGE, reviewing Lee MW, et al. Am J Gastroenterol 2020 Jan 10. Fecal blood testing is approved as a colorectal cancer

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Berberine Reduces Metachronous Colorectal Adenomas in Randomized Trial

Douglas K. Rex, MD, FASGE, reviewing Chen YX, et al. Lancet Gastroenterol Hepatol 2020 Jan 8. Berberine is a Chinese herbal extract used to treat

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Improving the Message of Mailed Outreach Improves CRC Screening Adherence

Douglas K. Rex, MD, FASGE, reviewing Bakr O, et al. Clin Transl Gastroenterol 2020 Jan. Mailed outreach, in which a fecal immunochemical test (FIT) kit

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Expanding Cold EMR to Large Laterally Spreading Lesions

Douglas K. Rex, MD, FASGE, reviewing Mangira D, et al. Gastrointest Endosc 2020 Jan 15. In 5 Australian academic hospitals, cold EMR was performed on

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High Definition Is Still the Only Way to Go

Douglas K. Rex, MD, FASGE, reviewing Tziatzios G, et al. Gastrointest Endosc 2020 Jan 15. Previous meta-analyses have suggested that the use of high-definition (HD)

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Artificial Intelligence for the Other Half of Detection at Colonoscopy

Douglas K. Rex, MD, FASGE, reviewing Thakkar S, et al. Gastroenterology 2020 Jan 13. Assuming that a colonoscopist knows what precancerous lesions look like, high-level

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Cancer After Colonoscopy in UK Study Associated With, Well, Some Very Poor-Quality Colonoscopy

Douglas K. Rex, MD, FASGE, reviewing Anderson R, et al. Gastroenterology 2020 Jan 8.  Interval cancer, or postcolonoscopy cancer, is one of the dreaded outcomes

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End-Stage Renal Disease Still Risk Factor for Colonoscopy Complications

Douglas K. Rex, MD, FASGE, reviewing Yang SC, et al. J Gastroenterol Hepatol 2020 Jan 3. End-stage renal disease (ESRD) has been considered a risk

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For Left-Sided Colon Lesions up to 25 mm and Right-Sided Colon Lesions up to 20 mm, Piecemeal EMR Is as Good as en Bloc Resection

Douglas K. Rex, MD, FASGE reviewing Tate DJ, et al. Gastrointest Endosc 2019 Dec 27. Advanced endoscopists are often tempted to remove laterally spreading lesions

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Observations on FIT-Fecal DNA Testing in Clinical Practice

Douglas K. Rex, MD, FASGE reviewing Vakil N, et al. Gastrointest Endosc 2020 Jan 2. The commercially available FIT (fecal immunochemical test)-fecal DNA test is

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Small Left-Sided Polyps Seen During Colonoscope Insertion: Remove Them When You See Them

Douglas K. Rex, MD, FASGE reviewing Teramoto A, et al. Gastrointest Endosc 2019 Dec 23. Experienced colonoscopists know that when a small polyp is encountered

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How Do We Get to 80% Screening?

Douglas K. Rex, MD, FASGE reviewing Inadomi JM, et al. Clin Gastroenterol Hepatol 2019 Dec 27. The National Colorectal Cancer Roundtable set a goal of

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Brits Shake Up Postpolypectomy Surveillance

Douglas K. Rex, MD, FASGE reviewing Rutter MD, et al. Gut 2019 Nov 27. British societies have always had their own postpolypectomy guidelines. Previous recommendations

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Review and Meta-analysis Finds FIT CRC Sensitivity Lower in Stage I and T1

Douglas K. Rex, MD, FASGE reviewing Niedermaier T, et al. Am J Gastroenterol 2019 Dec 10. Fecal immunochemical test (FIT) sensitivity for colorectal cancer (CRC)

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Polygenic Risk Score Has Predictive Value for Early Onset Colorectal Cancer

Douglas K. Rex, MD, FASGE reviewing Archambault AN, et al. Gastroenterology 2019 Dec 19. Everyone wants to understand the underlying drivers for why early-onset colorectal

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Not Asking Enough Questions: Low Rates of Recommending and Receiving Genetic Testing in U.S. in Those at Risk for Lynch Syndrome

Douglas K. Rex, MD, FASGE reviewing Faust N, et al. Gastroenterology 2019 Dec 6. The National Health Interview Survey is conducted every 5 years and

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New ASGE Guideline on Endoscopy and Management of ACPO and Colonic Volvulus

Douglas K. Rex, MD, FASGE reviewing Naveed M, et al. Gastrointest Endosc 2019 Nov 29. Some of the key and/or interesting findings in the new

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Endoscopic Resection Effective for SSPs ≥10 mm in Meta-analysis; Cold EMR May Be Best

Douglas K. Rex, MD, FASGE reviewing Chandrasekar VT, et al. Clin Gastroenterol Hepatol 2019 Nov 28. This systematic review and meta-analysis identified 911 patients with

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Endocuff Vision Defeats Cap in Tandem Study

Douglas K. Rex, MD, FASGE reviewing Rameshshanker R, et al. Gastrointest Endosc 2019 Dec 10. Recent controlled trials comparing Endocuff Vision (EV) to cap-assisted colonoscopy

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Colonoscopy in Inpatient Octogenarians: Beware

Douglas K. Rex, MD, FASGE reviewing Olaiya B, Adler DG. J Clin Gastroenterol 2019 Nov 22. Population-based studies have consistently shown that the risk of

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Pay Attention to Anal Cancer

Douglas K. Rex, MD, FASGE reviewing Deshmukh AA, et al. J Natl Cancer Inst 2019 Nov 19. In the period 2001 to 2015, squamous cell

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Endoscopic Mucosal Resection: First-Line Treatment for Laterally Spreading Lesions at Anorectal Junction

Douglas K. Rex, MD, FASGE reviewing Shahidi N, et al. Gut 2019 Nov 12. Laterally spreading lesions at the anorectal junction can be treated by

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ESGE Endorses Resect and Discard in Routine Practice

Douglas K. Rex, MD, FASGE reviewing Bisschops R, et al. Endoscopy 2019 Nov 11. The European Society of Gastrointestinal Endoscopy (ESGE) has issued an updated

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Another Study Supports Underwater Versus Conventional Endoscopic Mucosal Resection for Lesions ≥10 mm

Recent randomized controlled trials found that underwater endoscopic mucosal resection (UEMR) results in more en bloc resections and faster resection for flat and sessile colorectal

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Randomized Trial of Sequential Testing Versus Multiple Choices for CRC Screening

Many guidelines on colorectal cancer (CRC) screening advocate that the choice of screening tests should be based on a discussion between the provider and patient

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Ontario Physicians More Likely to Get Colonoscopy Than Their Patients

This study evaluated administrative health care data from Ontario, Canada, to determine colorectal cancer screening rates among physicians, aged 52 to 74 years, and their

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Colon Capsule Doesn’t Help in FIT-Positive Patients

Douglas K. Rex, MD, FASGE reviewing Pecere S, et al. Gastrointest Endosc 2019 Oct 17. In some European countries with limited colonoscopy resources, capsule colonoscopy

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Biennial Surveillance Is the Right Interval in Lynch

Douglas K. Rex, MD, FASGE reviewing Peterese EFP, et al. Clin Gastroenterol Hepatol 2019 Oct 17. Universal screening of colorectal cancers (CRCs) for Lynch syndrome

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ACP Issues CRC Screening “Guidance Statement”; Declines to Endorse Either FIT-Fecal DNA or CT Colonography

Douglas K. Rex, MD, FASGE reviewing Qaseem A, et al. Ann Intern Med 2019 Nov 5. The American College of Physicians (ACP) has issued a

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More on Bad Outcomes After Surgery for Benign Colon Polyps

Douglas K. Rex, MD, FASGE reviewing Ma C, et al. Am J Gastroenterol 2019 Oct 11.  Recent studies have established that surgery for benign colon

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Seven Percent Are “One-and-Done” Colonoscopists

Douglas K. Rex, MD, FASGE reviewing Fedewa SA, et al. Endosc Int Open 2019 Nov. “One and done” in colonoscopy refers to endoscopists who find

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Dual Antiplatelet Therapy Judged Safe for Cold Snare Polypectomy ≤10 mm

Douglas K. Rex, MD, FASGE reviewing Won D, et al. Clin Transl Gastroenterol 2019 Oct 10.  Patients on both aspirin and a second antiplatelet agent

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Endocuff Vision Made Polypectomy Faster

Douglas K. Rex, MD, FASGE reviewing von Figura G, et al. Endoscopy 2019 Oct 15. Endocuff Vision (EV) has been shown in randomized controlled trials

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Modeling Study Shows Current Surveillance Colonoscopy Paradigms Are Cost-Effective

Douglas K. Rex, MD, FASGE reviewing Meester RGS, et al. Ann Intern Med 2019 Sep 24. Some modeling studies suggest that surveillance colonoscopy in patients

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Follow Pyogenic Liver Abscess With Colonoscopy

Douglas K. Rex, MD, FASGE reviewing Mohan BP, et al. Dig Liver Dis 2019 Oct 7.  Researchers examined results from 12 previous studies including a

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Younger Physicians Are Better Detectors at Colonoscopy

Douglas K. Rex, MD, FASGE reviewing Shaukat A, et al. Clin Gastroenterol Hepatol 2019 Sep 10. A previous study showed that female endoscopists had higher

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Meta-analysis Confirms Two Observers Better Than One for Polyp Detection

Douglas K. Rex, MD, FASGE reviewing Aziz M, et al. Clin Gastroenterol Hepatol 2019 Oct 4. Among 5 randomized controlled trials, 2 observers increased the

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Cancer Incidence and Mortality in Adenoma Cohorts in Northern California Kaiser

Douglas K. Rex, MD, FASGE reviewing Lee JK, et al. Gastroenterology 2019 Oct 4. Databases developed from colonoscopies performed in the Kaiser Permanente Northern California

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Large RCT Shows No Benefit of Early Colonoscopy in Patients With Acute LGIB

A benefit of early colonoscopy (in the first 24 hours) after hospitalization for acute lower-GI bleeding (LGIB) remains uncertain. In a large, randomized, controlled trial

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One Positive FIT and One Negative? Still Do Colonoscopy

Most fecal immunochemical testing as a screen for colon cancer is done with one sample. However, patients with a positive test sometimes request a second

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Acute Diverticulitis Still an Indication for Colonoscopy

Acute diverticulitis is generally considered an indication for colonoscopy, but the results of studies have been mixed with regard to the risk of colorectal cancer

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6- to 9-mm Adenomas Again Shown to Predict Advanced Neoplasia Versus Diminutive Adenomas

Current postpolypectomy surveillance guidelines lump adenomas 1 to 9 mm in size together in a category of low-risk adenomas. Advanced adenomas are defined as those

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What’s the Best Way to Examine Lynch Colons?

Because of the more rapid transformation of adenomas to cancer in Lynch syndrome, one often sees recommendations that colonoscopists performing Lynch examinations should be proven

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Rising Rates of CRC in Young People: Not Unique to U.S.

It is now widely recognized that colorectal cancer (CRC) rates have been increasing in the U.S. in persons under age 50, while simultaneously decreasing in

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Screening Rates Still Behind in Blacks

Blacks have higher colorectal cancer (CRC) incidence and mortality rates, develop CRC at a younger age, and are screened for CRC less often than whites

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When Colonoscopy for a Positive Cologuard Is Negative, STOP the Workup

The Cologuard test from Exact Sciences looks for hemoglobin and abnormal DNA in the stool. Because abnormal DNA can be shed from the GI tract

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