Clinical Endoscopy

Systematic Review and Meta-analysis

One-day low-residue diet is equally effective as the multiple-day low-residue diet in achieving adequate bowel cleansing: a meta-analysis of randomized controlled trials: Raeni Dwi Putri, Fiki Amalia, Festy Aldina Utami, Yunisa Pamela, Mas Rizky A.A. Syamsunarno; Clin Endosc 2025;58(1):63-76. Published online December 12, 2024; DOI: https://doi.org/10.5946/ce.2024.061

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Background
/Aims: Colonoscopy is widely used as a diagnostic and preventive procedure for colorectal diseases. The most recent guidelines advocate the use of a low-residue diet (LRD) for bowel preparation before colonoscopy. LRD duration varies considerably, with recommended 1-day and multiple-day regimens in clinical practice.
Methods
We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched multiple databases for randomized controlled trials (RCTs) and analyzed the outcomes using a fixed-effects model.
Results
Six RCTs with 2,469 subjects were included in this study. The rates of adequate bowel preparation for 1-day and >1-day were 87.2% and 87.1%, respectively. No statistically significant differences were observed between the 1-day and >1-day LRD in adequate bowel preparation (odds ratio [OR], 1.03; 95% confidence interval [CI], 0.76–1.41; p=0.84; I2=0%), polyp detection rate (OR, 0.91; 95% CI, 0.76–1.09; p=0.29; I2=16%), adenoma detection rate (OR, 0.87; 95% CI, 0.71–1.08; p=0.21; I2=0%), and withdrawal time (mean difference, –0.01; 95% CI, –0.25 to 0.24; p=0.97; I2=63%).
Conclusions
The efficacy of 1-day and multiple-day LRD is comparable in achieving satisfactory bowel preparation, highlighting their similar impact on the detection of polyps and adenomas during colonoscopy.

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Effect of single-day versus multi-day low-residue diet on colonoscopy bowel preparation: a systematic review and meta -analysis
Jing Du, Xueqian He, Peng Li
BMC Gastroenterology.2025;[Epub] CrossRef

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Original Articles

Assessing the potential of artificial intelligence to enhance colonoscopy adenoma detection in clinical practice: a prospective observational trial: Søren Nicolaj Rønborg, Suresh Ujjal, Rasmus Kroijer, Magnus Ploug; Clin Endosc 2024;57(6):783-789. Published online August 23, 2024; DOI: https://doi.org/10.5946/ce.2024.038

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Background
/Aims: This study aimed to evaluate the effectiveness of the GI Genius (Medtronic) module in clinical practice, focusing on the adenoma detection rate (ADR) during colonoscopy. Computer-aided polyp detection (CADe) systems using artificial intelligence have been shown to improve adenoma detection in controlled trials. However, the effectiveness of these systems in clinical practice has recently been questioned.
Methods
This single-center prospective observational study was conducted at the University Hospital of Southern Denmark and included all individuals referred for colonoscopy between November 2020 and January 2021. The primary outcome was ADR, comparing patients examined with CADe to those examined without it. The selection of patients to be examined with the CADe module was completely random.
Results
A total of 502 patients were analyzed (318 in the control group and 184 in the CADe group). The overall ADR was 32.1% with a slight increase in the CADe group (34.7% vs. 30.5%). Multivariable analysis showed a very modest and statistically insignificant increase in ADR (risk ratio, 1.12; 95% confidence interval, 0.88–1.43).
Conclusions
The use of CADe in clinical practice did not increase ADR with statistical significance when compared to colonoscopy without CADe. These findings suggest that the impact of CADe systems in everyday clinical practice are modest.

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Random forests algorithm using basic medical data for predicting the presence of colonic polyps
Mihaela-Flavia Avram, Nicolae Lupa, Dimitrios Koukoulas, Daniela-Cornelia Lazăr, Mihaela-Ioana Mariș, Marius-Sorin Murariu, Sorin Olariu
Frontiers in Surgery.2025;[Epub] CrossRef
Artificial intelligence in endoscopy and colonoscopy: a comprehensive bibliometric analysis of global research trends
Negin Letafatkar, Amr Ali Mohamed Abdelgawwad El-Sehrawy, KDV Prasad, Ahmad Alkhayyat, Ehsan Amini-Salehi, Maryam Hasanpour, Masoomeh Namdar Taleshani, Mohammad Hashemi, Hadi Alotaibi, Pegah Rashidian, Mohammad-Hossein Keivanlou, Soheil Hassanipour
Frontiers in Medicine.2025;[Epub] CrossRef
GI Genius increases small and right-sided adenoma and sessile serrated lesion detection rate when used with EndoCuff in a real-world setting: a retrospective United States study
Jeong Hoon Kim, Jade Wang, Colton Pence, Patrick Magahis, Enad Dawod, Felice Schnoll-Sussman, Reem Z. Sharaiha, David Wan
Clinical Endoscopy.2025; 58(3): 438. CrossRef
Concordance with CONSORT-AI guidelines in reporting of randomised controlled trials investigating artificial intelligence in oncology: a systematic review
David Chen, Kristen Arnold, Ronesh Sukhdeo, John Farag Alla, Srinivas Raman
BMJ Oncology.2025; 4(1): e000733. CrossRef
Artificial intelligence in colonoscopy: polyp fiction or clinical reality?
Eun Jeong Gong, Chang Seok Bang
Clinical Endoscopy.2025; 58(5): 784. CrossRef
Understanding the discrepancy in the effectiveness of artificial intelligence-assisted colonoscopy: from randomized controlled trials to clinical reality
Jung Ho Bae
Clinical Endoscopy.2024; 57(6): 765. 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

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Colorectal Cancer Screening with Computed Tomography Colonography: Single Region Experience in Kazakhstan: Jandos Amankulov, Dilyara Kaidarova, Zhamilya Zholdybay, Marianna Zagurovskaya, Nurlan Baltabekov, Madina Gabdullina, Akmaral Ainakulova, Dias Toleshbayev, Alexandra Panina, Elvira Satbayeva, Zhansaya Kalieva; Clin Endosc 2022;55(1):101-112. Published online July 15, 2021; DOI: https://doi.org/10.5946/ce.2021.066

Abstract PDF PubReader ePub: Background
/Aims: The aim of our study was to determine the efficacy of computed tomography colonography (CTC) in screening for colorectal cancer (CRC).
Methods
A total of 612 females and 588 males aged 45 to 75 years were enrolled in CTC screening. CTC was performed following standard bowel preparation and colonic insufflation with carbon dioxide. The main outcomes were the detection rate of CRC and advanced adenoma (AA), prevalence of colorectal lesions in relation to socio-demographic and health factors, and overall diagnostic performance of CTC.
Results
Overall, 56.5% of the 1,200 invited subjects underwent CTC screening. The sensitivity for CRC and AA was 0.89 and 0.97, respectively, while the specificity was 0.71 and 0.99, respectively. The prevalence of CRC and AA was 3.0% (18/593) and 7.1% (42/593), respectively, with the highest CRC prevalence in the 66-75 age group (≥12 times; odds ratio [OR], 12.11; 95% confidence interval [CI], 4.45-32.92). CRC and AA prevalence were inversely correlated with Asian descent, physical activity, and negative fecal immunochemical test results (OR=0.43; 95% CI, 0.22-0.83; OR=0.16; 95% CI, 0.04-0.68; OR=0.5; 95% CI, 0.07-3.85, respectively).
Conclusions
Our study revealed high accuracy of CTC in diagnosing colonic neoplasms, good compliance with CTC screening, and high detection rate of CRC.

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Review

Current Status of Colorectal Cancer and Its Public Health Burden in Thailand: Kasenee Tiankanon, Satimai Aniwan, Rungsun Rerknimitr; Clin Endosc 2021;54(4):499-504. Published online March 15, 2021; DOI: https://doi.org/10.5946/ce.2020.245-IDEN

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Colorectal cancer (CRC) accounts for approximately 10.3% of new cancer cases in Thailand and is currently the 3rd most prevalent cancer found among the Thai population. Starting in 2017, the Thai government announced the national CRC screening program as a response to this important issue. Among the 70 million people currently residing in Thailand, 14 million require screening, while there are approximately a total of 1,000 endoscopists available to perform colonoscopy. Due to the limited resources and shortage of endoscopists in Thailand, applying a population-based one-step colonoscopy program as a primary screening method is not feasible. To reduce colonoscopy workload, with the help of others, including village health volunteers, institution-based health personnel, reimbursement coders, pathologists, and patients due for CRC screening, a two-step approach of one-time fecal immunochemical test (FIT), which prioritizes and filters out subjects for colonoscopy, is chosen. Moreover, additional adjustments to the optimal FIT cutoff value and the modified Asia-Pacific Colorectal Screening risk score, including body weight, were proposed to stratify the priority of colonoscopy schedule. This article aims to give an overview of the past and current policy developmental strategies and the current status of the Thailand CRC screening program.

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Mixed lesions in premalignant colorectal polyps
Toru Arano, Toshihiro Nishizawa, Hidenobu Watanabe, Mari Mizutani, Teppei Akimoto, Masaya Sano, Hirotoshi Ebinuma, Hidekazu Suzuki, Keisuke Hata, Osamu Toyoshima
Journal of Clinical Biochemistry and Nutrition.2026; 78(1): 83. CrossRef
Relationship between the protein expression of ARID1A, ARID1B and ARID2 with the clinicopathological characteristics of colorectal cancer
Wariya Mongkolwat, Phattarapon Sonthi, Keerakarn Somsuan, Siripat Aluksanasuwan, Ratirath Samol, Natthiya Sakulsak, Sasithorn Wanna‑Udom
Biomedical Reports.2025; 23(1): 1. CrossRef
The Effect of the Ethanolic Extracts from Syzygium aromaticum and Syzygium nervosum on Antiproliferative Activity and Apoptosis in HCT116 and HT-29 Cells
Thunyatorn Yimsoo, Weerakit Taychaworaditsakul, Sunee Chansakaow, Sumet Kongkiatpaiboon, Ngampuk Tayana, Teera Chewonarin, Parirat Khonsung, Seewaboon Sireeratawong
International Journal of Molecular Sciences.2025; 26(14): 6826. CrossRef
Efficacy of additional tissue sections for diminutive colorectal adenomas pathologically diagnosed as normal mucosa: a retrospective, cross-sectional study in Japan
Tsuyoshi Ishii, Toshihiro Nishizawa, Hidenobu Watanabe, Masaya Sano, Ai Fujimoto, Yoshiyuki Takahashi, Ryo Shimizu, Hirotoshi Ebinuma, Takahisa Matsuda, Osamu Toyoshima
Clinical Endoscopy.2025; 58(4): 577. CrossRef
Colonic neoplasm detection in patients with Streptococcus gallolyticus septicaemia versus average-risk individuals: a retrospective matched cohort study from a tertiary care center in Thailand
Pongnarin Nawalerspunya, Tanawat Pattarapuntakul, Thanawin Wong, Pimsiri Sripongpun, Swangjit Saejaow, Tanawat Jongraksak
BMJ Open.2025; 15(10): e103612. CrossRef
Impacts of polymorphisms in drug-metabolizing enzyme and transporter genes on irinotecan toxicity and efficacy in Thai colorectal cancer patients
Natthakul Akarapredee, Chalirmporn Atasilp, Chonlaphat Sukasem, Pimonpan Jinda, Rattanaporn Sukprasong, Jiraporn Jensuriyarkun, Soravit Wongjitjanyong, Patompong Satapornpong, Natchaya Vanwong, Germana Bancone
PLOS One.2025; 20(12): e0338442. CrossRef
Integrated Care Model by the Village Health Volunteers to Prevent and Slow down Progression of Chronic Kidney Disease in a Rural Community, Thailand
Ampornpan Theeranut, Nonglak Methakanjanasak, Sunee Lertsinudom, Pattama Surit, Nichanun Panyaek, Saisamon Leeladapattarakul, Peangtikumporn Nilpetch, Pattapong Kessomboon, Chalongchai Chalermwat, Watcharapong Rintara, Wudipong Khongtong, Pawich Paktipat,
Journal of Primary Care & Community Health.2024;[Epub] CrossRef
Cost-Effectiveness of Increasing Access to Colorectal Cancer Diagnosis: Analysis From Thailand
Peeradon Wongseree, Zeynep Hasgul, Mohammad S. Jalali
Value in Health Regional Issues.2024; 43: 101010. CrossRef
Dynamics of colorectal cancer screening in low and middle-income countries: A modeling analysis from Thailand
Peeradon Wongseree, Zeynep Hasgul, Borwornsom Leerapan, Cherdsak Iramaneerat, Pochamana Phisalprapa, Mohammad S. Jalali
Preventive Medicine.2023; 175: 107694. CrossRef
An Assessment of Physicians’ Recommendations for Colorectal Cancer Screening and International Guidelines Awareness and Adherence: Results From a Thai National Survey
Nonthalee Pausawasdi, Pongkamon Tongpong, Tanawat Geeratragool, Phunchai Charatcharoenwitthaya
Frontiers in Medicine.2022;[Epub] CrossRef
Cytotoxic effect of metformin on butyrate-resistant PMF-K014 colorectal cancer spheroid cells
Kesara Nittayaboon, Kittinun Leetanaporn, Surasak Sangkhathat, Sittirak Roytrakul, Raphatphorn Navakanitworakul
Biomedicine & Pharmacotherapy.2022; 151: 113214. CrossRef

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Original Article

Safety and Recipient Satisfaction of Propofol Sedation in Outpatient Endoscopy: A 24-Hour Prospective Investigation Using a Questionnaire Survey: Yoshihide Kanno, Tetsuya Ohira, Yoshihiro Harada, Shinsuke Koshita, Takahisa Ogawa, Hiroaki Kusunose, Yoshiki Koike, Taku Yamagata, Toshitaka Sakai, Kaori Masu, Keisuke Yonamine, Kazuaki Miyamoto, Megumi Tanaka, Tomohiro Shimada, Fumisato Kozakai, Kazuki Endo, Haruka Okano, Daichi Komabayashi, Takeshi Shimizu, Shohei Suzuki, Kei Ito; Clin Endosc 2021;54(3):340-347. Published online December 11, 2020; DOI: https://doi.org/10.5946/ce.2020.138

Abstract PDF PubReader ePub

Background
/Aims: The aim of this study was to evaluate the safety of sedation with propofol as an alternative to benzodiazepine drugs in outpatient endoscopy.
Methods
In this prospective study, examinees who underwent outpatient endoscopy under propofol sedation and submitted a nextday questionnaire with providing informed consent were evaluated. Periprocedural acute responses, late adverse events within 24 hours, and examinee satisfaction were evaluated.
Results
Among the 4,122 patients who received propofol in the 17,978 outpatient-based endoscopic examinations performed between November 2016 and March 2018, 2,305 eligible examinees (esophagogastroduodenoscopy for 1,340, endoscopic ultrasonography for 945, and total colonoscopy for 20) were enrolled, and their responses to a questionnaire were analyzed. The mean propofol dose was 69.6±24.4 mg (range, 20–200 mg). Diazepam, midazolam, and/or pentazocine in combination with propofol was administered to 146 examinees. Mild oxygen desaturation was observed in 59 examinees (2.6%); and mild bradycardia, in 2 (0.09%). Other severe reactions or late events did not occur. After eliminating 181 invalid responses, 97.7% (2,065/2,124) of the patients desired propofol sedation in future examinations.
Conclusions
Propofol sedation was found to be safe—without severe adverse events or accidents—for outpatient endoscopy on the basis of the patients’ next-day self-evaluation. Given the high satisfaction level, propofol sedation might be an ideal tool for painless endoscopic screening.

Citations

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Comparison of sedation with pentazocine or pethidine hydrochloride for endoscopic ultrasonography in outpatients: A single‐center retrospective study
Makiko Urabe, Kenji Ikezawa, Yusuke Seiki, Ko Watsuji, Yasuharu Kawamoto, Takeru Hirao, Yugo Kai, Ryoji Takada, Takuo Yamai, Kaori Mukai, Tasuku Nakabori, Hiroyuki Uehara, Kazuyoshi Ohkawa
DEN Open.2025;[Epub] CrossRef
Risk factors for adverse reactions to nurse-administered propofol during outpatient endoscopy: a cross-sectional study
Renzo Inca Villanueva, Cynthia Bazán Montero, María Estela Bulnes-Montánchez, Lary Salazar Alva, José Salvador Carrillo, Alejandra Zevallos, Fernando Salazar
BMC Anesthesiology.2025;[Epub] CrossRef
Remimazolam, a novel drug, for safe and effective endoscopic sedation
Jae Min Lee, Yehyun Park, Dong Won Ahn, Jun Kyu Lee, Kwang Hyuck Lee
Clinical Endoscopy.2025; 58(3): 370. CrossRef
Balancing safety and effectiveness in colonoscopy for older adults: a narrative review
Min-Jae Kim, Yuna Kim, Jie-Hyun Kim, Young Hoon Youn, Jaeyoung Chun
Intestinal Research.2025; 23(4): 443. CrossRef
Remimazolam and Its Place in the Current Landscape of Procedural Sedation and General Anesthesia
Matthew Brohan, Janette Brohan, Basavana Goudra
Journal of Clinical Medicine.2024; 13(15): 4362. CrossRef
How to implement adverse events as a quality indicator in gastrointestinal endoscopy
Tom G. Moreels
Digestive Endoscopy.2024; 36(1): 89. CrossRef
Propofol Alone versus Propofol in Combination with Midazolam for Sedative Endoscopy in Patients with Paradoxical Reactions to Midazolam
Ji Hyung Nam, Dong Kee Jang, Jun Kyu Lee, Hyoun Woo Kang, Byung-Wook Kim, Byung Ik Jang
Clinical Endoscopy.2022; 55(2): 234. CrossRef
Drugs used for sedation in gastrointestinal endoscopy
Jun Kyu Lee
Journal of the Korean Medical Association.2022; 65(11): 735. CrossRef

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The Significance of Fecal Occult Blood Testing to Screen for Colon Cancer: Jung Hyun Kwon, M.D., Myung Gyu Choi, M.D., Jung Pil Suh, M.D., Jae Hyuck Chang, M.D., Kwan Woo Nam, M.D., Ho Sung Park, M.D., Chang Nyol Paik, M.D., Jae Myung Park, M.D., Yu Kyung Cho, M.D., In Seok Lee, M.D., Sang Woo Kim, M.D. and In Sik Chung, M.D.; Korean J Gastrointest Endosc 2007;35(2):68-73. Published online August 30, 2007

Abstract PDF: Background
/Aims: We investigated the efficacy of the fecal occult blood test (FOBT) as a colon cancer screening tool in a tertiary hospital setting. Methods: This retrospective study analyzed patients who underwent routine check- ups at Kang-Nam St. Mary's Hospital Health Promotion Center from January 2004 to April 2005. All the subjects were encouraged to submit stool for a FOBT, while performing a double contrast barium enema (DCBE) was optional for those who wanted colon examination. Colonoscopy was performed if the FOBT or DCBE results were abnormal or if the patients had bowel symptoms. Results: The FOBT was performed in 8,198 of 10,182 patients (80.5%) who underwent routine check-ups. The overall positive rate of FOBT was 149 of 8,198 (1.8%) and this increased with age (p＜0.05). Colonoscopy and/or DCBE was performed in 33 of 149 patients (22.1%) in the FOBT positive group. Colon cancer and polyp were diagnosed 2 (6.1%) and 7 (21.2%) patients, respectively, in the FOBT positive group, whereas colon cancer and polyp were diagnosed in 3 (0.5%) and 102 (15.7%) patients, respectively, in the FOBT negative group. The sensitivity and specificity of the FOBT for colon cancer was 40% and 95.4%, respectively. Conclusions: Although it had low sensitivity, the FOBT was a useful screening tool for detecting colon cancer in a tertiary hospital setting.

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