Clinical Endoscopy

Computer-aided quality control in colonoscopy: clinical applications and limitations: Elizabeth Lee Yoong Chen, James Weiquan Li; Received August 30, 2025 Accepted October 23, 2025 Published online December 17, 2025; DOI: https://doi.org/10.5946/ce.2025.309 [Epub ahead of print]

Computer-aided quality control (CAQ) systems are redefining colonoscopy by enabling the objective evaluation of procedural metrics and providing real-time feedback. This review explores the clinical utility, implementation barriers, and future prospects of CAQ, with an emphasis on its role in standardizing quality assessment and enhancing patient outcomes. A systematic search of PubMed (inception to January 2025) identified 66 relevant publications, including eight systematic reviews or meta-analyses, seven randomized controlled trials, and five cohort studies, in addition to validation and observational reports. CAQ systems improve traditional quality indicators such as withdrawal time, bowel preparation scores, and cecal intubation rates (CIRs). Emerging metrics—including effective withdrawal time, fold examination quality, and withdrawal speed—offer novel, quantifiable insights. Artificial intelligence-assisted colonoscopy consistently increases adenoma detection rates (from 38.5% to 47.9%) and extends withdrawal time (from 5.68 to 7.03 minutes). Automated systems achieve high accuracy in bowel preparation scoring (93.3%), cecal intubation recognition (95.5%), and surveillance interval assignment (92.0%), thereby addressing persistent gaps in documentation and follow-up care. CAQ systems hold transformative promise for improving colonoscopy quality. Addressing implementation challenges—including false positives, clinician adoption, cost, and regulatory issues—is essential. Future research should emphasize comparative effectiveness, standardized metrics, and large-scale clinical integration to help reduce the burden of colorectal cancer.

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Artificial Intelligence in Colonoscopy Surveillance for Lynch Syndrome: Emerging Evidence, Lessons Learned From Average‐Risk Populations, and Future Directions
Robert Hüneburg, Querijn N. E. van Bokhorst, Evelien Dekker, Jacob Nattermann
International Journal of Cancer.2026;[Epub] CrossRef

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Where technology meets technique: computer-aided detection and mucosal exposure device to improve adenoma detection: James Weiquan Li; Clin Endosc 2025;58(3):404-405. Published online May 23, 2025; DOI: https://doi.org/10.5946/ce.2025.079

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Use of artificial intelligence in the management of T1 colorectal cancer: a new tool in the arsenal or is deep learning out of its depth?: James Weiquan Li, Lai Mun Wang, Katsuro Ichimasa, Kenneth Weicong Lin, James Chi-Yong Ngu, Tiing Leong Ang; Clin Endosc 2024;57(1):24-35. Published online September 25, 2023; DOI: https://doi.org/10.5946/ce.2023.036

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The field of artificial intelligence is rapidly evolving, and there has been an interest in its use to predict the risk of lymph node metastasis in T1 colorectal cancer. Accurately predicting lymph node invasion may result in fewer patients undergoing unnecessary surgeries; conversely, inadequate assessments will result in suboptimal oncological outcomes. This narrative review aims to summarize the current literature on deep learning for predicting the probability of lymph node metastasis in T1 colorectal cancer, highlighting areas of potential application and barriers that may limit its generalizability and clinical utility.

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Role of CADx in colonoscopy: lessons from real-life studies
Marco Bustamante-Balén
Best Practice & Research Clinical Gastroenterology.2026; 80: 102020. CrossRef
Computer‐Aided Diagnosis of Colorectal Polyps: Clinical Usefulness and Limitations
Kenneth Weicong Lin, Kwong Ming Fock, James Weiquan Li
Digestive Endoscopy.2026;[Epub] CrossRef
Endoscopic resection versus surgery for T1 rectal cancer: A systematic review and meta-analysis of oncologic and safety outcomes
Yeajin Moon, Youngki Hong, Hyun Jung Kim, Seun Ja Park, Hyo Seon Ryu, Jung-Myun Kwak, Seung Hun Lee, Jae Hyun Kim
Surgical Endoscopy.2026; 40(5): 3956. CrossRef
Endoscopic approach to the large non-pedunculated colorectal polyp: mucosal, submucosal, hot and cold techniques
Anthony Whitfield, Mayan Eitan, Michael J. Bourke
Best Practice & Research Clinical Gastroenterology.2026; : 102108. CrossRef
Prediction of Lymph Node Metastasis in T1 Colorectal Cancer Using Artificial Intelligence with Hematoxylin and Eosin-Stained Whole-Slide-Images of Endoscopic and Surgical Resection Specimens
Joo Hye Song, Eun Ran Kim, Yiyu Hong, Insuk Sohn, Soomin Ahn, Seok-Hyung Kim, Kee-Taek Jang
Cancers.2024; 16(10): 1900. CrossRef
Approaches and considerations in the endoscopic treatment of T1 colorectal cancer
Yunho Jung
The Korean Journal of Internal Medicine.2024; 39(4): 563. CrossRef
Edge Artificial Intelligence Device in Real-Time Endoscopy for Classification of Gastric Neoplasms: Development and Validation Study
Eun Jeong Gong, Chang Seok Bang, Jae Jun Lee
Biomimetics.2024; 9(12): 783. CrossRef

8,816 View
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Clinical Features and Predictors of Dysplasia in Proximal Sessile Serrated Lesions: Yi Yuan Tan, Gary Sei Kiat Tay, Yu Jun Wong, James Weiquan Li, Andrew Boon Eu Kwek, Tiing Leong Ang, Lai Mun Wang, Malcolm Teck Kiang Tan; Clin Endosc 2021;54(4):578-588. Published online April 29, 2021; DOI: https://doi.org/10.5946/ce.2020.198

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Background
/Aims: Proximal colorectal cancers (CRCs) account for up to half of CRCs. Sessile serrated lesions (SSLs) are precursors to CRC. Proximal location and presence of dysplasia in SSLs predict higher risks of progression to cancer. The prevalence of dysplasia in proximal SSLs (pSSLs) and clinical characteristics of dysplastic pSSLs are not well studied.
Methods
Endoscopically resected colonic polyps at our center between January 2016 and December 2017 were screened for pSSLs. Data of patients with at least one pSSL were retrieved and clinicopathological features of pSSLs were analysed. pSSLs with and without dysplasia were compared for associations.
Results
Ninety pSSLs were identified, 45 of which had dysplasia giving a prevalence of 50.0%. Older age (65.9 years vs. 60.1 years, p=0.034) was associated with the presence of dysplasia. Twelve pSSLs were 10 mm or larger. After adjusting for age, pSSLs ≥10 mm had an adjusted odds ratio of 5.98 (95% confidence interval, 1.21–29.6) of having dysplasia compared with smaller pSSLs.
Conclusions
In our cohort of pSSLs, the prevalence of dysplasia is high at 50.0% and is associated with lesion size ≥10 mm. Endoscopic resection for all proximal serrated lesions should be en-bloc to facilitate accurate histopathological examination for dysplasia as its presence warrants shorter surveillance intervals.

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Distinguishing colorectal sessile serrated lesions from hyperplastic polyps: development of a prediction model based on logistic regression
Dian Zhang, Xiao Tan, Weiling Hu
BMC Gastroenterology.2026;[Epub] CrossRef
Prevalence and characteristics of sessile serrated lesions with dysplasia in Dutch fecal immunochemical test-positive screenees
Nanette S. van Roermund, Valentina Angerilli, Iris D. Nagtegaal, Manon C.W. Spaander, Monique E van Leerdam, Joep E.G. IJspeert, Evelien Dekker
Endoscopy.2026;[Epub] CrossRef
Sessilis serrated laesio dysplasiával és invázióval
Ádám Ferenczi, Nóra Ördög, Zsuzsanna Újfaludi, Levente Kuthi, Anita Sejben
Orvosi Hetilap.2025; 166(11): 427. CrossRef
Histologic Reappraisal and Evaluation of MLH1 Protein Expression in Sessile Serrated Lesions of the Proximal Colon
Priscilla de Sene Portel Oliveira, Miriam Aparecida da Silva Trevisan, Rita Barbosa de Carvalho, Rita de Cássia Perina Martins, João José Fagundes, Claudio Saddy Rodrigues Coy, Ashwini Esnakula
Gastroenterology Research and Practice.2025;[Epub] CrossRef
Clinical and endoscopic characteristics of colorectal sessile serrated lesions with or without dysplasia/carcinoma: A systematic review and meta‐analysis
Qing Qing Zhang, Jian Di Wu, Xue Yan Li, Fei Fei Fang, Gang Ping Li, Tao Bai, Jun Song
Journal of Digestive Diseases.2024; 25(7): 424. CrossRef
Korean Guidelines for Postpolypectomy Colonoscopic Surveillance: 2022 revised edition
Su Young Kim, Min Seob Kwak, Soon Man Yoon, Yunho Jung, Jong Wook Kim, Sun-Jin Boo, Eun Hye Oh, Seong Ran Jeon, Seung-Joo Nam, Seon-Young Park, Soo-Kyung Park, Jaeyoung Chun, Dong Hoon Baek, Mi-Young Choi, Suyeon Park, Jeong-Sik Byeon, Hyung Kil Kim, Joo
Intestinal Research.2023; 21(1): 20. CrossRef
Microvesicular hyperplastic polyp and sessile serrated lesion of the large intestine: a biological continuum or separate entities?
Adrian C Bateman, Adam L Booth, Raul S Gonzalez, Neil A Shepherd
Journal of Clinical Pathology.2023; 76(7): 429. CrossRef
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Su Young Kim
The Korean Journal of Medicine.2023; 98(3): 102. CrossRef
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Ji Hyun Kim, Sung Chul Park
Journal of the Korean Medical Association.2023; 66(11): 633. CrossRef
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Su Young Kim, Min Seob Kwak, Soon Man Yoon, Yunho Jung, Jong Wook Kim, Sun-Jin Boo, Eun Hye Oh, Seong Ran Jeon, Seung-Joo Nam, Seon-Young Park, Soo-Kyung Park, Jaeyoung Chun, Dong Hoon Baek, Mi-Young Choi, Suyeon Park, Jeong-Sik Byeon, Hyung Kil Kim, Joo
The Korean Journal of Gastroenterology.2022; 80(3): 115. CrossRef
Impact of looping on premalignant polyp detection during colonoscopy
Osamu Toyoshima, Toshihiro Nishizawa, Shuntaro Yoshida, Tatsuya Matsuno, Toru Arano, Ryo Kondo, Kazunori Kinoshita, Yuki Yasumi, Yosuke Tsuji, Mitsuhiro Fujishiro
World Journal of Gastrointestinal Endoscopy.2022; 14(11): 694. CrossRef
Korean guidelines for postpolypectomy colonoscopic surveillance: 2022 revised edition
Su Young Kim, Min Seob Kwak, Soon Man Yoon, Yunho Jung, Jong Wook Kim, Sun-Jin Boo, Eun Hye Oh, Seong Ran Jeon, Seung-Joo Nam, Seon-Young Park, Soo-Kyung Park, Jaeyoung Chun, Dong Hoon Baek, Mi-Young Choi, Suyeon Park, Jeong-Sik Byeon, Hyung Kil Kim, Joo
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