Clinical Endoscopy

Original Article

Linked color imaging versus artificial intelligence-assisted linked color imaging for neoplasia detection in the colorectum: a randomized trial in Brazil: Carlos Eduardo Oliveira dos Santos, Naohisa Yoshida, Asadur Jorge Tchekmedyian, Gabriel Malaman dos Santos, Luma Alves Costa, Ivan David Arciniegas Sanmartin, Júlio Pereira-Lima; Clin Endosc 2026;59(2):264-272. Published online March 27, 2026; DOI: https://doi.org/10.5946/ce.2025.276

Graphical Abstract Abstract PDF: Background
/Aims: Adenomas and sessile serrated lesions (SSLs) are neoplasms that play a role in colorectal cancer development. Improving adenoma detection rate (ADR) and SSL detection rates (SDR) allows for more effective prevention of colorectal cancer. Linked color imaging (LCI) and artificial intelligence (AI) have contributed to increased ADR and SDR. This study aimed to compare the neoplasia detection rates (NDR, adenomas, or SSLs) between LCI and AI-assisted LCI colonoscopy.
Methods
We conducted a prospective randomized trial to compare LCI with LCI+AI. We evaluated ADR, SDR, and NDR as the primary outcomes.
Results
A total of 779 polyps were detected in 622 patients (304 in the LCI group and 318 in the LCI+AI group); 555 were adenomas and 62 were SSLs for a total of 617 neoplastic lesions (79.2%) in 363 patients. Comparing the LCI and LCI+AI groups, the ADR, SDR, and NDR were 46.7% vs. 53.1% (p=0.13), 8.2% vs. 8.5% (p=0.90), and 52.3% vs. 56.6% (p=0.30), respectively. The mean number of adenomas per patient, advanced ADR, and withdrawal time did not significantly differ between the two groups.
Conclusions
Similar results were observed in both groups, and even with the good performance of AI-assisted LCI, LCI alone yielded high ADR, SDR, and NDR.

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Systematic Review and Meta-analysis

Enhanced adenoma detection with Endocuff Vision: a GRADE assessed systematic review and meta-analysis: Ahmed Ali Khan, Fariha Hasan, Mohammed Dheyaa Marsool Marsool, Muhammad Uzair, Kanz Ul Eman Maryam, Muhammad Usman Babar, Mutahhar Talha, Haider Imran, Rayyan Mohammad Makki Bakhsh, Kalsoom Zulfiqar, Fatima Wahid, Amal Shahzad Khan, Daniel Ashraf Guirguis, Christina Tofani, Anthony Infantolino; Clin Endosc 2026;59(3):371-385. Published online February 2, 2026; DOI: https://doi.org/10.5946/ce.2025.163

Graphical Abstract Abstract PDF Supplementary Material: Background
/Aims: Colorectal cancer (CRC) is the second leading cause of cancer-related deaths and the third most common cancer worldwide. Detecting adenomas during colonoscopy reduces the CRC risk, with higher adenoma detection rates (ADRs) correlating with lower CRC incidence and mortality. Endocuff Vision (EV) enhances mucosal visualization and may improve ADRs.
Methods
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, PubMed, Embase, and Cochrane databases were searched through April 2025 for studies comparing EV-assisted and standard colonoscopy. The primary outcomes of interest were the ADRs, polyp detection rates (PDRs), and adverse events (AEs). Outcomes were pooled using a random-effects meta-analysis model and are presented as risk ratios (RRs) and mean differences. Heterogeneity in the pooled outcomes was assessed using the Higgins I².
Results
Thirty-four studies (43,702 participants) were included. EV significantly improved ADRs (RR, 1.15; 95% confidence interval [CI],1.07–1.25) and PDRs (RR, 1.16; 95% CI, 1.10–1.23). EV also improved lesion detection in the left colon (RR, 1.23; 95% CI, 1.11–1.35) and right colon (RR, 1.19; 95% CI, 1.09–1.29). No significant improvement was observed in advanced ADRs or cecal intubation. EV use was associated with more AEs.
Conclusions
EV-assisted colonoscopy improved ADRs and PDRs in both colonic regions and enhanced CRC screening despite increased AEs.

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Original Articles

Prognosis of Korean patients with familial adenomatous polyposis who did not undergo colectomy: a retrospective study: Min Kwan Kwon, Jin Hee Noh, Ji Yong Ahn, Woochang Lee, Seok-Byung Lim, Yong Sang Hong, Seung Wook Hong, Sung Wook Hwang, Sang Hyoung Park, Byong Duk Ye, Jeong-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang, Dong-Hoon Yang; Clin Endosc 2026;59(2):254-263. Published online December 31, 2025; DOI: https://doi.org/10.5946/ce.2025.191

Graphical Abstract Abstract PDF Supplementary Material

Background
/Aims: The International Society for Gastrointestinal Hereditary Tumors polyposis scoring system (IPSS) categorizes familial adenomatous polyposis (FAP) according to the burden of colorectal polyps and histology. However, the prognosis of patients with uncolectomized FAP has not been established.
Methods
Medical records of patients diagnosed with FAP between 1991 and 2021 were reviewed, and the IPSS stage was determined. The cumulative upstaging rate and risk factors for IPSS upstaging during surveillance were analyzed in patients without colectomies.
Results
Among 237 patients, 35 (28.9%) with IPSS stages 0–2 did not undergo colectomy. The cumulative risk of upstaging was 0%, 31%, 54%, and 73% at 1, 3, 7, and 10 years after FAP diagnosis, respectively. In univariate analysis, age (hazard ratio [HR], 1.05; 95% confidence interval [CI], 1.01–1.08; p=0.014) and having an ampulla of Vater adenoma (HR, 3.95; 95% CI, 1.17–13.30; p=0.027) were associated with upstaging. Multivariate analysis revealed that each 1-year increase in age was an independent risk factor of upstaging (adjusted HR, 1.04; 95% CI, 1.01–1.09; p=0.027).
Conclusions
In our analysis, patients with uncolectomized FAP and IPSS stages 0–2 at diagnosis showed a time-dependent progression in the IPSS stage.

Citations

Citations to this article as recorded by

Colonoscopic surveillance without prophylactic colectomy in familial adenomatous polyposis: who are the appropriate candidates?
Hyun Jung Lee
Clinical Endoscopy.2026; 59(2): 237. CrossRef

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Comparison of colon adenoma detection rate using cap-assisted and artificial intelligence-assisted colonoscopy at a tertiary hospital in the Philippines: a propensity score-matched analysis: Justin Ryan Lay Tan, Keith Brian Tan Enriquez, Kenneth Vergel Tecson Aballe, Mary Anne Gonzales Go, Michael Louie Ong Lim, Jonard Tan Co; Clin Endosc 2026;59(1):106-114. Published online December 31, 2025; DOI: https://doi.org/10.5946/ce.2024.337

Graphical Abstract Abstract PDF

Background
/Aims: The integration of artificial intelligence (AI)-powered image analysis and mucosal exposure devices, such as distal attachment caps, has been demonstrated to significantly improve the adenoma detection rate (ADR) during colonoscopy. This study aimed to compare AI-assisted colonoscopy (AIC) with cap-assisted colonoscopy (CAC).
Methods
This retrospective propensity score-matched cohort study was performed at a tertiary care hospital between January 2022 and May 2022. Data were extracted from the electronic health record system and colonoscopy video recordings. Adult patients aged 40 years who underwent screening or surveillance colonoscopies were included. The primary outcome was the ADR, whereas the secondary outcome was the polyp detection rate (PDR).
Results
A 1:1 propensity score-matched analysis was performed, resulting in 49 well-matched patient pairs. One patient from each pair was assigned to the CAC group, whereas the other was assigned to the AIC group. No significant difference in ADR was observed between the CAC and AIC groups (47% vs. 51%, p=0.69). Similarly, PDR did not significantly differ between the two groups (80% vs. 71%, p=0.35).
Conclusions
Both CAC and AIC have the potential to increase ADR and PDR. However, neither modality offers a significant advantage.

Citations

Citations to this article as recorded by

Is cap still useful for colon adenoma detection rate improvement in the artificial intelligence era?
Tae-Woo Kim, Soo-Young Na
Clinical Endoscopy.2026; 59(1): 73. CrossRef

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Review

Epidemiology of colonic adenoma and cancer: Dong Hyun Kim; Clin Endosc 2026;59(3):333-344. Published online September 29, 2025; DOI: https://doi.org/10.5946/ce.2025.189

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