Patient experience is a quality indicator in gastrointestinal endoscopy, as recognized by the European Society of Gastrointestinal Endoscopy (ESGE). Despite this, no standardized tools or metrics have been formally endorsed for routine use.

To identify and evaluate patient-reported experience measures (PREM) used in endoscopic procedures, assessing their psychometric properties and conceptual completeness, and to explore gaps for future development.

A systematic literature review was conducted up to March 2023, including studies involving adults (>18 years) who underwent endoscopic procedures and completed PREM. Instruments were assessed using the COSMIN risk of bias tool and a patient experience conceptual model.

Of 1.911 articles screened, 10 studies met the inclusion criteria. The Colonoscopy Experience Score Tool (CEST) proved the strongest psychometric performance, while the Endoscopic Patient-Reported Experience Measure (ENDOPREM) showed superior conceptual coverage. However, no single instrument met both psychometric and conceptual standards. A critical gap identified across all tools was the absence of items related to patient health motivation.

CEST is psychometrically superior and ENDOPREM is conceptually robust. Future PREM should adopt a hybrid approach-combining the psychometric strengths of CEST with the conceptual complexity of ENDOPREM-while also incorporating domains such as patient motivation to improve relevance and impact.

Measuring patient experience requires tools that are currently both scientifically rigorous and patient-centered. Developing a Hybrid PREM is an essential next step to support quality improvement in endoscopic care.

Background: This study aimed to contribute to the ongoing debate regarding the optimal age to initiate colorectal cancer (CRC) screening by evaluating adenoma detection rates (ADRs) across different age and sex groups and to explore whether national screening guidelines should be revised in line with international trends. Methods: In this single-center, retrospective observational study, 1216 average-risk patients who underwent colonoscopy between January and December 2024 were analyzed. The patients were stratified into three age groups: Group 1 (40-44 years), Group 2 (45-49 years), and Group 3 (50-54 years). ADR, advanced neoplasia detection rate (ADNR), ADR by sex, Boston Bowel Preparation Scale (BBPS) score, and withdrawal times were evaluated. Patients with a history of polypectomy, family history of CRC, incomplete colonoscopy, or inadequate bowel preparation (BBPS score <6) were excluded. Group comparisons were performed using Chi-square or Fisher's exact tests, with P < .05 considered statistically significant. Results: Overall ADR and ADNR were 20.8% and 2.6%, respectively. ADRs by group were 7.6%, 15.8%, and 18.9% in Groups 1, 2, and 3, respectively. A significant difference was found between Groups 1 and 2 (P = .032) but not between Groups 2 and 3 (P = .55). ADR was significantly higher in males (30.2%) than in females (13.1%; P < .001). ADNR was also higher in males (3.7%) than in females (1.8%; P = .048). All patients had withdrawal times >6 minutes. Conclusion: ADR significantly increased from age 45, supporting the potential need to lower the CRC screening age and consider sex-specific strategies. Further prospective multicenter studies are warranted.

Intestinal metaplasia (IM) is a significant gastric mucosal change that warrants attention due to its potential role in the pathogenesis of gastric cancer. IM is often triggered by Helicobacter pylori (H. pylori) infection and some risk factors.

This study examined H. pylori infection and related risk factors in 7,096 participants, identifying 2,200 cases of IM linked to H. pylori and 4,896 controls without the infection in Wuwei, Gansu Province, China. The Operative Link on Gastritis/Intestinal Metaplasia (OLGIM) and (Operative Link on Gastritis Assessment (OLGA) classifications tools were used for identifying participants at high risk for gastric cancer by evaluating the severity and extent of H. pylori infection and IM.

The study found that IM and H. pylori prevalence were gender-related, with males representing 41.09 % of cases compared to 33.92 % of controls, a significant difference (P < 0.0001). Conversely, females were more prevalent in the control group (66.07 %) compared to the case group (58.91 %). Age analysis showed higher proportions of IM cases in the 40-49 years group (46.95 %) compared to controls (43.40 %), with significant differences across age groups (P < 0.0001). IM showed significant positive correlations with smoking , alcohol consumption , and drinking water sources . H. pylori infection was detected in 238 (10.81 %) of the case group and 542 (11.07 %) of the control group. Using the OLGIM classification, which incorporates IM into gastric cancer risk assessment, stage 0 (no IM) was observed in 1,189 (24.28 %) of the control group and 530 (24.09 %) of the case group. Stage 1 (mild IM) was found in 3,165 (64.62 %) of the controls and 1,432 (65.09 %) of the cases. Stage 2 (moderate IM) was present in 520 (10.62 %) of the controls and 220 (10 %) of the cases, while stage 3 (severe IM) was observed in 24 (0.49 %) of the controls and 18 (0.82 %) of the cases. For OLGA staging, the case group had a higher percentage of individuals in higher stages (III and IV) compared to the control group. Specifically, 50.84 % of the cases were classified as stage 0, 19.75 % , stage I, 14.71 %, stage II, 8.40 %, stage III, and IV, 6.30 %. In the control group, 54.43 % were classified as stage 0, 24.17 %, stage I, 18.45 %, stage II, 1.66 %, stage III, and IV, 1.29 % respectively.

These findings suggest that older individuals, males, smokers, drinkers, and those using certain drinking water sources are more likely to develop IM. The study highlights the combined impact of H. pylori and risk factors on IM development, emphasizing the need for comprehensive public health strategies to address these risks. The higher proportion of advanced OLGA stages in the case group suggests more severe gastric atrophy, potentially indicating a higher risk for gastric cancer development.

The combination of fecal immunochemical test (FIT) followed by colonoscopy has established itself as one of the preferred population-based screening strategies. Despite extensive exploration of various techniques and technologies, their impact on adenoma detection rate has shown inconsistency across studies in this specific setting "FIT+ population." We aimed to assess the impact of the computer-aided detection (CADe) system in all randomized trials focused on this subpopulation.

We searched MEDLINE, EMBASE, and Scopus databases until September 2023 for randomized controlled trials reporting diagnostic accuracy of CADe systems for detection of colorectal neoplasia. The primary outcome was pooled adenoma detection rate, and secondary outcomes were adenoma per colonoscopy, advanced adenoma per colonoscopy, serrated lesions, and nonneoplastic per colonoscopy.

Ten randomized trials on 5421 patients were included. Adenoma detection rate was higher in the CADe group than in the standard colonoscopy group (0.62 vs. 0.52; relative risk 1.19; 95% confidence interval 1.08-1.31). CADe also resulted in higher detection performances of both adenomas (incidence rate ratio 1.16; 95% confidence interval 1.09-1.24) and serrated lesions (incidence rate ratio, 1.20; 95% confidence interval 1.05-1.38) at per-polyp analysis. No differences were found for advanced adenomas between the groups. On the other hand, more nonneoplastic polyps were removed in the CADe than the standard group (0.45 vs. 0.34; mean difference 0.06; P = 0.026) in a comparable inspection time.

The use of CADe during colonoscopy results in an increased detection of adenomas, and serrated lesions, in a FIT+ setting. The impact on advanced adenomas was not significant. Higher rates of unnecessary removal of nonneoplastic polyps were also reported.

Colonoscopy is a widely used diagnostic and therapeutic tool for colonic diseases and serves as the preferred screening method for colorectal cancer (CRC). A common difficulty during colonoscopy is the looping of the colon, which can result in patient discomfort, prolonged cecal intubation time (CIT), and the need for auxiliary maneuvers. This study aimed to evaluate the efficacy and safety of using an abdominal binder during colonoscopy performed by trainees.

This randomized, double-blind, sham-controlled trial was conducted at a tertiary center. Participants were outpatients aged 20-80 years undergoing elective colonoscopy. They were randomly assigned to either the abdominal binder (AB) group or the sham binder (SB) group. The primary outcome measured was cecal intubation time. Secondary outcomes included the need for manual abdominal compression and postural adjustments during the procedure.

A total of 211 participants were enrolled in the study. The median CIT was significantly shorter in the AB group compared to the SB group (728 s vs. 774 s, p = 0.008). Additionally, the AB group demonstrated a significantly reduced need for manual abdominal compression (p ≤ 0.001) and postural adjustments (p = 0.01). The requirement for abdominal compression decreased by 40% (95% CI 27.7-52.9%), while the need for postural changes was reduced by 9.4% (95% CI 1.9-88.7%).

The use of an abdominal binder during colonoscopy performed by trainees significantly reduced cecal intubation time and minimized the need for ancillary maneuvers, such as manual abdominal compression and postural adjustments.

Determining adenoma detection rate (ADR) and serrated polyp detection rate (SDR) can be challenging as they usually involve manual matching of colonoscopy and histology reports. This study aimed to validate a Natural Language Processing (NLP) code that enables rapid and efficient data extraction to calculate ADR and SDR.

A NLP code was developed to automatically extract colonoscopy quality indicators from colonoscopy and histology reports at a tertiary health service. These reports were manually reviewed to verify the concordance of ADR and SDR between the two methods. This process was applied in the initial training phase, repeated following modification of the code, and again with a validation cohort.

Included in the training and test phases were 5911 colonoscopies, with 2022 in the validation phase. The NLP code extracted patient names with 99.9% concordance and had a 98.9% accuracy in ADR and SDR in the training phase. Search terms were subsequently modified to take into consideration spelling variations and overlapping terminologies. Using data from the same cohort, accuracy of the NLP improved to 100%, excluding four colonoscopies that had missing histology reports in the test phase. Using a validated cohort, NLP had a 99.9% accuracy in ADR and SDR. The total time taken for auditing using NLP in the validation phase was less than 1 h.

An automatic NLP code had an accuracy of almost 100% in determining ADR and SDR in a tertiary colonoscopy service. Wider adoption of NLP enables significant improvements in colonoscopy audits that is accurate and time efficient.

To assess the impact of bowel cleansing quality on polyp detection rate (PDR) and adenoma detection rate (ADR) and explore predictors of lesion detection rate in patients undergoing colonoscopy.

This is a post-hoc analysis of a multicenter randomized controlled trial (RCT) comparing 1L polyethylene glycol plus ascorbate (1L PEG+ASC) vs. 4L PEG as bowel preparation for colonoscopy.

PDR was significantly higher (35.6% vs. 18.5%, p = 0.013), and ADR was higher even if not significantly (25.6% vs. 16.7%, p = 0.153) in patients with Boston Bowel Preparation Scale (BBPS) ≥6 over BBPS <6. Comparing patients with BBPS = 9 over BBPS = 7-8, no significant differences were found in PDR (34.5% vs. 38.4%, p = 0.483) nor ADR (24.1% vs. 27.2%, p = 0.553). At multivariable regression analysis, older age (OR = 1.042, 95%CI = 1.021-1.063; p < 0.001), shorter intubation time (OR = 0.891, 95%CI = 0.816-0.972; p = 0.010), higher withdrawal time (OR = 1.171, 95%CI = 1.094-1.253; p < 0.001) and full consumption of the first dose (OR = 8.368, 95%CI = 1.025-68.331; p = 0.047) were independently associated with ADR.

This post-hoc analysis of a RCT showed that excellent cleansing (BBPS = 9) over high-quality cleansing (BBPS = 7-8) does not significantly improve PDR or ADR. Neither cleansing success nor preparation types were independently associated with ADR. Compliance with bowel preparation, timing of colonoscopy and withdrawal time are key elements for adequate ADR with potential implications for reducing interval colorectal cancer.

Detecting gastric precancerous lesions (GPLs) is critical for the early diagnosis and treatment of gastric cancer. Endoscopy combined with tissue examination is an important method for detecting GPLs. However, negative biopsy results often increase patients' risks, economic burdens, and lead to additional healthcare costs. Improving the detection rate of GPLs and reducing the rate of negative biopsies is currently a key focus in endoscopic quality control.

To explore the relationships between the endoscopist biopsy rate (EBR), qualifications of endoscopists and endoscopic assistants, and detection rate of GPLs.

EBR, endoscopists, and endoscopic assistants were divided into four groups: Low, moderate, high, and very high levels. Multivariable logistic regression analysis was used to analyze the relationships between EBR and the qualifications of endoscopists with respect to the detection rate of positive lesions. Pearson and Spearman correlation analyses were used to evaluate the correlation between EBR, endoscopist or endoscopic assistant qualifications, and the detection rate of positive lesions.

Compared with those in the low EBR group, the odds ratio (OR) values for detecting positive lesions in the moderate, high, and very high EBR groups were 1.12 [95% confidence interval (CI): 1.06-1.19, P < 0.001], 1.22 (95%CI: 1.14-1.31, P < 0.001), and 1.38 (95%CI: 1.29-1.47, P < 0.001), respectively. EBR was positively correlated with the detection rate of gastric precancerous conditions (atrophic gastritis/intestinal metaplasia) (ρ = 0.465, P = 0.004). In contrast, the qualifications of the endoscopists were positively correlated with GPLs detection (ρ = 0.448, P = 0.005). Compared to endoscopists with low qualification levels, those with moderate, high, and very high qualification levels endoscopists demonstrated increased detection rates of GPLs by 13% (OR = 1.13, 95%CI: 0.98-1.31), 20% (OR = 1.20, 95%CI: 1.03-1.39), and 32% (OR = 1.32, 95%CI: 1.15-1.52), respectively. Further analysis revealed that the qualifications of endoscopists were positively correlated with the detection rates of GPLs in the cardia (ρ = 0.350, P = 0.034), angularis (ρ = 0.396, P = 0.015) and gastric body (ρ = 0.453, P = 0.005) but not in the antrum (ρ = 0.292, P = 0.079). Moreover, the experience of endoscopic assistants was positively correlated with the detection rate of precancerous lesions by endoscopists with low or moderate qualifications (ρ = 0.427, P = 0.015).

Endoscopists and endoscopic assistants with high/very high qualifications, but not EBR, can improve the detection rate of GPLs. These results provide reliable evidence for the development of gastroscopic quality control indicators.

The broad use of artificial intelligence (AI) and its various applications have already shown significant impact in medicine and in everyday life. In gastroenterology, the most studied AI tools at present are computer-aided detection (CADe) and computer-aided diagnosis (CADx). These tools have been mainly assessed during colonoscopy for the detection of polyps and for the prediction of their histology based on their appearance. Their use aims to improve colonoscopy quality, standardize procedures, and potentially reduce costs. Data on CADe demonstrate clear benefits that are applicable to clinical practice. While CADx shows good diagnostic performance, its additional benefits in assisting endoscopists remain unclear.

Quality markers and patient experience are being implemented to ensure standardization of practice across gastrointestinal (GI) endoscopy procedures. The set benchmarks ensure high quality procedures are delivered and linked to measurable outcomes.There has been an increase in the demand for small-bowel endoscopy. In 2019, the European Society of Gastrointestinal Endoscopy (ESGE) embarked on setting performance measures for small-bowel endoscopy. This included major (key) and minor performance indicators for both small-bowel capsule endoscopy (SBCE) and device-assisted enteroscopy (DAE). These suggested quality indicators cover all procedure domains, from patient selection and preparation, to intraprocedural aspects such as pathology identification, appropriate management, the patient experience, and post-procedure complications. Since 2019, there has been an increase in published studies looking at different aspects of small-bowel endoscopy, including real-world data. This paper provides an update on the 2019 performance measures, considering the latest literature.

Computer-aided detection software (CADe) has shown promising results in real-time polyp detection, but a limited head-to-head comparison of the available CADe systems has been performed. Moreover, such systems have not been compared to endoscopists using standardized videos. This study aims to compare the performance of three CADe systems in detecting polyps, employing a novel standardized methodology.

Videos from 300 colonoscopies conducted at Oslo University Hospital were analyzed. Short video clips (20-45 s) presenting normal mucosa or polyps were randomly selected. These videos were then streamed through each CADe system from Medtronic, Olympus, and Augere Medical. Each system featured diverse configurations, resulting in a total of six software settings. Sensitivity and false positivity (FP) were assessed by comparing the CADe systems to both the mean of the systems and pairwise between them. Furthermore, the systems' performance was compared to the performance of five endoscopists.

CADe systems' sensitivity ranged between 84.9% and 98.7%, with statistically significant differences observed between the systems, both in comparison to the mean and to each other. FP rates ranged between 1.2% and 5.6%, also differing statistically significantly between the systems. The CADe systems achieving the highest sensitivity also exhibited the highest FP. Statistically significant differences in the alert delay were observed between different CADe systems and endoscopists.

This study highlights significant differences between commercially available CADe software regarding sensitivity and FP, but a superior performance compared to endoscopists. The software with the highest sensitivity also exhibited the highest FP, highlighting the need for further refinement.

Colon hydrotherapy devices serve as a physiotherapeutic modality to manage colonic disorders by promoting intestinal peristalsis and enhancing gastrointestinal functionality. This study aims to assess and compare the effectiveness, safety, and tolerability of two remedial strategies for inadequate bowel preparation: colon hydrotherapy device enema and oral polyethylene glycol electrolyte powder.

A retrospective analysis was performed on 109 patients who failed to adequately prepare for colonoscopy. These patients received remedial bowel preparation on the same day as their procedure, with 55 undergoing colon hydrotherapy enema and 54 receiving oral polyethylene glycol electrolyte powder. Patient satisfaction and tolerance were evaluated through telephone follow-up. Key metrics included the Boston Bowel Preparation Scale scores, preparation time, incidence of adverse reactions, and patient tolerance and satisfaction.

No significant differences were observed in baseline characteristics between groups (P >  0.05). The Boston Bowel Preparation Scale scores for the entire colon were 7 (3) in the hydrotherapy group and 6.5 (1) in the oral group (z =  -2.075, P =  0.038). Notably, scores for the left colon were significantly higher in the hydrotherapy group [3 (1) vs. 2 (0), z =  -5.586, P <  0.001]. The hydrotherapy group also exhibited a shorter preparation time [80 (20) min vs. 92.5 (20) min, z =  -3.961, P <  0.001] and a lower incidence of adverse effects (36.4% vs. 88.9%, χ² =  32.035, P <  0.001). Patient satisfaction metrics, including re-selection rates and tolerance of side effects, were significantly higher in the hydrotherapy group.

The colon hydrotherapy device enema is an effective, efficient, and well-tolerated method for bowel cleansing, demonstrating a low incidence of adverse events. It is recommended as an effective and safe remedial therapy for patients with inadequate bowel preparation prior to colonoscopy.

The European Society of Gastrointestinal Endoscopy (ESGE) and British Society of Gastroenterology (BSG) formulated performance measures to improve the detection rate for upper gastrointestinal (UGI) endoscopy. We aimed to assess adherence to and impact of training on adherence to performance measures for UGI endoscopy.

In this multicenter, prospective, cohort study, endoscopists at three centers underwent 1-hour face-to-face training based on ESGE and BSG procedure performance measures (≥ 7-minute inspection time; photodocumentation of ≥ 10 anatomical landmarks + abnormalities; standardized terminology; biopsy protocols). A self-developed quality assessment score was used to assess diagnostic UGI endoscopies before (control group) and after (intervention group) training. The primary endpoint was improvement in overall quality score (percentage of the maximum score).

Of 1,733 consecutive UGI endoscopies, 570 were eligible for inclusion (mean patient age 60 years [standard deviation 15]; male 47%): 285 in the control group and 285 in the intervention group. Overall quality score increased from 60% before to 67% after the training intervention (difference 7%, 95% confidence interval [CI] 5-10, P < 0.001). Male patients (3.2%, 95% CI 0.7-5.7), alarming features (-3.1%, 95% CI -5.6 to -0.5), and endoscopist age (-0.4% increment per year, 95% CI -0.8 to -0.1) were associated with higher quality scores.

Adherence to the ESGE and BSG procedure performance measures for UGI endoscopy persistently increased after a 1-hour face-to-face training intervention, suggesting that a simple training intervention tool can improve the quality of UGI endoscopy and potentially could prevent missed lesions.

There are no existing data in the literature on the learning curve of French interns in colonoscopy or on the comparison between different frequencies of colonoscopy training modalities. We aimed to assess the number of procedures required for French residents in hepatogastroenterology to achieve competency in colonoscopy.

The primary outcome was achieving greater than 90% cecal intubation rate (CIR90) competency using the Learning Curve-Cumulative Summation (LC-CUSUM) method. Participants with over 80 procedures were categorized into intensive and progressive training groups. We compared the proportion of residents reaching competency, the number of colonoscopies to reach it, and the speed of competency.

The study included 81 residents, totaling 6,259 procedures. 29 did more than 80 procedures: 12 in the progressive group and 17 in the intensive group. 204 colonoscopies were needed for reaching CIR90 competency (21% of residents). Achievement rates were similar across groups: 50% in the progressive and 65% in the intensive group (p = 0.50). LC competency was reached by 8.6% of residents after an average of 225 procedures, with no significant difference between groups (p = 0.21). Survival analysis showed no significant difference in the speed of competency acquisition between groups (p = 0.77 and p = 0.14, respectively). The Polyp Detection Rate (PDR) averaged 40%.

Given that only 21% reached CIR90, efforts are needed to increase the number of colonoscopies during training.

Not applicable.

Colonoscopy, a crucial procedure for detecting and removing colorectal polyps, has seen transformative advancements through the integration of artificial intelligence, specifically in computer-aided detection (CADe) and diagnosis (CADx). These tools enhance real-time detection and characterization of lesions, potentially reducing human error, and standardizing the quality of colonoscopy across endoscopists. CADe has proven effective in increasing adenoma detection rate, potentially reducing long-term colorectal cancer incidence. However, CADe's benefits are accompanied by challenges, such as potentially longer procedure times, increased non-neoplastic polyp resections, and a higher surveillance burden. CADx, although promising in differentiating neoplastic and non-neoplastic diminutive polyps, encounters limitations in accuracy, particularly in the proximal colon. Real-world data also revealed gaps between trial efficacy and practical outcomes, emphasizing the need for further research in uncontrolled settings. Moreover, CADx limited specificity and binary output underscore the necessity for explainable artificial intelligence to gain endoscopists' trust. This review aimed to explore the benefits, harms, and limitations of artificial intelligence for colon cancer screening, surveillance, and treatment focusing on CADe and CADx systems for lesion detection and characterization, respectively, while addressing challenges in integrating these technologies into clinical practice.

Colonoscopy surveillance for Lynch syndrome is burdensome and postcolonoscopy colorectal cancers (CRCs) still occur. The noninvasive fecal immunochemical test (FIT) might guide optimal colonoscopy intervals.

Prospective, multicenter observational study in which individuals with Lynch syndrome performed a quantitative FIT before high-quality surveillance colonoscopy. Diagnostic performance of FIT at various thresholds ≤20 μg Hb/g feces was assessed for relevant neoplasia, including advanced neoplasia (CRC, advanced adenomas [AAs] and advanced serrated lesions [ASLs]) and non-advanced adenomas (NAAs).

Of the 217 included individuals (59% female, median age 51 years), 4 had CRC, 5 AA, 4 ASL, and 57 NAA as most relevant neoplasia. The lowest FIT positivity threshold (2.5 μg Hb/g feces, 14% positivity rate) maximized detection: 4/4 CRCs, 4/5 AA, 1/4 ASL, and 9/57 NAA were detected, resulting in a sensitivity and negative predictive value of, respectively, 89% and 99% for CRC plus AA, 69% and 97% for advanced neoplasia, and 26% and 72% for all relevant neoplasia (91% specificity for all groups). At equal sensitivity and negative predictive value, specificity for advanced neoplasia optimized to 94% at threshold 4.1 μg/g. Per 100 FITs at threshold 4.1 μg/g, 11 individuals would test positive and thus proceed to colonoscopy, 2 individuals with advanced neoplasia would be missed and 3 individuals would need colonoscopy to detect 1 advanced neoplasia.

FIT at thresholds ≤4.1 μg Hb/g feces may be a promising strategy to postpone colonoscopy in approximately 9 of 10 individuals with Lynch syndrome. Large validation studies that also provide gene variant-specific outcomes should be prioritized.

Adenoma detection rate (ADR) serves as a primary quality metric in colonoscopy. Various computer-aided detection (CADe) tools have emerged, yielding diverse impacts on ADR across different demographic cohorts. This study aims to evaluate a new CADe system in patients undergoing colonoscopy.

This is an Italian multicenter randomized control trial (RCT) that included patients aged 40-85 scheduled for screening, surveillance or diagnostic colonoscopy randomly assigned to CADe or standard colonoscopy (SC). Patients with a Boston Bowel Preparation Scale < 2 in any segment were excluded. The primary outcome was ADR in both groups. Secondary outcomes included adenoma per colonoscopy (APC), polyp per colonoscopy (PPC) and sessile serrated lesion detection rate (SSLDR).

1228 patients were enrolled of whom 70 were excluded for inadequate bowel cleansing or missed cecal intubation. Therefore, 1158 subjects (578 CADe vs 580 SC) were included in the final analysis. ADR was significantly higher in CADe than in the control group (50.2 % vs 40.5 %, p = 0.001). CADe also significantly increased PPC and APC (1.64 ± 2.03 vs 1.23 ± 1.72, p < 0.001; 1.16 ± 1.82 vs 0.80 ± 1.46 p < 0.001; respectively). No significant differences were found in SSLDR between CADe and SC (12.1 % vs 11.0 %, p = 0.631).

The results of this RCT indicate that AI-assisted colonoscopy significantly improved ADR in a non-selected population undergoing colonoscopy without causing any significant delay in procedure time or increasing the detection of nonneoplastic lesions. (Ethical committee approval: NCT05862948).

Endoscopic classification of ulcerative colitis (UC) shows high interobserver variation. Previous research demonstrated that artificial intelligence (AI) can match the accuracy of central reading in scoring still images. We now extend this assessment to longer colon segments and integrate AI into clinical workflows, evaluating its use for real-time, video-based classification of disease severity, and as a support system for physicians.

We trained a convolutional neural network with the Mayo Endoscopic Subscores (MESs) of 2,561 images and 53 videos from 645 patients. The model differentiated scorable from unscorable endoscopy sections through open-set recognition. Validation involved 140 video clips from 44 patients with UC. Six inflammatory bowel disease (IBD) experts and 16 nonexperts rated these videos, with expert scores as the gold standard. We assessed the model's performance and the value as a supporting system. Last, the model underwent an alpha test on a real-world patient as a real-time endoscopic support.

The model achieved an accuracy of 82%, with no significant differences between the experts and the AI. When used as a supporting system, it improved non-IBD experts' performance by 12% and disagreed with the primary physician in 20%-39% of cases. During the alpha test, it was successfully integrated into clinical practice, accurately distinguishing between MES 0 and MES 1, consistent with endoscopists' assessments.

Our innovative AI model shows significant potential for enhancing the accuracy of UC severity classification and improving the proficiency of non-IBD experts. It is designed for clinical use and has proven feasible in real-world testing.

Clinical trials and real-world studies show a 1L polyethene glycol and ascorbic acid solution (1L PEG-ASC) to be an effective and safe bowel preparation for colonoscopy in the general population. Here, the effectiveness and safety of 1L PEG-ASC were evaluated in patients aged 80 years or older in a real-world setting.

A post-hoc analysis of an observational, multicenter, retrospective study assessed the effectiveness and safety of 1L PEG-ASC on outpatients aged ≥ 80 years old undergoing colonoscopy at eight centers in Spain and Portugal. Cleansing quality was assessed using the Boston Bowel Preparation Scale, with overall scores ≥ 6 and all segmental scores ≥ 2 considered adequate colon cleansing, and overall scores ≥ 8 or 3 in the right colon considered high-quality cleansing. Cecal intubation rate, withdrawal time, polyp and adenoma detection rates (ADR), and adverse events (AEs) were also monitored.

Data were analyzed from 423 patients aged ≥ 80 years; mean age 83.5 years (±3.2) and 49.2% males. The adequate colon cleansing success rate was 88.9%, with high-quality cleansing of the overall and right colon achieved in 54.1% and 46.1% of patients, respectively. Colonoscopy was complete in 94.1% of cases and the ADR was 51.3%. At least one AE was experienced by 4.5% of participants, the most frequent being mild dehydration (2.8%) and nausea (1.2%).

This post-hoc analysis confirms 1L PEG-ASC to be an effective and safe bowel cleansing preparation for patients aged 80 years or older in a real-world setting.

Colorectal cancer (CRC) prevention depends on effective colonoscopy; yet variability in adenoma detection rates (ADRs) and missed lesions remain significant hurdles. Artificial intelligence-powered computer-aided detection (CADe) systems offer promising advancements in enhancing polyp detection. This review examines the role of CADe in improving ADR and reducing adenoma miss rates (AMRs) while addressing its broader clinical implications. CADe has demonstrated consistent improvements in ADRs and AMRs; largely by detecting diminutive polyps, but shows limited efficacy in identifying advanced adenomas or sessile serrated lesions. Challenges such as operator deskilling and the need for enhanced algorithms persist. Combining CADe with adjunctive techniques has shown potential for further optimizing performance. While CADe has standardized detection quality; its long-term impact on CRC incidence and mortality remains inconclusive. Future research should focus on refining CADe technology and assessing its effectiveness in reducing the global burden of CRC.

Adenoma detection rate (ADR) is a key performance measure with variability among endoscopists. Artificial intelligence (AI) in colonoscopy could reduce this variability and has shown to improve ADR. This study assessed the impact of AI on ADR among Danish endoscopists of varying experience levels.

We conducted a prospective, quasi-randomized, controlled, multicenter trial involving patients aged 18 and older undergoing screening, surveillance, and diagnostic colonoscopy at four centers. Participants were assigned to AI-assisted colonoscopy (GI Genius, Medtronic) or conventional colonoscopy. Endoscopists were classified as experts (> 1000 colonoscopies) or non-experts (≤ 1000 colonoscopies). The primary outcome was ADR. We performed a subgroup analysis stratified on endoscopist experience and a subset analysis of the screening population.

A total of 795 patients were analyzed: 400 in the AI group and 395 in the control group. The AI group demonstrated a significantly higher ADR than the control group (59.1% vs. 46.6%, P < 0.001). The increase was significant among experts (59.9% vs. 47.3%, P < 0.002) but not among non-experts. AI assistance significantly improved ADR (74.4% vs. 58.1%, P = 0.003) in screening colonoscopies. Polyp detection rate (PDR) was also higher in the AI group (69.8% vs. 56.2%, P < 0.001). There was no significant difference in the non-neoplastic resection rate (NNRR) (15.1% vs. 17.1%, P = 0.542).

AI-assisted colonoscopy significantly increased ADR by 12.5% overall, with a notable 16.3% increase in the screening population. The unchanged NNRR indicates that the higher PDR was due to increased ADR, not unnecessary resections.

The carcinogenesis of colorectal cancer is well understood. Adenomas are the precursor lesions in about 70% of cases, highlighting the importance of screening programs.

The aim of this study was to analyze the effectiveness of colonoscopy examinations performed in a private tertiary service by calculating the polyp detection rate (PDR) and adenoma detection rate (ADR) and comparing these rates with literature data.

This retrospective observational study evaluated colonoscopies performed at Hospital Centro Médico de Campinas between 2018 and 2020. It assessed the indications and complications of colonoscopy, sex, age group, bowel preparation, cecal intubation rate, ADR, PDR, and advanced adenoma detection rate (AADR).

During the period, 3,686 colonoscopies were performed, and 3,076 were included in the analysis. The mean patient age was 57.2 years, and most patients were female (53.5%). Complications occurred in 39 colonoscopies (1.3%), with bleeding in six cases and perforation in one case. Tubular adenoma was the most prevalent histological subtype found in 20% of tests and in 62.7% of those with positive findings. The PDR was 23% and significantly increased with advancing age (p<0.01). The ADR was 20% and also significantly increased with age (p<0.001). This rate was higher in men (27%). The AADR was 4%.

Colonoscopy is an effective polyp detection method, and the PDR was higher in men and significantly increased with age. The ADR and AADR were comparable to the literature data.

Computer-aided detection (CADe) systems may increase adenoma detection rate (ADR) during colonoscopy. However, the variable results of CADe effects in different RCTs warrant investigation into factors influencing these results.

Investigate the different variables possibly affecting the impact of CADe-assisted colonoscopy and its effect on ADR.

We searched MEDLINE, EMBASE, and Scopus databases until July 2023 for RCTs reporting performance of CADe systems in the detection of colorectal neoplasia. The main outcome was pooled ADR. A random-effects meta-analysis was performed to obtain the pooled risk ratios (RR) with 95 % confidence intervals (CI)). To explore sources of heterogeneity, we conducted a meta-regression analysis using both univariable and multivariable mixed-effects models. Potential explanatory variables included factors influencing adenoma prevalence, such as patient gender, age, and colonoscopy indication. We also included both key (ADR), and minor (Withdrawal time) performance measures considered as quality indicators for colonoscopy.

Twenty-three randomized controlled trials (RCTs) on 19,077 patients were include. ADR was higher in the CADe group (46 % [95 % CI 39-52]) than in the standard colonoscopy group (38 % [95 % CI 31-46]) with a risk ratio of 1.22 [95 % CI 1.14-1.29]); and a substantial level of heterogeneity (I2 = 67.69 %). In the univariable meta-regression analysis, patient age, ADR in control arms, and withdrawal time were the strongest predictors of CADe effect on ADR (P < .001). In multivariable meta-regression, ADR in control arms, and withdrawal time were simultaneous significant predictors of the proportion of the CADe effect on ADR.

The substantial level of heterogeneity found appeared to be associated with variability in colonoscopy quality performances across the studies, namely ADR in control arm, and withdrawal time.

In colorectal cancer screening with the fecal immunochemical test (FIT), the optimal follow-up after first-round colonoscopy for a positive FIT, particularly after negative colonoscopy, is unknown. Therefore, using Screening of Swedish Colons (SCREESCO) study data, we aimed to elucidate the risk factors for the detection of colorectal neoplasia in second-round colonoscopy, which can affect recommendations for the optimal follow-up.

We performed a cross-sectional analysis using data from SCREESCO participants undergoing colonoscopy after a positive 2-stool FIT, with a positivity cutoff value of ≥10 μg/g feces, in both the first and second rounds separated by a 2-year interval. We assessed the associations between colorectal neoplasia detection in second-round colonoscopy and participant characteristics, FIT concentrations, first-round colonoscopy results, and endoscopists' adenoma detection rates (ADRs), which were categorized as very low, low, intermediate, and high.

This study included 343 individuals. Despite negative first-round colonoscopies (n = 230), colorectal cancer and advanced colorectal neoplasia (ACN) were detected in 0.9% and 8.3% of participants in the second-round colonoscopy, respectively. An association was demonstrated between the first-round endoscopists' ADRs and the risk of second-round ACN detection. The multivariable odds ratios of the first-round intermediate and high ADRs, compared with the very low ADR, for second-round ACN detection were 0.17 (95% confidence interval [CI], 0.02-0.79) and 0.19 (95% CI, 0.04-0.86), respectively.

The impact of endoscopists' ADRs on ACN detection in subsequent-round colonoscopies underscores the importance of considering ADR for optimal follow-up after first-round colonoscopy in an FIT-based screening program.

This study investigated the detection rate of colorectal neuroendocrine neoplasms (NENs) using large-scale colonoscopy data.

This cross-sectional analysis used large-scale data from a Japanese multicenter observational study of colonoscopies performed from 2010 to 2020.

Among 82,005 colonoscopy cases, colorectal NENs were identified in 71 (67 of which were neuroendocrine tumors), with a detection rate of 0.087% (95% confidence interval: 0.069-0.109). Most were small rectal lesions, with only 4 >10 mm in size and 3 located in the colon.

The detection rate of colorectal NENs during colonoscopy is substantially higher than expected.

Postendoscopic submucosal dissection (ESD) coagulation syndrome (PECS) prevention is one of the common postoperative complications of colorectal ESD. Considering the increasing incidence of PECS, it is critical to investigate various prevention methods. The objective of this study was to evaluate the efficacy of transrectal drainage tubes (TDTs) in PECS prevention in patients following colorectal ESD.

From July 2022 to July 2023, a multicenter, randomized controlled clinical trial was conducted in 3 hospitals in China. Patients with superficial colorectal lesions ≥20 mm who had undergone ESD for a single lesion were enrolled. Initially, 229 patients were included in the study and 5 were excluded. Two hundred twenty-four were randomly assigned to the TDT and non-TDT group in the end. This open-label study utilized a parallel design with a 1:1 allocation ratio, and endoscopists and patients were not blind to the randomization, and a 24 Fr drainage tube was inserted approximately 10-15 cm above the anus after the ESD under the endoscopy and tightly attached to a drainage bag. The TDTs were removed in 1-3 days following the ESD.

A total of 229 eligible patients were enrolled in this study, and 5 patients were excluded. Ultimately, 224 patients were assigned to the TDT group (n = 112) and non-TDT group (n = 112). The median age for the patients was 63.45 years (IQR 57-71; 59 men [52.68%]) in the TDT group and 60.95 years (IQR 54-68; 60 men [53.57%]) in the non-TDT group. Intention-to-treat analysis showed patients in the TDT group had a lower incidence of PECS than patients in the non-TDT group (7 [6.25%] vs 20 [17.86%]; relative risk, 0.350; 95% confidence interval [CI], 0.154-0.795; P = 0.008). In the subgroup analysis, TDTs were found to prevent PECS in patients of the female gender (odd ratio, 0.097; 95% CI, 0.021-0.449; P = 0.001), tumor size <4 cm (odd ratio, 0.203; 95% CI, 0.056-0.728; P = 0.011), tumor located in the left-sided colorectum (odd ratio, 0. 339 95% CI, 0.120-0.957; P = 0.035), and shorter procedure time (<45 minutes) (odd ratio, 0.316; 95% CI, 0.113-0.879; P = 0.023). The tube fell off in 1 case (0.89%) accidentally ahead of time. No TDT-related complication was observed.

The results from this randomized clinical study indicate that the application of TDTs effectively reduced the incidence of PECS in patients after colorectal ESD ( chictr.org.cn Identifier: ChiCTR2200062164).

Inefficiencies in the endoscopy suite cause frustration for physicians, hospital administrators, staff, and patients. Turnover time (TOT), the time between one case ending and another beginning, is subjectively disproportionate between various team members. We aimed to define perceptions of TOT and target steps within the process to improve efficiency.

This was a prospective cohort study at a tertiary center outpatient endoscopy unit. Phase I aimed to identify the TOT process components based on time stamps in the electronic medical record (N = 686). We defined gastroenterologist perceived TOT (pTOT), anesthesia pTOT, and standard TOT (sTOT). TOT length was calculated for each subgroup. Patient transport was identified as an intervenable target. In Phase II, the task of patient transport moved from the anesthesiology team to endoscopy nurses. Mean TOT and proportion of cases with sTOT <15 minutes' preintervention (n = 2192) and postintervention (n = 292) were compared.

Seven key TOT components were identified that explain variations in pTOT. Average anesthesia pTOT was 15 minutes, whereas average gastroenterologist pTOT was 34 minutes (25.9% vs 57.2% of case length; P = .0007). In Phase II, mean sTOT improved from 18.51 to 14.25 minutes (P < .0001), and proportion of sTOT within 15 minutes improved from 41.79% to 58.90% (P < .0001). This intervention saved 45 minutes per room per day, allowing for a revenue potential of more than $300,000 per year per procedure room.

This study defines variations in TOT and shows that finding imbalances and sharing the workload significantly cuts costs and improves the overall efficiency of the different subgroups in the turnover process.

Non-invasive biomarkers may reduce post-colonoscopy colorectal cancer (CRC) rates and colonoscopy overuse in Lynch syndrome. Unlike faecal immunochemical test (FIT), faecal volatile organic compounds (VOCs) may accurately detect both advanced and non-advanced colorectal neoplasia.

The aim of this study was to evaluate the potential of faecal VOCs-separately and with FIT-to guide optimal colonoscopy intervals in Lynch syndrome.

Prospective longitudinal multicentre study in which individuals with Lynch syndrome collected faeces before and after high-quality surveillance colonoscopy. VOC-patterns were analysed using field asymmetric ion mobility spectrometry (FAIMS) and gas chromatography-ion mobility spectrometry (GC-IMS) followed by machine learning pipelines, and combined with FIT at 2.55 μg Hb/g faeces. Gas chromatography time-of-flight mass spectrometry analysed individual VOC abundance.

Among 200 included individuals (57% female, median 51 years), 62 had relevant neoplasia at colonoscopy: 3 CRC, 6 advanced adenoma (AA), 3 advanced serrated lesion (ASL), and 50 non-advanced adenoma (NAA). Respective sensitivity and negative predictive value for CRC and AA (and also ASL in case of FAIMS) were 100% and 100% using FAIMS (54% specificity), and 89% and 99% using GC-IMS (58% specificity). Respective sensitivity and specificity for any relevant neoplasia were 88% and 44% (FAIMS) and 84% and 28% (GC-IMS); accuracy did not significantly improve upon VOC-FIT. VOC-patterns differed before and after polypectomy (AUC 0.70). NAA showed decreased faecal abundance of butanal, 2-oxohexane, dimethyldisulphide and dimethyltrisulphide.

In Lynch syndrome, faecal VOCs may be a promising strategy for postponing colonoscopy and for follow-up after polypectomy. Our results serve as a stepping stone for large validation studies.

NL8749.

Suboptimal bowel preparation adversely affects colonoscopy quality, increases healthcare costs, and prolongs waiting time. The primary contributing factors include poor tolerance to the preparation solutions, noncompliance with prescribed instructions, and suboptimal efficacy of the bowel cleansing solution itself.

This review examined the predictive factors associated with suboptimal bowel preparation and discussed interventions aimed at improving bowel cleansing. It also provides evidence-based practical algorithms supplemented by insights from our own clinical experience. Relevant topics were reviewed using resources from the PubMed database.

Although current bowel preparation protocols are effective for the majority of patients, a significant proportion still present challenges for optimal preparation. These patients may benefit from personalized strategies tailored to the specific causes of preparation failure. Conducting a thorough interview is crucial for identifying the reasons for failure, particularly in patients who have previously experienced suboptimal preparation during colonoscopy. In colonoscopy-naïve patients, it is essential to assess the risk of suboptimal preparation. In both cases, interventions should be customized to either address the identified causes in the former group or employ preventive strategies to reduce the likelihood of failure in the latter.

Water-assisted colonoscopy (WAC) application in inflammatory bowel diseases (IBD) endoscopy offers significant technical opportunities. Traditional gas-aided insufflation colonoscopy increases patient discomfort, presenting challenges in the frequent and detailed mucosal assessments required for IBD endoscopy. WAC techniques, including water immersion and exchange, provide superior patient comfort and enhanced endoscopic visualisation. WAC effectively reduces procedural pain, enhances bowel cleanliness, and increases adenoma detection rates, which is crucial for colorectal cancer screening and disease-related evaluations in IBD patients. Additionally, underwater techniques facilitate basic and advanced endoscopic resections, such as polypectomy and endoscopic mucosal and submucosal resections, often required for resecting IBD-associated neoplasia.

Controlling colonoscopic quality is important in the detection of colon polyps during colonoscopy as it reduces the overall long-term colorectal cancer risk. Artificial intelligence has recently been introduced in various medical fields. In this study, we aimed to validate a previously developed artificial intelligence (AI) computer-aided detection (CADe) algorithm called ALPHAON® and compare outcomes with previous studies that showed that AI outperformed and assisted endoscopists of diverse levels of expertise in detecting colon polyps.

We used the retrospective data of 500 still images, including 100 polyp images and 400 healthy colon images. In addition, we validated the CADe algorithm and compared its diagnostic performance with that of two expert endoscopists and six trainees from Gachon University Gil Medical Center. After a washing-out period of over 2 weeks, endoscopists performed polyp detection on the same dataset with the assistance of ALPHAON®.

The CADe algorithm presented a high capability in detecting colon polyps, with an accuracy of 0.97 (95% CI: 0.96 to 0.99), sensitivity of 0.91 (95% CI: 0.85 to 0.97), specificity of 0.99 (95% CI: 0.97 to 0.99), and AUC of 0.967. When evaluating and comparing the polyp detection ability of ALPHAON® with that of endoscopists with different levels of expertise (regarding years of endoscopic experience), it was found that ALPHAON® outperformed the experts in accuracy (0.97, 95% CI: 0.96 to 0.99), sensitivity (0.91, 95% CI: 0.85 to 0.97), and specificity (0.99, 95% CI: 0.97 to 0.99). After a washing-out period of over 2 weeks, the overall capability significantly improved for both experts and trainees with the assistance of ALPHAON®.

The high performance of the CADe algorithm system in colon polyp detection during colonoscopy was verified. The sensitivity of ALPHAON® led to it outperforming the experts, and it demonstrated the ability to enhance the polyp detection ability of both experts and trainees, which suggests a significant possibility of ALPHAON® being able to provide endoscopic assistance.

Colonoscopy (CS) is an important screening method for the early detection and removal of precancerous lesions. The stool state during bowel preparation (BP) should be properly evaluated to perform CS with sufficient quality. This study aimed to develop a smartphone application (app) with an artificial intelligence (AI) model for stool state evaluation during BP and to investigate whether the use of the app could maintain an adequate quality of CS.

First, stool images were collected in our hospital to develop the AI model and were categorized into grade 1 (solid or muddy stools), grade 2 (cloudy watery stools), and grade 3 (clear watery stools). The AI model for stool state evaluation (grades 1-3) was constructed and internally verified using the cross-validation method. Second, a prospective study was conducted on the quality of CS using the app in our hospital. The primary end-point was the proportion of patients who achieved Boston Bowel Preparation Scale (BBPS) ≥6 among those who successfully used the app.

The AI model showed mean accuracy rates of 90.2%, 65.0%, and 89.3 for grades 1, 2, and 3, respectively. The prospective study enrolled 106 patients and revealed that 99.0% (95% confidence interval 95.3-99.9%) of patients achieved a BBPS ≥6.

The proportion of patients with BBPS ≥6 during CS using the developed app exceeded the set expected value. This app could contribute to the performance of high-quality CS in clinical practice.

A lower-quality colonoscopy has been shown to be less effective in reducing colorectal cancer (CRC) incidence than a higher-quality colonoscopy, but the comparison with no-screening colonoscopy (noSC) is lacking. We aimed to compare the 13-year risk of developing CRC between persons with I) a higher-quality screening colonoscopy (higherQualSC), II) a lower-quality screening colonoscopy (lowerQualSC), and III) without a screening colonoscopy.

A health-care database (∼20% of the German population) was used to emulate a target trial with three arms: higherQualSC vs lowerQualSC vs noSC at baseline. The quality of screening colonoscopy was categorized based on the polyp detection rate of the examining physician (cut-off: 21.8%). We included persons aged 55-69 years at average CRC risk and CRC screening naïve at baseline. We estimated adjusted cumulative CRC incidence over 13 years of follow-up.

The higherQualSC arm comprised 142,960 persons, the lowerQualSC arm 62,338 persons, and the noSC arm 124,040 persons. The adjusted 13-year CRC risk was 1.77% in the higherQualSC arm, 2.09% in the lowerQualSC arm, and 2.74% in the noSC arm. Compared to the noSC arm, the adjusted relative risk was 0.76 (95% CI: 0.70-0.84) in the lowerQualSC arm and 0.65 (95% CI: 0.60-0.69) in the higherQualSC arm.

Our study shows that a lowerQualSC is also effective in reducing CRC incidence compared to noSC. However, the effect is about one-third less than that of a higherQualSC.

Terminal ileal intubation (TII) demonstrates a complete colonoscopy, but whether it should be performed in routine colonoscopies remains uncertain. We aimed to explore the diagnostic yield of TII in routine colonoscopy and investigate the association of TII and the detection of lesion.

We conducted a retrospective study included patients who underwent colonoscopy with cecal intubation at our endoscopic center between November 1 2022 and July 31 2023. Macroscopic and histologic findings of terminal ileum were recorded. We used propensity score matching to adjust for differences between groups and further analyzed the difference of polyp detection rate (PDR), adenoma detection rate (ADR), sessile serrated lesion detection rate (SSDR) and lesion detection rate of right-sided colon, cecum and ascending colon between patients underwent TII or not.

There were 13,372 patients with cecal intubation colonoscopy, including 7599 (56.8%) with TII and 5773 (43.2%) without TII. Abnormal endoscopic findings were observed in 150 of 7599 unselected individuals and only 7 of these cases were regarded as pathologically significant. Likewise, abnormal endoscopic findings were found in 62 of 3502 asymptomatic individuals with 54 nonspecific ileitis determined by histopathology. After PSM, there were no significant differences in PDR (52.0% vs. 52.3%, P = 0.761), ADR (30.9% vs. 32.2%, P = 0.208), SSDR (1.6% vs. 1.5%, P = 0.541), right-sided lesion detection rate (16.9% vs. 16.8%, P = 0.908), lesion detection rate of cecum (4.9% vs. 4.7%, P = 0.613) and ascending colon (13.5% vs. 13.2%, P = 0.656) between the two groups.

TII was not necessary in routine colonoscopy, owing to the limited diagnostic value and lack of superiority on lesion detection.

Adenoma surveillance guidelines are based on non-fecal immunochemical test (FIT)-based screening settings. However, colorectal cancer (CRC) risk may be different in FIT-positive screening populations. We evaluated the CRC and advanced adenoma risk within the recommended surveillance periods in the Danish FIT-based CRC screening program for participants with intermediate or high risk adenomas according to 2010 European guidelines. Furthermore, we estimated CRC risk for those who were not recommended surveillance according to European Society of Gastrointestinal Endoscopy (ESGE) 2020 guidelines.

Using nationwide health registries, we identified 17 936 FIT-screening participants from 2014-2017 with adenomas undergoing surveillance (high risk 1 year, intermediate risk 3 years). Participants with a follow-up examination were included (N = 10 068). Relative risk (RR) of CRC and advance adenoma was compared between intermediate and high risk groups and between intermediates who were recommended surveillance (S) or no surveillance (NS) according to 2020 ESGE guidelines.

During surveillance, CRC occurred in 0.59% of the high risk group and 1.11% of the intermediate risk group (RR 0.53 [95%CI 0.34-0.84]). The high risk group had a 24% increased risk of advanced adenoma. CRC occurred in 1.69% of the intermediateNS group and 0.87% of the intermediateS group (RR 1.94 [95%CI 1.18-3.21]), and RR for advanced adenoma was 1.19 (95%CI 1.03-1.37).

CRC detection was lower among participants rated at higher risk at initial CRC screening. Findings at first screen-derived colonoscopy might not be as good a predictor of CRC risk in a FIT-positive screening population.