Cold snare polypectomy of colorectal polyps sometimes leaves a cord of white tissue consisting of submucosa and, sometimes, muscularis mucosa. These defects are called “cold

Sedation practice for endoscopy varies widely in the United States. One model is to use anesthesia specialists to administer propofol for complex endoscopic procedures, such

This study utilized data from two cohorts of the Nurses‘ Health Study involving nearly 159,000 women and 3.5 million person-years of follow-up. The investigators discovered

Among 2629 large nonpedunculated colorectal polyps in 2350 patients, 10 were classified as anastomotic and had a median lesion size of 35 mm. All lesions

About 15% of large (≥20 mm) nonpedunculated colorectal polyps (LNPCPs) removed by piecemeal endoscopic mucosal resection (EMR) have evidence of recurrence at the first endoscopic

Texture and color enhancement imaging (TXI) is a new image-processing feature on the latest generation of Olympus colonoscopes (Tokyo, Japan). These instruments have been commercially

Peutz-Jeghers syndrome (PJS) and juvenile polyposis syndrome (JPS) are hamartomatous polyposis syndromes associated with increased cancer risk. The Danish national health registries systematically record health

Previous studies have shown that most patients who had not undergone colorectal cancer (CRC) screening reportedly had not been offered screening by their primary care

Most randomized controlled trials (RCTs) of computer-aided detection (CADe) demonstrate increased detection, but some RCTs and real-world experiences with CADe have failed to show a

Serrated polyposis syndrome (SPS) is the most common type of polyposis syndrome, affecting as many as one in every 250 persons undergoing screening colonoscopy. It

The value of colorectal cancer (CRC) screening lies in CRC prevention through polyp detection and prevention of CRC mortality by early-stage CRC detection. Compared with

These data are from a population-based Chinese screening program involving 595,180 persons aged 40 to 74 years with 16 years of follow-up. There were 42,353

Twenty-five studies with 30 interventions were analyzed for this study on the effect of behavioral interventions on colonoscopy uptake. Of the interventions evaluated by the

Current recommended postpolypectomy surveillance intervals for patients with serrated lesions are based on limited evidence. This single-center study evaluated risk factors for metachronous advanced serrated

Among the key and newer points from a recent review on the best performance of basic colonoscopy, including the resection of lesions <20 mm in

Over-the-scope suturing (OTSS) requires a double-channel gastroscope, and closure of defects in the right side of the colon may require an overtube. Through-the-scope suturing (TTSS)

This is a single, blind, multicenter, randomized, controlled trial that compared oral sulfate solution (OSS) to a sports drink-like flavored solution of polyethylene glycol and

There is agreement that endoscopic full-thickness resection (EFTR) is a great procedure for lesions extending into the appendiceal orifice (AO) when there has been a

In a cross-sectional retrospective study at a single U.S. health care system, colonoscopic findings of 150 randomly selected patients with early-onset colorectal cancer (CRC) were

Increasingly, we are consulted on or asked to perform colonoscopies on patients who previously underwent multigene panel testing for oncogenes associated with colorectal cancer (CRC).

Recent studies have found that significant fractions of colonoscopists possess adequate detection of conventional adenomas, as measured by adenoma detection rate (ADR), but low detection

The serrated pathway of colorectal cancer (CRC) is considered to account for about 20% of all CRCs. Patients with serrated polyposis syndrome (SPS) have higher

The U.S. Multi-Society Task Force on Colorectal Cancer recommends that polyps ≥1 cm be photographed before resection to document size and the resection site photographed

Tip-in endoscopic mucosal resection (T-EMR) involves submucosal injection, followed by a small incision into the submucosal mound on the cecal side of the lesion. The

This systematic review and meta-analysis identified 6 studies with 1025 patients and 1111 polyps with a mean size ranging from 4 to 8.5 mm. Cold

Underwater endoscopic submucosal dissection (U-ESD; typically performed with saline rather than water) has several potential advantages over conventional ESD (C-ESD; performed with carbon dioxide insufflation).

This study used SEER (Surveillance, Epidemiology, and End Results) data to update colorectal cancer (CRC) incidence and mortality trends from 1992 to 2019. The well-known

Cold snare polypectomy (CSP) is the preferred resection method for colorectal lesions ≤10 mm. Competence in CSP can be assessed using the CSPAT (Cold Snare

Those performing endoscopic mucosal resection (EMR) in the colorectum should be aware of this remarkably comprehensive document from the European Society of Gastrointestinal Endoscopy that

Current recommendations suggest measuring the adenoma detection rate (ADR) in first-time screening colonoscopies. Several studies have found that including surveillance and diagnostic colonoscopies in an

This study looked at retained tissue in the endoscope after EGD and colonoscopy in which only cold forceps biopsies were performed. The study cases were

Very large specimens obtained by endoscopic submucosal dissection may fragment during retrieval through the anus. The Endo Carry Large Type (Hakko Co, Tokyo, Japan) is

Cold snare resection is the treatment of choice for 4- to 9-mm polyps, yet some practitioners perform submucosal injection for polyps in this size range.

In some countries, pathologists and pathology departments are overworked. A number of artificial intelligence (AI) programs have shown substantial accuracy in interpretation of whole slide

This study examined the quality of answers provided by ChatGPT (OpenAI, San Francisco, Calif) to 8 common questions about colonoscopy, compared with answers to the

Cancer incidence studies in national registries, such as that maintained in Denmark, are of interest because they reduce referral bias. A study used nationwide Danish

According to data, 1.5% of the U.S. population has hereditary breast and ovarian cancer syndrome (0.72%), Lynch syndrome (0.35%), or familial hypercholesterolemia (FH; 0.43%). This

Water instillation is now commonly used for a variety of purposes during colonoscopy. Water filling during colonoscope insertion has been shown to decrease pain, reduce

Patients with advanced or high-risk adenomas are recommended to undergo surveillance earlier than patients with low-risk adenomas. In the U.S., the traditional high-risk group classification

In a systematic review and meta-analysis, 15 studies evaluating the impact of report cards on adenoma detection rate (ADR) were among the 34 studies that

Birth by cesarean delivery has been associated with intestinal dysbiosis in childhood. This study is a population-based, nationwide, case-control study from Sweden involving 564 cases

In a prospective study from Singapore, the computer-aided diagnosis (CADx) program CAD EYE (Fujifilm, Tokyo, Japan) was assessed in 661 consecutive polyps of all sizes

This study from the Northern California Kaiser Permanente health care system evaluated the impact of a 30-minute online interactive training program collaboratively developed by endoscopists,

In a randomized trial, 1316 patients underwent colonoscopy with either computer-aided detection (CADe) assistance alone or CADe plus Endocuff Vision (ECV; Olympus America, Center Valley,

In a Japanese experience of endoscopic submucosal dissection (ESD) performed on 483 rectal lesions over 23 years, a prolonged ESD was considered longer than 120

This study used the World Endoscopy Organization classification of postcolonoscopy colorectal cancer (PCCRC) to assess 762 PCCRC cases that accumulated during 1995 to 2021. PCCRC

Adenomas are commonly diagnosed in patients younger than age 50 undergoing colonoscopy. Adenomas in young people often initiate surveillance at shorter than the recommended intervals,

This was a randomized controlled trial in 359 veterans aged 50 to 75 years who had declined colonoscopy and a fecal immunochemical test (FIT) in

The U.S. Preventive Services Task Force recommends that the decision regarding whether to screen persons aged 75 to 85 years for colorectal cancer be individualized

Experienced endoscopists are aware that the mucosa on the ileocecal valve (ICV) lips has a 3- to 10-mm-wide transition zone between normal colonic mucosa and

In a study of 29,877 patients with colorectal cancer (CRC) in the U.S. Veterans Affairs (VA) health care system, the rate of postcolonoscopy colorectal cancer

Cold snare polypectomy is now the resection method of choice for colorectal lesions ≤10 mm in size. The risk of resecting a cancerous lesion in

Endoscopic submucosal dissection (ESD) is an option for scarred, large colorectal adenomas that do not lift well and/or contain a suspicious area of an advanced

In 3 U.S. centers, asymptomatic patients aged 50 to 69 years (or 40-69 if Black) were randomized to screening colonoscopy or annual sequential high-sensitivity guaiac

The overwhelming majority of randomized trials testing the impact of computer-aided detection (CADe) programs have shown substantial benefits. In a randomized controlled trial in 4

An expert colonoscopist recommends the following for photography during colonoscopy:  Cecal landmarks Terminal ileum, if intubated Bowel preparation quality Large lesions before and after endoscopic

Colonoscopists are advised to consider age, comorbidities, and colonoscopy findings before recommending surveillance. In a study of the New Hampshire Colonoscopy Registry, 9831 adults older

X-Tack (Apollo Endosurgery, Austin, Texas) is a through-the-scope suturing device that can be an alternative to through-the-scope clips. No controlled trial of X-Tack versus clips

Cold snare polypectomy is now widely accepted as the treatment of choice for colorectal polyps 4 to 10 mm in size. Despite overwhelming evidence that

Randomized controlled trials (RCTs) have generally shown consistent improvements in adenoma detection rates (ADRs) with the use of computer-aided detection (CADe) during colonoscopy, but a

Colonoscopy is often recommended after an episode of acute diverticulitis, particularly complicated diverticulitis, and when no colonoscopy was performed the previous year. Colonoscopy in prior

Some previous work has suggested that the prevalence of advanced lesions in the appendix is high enough to warrant routine appendectomy in patients with serrated

In this retrospective study from Japan, researchers compared delayed bleeding rates for 82 patients who underwent ESD while continuing antithrombotic medications versus 386 patients without

Large (≥20 mm) colorectal lesions are often accompanied by synchronous lesions, including a high prevalence of synchronous advanced lesions. This study examined the relationship between

Patients with colorectal cancer (CRC) metastatic to the liver or lung often do not undergo surgical resection of their primary tumor. However, the primary tumor

Cold snare polypectomy is the accepted treatment of choice for all colorectal polyps smaller than 10 mm and with no suggestion of cancer on endoscopic

Lynch syndrome is caused by germline mutations in MLH1, MSH2, MSH6, or PMS2 genes, but the most commonly affected genes are MLH1 and MSH2. Increasingly, surveillance recommendations are on a gene-specific basis, with

Endoscopic submucosal dissection (ESD) is frequently followed by hospital admission for multiple days in Asian countries. However, hospitalization is much more expensive in the U.S.,

In an observational study of colorectal EMR, 67 of 336 patients (19.9%) experienced postprocedural pain. All EMRs were performed with electrocautery and adrenaline injection. Pain

In a very large study, 11.8% of 77,007 patients receiving antithrombotic treatment had a positive fecal immunochemical test (FIT) result, compared with 6% of those

Traditionally, even if careful inspection of an EMR scar at follow-up shows no residual polyp, a biopsy should still be performed to rule out histologic

Although there are rules for when to stop colorectal cancer screening, there are no rules about when to stop surveillance colonoscopy in patients with precancerous

Case-control studies and cohort studies have found that colonoscopy prevents colorectal cancer (CRC) for 15 to 20 years or more. However, only a few small

It is well known that the rates of follow-up colonoscopy after a positive fecal screening test are suboptimal, and delays in colonoscopy versus prompt colonoscopy

This study used eye tracking of 7 endoscopy trainees to determine whether missed polyps had not been seen versus seen but not recognized.  Trainees identified

This study describes the prospective testing of a computer-aided diagnosis (CADx) system called POLyp Artificial Recognition (POLAR), developed for real-time diagnosis of diminutive colorectal polyps.

This systematic review and meta-analysis identified 22 studies from 3 continents that addressed the risk of colorectal cancer (CRC) after appendectomy in the general population.

This study examined the positive predictive value (PPV) of a second round of screening with a fecal immunochemical test (FIT)-fecal DNA test (Cologuard, Exact Sciences).

This report is from the National Health Interview Survey, an annual survey of U.S. households covering a wide range of health topics. Response rates were

In a study from China, 548 patients were randomized to receive 2 L of polyethylene glycol (PEG) on the day of colonoscopy or 290 µg

Increasingly, antibiotics are used to treat acute uncomplicated appendicitis. Successful antibiotic treatment can be followed by recurrence. An alternative nonoperative approach is endoscopic retrograde appendicitis

Many experts now routinely examine the proximal colon twice because colonoscopy is less protective against colorectal cancer in the proximal colon than in the distal

Computer-aided detection (CADe) programs are expensive to implement in clinical practice; therefore, endoscopy groups often want to trial the programs before purchase or lease. In

Artificial intelligence programs for highlighting or detecting polyps during colonoscopy are designated computer-aided detection (CADe) programs. In general, randomized controlled trials of CADe have been

Bleeding can be problematic during endoscopic submucosal dissection (ESD). The bleeding point may be difficult to identify, and coagulation may lead to muscle injury and

This study assessed 94 randomized controlled trials with 61,172 patients to determine how artificial intelligence (AI) impacts the adenoma detection rate (ADR). In short, AI

Postcolonoscopy colorectal cancer (PCCRC) is a dreaded event. Previous studies have found that PCCRC is associated with a lower adenoma detection rate (ADR), nongastroenterologist performance

Endoscopic mucosal resection (EMR) is the cornerstone of the treatment of large (≥20 mm) nonpedunculated colorectal lesions. This study from a Canadian expert center examined

Nonampullary adenomas are frequently associated with an increased risk of colorectal adenomas. There is less known about the association between ampullary adenomas and colorectal neoplasia.

Cold snare is now considered the polypectomy method of choice for polyps <10 mm in size, and recent studies have extended the use of cold

Patients taking direct oral anticoagulants (DOACs) are often considered to be at increased risk for bleeding after therapeutic endoscopic procedures such as polypectomy and sphincterotomy. 

This study updates complication rates associated with the full-thickness resection device (FTRD) from a combined Dutch and German registry, with 1892 procedures performed between July

Previous studies have found that patients with large (≥20 mm) nonpedunculated colorectal polyps have a high prevalence of synchronous colorectal neoplasia. This study investigated synchronous

Previous studies have found yoga as effective as other treatments for irritable bowel syndrome (IBS) symptoms. This study tested whether virtually delivered yoga improved IBS

This study evaluated 3766 patients with colon cancer in the U.K., of whom 16.5% had preexisting mental health morbidities (MHMs) recorded in their primary care

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

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

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

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

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

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.,

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

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. 

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%),

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

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

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

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

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

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

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,

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

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,

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

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

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

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

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

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

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

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

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

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

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%

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

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

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)

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

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

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

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

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

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

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

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

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

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.

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

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

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.

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

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

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

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

“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

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

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

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,

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

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

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

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

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

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

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

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

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

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

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

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

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).

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

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

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%.

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

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

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

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

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

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

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

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

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

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

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

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

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.

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

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%

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

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. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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.

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

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

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

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

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

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

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.

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

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

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

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.

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

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

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;

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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,

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

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

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

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.

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

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. 

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

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

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

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

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.

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.

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

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

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

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

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

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

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

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

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

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,

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

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

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

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

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

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

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

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

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

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

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

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

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

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.

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

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

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,

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,

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

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%

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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,

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

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

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

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

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

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

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

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

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

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

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%)

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

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

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

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

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

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

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

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

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

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

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

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

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)

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

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

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

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

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

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

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;

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

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

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

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

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

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

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

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

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

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

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,

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.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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)

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

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

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

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

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

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

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

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

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

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,

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

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

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

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

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

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).

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

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

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

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

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

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.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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).

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

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

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

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

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

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)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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)

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

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

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

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

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

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

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

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

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)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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