Clinical Endoscopy

Original Articles

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; Received December 12, 2024 Accepted June 21, 2025 Published online December 31, 2025; DOI: https://doi.org/10.5946/ce.2024.337 [Epub ahead of print]

Graphical Abstract Abstract PDF PubReader ePub: 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-matching 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.

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Assessment of colorectal polyp detection along the short-axis direction of the intestinal lumen during colonoscopic observation: a retrospective study in Japan: Daichi Mori, Atsushi Katagiri, Yoshinao Onishi, Yuta Yamazaki, Kensuke Higuchi, Norihiro Suzuki, Kazuo Kikuchi, Shinya Nakatani, Takahisa Fujiwara, Kazuya Inoki, Kenichi Konda, Masayuki Tojo, Fuyuhiko Yamamura, Hitoshi Yoshida; Received April 10, 2025 Accepted May 26, 2025 Published online October 23, 2025; DOI: https://doi.org/10.5946/ce.2025.112 [Epub ahead of print]

Graphical Abstract Abstract PDF Supplementary Material PubReader ePub: Background
/Aims: Colorectal polyp detection during colonoscopy is influenced by the lesion location, size, morphology, and histology. However, no studies have systematically assessed the difficulty of detection along the short axis of the intestinal lumen. This study aimed to evaluate the colorectal polyp detection rates on this axis during colonoscopy.
Methods
This retrospective study analyzed 1,169 polyps in 513 patients who underwent colonoscopy at Showa University Hospital between November 2022 and February 2023. The short-axis lumen was divided into: upper right, lower right, lower left, and upper left. Each polyp detected was assigned to a quadrant. Detection rates were compared across quadrants and analyzed for associations with clinicopathological factors including lesion size, location, macroscopic type, and examiner experience.
Results
The lesion detection rates varied significantly by quadrant. The upper left quadrant had the lowest detection rate (17.5%) compared with the expected 25.0% per quadrant. Subgroup analyses consistently confirmed the lower detection rates in this quadrant across most lesion types and patient groups, except for lesions in the cecum and rectum.
Conclusions
The lower detection rate in the upper left quadrant suggests that this orientation poses a challenge and may increase the number of missed lesions. Enhanced examination of this area may improve detection; however, further prospective studies are required.

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Reviews

Clinical significance of computer-aided quality assessment systems in colonoscopy: a comprehensive review: Wai Phyo Lwin, Katsuro Ichimasa, Shin-Ei Kudo, Yuta Kouyama, Taishi Okumura, Yasuharu Maeda, Yutaro Ide, Khay Guan Yeoh, Masashi Misawa; Clin Endosc 2025;58(5):638-645. Published online May 27, 2025; DOI: https://doi.org/10.5946/ce.2025.022

Abstract PDF PubReader ePub

Colonoscopy is the primary tool for colorectal cancer screening. High-quality colonoscopy is crucial for the detection of precancerous adenomas; however, the adenoma detection rate varies depending on the skill and experience of the endoscopist. Computer-aided quality assessment (CAQ) uses artificial intelligence (AI) technology to evaluate the quality of colonoscopy examinations. It plays an important role in reducing variations in examination quality and obtaining high-quality colonoscopic images. In this review, we focus specifically on the speedometer, effective withdrawal time, fold examination quality, bowel preparation quality assessment, and cecal intubation with CAQ systems and discuss the role and effectiveness of these systems. CAQ systems are expected to contribute to increase in adenoma detection rates, improvement in endoscopist skills, and standardization of examination quality. However, challenges such as variability in AI performance across different clinical settings and potential overreliance on automated prompts remain key limitations.

Citations

Citations to this article as recorded by

Artificial Intelligence and Its Role in Endoscopic Adenoma and Cancer Detection
Hannah R. Phillips, Wilfor J. Diaz Fernandez, Cadman L. Leggett
Clinics in Colon and Rectal Surgery.2026;[Epub] CrossRef
Prospective Validation of the First US FDA-Approved Computer-Aided Quality Assessment Tool for Colonoscopy: An Initial Clinical Experience
Todd A. Brenner, Chris Labaki, Joseph D. Feuerstein, Tyler M. Berzin
American Journal of Gastroenterology.2025;[Epub] CrossRef

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Recent advancement in size measurement during endoscopy: Hye Kyung Jeon, Gwang Ha Kim; Received March 4, 2025 Accepted March 24, 2025 Published online May 23, 2025; DOI: https://doi.org/10.5946/ce.2025.070 [Epub ahead of print]

Abstract PDF PubReader ePub: Accurate lesion size measurement is essential in endoscopic practice as it influences treatment strategies, surveillance decisions, and clinical outcomes, especially in colorectal polyps. Traditional measurement techniques, including visual estimation and biopsy forceps, have significant interobserver variability and procedural inefficiencies. Recent advancements in digital measurement technologies, including virtual scale endoscopy (VSE) and artificial intelligence (AI)-assisted virtual rulers, have addressed these limitations. VSE projects a virtual scale onto endoscopic images, enhancing measurement precision and reducing variability. Several studies have demonstrated its superior accuracy compared with conventional methods; however, limitations such as increased procedure time and operator training requirements persist. AI-assisted virtual rulers utilize deep learning algorithms to automate lesion size estimation, significantly improving reproducibility and diagnostic reliability. Although these technologies offer promising improvements, challenges remain, including real-time integration, standardization, and regulatory approval. Future research should focus on refining AI models, expanding validation studies, and optimizing their usability in routine practice. A hybrid approach that combines AI automation with real-time digital tools may enhance the precision and efficiency of endoscopic lesion assessment, ultimately improving patient outcomes.

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Classification of image-enhanced endoscopy in colon tumors: One-Zoong Kim; Clin Endosc 2025;58(3):337-351. Published online May 8, 2025; DOI: https://doi.org/10.5946/ce.2024.263

Abstract PDF PubReader ePub: Colorectal cancer accounts for 10% of global cancer cases in each year, making accurate evaluation and resection crucial. Imaging-enhanced endoscopy helps differentiate between hyperplastic polyps and adenomas, guiding treatment decisions. Colon tumors are classified into benign (e.g., serrated and adenomatous polyps) and malignant (e.g., adenocarcinomas). The Paris classification categorizes superficial neoplastic lesions by morphology, while laterally spreading tumors are classified by size and growth pattern. Effective classification aids in determining resectability and appropriate interventions for colon tumors, ultimately improving patient outcomes. Image-enhanced endoscopy improves colon tumor diagnosis using various techniques like dye, optical, and electronic methods. Kudo’s pit pattern categorizes lesions based on surface morphology using dye, while Sano, Jikei, and Hiroshima classifications focus on vascular patterns using narrow-band imaging (NBI). The NBI International Colorectal Endoscopic (NICE) classification integrates these methods to identify lesions, especially deep submucosal invasive cancers. The Workgroup Serrated Polyps and Polyposis (WASP) classification targets sessile serrated lesions, and the Japan NBI Expert Team (JNET) classification further refines adenoma categorization with low- and high-grade adenoma. The Colorectal Neoplasia Endoscopic Classification to Choose the Treatment (CONECCT) classification consolidates multiple systems for comprehensive assessment, aiding in treatment decisions and potentially applicable to artificial intelligence for diagnostic validation across imaging modalities like linked color imaging, blue light imaging, or i-scan.

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Original Articles

Effectiveness of a novel artificial intelligence-assisted colonoscopy system for adenoma detection: a prospective, propensity score-matched, non-randomized controlled study in Korea: Jung-Bin Park, Jung Ho Bae; Clin Endosc 2025;58(1):112-120. Published online August 5, 2024; DOI: https://doi.org/10.5946/ce.2024.168

Graphical Abstract Abstract PDF PubReader ePub

Background
/Aims: The real-world effectiveness of computer-aided detection (CADe) systems during colonoscopies remains uncertain. We assessed the effectiveness of the novel CADe system, ENdoscopy as AI-powered Device (ENAD), in enhancing the adenoma detection rate (ADR) and other quality indicators in real-world clinical practice.
Methods
We enrolled patients who underwent elective colonoscopies between May 2022 and October 2022 at a tertiary healthcare center. Standard colonoscopy (SC) was compared to ENAD-assisted colonoscopy. Eight experienced endoscopists performed the procedures in randomly assigned CADe- and non-CADe-assisted rooms. The primary outcome was a comparison of ADR between the ENAD and SC groups.
Results
A total of 1,758 sex- and age-matched patients were included and evenly distributed into two groups. The ENAD group had a significantly higher ADR (45.1% vs. 38.8%, p=0.010), higher sessile serrated lesion detection rate (SSLDR) (5.7% vs. 2.5%, p=0.001), higher mean number of adenomas per colonoscopy (APC) (0.78±1.17 vs. 0.61±0.99; incidence risk ratio, 1.27; 95% confidence interval, 1.13–1.42), and longer withdrawal time (9.0±3.4 vs. 8.3±3.1, p<0.001) than the SC group. However, the mean withdrawal times were not significantly different between the two groups in cases where no polyps were detected (6.9±1.7 vs. 6.7±1.7, p=0.058).
Conclusions
ENAD-assisted colonoscopy significantly improved the ADR, APC, and SSLDR in real-world clinical practice, particularly for smaller and nonpolypoid adenomas.

Citations

Citations to this article as recorded by

Role of Artificial Intelligence in Improving Quality of Colonoscopy
Ji Hyun Kim, Sung Chul Park, Hyun-Soo Kim
The Korean Journal of Gastroenterology.2025; 85(2): 137. CrossRef
Usefulness of an artificial intelligence-based colonoscopy report generation support system
Tatsushi Naito, Takuto Nosaka, Tomoko Tanaka, Yu Akazawa, Kazuto Takahashi, Masahiro Ohtani, Yasunari Nakamoto
Clinical Endoscopy.2025; 58(2): 327. CrossRef
Edge Artificial Intelligence Device in Real-Time Endoscopy for the Classification of Colonic Neoplasms
Eun Jeong Gong, Chang Seok Bang
Diagnostics.2025; 15(12): 1478. 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
Clinical significance of computer-aided quality assessment systems in colonoscopy: a comprehensive review
Wai Phyo Lwin, Katsuro Ichimasa, Shin-Ei Kudo, Yuta Kouyama, Taishi Okumura, Yasuharu Maeda, Yutaro Ide, Khay Guan Yeoh, Masashi Misawa
Clinical Endoscopy.2025; 58(5): 638. CrossRef
Artificial intelligence in colonoscopy: polyp fiction or clinical reality?
Eun Jeong Gong, Chang Seok Bang
Clinical Endoscopy.2025; 58(5): 784. CrossRef
Artificial intelligence-assisted colonoscopy improves adenoma detection rates in routine colonoscopy practice: a single-center, retrospective, propensity score-matched study with concurrent controls
Da Yeon Ham, Jae Gon Lee, Chung Il Ahn, Sea Hyub Kae, Hyun Joo Jang
BMC Gastroenterology.2025;[Epub] CrossRef
Colorectal cancer worldwide: epidemiological trends, economic burden, and the promise of AI-driven solutions
Dinh T. P. Le, Tuan D. Pham
Exploration of Medicine.2025;[Epub] CrossRef
Impact of Artificial Intelligence on Polyp Size and Surveillance Colonoscopy: A Phantom Study
Muhammad N Yousaf, Neal Sharma, Michelle L Matteson-Kome, Srinivas Puli, Douglas Nguyen, Matthew L Bechtold
Cureus.2024;[Epub] 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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Endoscopic management of giant colonic polyps: a retrospective Italian study: Paolo Quitadamo, Sara Isoldi, Germana De Nucci, Giulia Muzi, Flora Caruso; Clin Endosc 2024;57(4):501-507. Published online June 5, 2024; DOI: https://doi.org/10.5946/ce.2023.229

Graphical Abstract Abstract PDF PubReader ePub

Background
/Aims: Polyps greater than 30 mm are classified as “giants”. Their endoscopic removal represents a technical challenge. The choice of the endoscopic removal technique is important because it provides a resection sample for precise histopathological staging. This is pivotal for diagnostic, prognostic, and management purposes.
Methods
From a retrospective analysis, we obtained a sample of 38 giant polyps. Eighteen polypectomies were performed using the epinephrine volume reduction (EVR) method, nine polypectomies utilized endo-looping or clipping methods, and 11 patients underwent surgery.
Results
We obtained en bloc resection with the EVR method in all cases; histology confirmed the correct indication for endoscopic resection in all cases. Moreover, no early or delayed complications were observed, and no patient required hospitalization. Using endo-looping or clipping methods, we observed advanced histology in 1/9 (11.1%) cases, while another patient (1/9, 11.1%) had delayed bleeding. Among patients who underwent surgery, 5/11 (45.5%) were deemed overtreated and three had post-surgical complications.
Conclusions
We propose EVR as an alternative technique for giant polyp resection due to its safety, effectiveness, cost-efficiency, and the advantage of avoiding the need to postpone polypectomy to a later time. Further prospective studies might help improve this experience and enhance the technique.

Citations

Citations to this article as recorded by

Large colorectal lesions: Expanding the boundaries of endoscopic management
Amit Bagrodia, Venkatesh Vaithiyam, Supraja Laguduva Mohan
World Journal of Gastrointestinal Endoscopy.2025;[Epub] CrossRef
Endoscopic approaches for the management of giant colonic polyps
Yunho Jung
Clinical Endoscopy.2024; 57(4): 468. CrossRef

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Performance comparison between two computer-aided detection colonoscopy models by trainees using different false positive thresholds: a cross-sectional study in Thailand: Kasenee Tiankanon, Julalak Karuehardsuwan, Satimai Aniwan, Parit Mekaroonkamol, Panukorn Sunthornwechapong, Huttakan Navadurong, Kittithat Tantitanawat, Krittaya Mekritthikrai, Salin Samutrangsi, Peerapon Vateekul, Rungsun Rerknimitr; Clin Endosc 2024;57(2):217-225. Published online February 7, 2024; DOI: https://doi.org/10.5946/ce.2023.145

Graphical Abstract Abstract PDF Supplementary Material PubReader ePub

Background
/Aims: This study aims to compare polyp detection performance of “Deep-GI,” a newly developed artificial intelligence (AI) model, to a previously validated AI model computer-aided polyp detection (CADe) using various false positive (FP) thresholds and determining the best threshold for each model.
Methods
Colonoscopy videos were collected prospectively and reviewed by three expert endoscopists (gold standard), trainees, CADe (CAD EYE; Fujifilm Corp.), and Deep-GI. Polyp detection sensitivity (PDS), polyp miss rates (PMR), and false-positive alarm rates (FPR) were compared among the three groups using different FP thresholds for the duration of bounding boxes appearing on the screen.
Results
In total, 170 colonoscopy videos were used in this study. Deep-GI showed the highest PDS (99.4% vs. 85.4% vs. 66.7%, p<0.01) and the lowest PMR (0.6% vs. 14.6% vs. 33.3%, p<0.01) when compared to CADe and trainees, respectively. Compared to CADe, Deep-GI demonstrated lower FPR at FP thresholds of ≥0.5 (12.1 vs. 22.4) and ≥1 second (4.4 vs. 6.8) (both p<0.05). However, when the threshold was raised to ≥1.5 seconds, the FPR became comparable (2 vs. 2.4, p=0.3), while the PMR increased from 2% to 10%.
Conclusions
Compared to CADe, Deep-GI demonstrated a higher PDS with significantly lower FPR at ≥0.5- and ≥1-second thresholds. At the ≥1.5-second threshold, both systems showed comparable FPR with increased PMR.

Citations

Citations to this article as recorded by

Effectiveness of a novel artificial intelligence-assisted colonoscopy system for adenoma detection: a prospective, propensity score-matched, non-randomized controlled study in Korea
Jung-Bin Park, Jung Ho Bae
Clinical Endoscopy.2025; 58(1): 112. 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
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

5,532 View
194 Download
5 Web of Science
4 Crossref

Endoscopic and histological characteristics of small bowel tumors diagnosed by double-balloon enteroscopy: Suleyman Dolu, Soner Onem, Zarni Htway, Farid Hajıyev, Ali Bilgen, Hatice Cilem Binicier, Ecem Kalemoglu, Ozgul Sagol, Mesut Akarsu; Clin Endosc 2023;56(1):83-91. Published online October 27, 2022; DOI: https://doi.org/10.5946/ce.2022.131

Abstract PDF PubReader ePub

Background
/Aims: Double-balloon enteroscopy (DBE) allows for the diagnoses and treatment of small bowel tumors (SBTs). This study aimed to evaluate the utility of DBE for the diagnosis and treatment of SBTs.
Methods
Patients diagnosed with SBTs who underwent DBE were included in this study. According to their endoscopic appearances, they were categorized as polyps or masses, and according to their histological characteristics, they were categorized as benign or malignant SBTs.
Results
A total of 704 patients were retrospectively analyzed, and 90 (12.8%) were diagnosed with SBTs. According to their endoscopic appearance, 48 (53.3%) had polyps and 42 (46.7%) had masses. Additionally, 53 (58.9%) and 37 (41.1%) patients had malignant and benign SBTs, respectively, depending on their histological characteristics. Patients diagnosed with polyps were younger than those diagnosed with masses (p<0.001). Patients diagnosed with benign SBTs were younger than those diagnosed with malignant SBT (p<0.001). Overall, histological diagnosis was determined using DBE in 73 (81.1%) patients.
Conclusions
DBE is a useful method for diagnosing SBTs. Additionally, the histological type of the lesion can be determined using DBE.

Citations

Citations to this article as recorded by

Effectiveness of Double Balloon Enteroscopy in the Diagnosis and Treatment of Small Bowel Varices
Suleyman Dolu, Mehmet Emin Arayici, Soner Onem, Ilker Buyuktorun, Huseyin Dongelli, Goksel Bengi, Mesut Akarsu
Diagnostics.2025; 15(3): 336. CrossRef
Balloon-assisted enteroscopy in the management of adult small-bowel intussusception: a comparative analysis of with and without double-balloon enteroscopy
Won Shik Kim, Beom Jae Lee, Moon Kyung Joo, Seung Han Kim, Jong-Jae Park
Surgical Endoscopy.2025; 39(3): 2044. CrossRef
Diagnostic and Clinical Impact of Double-Balloon Enteroscopy in Small-Bowel Inflammatory Lesions: A Retrospective Cohort Study in a Turkish Population
Suleyman Dolu, Mehmet Emin Arayici, Soner Onem, Huseyin Dongelli, Mesut Akarsu
Diagnostics.2025; 15(6): 661. CrossRef
Small Bowel Tumors: A 7-Year Study in a Tertiary Care Hospital
Sergiu Marian Cazacu, Dan Cârțu, Mihai Popescu, Liliana Streba, Bogdan Silviu Ungureanu, Vlad Florin Iovănescu, Mihai Cimpoeru, Cecil Sorin Mirea, Valeriu Marian Surlin, Stelian Mogoantă, Mirela Marinela Florescu
Cancers.2025; 17(9): 1465. CrossRef

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Factors influencing endoscopic estimation of colon polyp size in a colon model: Koen Robert Beukema, Jaimy A. Simmering, Marjolein Brusse-Keizer, Sneha John, Rutger Quispel, Peter B. Mensink; Clin Endosc 2022;55(4):540-548. Published online July 28, 2022; DOI: https://doi.org/10.5946/ce.2022.017

Abstract PDF PubReader ePub

Background
/Aims: Colorectal polyps are removed to prevent progression to colorectal cancer. Polyp size is an important factor for risk stratification of malignant transformation. Endoscopic size estimation correlates poorly with pathological reports and several factors have been suggested to influence size estimation. We aimed to gain insight into the factors influencing endoscopic polyp size estimation.
Methods
Images of polyps in an artificial model were obtained at 1, 3, and 5 cm from the colonoscope’s tip. Participants were asked to estimate the diameter and volume of each polyp.
Results
Fifteen endoscopists from three large-volume centers participated in this study. With an intraclass correlation coefficient of 0.66 (95% confidence interval [CI], 0.62–0.71) for diameter and 0.56 (95% CI, 0.50–0.62) for volume. Polyp size estimated at 3 cm from the colonoscope’s tip yielded the best results. A lower distance between the tip and the polyp was associated with a larger estimated polyp size.
Conclusions
Correct endoscopic estimation of polyp size remains challenging. This finding can affect size estimation skills and future training programs for endoscopists.

Citations

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Endoscopic size measurement of colorectal polyps: a systematic review of techniques
Mahsa Taghiakbari, Roupen Djinbachian, Juliette Labelle, Daniel von Renteln
Endoscopy.2025; 57(05): 460. CrossRef
Taking the Guess Work Out of Endoscopic Polyp Measurement
Anthony Kerbage, Tarek Souaid, Kailash Singh, Carol A. Burke
Journal of Clinical Gastroenterology.2025; 59(6): 497. CrossRef
Accuracy of Visual Estimation for Measuring Colonic Polyp Size: A Systematic Review and Meta-Analysis
Abraham Z. Cheloff, Leah Kim, Mark B. Pochapin, Aasma Shaukat, Violeta Popov
American Journal of Gastroenterology.2025; 120(10): 2251. CrossRef
Usefulness and Educational Benefit of a Virtual Scale Endoscope in Measuring Colorectal Polyp Size
Yudai Takehara, Ken Yamashita, Shin Morimoto, Fumiaki Tanino, Noriko Yamamoto, Yuki Kamigaichi, Hidenori Tanaka, Hidehiko Takigawa, Ryo Yuge, Yuji Urabe, Shiro Oka
Digestion.2024; 105(2): 73. CrossRef
Expert endoscopist assessment of colorectal polyp size using virtual scale endoscopy, visual or snare-based estimation: a prospective video-based study
Ioana Popescu Crainic, Roupen Djinbachian, Douglas K. Rex, Alan Barkun, Aasma Shaukat, James East, Cesare Hassan, Yuichi Mori, Heiko Pohl, Amit Rastogi, Prateek Sharma, Joseph C. Anderson, Mahsa Taghiakbari, Edgard Medawar, Daniel von Renteln
Scandinavian Journal of Gastroenterology.2024; 59(5): 608. CrossRef

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156 Download
5 Web of Science
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Review

Can Computed Tomography Colonography Replace Optical Colonoscopy in Detecting Colorectal Lesions?: State of the Art: Alessia Chini, Michele Manigrasso, Grazia Cantore, Rosa Maione, Marco Milone, Francesco Maione, Giovanni Domenico De Palma; Clin Endosc 2022;55(2):183-190. Published online February 24, 2022; DOI: https://doi.org/10.5946/ce.2021.254

Abstract PDF PubReader ePub

Colorectal cancer is an important cause of morbidity and mortality worldwide. Optical colonoscopy (OC) is widely accepted as the reference standard for the screening of colorectal polyps and cancers, and computed tomography colonography (CTC) is a valid alternative to OC. The purpose of this review was to assess the diagnostic accuracy of OC and CTC for colorectal lesions. A literature search was performed in PubMed, Embase, and Cochrane Library, and 18 articles were included. CTC has emerged in recent years as a potential screening examination with high accuracy for the detection of colorectal lesions. However, the clinical application of CTC as a screening technique is limited because it is highly dependent on the size of the lesions and has poor performance in detecting individual lesions <5 mm or flat lesions, which, although rarely, can have a malignant potential.

Citations

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Virtual Colonoscopy: Retrospective Comparison of the Findings in Supine and Prone Positions
Mehmet Gürdal Demirci, Yasir Musa Kesgin
Surgical Innovation.2025; 32(3): 242. CrossRef
Spectroscopic Nuclear Magnetic Resonance and Fourier Transform–Infrared Approach Used for the Evaluation of Healing After Surgical Interventions for Patients with Colorectal Cancer: A Pilot Study
Lavinia Raluca Șaitiș, David Andras, Ioana-Alina Pop, Cătălin Șaitiș, Ramona Crainic, Radu Fechete
Cancers.2025; 17(5): 887. CrossRef
DIVERT-Ca: unveiling the hidden link between acute diverticulitis and colorectal cancer risk—multicentre retrospective study
Mohamed Talaat Issa, Emiko Sultana, Mohammed Hamid, Ali Yasen Mohamedahmed, Mohamed Albendary, Shafquat Zaman, Santosh Bhandari, William Ball, Sangara Narayanasamy, Pradeep Thomas, Najam Husain, Rajeev Peravali, Diwakar Sarma
International Journal of Colorectal Disease.2025;[Epub] CrossRef
Advances in colorectal cancer screening and detection: a narrative review on biomarkers, imaging and preventive strategies
Adil khan, Uswa Hasana, Iman Anum Nadeem, Swara Punit Khatri, Shayan Nawaz, Qurat Ulain Makhdoom, Shahab Wazir, Kirtan Patel, Mohamd Ghaly
Journal of the Egyptian National Cancer Institute.2025;[Epub] CrossRef
Ways to improve the diagnosis and treatment of early colorectal cancer: a literature review and a clinical case study
V. O. Gaulikà, A. M. Parsadanyan, K. K. Kostanyan
Siberian journal of oncology.2025; 24(3): 114. CrossRef
GFANet: Global Feature Attention Network for Polyp Segmentation
Leping Lin, Wenjie Huang, Ning Ouyang
Journal of Imaging Informatics in Medicine.2025;[Epub] CrossRef
Implications of Computerized Tomography Colonography in Fully Intended but Aborted Optical Colonoscopy – a Retrospective Case-Control Study
Constanze Jakob, Thomas Arens, Annett Borkenhagen, Christina Nikolaus, Tobias Klugmann, Chris Klecker, Peter Dietel, Philipp A. Reuken, Andreas Stallmach, Niels Teich
Zeitschrift für Gastroenterologie.2025; 63(12): 1253. CrossRef
Multi-view orientational attention network combining point-based affinity for polyp segmentation
Yan Liu, Yan Yang, Yongquan Jiang, Zhuyang Xie
Expert Systems with Applications.2024; 249: 123663. CrossRef
The Influence of Mechanical Bowel Preparation on Volatile Organic Compounds for the Detection of Gastrointestinal Disease—A Systematic Review
Ashwin Krishnamoorthy, Subashini Chandrapalan, Sofie Bosch, Ayman Bannaga, Nanne K.H. De Boer, Tim G.J. De Meij, Marcis Leja, George B. Hanna, Nicoletta De Vietro, Donato Altomare, Ramesh P. Arasaradnam
Sensors.2023; 23(3): 1377. CrossRef
The Detection of Colorectal Cancer through Machine Learning-Based Breath Sensor Analysis
Inese Poļaka, Linda Mežmale, Linda Anarkulova, Elīna Kononova, Ilona Vilkoite, Viktors Veliks, Anna Marija Ļeščinska, Ilmārs Stonāns, Andrejs Pčolkins, Ivars Tolmanis, Gidi Shani, Hossam Haick, Jan Mitrovics, Johannes Glöckler, Boris Mizaikoff, Mārcis Lej
Diagnostics.2023; 13(21): 3355. CrossRef

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Case Report

Less invasive transoral resection of esophageal fibrovascular polyps: case reports: Janusz Włodarczyk, Tomasz Smęder; Clin Endosc 2022;55(5):683-687. Published online December 6, 2021; DOI: https://doi.org/10.5946/ce.2021.144

Abstract PDF PubReader ePub

We report five patients treated for esophageal fibrovascular polyps using a minimally invasive technique. Esophageal fibrovascular polyps are benign pedunculated submucosal tumors of considerable size. The treated polyps size ranged from 1.5 to 13 cm. The polyps were removed by relocation to the oral cavity under endoscopic control. No perioperative complications occurred after the treatment. The follow-up of patients after surgery was 9–89 months, with no evidence of polyp recurrence. Thus, the described treatment is safe but requires experience with endoscopy as well as esophageal surgery.

Citations

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A case of esophageal fibrous polyp treated by suspended laryngoscope in the department of otorhinolaryngology
Fengling Yang, Zhenhua Jiang, Qian He, Shuangyan He
Asian Journal of Surgery.2025; 48(7): 4518. CrossRef

5,462 View
185 Download
1 Web of Science
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Original Articles

Artificial Intelligence-Based Colorectal Polyp Histology Prediction by Using Narrow-Band Image-Magnifying Colonoscopy: Istvan Racz, Andras Horvath, Noemi Kranitz, Gyongyi Kiss, Henriett Regoczi, Zoltan Horvath; Clin Endosc 2022;55(1):113-121. Published online September 23, 2021; DOI: https://doi.org/10.5946/ce.2021.149

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Background
/Aims: We have been developing artificial intelligence based polyp histology prediction (AIPHP) method to classify Narrow Band Imaging (NBI) magnifying colonoscopy images to predict the hyperplastic or neoplastic histology of polyps. Our aim was to analyze the accuracy of AIPHP and narrow-band imaging international colorectal endoscopic (NICE) classification based histology predictions and also to compare the results of the two methods.
Methods
We studied 373 colorectal polyp samples taken by polypectomy from 279 patients. The documented NBI still images were analyzed by the AIPHP method and by the NICE classification parallel. The AIPHP software was created by machine learning method. The software measures five geometrical and color features on the endoscopic image.
Results
The accuracy of AIPHP was 86.6% (323/373) in total of polyps. We compared the AIPHP accuracy results for diminutive and non-diminutive polyps (82.1% vs. 92.2%; p=0.0032). The accuracy of the hyperplastic histology prediction was significantly better by NICE compared to AIPHP method both in the diminutive polyps (n=207) (95.2% vs. 82.1%) (p<0.001) and also in all evaluated polyps (n=373) (97.1% vs. 86.6%) (p<0.001)
Conclusions
Our artificial intelligence based polyp histology prediction software could predict histology with high accuracy only in the large size polyp subgroup.

Citations

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Edge Artificial Intelligence Device in Real-Time Endoscopy for the Classification of Colonic Neoplasms
Eun Jeong Gong, Chang Seok Bang
Diagnostics.2025; 15(12): 1478. CrossRef
Artificial intelligence-assisted colonoscopy for colorectal lesion detection: a case-control study on diagnostic accuracy and histopathological agreement
Marcio Roberto FACANALI JUNIOR, Afonso Henrique da Silva SOUSA JUNIOR, Carlos Frederico Sparapan MARQUES, Adriana Vaz SAFATLE-RIBEIRO
ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo).2025;[Epub] CrossRef
Artificial intelligence in colonoscopy: Enhancing quality indicators for optimal patient outcomes
Konstantina Dimopoulou, Marianna Spinou, Alexandros Ioannou, Eleni Nakou, Petros Zormpas, George Tribonias
World Journal of Gastroenterology.2025;[Epub] CrossRef
Application of AI-assisted magnifying colonoscopy system in the diagnosis of colorectal tumors: a multicenter exploratory diagnostic study
Xiaofei Fan, Ayixie Maihemuti, Xiaohan Cai, Jia Huang, Siqi Zhao, Tao Wang, Xin Chen, Haoyu Zhai, Jia Li, Zhongqing Zheng, Chunshan Zhao, Yufeng Wang, Yue Feng, Jinbao Mu, Xiangdong Lu, Hongbin Zhu, Bangmao Wang, Wentian Liu
Surgical Endoscopy.2025;[Epub] CrossRef
Colon polyps: updates in classification and management
David Dornblaser, Sigird Young, Aasma Shaukat
Current Opinion in Gastroenterology.2024; 40(1): 14. CrossRef
Employing deep learning for predicting the thermal properties of water and nano-encapsulated phase change material
Saihua Xu, Ali Basem, Hasan A Al-Asadi, Rishabh Chaturvedi, Gulrux Daminova, Yasser Fouad, Dheyaa J Jasim, Javid Alhoee
International Journal of Low-Carbon Technologies.2024; 19: 1453. CrossRef
Endoscopic Artificial Intelligence for Image Analysis in Gastrointestinal Neoplasms
Ryosuke Kikuchi, Kazuaki Okamoto, Tsuyoshi Ozawa, Junichi Shibata, Soichiro Ishihara, Tomohiro Tada
Digestion.2024; 105(6): 419. CrossRef
Detecting colorectal lesions with image-enhanced endoscopy: an updated review from clinical trials
Mizuki Nagai, Sho Suzuki, Yohei Minato, Fumiaki Ishibashi, Kentaro Mochida, Ken Ohata, Tetsuo Morishita
Clinical Endoscopy.2023; 56(5): 553. CrossRef
AI-powered medical devices for practical clinicians including the diagnosis of colorectal polyps
Donghwan Kim, Eunsun Kim
Journal of the Korean Medical Association.2023; 66(11): 658. CrossRef
Artificial Intelligence-Based Colorectal Polyp Histology Prediction: High Accuracy in Larger Polyps
Naoki Muguruma, Tetsuji Takayama
Clinical Endoscopy.2022; 55(1): 45. CrossRef
Artificial intelligence-based colorectal polyp histology prediction using narrow-band image-magnifying colonoscopy: a stepping stone for clinical practice
Ji Young Chang
Clinical Endoscopy.2022; 55(5): 699. CrossRef
Response to Artificial intelligence-based colorectal polyp histology prediction using narrow-band image-magnifying colonoscopy: a stepping stone for clinical practice
Istvan Racz, Andras Horvath, Zoltán Horvath
Clinical Endoscopy.2022; 55(5): 701. CrossRef

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Underwater Endoscopic Mucosal Resection for 10 mm or Larger Nonpedunculated Colorectal Polyps: A Systematic Review and Meta-Analysis: Rajat Garg, Amandeep Singh, Manik Aggarwal, Jaideep Bhalla, Babu P. Mohan, Carol Burke, Tarun Rustagi, Prabhleen Chahal; Clin Endosc 2021;54(3):379-389. Published online April 29, 2021; DOI: https://doi.org/10.5946/ce.2020.276

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Background
/Aims: Recent studies have reported the favorable outcomes of underwater endoscopic mucosal resection (UEMR) for colorectal polyps. We performed a systematic review and meta-analysis evaluating the efficacy and safety of UEMR for nonpedunculated polyps ≥10 mm.
Methods
We performed a comprehensive search of multiple databases (through May 2020) to identify studies reporting the outcomes of UEMR for ≥10 mm nonpedunculated colorectal polyps. The assessed outcomes were recurrence rate on the first follow-up, en bloc resection, incomplete resection, and adverse events after UEMR.
Results
A total of 1276 polyps from 16 articles were included in our study. The recurrence rate was 7.3% (95% confidence interval [CI], 4.3–12) and 5.9% (95% CI, 3.6–9.4) for nonpedunculated polyps ≥10 and ≥20 mm, respectively. For nonpedunculated polyps ≥10 mm, the en bloc resection, R0 resection, and incomplete resection rates were 57.7% (95% CI, 42.4–71.6), 58.9% (95% CI, 42.4–73.6), and 1.5% (95% CI, 0.8–2.6), respectively. The rates of pooled adverse events, intraprocedural bleeding, and delayed bleeding were 7.0%, 5.4%, and 2.9%, respectively. The rate of perforation and postpolypectomy syndrome was 0.8%.
Conclusions
Our systematic review and meta-analysis demonstrates that UEMR for nonpedunculated colorectal polyps ≥10 mm is safe and effective with a low rate of recurrence.

Citations

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Endoscopic Resection for Superficial Non-Ampullary Duodenal Epithelial Tumors
Hye Kyung Jeon, Gwang Ha Kim
Gut and Liver.2025; 19(1): 19. CrossRef
Underwater vs conventional endoscopic mucosal resection for nonpedunculated colorectal neoplasms: A randomized controlled trial
Quang D Le, Nhan Q Le, Duc T Quach
World Journal of Gastrointestinal Surgery.2025;[Epub] CrossRef
New chapter in precision medicine: strategies for endoscopic resection of 10–20 mm non-pedunculated colorectal polyps
Changwei Duan, Zhen Liu, Xin Wang, Mingjie Zhang, Jianqiu Sheng, Yuqi He, Xianzong Ma
Therapeutic Advances in Gastroenterology.2025;[Epub] CrossRef
Current Management of Duodenal Neoplasia: Endoscopic Treatment for Large Superficial Non-Ampullary Duodenal Epithelial Tumor
Kurato Miyazaki, Naohisa Yahagi, Motohiko Kato
Digestion.2025; : 1. CrossRef
Management of recurrent colorectal polyps post initial polypectomy: a review of the current evidence
Giovanna McGinty, Zeino Zeino
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Water-assisted colonoscopy in inflammatory bowel diseases: From technical implications to diagnostic and therapeutic potentials
Raffaele Pellegrino, Giovanna Palladino, Michele Izzo, Ilaria De Costanzo, Fabio Landa, Alessandro Federico, Antonietta Gerarda Gravina
World Journal of Gastrointestinal Endoscopy.2024; 16(12): 647. CrossRef
Underwater Versus Conventional Endoscopic Mucosal Resection for Colorectal Laterally Spreading Tumors: A Post Hoc Analysis of Efficacy
Quang Dinh Le, Nhan Quang Le, Duc Trong Quach
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Polypectomy Techniques for Pedunculated and Nonpedunculated Polyps
Karl Kwok, Sasan Mosadeghi, Daniel Lew
Techniques and Innovations in Gastrointestinal Endoscopy.2023; 25(4): 361. CrossRef
Underwater versus conventional endoscopic mucosal resection for colorectal lesions: a systematic review and meta-analysis of randomized clinical trials
Matheus Henrique Gonçalves de Souza, Paula Arruda do Espirito Santo, Fauze Maluf-Filho, Luciano Lenz
International Journal of Colorectal Disease.2023;[Epub] CrossRef
Endoscopic treatment of colorectal polyps and early colorectal cancer
Yunho Jung
Journal of the Korean Medical Association.2023; 66(11): 642. CrossRef
EMR and ESD: Indications, techniques and results
Mamoon Ur Rashid, Mohammad Alomari, Sadaf Afraz, Tolga Erim
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Safety and effectiveness of underwater cold snare resection without submucosal injection of large non-pedunculated colorectal lesions
Andrew W. Yen, Joseph W. Leung, Malcom Koo, Felix W. Leung
Endoscopy International Open.2022; 10(06): E791. CrossRef
Underwater or conventional endoscopic mucosal resection for intermediate‐sized colorectal neoplasm?
Li‐Chun Chang
Advances in Digestive Medicine.2021; 8(3): 133. CrossRef

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Is Submucosal Injection Helpful in Cold Snare Polypectomy for Small Colorectal Polyps?: Ji Hyun Song, Shai Friedland; Clin Endosc 2021;54(3):397-403. Published online February 9, 2021; DOI: https://doi.org/10.5946/ce.2020.226

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Background
/Aims: Cold snare polypectomy (CSP) is an effective method of polyp removal for small colorectal polyps. However, the effect of submucosal injection in cold snare endoscopic mucosal resection (CS-EMR) for small polyps is unclear. Therefore, this study aimed to evaluate the effect of submucosal injection in CS-EMR for small polyps.
Methods
Between 2018 and 2019, 100 consecutive small colorectal polyps (5–10 mm) were identified in 58 patients. The first 50 consecutive polyps were removed by CS-EMR, and the remaining 50 were removed by CSP. Demographic data, clinical data, endoscopic findings, procedure times, complication rates, and pathology data were collected.
Results
No difference in the complete resection rate was observed between the CS-EMR and CSP groups. A total of 9 polyps showed post-polypectomy bleeding (7 had immediate bleeding, 1 had delayed bleeding, and 1 had both immediate and delayed bleeding). No difference in the bleeding rate was observed between the two groups. In multivariate analysis, warfarin (odds ratio [OR], 42.334; 95% confidence interval [CI], 1.006–1,781.758) and direct-acting oral anticoagulants (OR, 35.244; 95% CI, 3.853–322.397) showed a significantly increased risk of bleeding.
Conclusions
The effect of submucosal injection in CSP was not significant for small colorectal polyps.

Citations

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Survey of the Actual Practices Used for Endoscopic Removal of Colon Polyps in Korea: A Comparison with the Current Guidelines
Jeongseok Kim, Tae-Geun Gweon, Min Seob Kwak, Su Young Kim, Seong Jung Kim, Hyun Gun Kim, Sung Noh Hong, Eun Sun Kim, Chang Mo Moon, Dae Seong Myung, Dong-Hoon Baek, Shin Ju Oh, Hyun Jung Lee, Ji Young Lee, Yunho Jung, Jaeyoung Chun, Dong-Hoon Yang, Eun R
Gut and Liver.2025; 19(1): 77. CrossRef
Impact of contrast dye submucosal pre-lifting on cold snare resection of small polyps: an Italian randomized observational trial
Ramona Schiumerini, Paola Baccarini, Adele Fornelli, Davide Allegri, Francesca Lodato, Alessia Gazzola, Pasquale Apolito, Nunzio P. Longo, Anna M. Polifemo, Franca Patrizi, Federica Buonfiglioli, Stefania Ghersi, Marco Bassi, Liza Ceroni, Antonella Ghetti
Clinical Endoscopy.2025; 58(2): 291. CrossRef
Cold sub-mucosal injection versus traditional cold snare polypectomy for diminutive and small colorectal polyps: A systematic review and meta-analysis
Yong-Cai Lv, Quan Dong, Yan-Hua Yao, Jing-Jing Lei
Indian Journal of Gastroenterology.2024; 43(6): 1111. CrossRef
Colorectal cold snare polypectomy: Current standard technique and future perspectives
Fumiaki Ishibashi, Sho Suzuki, Mizuki Nagai, Kentaro Mochida, Tetsuo Morishita
Digestive Endoscopy.2023; 35(3): 278. CrossRef
The efficacy and safety of cold snare polypectomy with submucosal injection for the removal of polyps less than 20 mm in size: a systematic review and meta‐analysis
Zheng Liang, Yongqiu Wei, Shutian Zhang, Peng Li
Journal of Gastroenterology and Hepatology.2023; 38(11): 1892. CrossRef
Impact of Submucosal Saline Injection During Cold Snare Polypectomy for Colorectal Polyps Sized 3–9 mm: A Multicenter Randomized Controlled Trial
Yi Mou, Liansong Ye, Xiaobo Qin, Rui Feng, Lifan Zhang, Qin Hu, Tingting Cao, Xinyue Zhou, Wu Wen, Chuanming Zhang, Zonghua Chen, Yi Liu, Zhimin Yang, Tao Huo, Fang Pan, Xuelian Li, Bing Hu
American Journal of Gastroenterology.2023; 118(10): 1848. CrossRef
Cold resection for colorectal polyps: where we are and where we are going?
Antonio Capogreco, Ludovico Alfarone, Davide Massimi, Alessandro Repici
Expert Review of Gastroenterology & Hepatology.2023; 17(7): 719. CrossRef
Cold snare endoscopic mucosal resection for colon polyps: a systematic review and meta-analysis
Mohamed Abdallah, Khalid Ahmed, Daniyal Abbas, Mouhand F. H. Mohamed, Gaurav Suryawanshi, Nicholas McDonald, Natalie Wilson, Shifa Umar, Aasma Shaukat, Mohammad Bilal
Endoscopy.2023; 55(12): 1083. CrossRef
Endoscopic treatment of colorectal polyps and early colorectal cancer
Yunho Jung
Journal of the Korean Medical Association.2023; 66(11): 642. CrossRef

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Dedicated Cold Snare vs. Traditional Snare for Polypectomy of Diminutive and Small Lesions in a Porcine Model: A Research Group for Endoscopic Instruments and Stents (REIS) Study: Han Hee Lee, Bo-In Lee, Jung-Wook Kim, Hyun Lim, Si Hyung Lee, Jun-Hyung Cho, Yunho Jung, Kyoung Oh Kim, Chan Gyoo Kim, Kee Myung Lee, Jong-Jae Park, Myung-Gyu Choi, Hoon Jai Chun, Ho Gak Kim; Clin Endosc 2021;54(3):390-396. Published online September 10, 2020; DOI: https://doi.org/10.5946/ce.2020.096

Abstract PDF Supplementary Material PubReader ePub

Background
/Aims: The aim of this in vivo animal study was to evaluate the effectiveness and safety of dedicated cold snare (DCS) compared with those of traditional snare (TS) for cold snare polypectomy (CSP).
Methods
A total of 36 diminutive (5 mm) and 36 small (9 mm) pseudolesions were made by electrocoagulation in the colons of mini-pigs.
Results
For the diminutive lesions, there were no significant differences in technical success rate, procedure time, or complete resection rate between the DCS and TS groups; the rate of uneven resection margin in the DCS group was significantly lower than that of the TS group. For small lesions, technical success rate and complete resection rate were significantly higher in the DCS group than in the TS group (100% [18/18] vs. 55.6% [10/18], p=0.003; 94.4% [17/18] vs. 40% [4/10], p=0.006). In addition, the procedure duration was significantly shorter, and the rate of uneven resection margin was significantly lower in the DCS group (28.5 sec vs. 66.0 sec, p=0.006; 11.1% [2/18] vs. 100% [10/10], p<0.001). Two cases of perforation occurred in the DCS group. Multivariate analysis revealed that DCS use was independently associated with complete resection.
Conclusions
DCS is superior to TS in terms of technical success, complete resection, and reducing the duration of the procedure for CSP of small polyps.

Citations

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Comparison of complete resection rates in cold snare polypectomy using two different wire diameter snares: A randomized controlled study
Toshiki Horii, Sho Suzuki, Akihiro Sugita, Misa Yamauchi, Hisatomo Ikehara, Chika Kusano, Takuji Gotoda
Journal of Gastroenterology and Hepatology.2023; 38(5): 752. CrossRef
Comparison of the clinical efficacy of cold snare polypectomy using a thin-wire snare and thick-wire snare for small colorectal polyps
Hong Jin Yoon, Yunho Jung, Young Sin Cho, Il-Kwun Chung
International Journal of Gastrointestinal Intervention.2023; 12(4): 183. CrossRef
Big Issues on Small Polyps: An Ideal Device, But Is It for an Ideal Indication?
Yoji Takeuchi
Clinical Endoscopy.2021; 54(3): 297. CrossRef
Cold versus hot polypectomy/endoscopic mucosal resection–A review of current evidence
Raquel Ortigão, Jochen Weigt, Ahmed Afifi, Diogo Libânio
United European Gastroenterology Journal.2021; 9(8): 938. CrossRef

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Endoscopic Findings in Children with Isolated Lower Gastrointestinal Bleeding: Ari Silbermintz, Manar Matar, Amit Assa, Noam Zevit, Yael Mozer Glassberg, Raanan Shamir; Clin Endosc 2019;52(3):258-261. Published online May 14, 2019; DOI: https://doi.org/10.5946/ce.2018.046

Abstract PDF PubReader ePub

Background
/Aims: Colorectal polyps are a common cause of lower gastrointestinal bleeding in children. Our aim was to study the causes of isolated lower gastrointestinal bleeding and to analyze the characteristics of the colorectal polyps found in our cohort.
Methods
We retrospectively reviewed colonoscopic procedures performed between 2007 and 2015. Children with isolated lower gastrointestinal bleeding were included in the study.
Results
A total of 185 colonoscopies were performed for isolated lower gastrointestinal bleeding. The median patient age was 8 years, and 77 patients (41.6%) were found to have colonic polyps. Normal colonoscopy findings were observed and acute colitis was detected in 77 (41.6%) and 14 (7.4%) patients, respectively. Single colonic polyps and 2–3 polyps were detected in 73 (94.8%) and 4 (5.2%) patients with polyps, respectively. Of the single polyps, 69 (94.5%) were juvenile polyps, among which 65 (94.2%) were located in the left colon.
Conclusions
Single left-sided juvenile polyps were the most common cause of isolated lower gastrointestinal bleeding in our study. It was rare to find multiple polyps and polyps proximal to the splenic flexure in our cohort. A full colonoscopy is still recommended in all patients in order to properly diagnose the small but significant group of patients with pathologies found proximal to the splenic flexure.

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Ahmed F. Khalil, Ikram M. Helmy, Noha Hammad
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Review

Should We Resect and Discard Low Risk Diminutive Colon Polyps: Pujan Kandel, Michael B. Wallace; Clin Endosc 2019;52(3):239-246. Published online January 21, 2019; DOI: https://doi.org/10.5946/ce.2018.136

Abstract PDF PubReader ePub

Diminutive colorectal polyps <5 mm are very common and almost universally benign. The current strategy of resection with histological confirmation of all colorectal polyps is costly and may increase the risk of colonoscopy. Accurate, optical diagnosis without histology can be achieved with currently available endoscopic technologies. The American Society of Gastrointestinal Endoscopy Preservation and Incorporation of Valuable endoscopic Innovations supports strategies for optical diagnosis of small non neoplastic polyps as long as two criteria are met. For hyperplastic appearing polyps <5 mm in recto-sigmoid colon, the negative predictive value should be at least 90%. For diminutive low grade adenomatous appearing polyps, a resect and discard strategy should be sufficiently accurate such that post-polypectomy surveillance recommendations based on the optical diagnosis, agree with a histologically diagnosis at least 90% of the time. Although the resect and discard as well as diagnose and leave behind approach has major benefits with regard to both safety and cost, it has yet to be used widely in practice. To fully implement such as strategy, there is a need for better-quality training, quality assurance, and patient acceptance. In the article, we will review the current state of the science on optical diagnose of colorectal polyps and its implications for colonoscopy practice.

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Original Article

Mis-sizing of Adenomatous Polyps is Common among Endoscopists and Impacts Colorectal Cancer Screening Recommendations: Thu Pham, Aung Bajaj, Lorela Berberi, Chengcheng Hu, Sasha Taleban; Clin Endosc 2018;51(5):485-490. Published online June 21, 2018; DOI: https://doi.org/10.5946/ce.2017.183

Abstract PDF PubReader ePub

Background
/Aims: To determine the accuracy of identifying ≥6-mm adenomatous polyps during colonoscopy and define its impact on subsequent interval screening.
Methods
We conducted a retrospective study of patients who underwent colonoscopies at Banner University Medical Center, Tucson from 2011 to 2015. All patients with ≥6-mm adenomatous polyps based on their colonoscopy report were included. Adenomatous polyps were excluded if they did not meet the criteria. Discrepancies in the polyp size were determined by calculating the percentage of size variation (SV). Clinical mis-sizing was defined as SV >33%.
Results
The polyps analyzed were predominantly <10 mm in size. Approximately 13% of the examined polyps met the inclusion criteria, and 40.7% of the adenomas were ≥10 mm. A total of 189 ≥6-mm adenomatous polyps were collected from 10 different gastroenterologists and a colorectal surgeon. Adenomatous polyps were clinically mis-sized in 56.6% of cases and overestimated in 71.4%. Among the adenomas reviewed, 22% of mis-sized polyps and 11% of non-mis-sized polyps resulted in an inappropriate surveillance interval.
Conclusions
We found that more than half of ≥6-mm adenomatous polyps are mis-sized and that there is a tendency to overestimate adenoma size among endoscopists. This frequently leads to inappropriate intervals of surveillance colonoscopy.

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Polyp Characteristics of Nonsyndromic and Potentially Syndromic Juvenile Polyps
Nadia Ibrahimi, Seth S. Septer, Brian R. Lee, Robert Garola, Raj Shah, Thomas M. Attard
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Importance of the Size of Adenomatous Polyps in Determining Appropriate Colonoscopic Surveillance Intervals
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Case Report

Primary Colonic Follicular Lymphoma Presenting as Four Diminutive Sessile Polyps Found Incidentally During Colonoscopy: Sun Jin, Hyun Seok Lee, Ji Yun Jeong, Young Wook Jo; Clin Endosc 2018;51(4):388-392. Published online April 18, 2018; DOI: https://doi.org/10.5946/ce.2017.114

Abstract PDF PubReader ePub

Follicular lymphomas, which typically arise in the lymph nodes with spleen, liver, and bone marrow involvement, have generally low occurrence rates in Asian countries as compared with Western countries. Follicular lymphomas of the gastrointestinal tract are rare, and primary colonic follicular lymphomas are particularly rare compared with others found in the small intestine and duodenum. Colonoscopic imaging of colonic lymphomas, including follicular lymphoma, may reveal mucosal ulcerations, erosions, indurations, polypoid mass-like lesions, and diffuse mucosal nodularity. Herein, we report a unique case of a follicular lymphoma of the transverse colon characterized by four sessile diminutive polyps located intermittently with multiple lymph node involvement in a 62-year-old man.

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Primary Colorectal Follicular Lymphoma Observed by Magnifying Endoscopy, with a Five-year Follow-up
Masaki Katsurahara, Yuhei Umeda, Takashi Sakuno, Jyunya Tsuboi, Reiko Yamada, Misaki Nakamura, Yasuhiko Hamada, Hiroyuki Inoue, Kyosuke Tanaka, Noriyuki Horiki, Yoshiyuki Takei
Internal Medicine.2020; 59(11): 1395. CrossRef
Follicular non-Hodgkin lymphoma with primary colonic involvement
Raquel Muñoz González, Pablo Miranda García, Cecilio Santander Vaquero
Revista Española de Enfermedades Digestivas.2020;[Epub] CrossRef

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144 Download
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5 Crossref

Reviews

Endoscopic Mucosal Resection versus Endoscopic Submucosal Dissection for Large Polyps: A Western Colonoscopist’s View: Ian Holmes, Shai Friedland; Clin Endosc 2016;49(5):454-456. Published online August 26, 2016; DOI: https://doi.org/10.5946/ce.2016.077

Abstract PDF PubReader ePub

To discuss the rationale for the widespread application of endoscopic mucosal resection (EMR) rather than endoscopic submucosal dissection (ESD) in Western centers. In Western centers, EMR is the treatment of choice for most non-pedunculated colorectal adenomas >2 cm in size. EMR is sufficiently effective and safe to be performed without post-procedure hospitalization. Advances in EMR have led to reduced recurrence rates, and recent studies have demonstrated excellent outcomes with endoscopic treatment of recurrent adenomas. While studies from Asia have demonstrated lower recurrence rates with ESD, concern about the higher perforation risk and lengthy procedure time of ESD are two of the barriers preventing widespread adoption of ESD in the West. EMR is likely to continue as the dominant method for the treatment of large colorectal adenomas in Western centers until the limitations of ESD are overcome.

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Resection of Diminutive and Small Colorectal Polyps: What Is the Optimal Technique?: Jun Lee; Clin Endosc 2016;49(4):355-358. Published online July 22, 2016; DOI: https://doi.org/10.5946/ce.2016.063

Abstract PDF PubReader ePub

Colorectal polyps are classified as neoplastic or non-neoplastic on the basis of malignant potential. All neoplastic polyps should be completely removed because both the incidence of colorectal cancer and the mortality of colorectal cancer patients have been found to be strongly correlated with incomplete polypectomy. The majority of colorectal polyps discovered on diagnostic colonoscopy are diminutive and small polyps; therefore, complete resection of these polyps is very important. However, there is no consensus on a method to remove diminutive and small polyps, and various techniques have been adopted based on physician preference. The aim of this article was to review the diverse techniques used to remove diminutive and small polyps and to suggest which technique will be the most effective.

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Real-Time Polyp Detection, Localization and Segmentation in Colonoscopy Using Deep Learning
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Original Articles

Increased Detection of Colorectal Polyps in Screening Colonoscopy Using High Definition i-SCAN Compared with Standard White Light: Woo Jung Kim, Sang Young Park, Iksoo Park, Wook Jin Lee, Jaechan Park, Nuri Chon, Tak Geun Oh, Kwang Hyun Kim; Clin Endosc 2016;49(1):69-75. Published online January 28, 2016; DOI: https://doi.org/10.5946/ce.2016.49.1.69

Abstract PDF PubReader ePub

Background
/Aims: The aim of this study was to evaluate the efficacy of high definition (HD) i-SCAN for colorectal polyp detection in screening colonoscopy.
Methods
We retrospectively analyzed the records of 501 patients who had undergone screening colonoscopy performed by three endoscopists with either HD i-SCAN (n=149) or standard white light (n=352) from January 2, 2014 through June 30, 2014. Patient information and inter-endoscopist variation as well as polyp number, endoscopic findings, and pathologic characteristics were reviewed.
Results
The detection rates of colorectal and neoplastic polyps were significantly higher using HD i-SCAN than standard white light colonoscopy (52% vs. 38.1%, p=0.004 for colorectal polyps; and 37.2% vs. 27.9%, p=0.041 for neoplastic polyps). Analysis of endoscopic findings revealed no difference in detected polyp size between HD i-SCAN and standard white light colonoscopy (4.59±2.35 mm vs. 4.82±2.81 mm, p=0.739), but non-protruding polyps were more commonly detected by i-SCAN than by standard white light colonoscopy (24.6% vs. 13.5%, p=0.007).
Conclusions
Colonoscopy using HD i-SCAN had a significantly higher detection rate of colorectal polyps, including neoplastic polyps, because of improved sensitivity for detecting non-protruding lesions.

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Edward John Young, Arvinf Rajandran, Hamish Lachlan Philpott, Dharshan Sathananthan, Sophie Fenella Hoile, Rajvinder Singh
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Técnicas colonoscópicas para la detección de pólipos: un estudio egipcio
M. Abdelbary, S. Hamdy, H. Shehab, N. ElGarhy, M. Menesy, R. Marzaban
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Enhanced flat adenoma detection rate with high definition colonoscopy plus i-scan for average-risk colorectal cancer screening
Antonio Rodríguez-D´Jesus, Esteban Saperas
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The Colonoscopist's Expertise Affects the Characteristics of Detected Polyps: Da Kyoung Jung, Tae Oh Kim, Mi Seon Kang, Mo Se Kim, Min Sik Kim, Young Soo Moon; Clin Endosc 2016;49(1):61-68. Published online January 28, 2016; DOI: https://doi.org/10.5946/ce.2016.49.1.61

Abstract PDF PubReader ePub

Background
/Aims: The influence of the endoscopist on the polyp detection rate (PDR) is underappreciated in clinical practice. Moreover, flat lesions or lesions of the proximal colon are more difficult to detect. Here, we evaluated the differences in the PDR and the characteristics of detected polyps according to the experience of the colonoscopist.
Methods
We collected data on 2,549 patients who underwent screening colonoscopy performed by three fellows. The PDR was calculated according to the percentage of patients who had at least one polyp (method A) and according to the percentage of detected lesions (method B). The primary outcome included the change in the PDR, and the secondary outcome included the change in the characteristics of the detected polyps with increasing experience of the colonoscopist.
Results
No proportional correlation was found between the PDR and increasing experience in colonoscopy with method A; however, with method B, the PDR increased after 400 colonoscopies (p=0.0209). With method B, the detection rates of small polyps (<5 mm) (p=0.0015) and polyps in proximal sites (p=0.0050) increased after 300 colonoscopies.
Conclusions
Our study demonstrated that the quality of a colonoscopy, measured by using the PDR, may increase when performed by experienced fellows.

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Focused Review Series: Image Enhanced Endoscopy

Polyp Detection, Characterization, and Management Using Narrow-Band Imaging with/without Magnification: Takahiro Utsumi, Mineo Iwatate, Wataru Sano, Hironori Sunakawa, Santa Hattori, Noriaki Hasuike, Yasushi Sano; Clin Endosc 2015;48(6):491-497. Published online November 30, 2015; DOI: https://doi.org/10.5946/ce.2015.48.6.491

Abstract PDF PubReader ePub

Narrow-band imaging (NBI) is a new imaging technology that was developed in 2006 and has since spread worldwide. Because of its convenience, NBI has been replacing the role of chromoendoscopy. Here we review the efficacy of NBI with/without magnification for detection, characterization, and management of colorectal polyps, and future perspectives for the technology, including education. Recent studies have shown that the next-generation NBI system can detect significantly more colonic polyps than white light imaging, suggesting that NBI may become the modality of choice from the beginning of screening. The capillary pattern revealed by NBI, and the NBI International Colorectal Endoscopic classification are helpful for prediction of histology and for estimating the depth of invasion of colorectal cancer. However, NBI with magnifying colonoscopy is not superior to magnifying chromoendoscopy for estimation of invasion depth. Currently, therefore, chromoendoscopy should also be performed additionally if deep submucosal invasive cancer is suspected. If endoscopists become able to accurately estimate colorectal polyp pathology using NBI, this will allow adenomatous polyps to be resected and discarded; thus, reducing both the risk of polypectomy and costs. In order to achieve this goal, a suitable system for education and training in in vivo diagnostics will be necessary.

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Original Article

Endoscopic Mucosal Resection with Circumferential Incision for the Treatment of Large Sessile Polyps and Laterally Spreading Tumors of the Colorectum: Young Mi Hong, Hyung Wook Kim, Su Bum Park, Cheol Woong Choi, Dae Hwan Kang; Clin Endosc 2015;48(1):52-58. Published online January 31, 2015; DOI: https://doi.org/10.5946/ce.2015.48.1.52

Abstract PDF PubReader ePub

Background/Aims

Endoscopic mucosal resection (EMR) is the standard treatment for colorectal polyps such as adenomas and early cancers with no risk of lymph node metastasis. However, endoscopic resection of large colorectal polyps (≥20 mm diameter) is difficult to perform. We evaluated the clinical outcomes of EMR with circumferential incision (EMR-CI) for the resection of large sessile polyps (Is) and laterally spreading tumors (LSTs) in the colorectum.

Methods

Between February 2009 and March 2011, we resected 80 large colorectal polyps by EMR-CI. We retrospectively investigated the en bloc resection rate, histologic complete resection rate, recurrence rate, and complications.

Results

The median polyp size was approximately 25 mm (range, 20 to 50), and the morphologic types included Is (13 cases), LST-granular (37 cases), and LST-nongranular (30 cases). The en bloc and complete histologic resection rates were 66.3% and 45.0%, respectively. The recurrence rate was 0% (median follow-up duration, 23 months), and perforation occurred in five cases (6.3%).

Conclusions

EMR-CI is an effective treatment modality for 20 to 30 mm-sized colorectal polyps, and may be considered as a second line therapeutic option if ESD is difficult.

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Case Reports

Gastric Squamous Papilloma in a 52-Year-Old Female Patient: Hyung Ha Jang, Hyung Wook Kim, Su Jin Kim, Choel Woong Choi, Su Bum Park, Byeong Jun Song, Dong Hoon Shin, Dae Hwan Kang; Clin Endosc 2014;47(6):571-574. Published online November 30, 2014; DOI: https://doi.org/10.5946/ce.2014.47.6.571

Abstract PDF PubReader ePub

A papilloma is a benign epithelial lesion characterized by finger-like projections of tissue lined by an overgrowth of squamous cells and a core of connective tissue. We report a case of squamous papilloma on the cardia in a 52-year-old asymptomatic female. Endoscopy showed a 1-cm sized is polyp with hyperemic change originating from the cardia adjacent to the esophagogastric junction, the biopsy of which suggested a diagnosis of squamous papilloma. Endoscopic mucosal resection was performed to obtain a definite diagnosis and the polyp was completely removed. The histological result was compatible with squamous papilloma, and its surrounding tissues showed foveolar epithelium, which suggested a stomach origin. This is the first report of endoscopic resection of a gastric squamous papilloma. Squamous papilloma should be considered in the differential diagnosis of a gastric polyp, especially one in the cardia. As the prognostic value of a squamous papilloma is not well known, we recommend endoscopic resection to treat a gastric squamous papilloma, when possible.

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Overexpression of Neutrophil MMP-9 and HIF-1α May Contribute to the Finger-Like Projections Formation and Histo-Pathogenesis in Nasal Inverted Papilloma
Tao Li, Kai Sen Tan, Yan Yi Tu, Li Zhao, Jing Liu, Hsiao Hui Ong, De Yun Wang, Li Shi
Journal of Inflammation Research.2021; Volume 14: 2979. CrossRef

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A Case of Mucosa-Associated Lymphoid Tissue Lymphoma of the Sigmoid Colon Presenting as a Semipedunculated Polyp: Myung Hwan Kim, Jin Tae Jung, Eui Jung Kim, Tae Won Kim, Seon Young Kim, Joong Goo Kwon, Eun Young Kim, Woo Jung Sung; Clin Endosc 2014;47(2):192-196. Published online March 31, 2014; DOI: https://doi.org/10.5946/ce.2014.47.2.192

Abstract PDF PubReader ePub

Mucosa-associated lymphoid tissue (MALT) lymphomas are characterized by lymphoepithelial lesions pathologically. Colonic MALT lymphomas are relatively rarer than lymphomas of the stomach or small intestine. Endoscopically, colonic MALT lymphoma frequently appears as a nonpedunculated protruding polypoid mass and/or an ulceration in the cecum and/or rectum. We report a unique case of a colonic MALT lymphoma presenting as a semipedunculated polyp. A 54-year-old man was found to have a 2-cm semipedunculated polyp in the sigmoid colon during screening colonoscopy. The polyp was removed by endoscopic mucosal resection. Histologic examination of the resected polyp revealed diffuse epithelial infiltration by discrete aggregates of lymphoma cells. We diagnosed the tumor as low-grade B-cell MALT lymphoma by immunohistochemical staining.

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T Zhu, H Lei, Y -H Wang, L -P Liu, Y -L Lei, N Wang, Y -H Zheng
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Jeongmin Choi
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Jenny Tannoury, Aurélien Amiot, François Lemonnier, Jehan Dupuis, Charlotte Gagnière, Karim Belhadj, Fabien Le Bras, Iradj Sobhani, Corinne Haioun, Christiane Copie-Bergman, Michaël Lévy
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Norris Hollie, Saja Asakrah
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Juan-Juan Li, Bing-Chen Chen, Jie Dong, Yuan Chen, You-Wei Chen
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Brian L. Schwartz, Robert C. Lowe
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Min Kyung Jeon, Hoonsub So, Jooryung Huh, Hee Sang Hwang, Sung Wook Hwang, Sang Hyoung Park, Dong-Hoon Yang, Kee Don Choi, Byong Duk Ye, Seung-Jae Myung, Suk-Kyun Yang, Jeong-Sik Byeon
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Kevin Singh, Soren Gandhi, Behzad Doratotaj
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Hafsa Abbas, Masooma Niazi, Jasbir Makker
American Journal of Case Reports.2017; 18: 491. CrossRef
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Masaya Iwamuro, Hiroyuki Okada, Katsuyoshi Takata, Ryuta Takenaka, Tomoki Inaba, Motowo Mizuno, Haruhiko Kobashi, Shouichi Tanaka, Masao Yoshioka, Eisei Kondo, Tadashi Yoshino, Kazuhide Yamamoto
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Original Article

Diagnostic Yield and Therapeutic Impact of Rectal Retroflexion: A Prospective, Single-Blind Study Conducted in Three Centers: Félix Téllez-Ávila, Josué Barahona-Garrido, Sandra García-Osogobio, Gustavo López-Arce, Jesús Camacho-Escobedo, Angela Saúl, Salvador Herrera-Gómez, Javier Elizondo-Rivera, Rafael Barreto-Zúñiga; Clin Endosc 2014;47(1):79-83. Published online January 24, 2014; DOI: https://doi.org/10.5946/ce.2014.47.1.79

Abstract PDF PubReader ePub

Background/Aims

No clear data have been established and validated regarding whether rectal retroflexion has an important and therapeutic impact. The aim of the present study was to evaluate the diagnostic yield and therapeutic impact of rectal retroflexion compared with straight view examination.

Methods

A prospective single-blind study was conducted. Consecutive patients evaluated between October 2011 and April 2012 were included.

Results

A total of 934 patients (542 women, 58%) were included. The mean age was 57.4±14.8 years. Retroflexion was successful in 917 patients (98.2%). Distinct lesions in the anorectal area were detected in 32 patients (3.4%), of which 10 (1%) were identified only on retroflex view and 22 (2.4%) on both straight and retroflex views. Of the 32 identified lesions, 16 (50%) were polyps, nine (28.1%) were angiodysplasias, six (18.8%) were ulcers, and one (3.1%) was a flat lesion. All 10 patients (1%) in whom lesions were detected only by rectal retroflexion showed a therapeutic impact.

Conclusions

Rectal retroflexion has minimal diagnostic yield and therapeutic impact. However, its low rate of major complications and the possibility of detecting lesions undetectable by straight viewing justify its use.

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Case Report

A Case of Esophageal Fibrovascular Polyp That Induced Asphyxia during Sleep: Jin-Seok Park, Byoung Wook Bang, Junyoung Shin, Kye Sook Kwon, Hyung Gil Kim, Yong Woon Shin, Suk Jin Choi; Clin Endosc 2014;47(1):101-103. Published online January 24, 2014; DOI: https://doi.org/10.5946/ce.2014.47.1.101

Abstract PDF PubReader ePub

Esophageal fibrovascular polyps are rare, benign, submucosal tumors of the upper digestive tract that usually have an indolent course until the lesion attains a very large size. The most frequent complaints associated with these tumors include dysphagia and foreign body sensation. However, a long pedunculated polyp can regurgitate into the pharynx or oral cavity and cause asphyxia and sudden death if the larynx is occluded. We describe the case of a 51-year-old man who experienced snoring and occasional asphyxia during sleep. Upper endoscopy was performed, which indicated the presence of a pedunculated esophageal polyp that regurgitated into the vocal cords. The polyp was removed using a polypectomy snare and was confirmed to be a fibrovascular polyp based on pathologic examination findings. Three months after the excision of the polyp, the patient was found to be doing well without any further occurrence of asphyxia or sleep disturbances.

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Review

Gastric Polyps and Protruding Type Gastric Cancer: Jin Tae Jung; Clin Endosc 2013;46(3):243-247. Published online May 31, 2013; DOI: https://doi.org/10.5946/ce.2013.46.3.243

Abstract PDF PubReader ePub

Gastric protruding lesions are frequently encountered by health screening esophagogastroduodenoscopy. They can be classified into epithelial lesion and subepithelial lesion. Epithelial gastric lesions are generally divided into benign and malignant. Benign lesions include some types of polyps, i.e., hyperplastic polyp, fundic gland polyp, and gastric adenoma. Malignant lesions include carcinoid, early gastric cancer and advanced gastric cancer. They can be accurately diagnosed by magnifying endoscopy or narrow band imaging. Here, I will discuss benign and malignant epithelial lesions of the stomach.

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Case Report

A Case of Large Fibrovascular Polyp of the Stomach: Eun Ji Lee, Seung Goun Hong, Hae Ri Baek, Chan Bok Lee, Sang Myung Choi, Sung Jin Kim, Byoung Gy Chae, Cheul Young Choi; Clin Endosc 2013;46(2):186-188. Published online March 31, 2013; DOI: https://doi.org/10.5946/ce.2013.46.2.186

Abstract PDF PubReader ePub

A fibrovascular polyp is a rare benign disease of the upper digestive tract and is usually located in the esophagus. To our knowledge, this is the first case of gastric fibrovascular polyp presenting with melena reported in the English literature. The polyp was well visualized on endoscopy and removed with laparoscopic wedge resection. Histology confirmed fibrovascular polyp of the stomach.

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Focused Review Series: Optical Diagnosis and New Management Strategys of Colorectal Polyps

Optical Diagnosis of Small Colorectal Polyp Histology with High-Definition Colonoscopy Using Narrow Band Imaging: Amit Rastogi; Clin Endosc 2013;46(2):120-129. Published online March 31, 2013; DOI: https://doi.org/10.5946/ce.2013.46.2.120

Abstract PDF PubReader ePub

Optical diagnosis of polyp histology can potentially result in enormous cost savings by way of the "resect and discard" strategy for diminutive polyps and the "do not resect" strategy for diminutive hyperplastic polyps in the distal colon. Narrow Band Imaging (NBI) highlights the surface mucosal and vascular pattern on polyps and has been shown to accurately characterize adenomatous and hyperplastic polyps by experts. However, the results have been a little discouraging amongst lesser experienced endoscopists. Studies have also shown that using the NBI diagnosis of diminutive polyp histology, experts can accurately define the future surveillance colonoscopy intervals. However nonexperts in academic or community setting have as yet failed to achieve the recommended thresholds. The subjectivity in assessment by endoscopists leads to the variable accuracy rates and can be circumvented by computer based automated tools. Although initial experience with a few computer based algorithms have shown accuracies comparable to experts, further refinement and validation will be required before these can be implemented in clinical practice. Incorporation of optical diagnosis of diminutive polyps into clinical practice is bound to face several hurdles. But the potential for enormous cost saving makes it an attractive strategy that can make colonoscopy more cost effective.

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Randomized Controlled Trial of Self-directed Versus In-Classroom Education of Narrow Band Imaging in Diagnosing Colorectal Polyps Using the NICE Criteria
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Tools for Polyp Histology Prediction
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Introduction: What Are New Roles of Current Colonoscopy?: Hyung Wook Kim; Clin Endosc 2013;46(2):118-119. Published online March 31, 2013; DOI: https://doi.org/10.5946/ce.2013.46.2.118

Abstract PDF PubReader ePub

The recent advances in endoscopic imaging technologies make great changes in the management of colorectal polyps. These changes include optical histologic diagnosis with high definition colonscopy, new management strategies such as resect and discard or do not resect, and differentiation of depth of submucosal invasion. In this focused review series, these new paradigms in management of colorectal polyps are discussed by three, world famous authors. First, Amit Rastogi explained optical diagnosis of small colorectal polyp with high definition colonoscopy using narrow band imaging. Second, Cesare Hassan explained new paradigms for colonoscopic management of diminutive colorectal polyps: resect and discard or do not resect. In the last, Shinji Tanaka described, in detail, endoscopic assessment of invasive colorectal cancer: slight vs. deep submucosal invasion. These focused review series introduce the new roles of current colonoscopy to readers and will help the readers to know how to use the new imaging technologies and paradigms in clinical practices.

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Special Issue Articles of IDEN 2012

How Do I Manage Post-Polypectomy Bleeding?: Sung Pil Hong; Clin Endosc 2012;45(3):282-284. Published online August 22, 2012; DOI: https://doi.org/10.5946/ce.2012.45.3.282

Abstract PDF PubReader ePub

Colonoscopic polypectomy is an effective method for prevention of colorectal cancer and has become one of the most common procedures worldwide. Most colorectal polyps can be removed safely by various polypectomy techniques; however, serious complications can occur. Postpolypectomy bleeding is the most common complication of colonoscopic polypectomy, accounting for 0.3% to 6.1% of polypectomy. This issue summarizes various endoscopic techniques to treat postpolypectomy bleeding.

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Successful Treatment of Gastric Hamartomatous Polyp with Hemorrhage by Endoscopic Mucosal Resection: Jung Min Lee, M.D., Ji Hoon Baek, M.D., Hye Mi Kang, M.D., Byeng Do Min, M.D., Sang Hoon Park, M.D., Ji Woong Kim, M.D., Jin Woong Cho, M.D. and Myoung Jin Ju, M.D.*; Korean J Gastrointest Endosc 2009;39(5):300-303. Published online November 30, 2009

Abstract PDF: Hamartomatous polyp is an uncommon lesion. Most of the gastric hamartomatous polyps occur in patients in their 40s because of polyposis coli. Gastric hamartomaotus polyps are usually asymptomatic, but they occasionally manifest with hematemesis or anemia. If they are congenital, then sessile polyps in children should be observed with some measurable frequency. However, many reports have revealed that if the polyp size is big and the risk of rebleeding is high, then ESD or surgical resection can be used to completely remove them. An inverted gastric hamartomatous polyp may have an early gastric cancer component. We report here on an unusual polyp in a 14-years male who presented with hematemesis. Those were about two 3 cm sized large polyps at the proximal antrum and mid body of the stomach, respectively. The polyps were successfully removed by an endoscopic mucosal resection and the lesions were diagnosed as gastric harmatomas. (Korean J Gastrointest Endosc 2009;39:300-303)

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Endoscopic Resection of a Pedunculated Colonic Leiomyoma Resembling a Hyperplastic Polyp: Yong Wan Park, M.D., Young Seok Cho, M.D., Jin Soo Kim, M.D., Hye Sook Son, M.D., Hyung Keun Kim, M.D., Sung Soo Kim, M.D., Hiun Suk Chae, M.D. and Kyu Yong Choi, M.D.; Korean J Gastrointest Endosc 2008;37(3):218-221. Published online September 30, 2008

Abstract PDF: Colonic leiomyoma is a rare condition that accounts for 3% of all gastrointestinal leiomyomas. Many colonic leiomyomas are found incidentally and are sometimes confused with epithelial neoplasms. Most leiomyomas are removed surgically. However, a small peduculated leiomyoma can be removed endoscopically as it has the appearance of an adenomatous polyp. A 54 year-old man underwent a colonoscopic examination due to frequent loose stools. Colonoscopy demonstrated the presence of a small reddish polyp with a short stalk in the sigmoid colon. We performed a successful polypectomy by the use of colonoscopic snare electrocauterization. A pathological examination revealed the presence of a leiomyoma originating in the muscularis mucosa. We report a case of a small peduculated leiomyoma that was removed endoscopically, with a review of the literature. (Korean J Gastrointest Endosc 2008;37:218-221)

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The Pathological Differences of Colorectal Polyps Examined between the Use of a Forcep Biopsy and Endoscopic Resection: In Do Song, M.D., Jeong Wook Kim, M.D. and In Soo Oh, M.D.; Korean J Gastrointest Endosc 2008;37(1):14-19. Published online July 30, 2008

Abstract PDF: Background
/Aims: Complete excision of colorectal polyps is not always performed for various reasons. We investigated the discrepancy between the histologic findings of polyps excised by a forcep biopsy and histologic findings of polyps excised by endoscopic resection. Methods: We reviewed 137 patients with 206 colorectal polyps removed by endoscopic resection following forcep biopsies. Endoscopic records and pathological reports of patients were analyzed retrospectively. Results: The discrepancy of the histological type was 18.4% between the histologic findings of a polyp evaluated after a forceps biopsy and the histologic findings of a polyp evaluated after endoscopic resection. The discrepancy of high-grade dysplasia (HGD) and a cancerous condition was 22.3% using the two procedures. A total of 15.5% of adenomas without HGD and 3.0% of hyperplasia in the forcep biopsy specimens were identified as adenomas with HGD in the resected specimens. A total of 18.2% of adenomas with HGD and 4.1% of adenomas without HGD in the forcep biopsy specimens were identified as adenomas with carcinoma in the resected specimens. The discrepancy rates of the histological type for HGD and a cancerous condition were high for penduculated polyps with a diameter of less than 10 mm and for polyps with a diameter of greater than 16 mm. Conclusions: Approaches to review the histology of an entire colorectal polyp should be performed, especially for polyps with an adenomatous histology and for polyps of the pedunculated form with a diameter of less than 10 mm and a diameter of greater than 16 mm after a forcep biopsy. (Korean J Gastrointest Endosc 2008;37:14-19)

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A Case of Sarcoidosis Presenting as a Rectal Polyp: Wonseok Kang, M.D., Beom Kyung Kim, M.D., Min Ju Kim, M.D.^†, Jae Hee Cheon, M.D.*, Yong Chan Lee, M.D.*, Won Ho Kim, M.D.* and Sang Kil Lee, M.D.*; Korean J Gastrointest Endosc 2008;36(4):238-241. Published online April 30, 2008

Abstract PDF: Sarcoidosis is a multi-systemic syndrome with an unknown etiology that is characterized by the formation of multiple non-caseating granulomas that disrupts the architecture and function of the tissues. A 58-year-old woman was referred for a skin rash and papules. No specific findings were observed on the initial skin biopsy. On gastroscopy and colonoscopy, gastric erosion and rectal polyp were noted. The rectal biopsy revealed non-caseating granulomas without acid-fast bacilli, indicating a differential diagnosis of Crohn's disease and other granulomatous diseases. A repeat skin biopsy of the papular lesion showed non-caseating granulomas that was consistent with sarcoidosis. The chest x-ray and computed tomography (CT) revealed cardiomegaly without hilar lymphadenopathy. The serum angiotensin converting enzyme level was 122 U/L (normal: 8∼52 U/L) with normal liver chemistry as well as normal electrolyte, serum calcium and c-reactive protein levels. Finally, the patient was diagnosed with sarcoidosis with rectal involvement. We report this rare case of sarcoidosis that presented as a rectal polyp. (Korean J Gastrointest Endosc 2008;36:238-241)

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The Colonoscopic Miss Rates of Colorectal Polyps as Determined by a Polypectomy: Se Young Park, M.D., Won Moon, M.D., Seun Ja Park, M.D., Moo In Park, M.D., Kyu Jong Kim, M.D., Sun Jung Kim, M.D., Hong Jun You, M.D. and Woo Seong Jeon, M.D.; Korean J Gastrointest Endosc 2008;36(3):132-137. Published online March 30, 2008

Abstract PDF: Background
/Aims: Colonoscopy is the most effective method to detect and remove colonic polyps and for colorectal cancer screening and prevention. However, polyps are frequently missed during colonoscopy. The aim of this study was to determine the miss rates of polyps by colonoscopy and to evaluate the factors that affect the miss rates. Methods: Within sixty days after a first-time colonoscopy, consecutive polypectomies were performed in 317 patients who had one or more colon polyps. Results: The overall miss rate for polyps was 26.6%. As the withdrawal time increased, the number of polyps detected on the first colonoscopy decreased, and the miss rate decreased significantly (respectively p=0.000, p=0.028). The withdrawal time for an expert operator was shorter than the withdrawal time for a beginner operator (p=0.001). The miss rate for a beginner operator and expert operator was not different (p=0.271) due to interference with withdrawal time. The most frequent location of a polyp was the ascending colon and the most frequent size of a polyp was ≤5 mm. Conclusions: Although colonoscopy is the gold standard for colorectal polyp detection, it is imperfect even when meticulously performed. To reduce the miss rates of polyps, it is important that a careful examination with sufficient withdrawal time is performed, the colonoscopy is complete to the cecum, and that the bowel preparation is adequate. (Korean J Gastrointest Endosc 2008;36:132-137)

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A Case of Gastric and Colonic Hyperplastic Polyposis Associated with Colonic Adenomas: Jennifer Lee, M.D., Sung Eun Lee, M.D., Ye Ree Park, M.D., Shin Ae Park, M.D., Eui Hyung Kim, M.D., Kon Ho Shim, M.D., Eun Jung Jeon, M.D., Jung Hwan Oh, M.D., Sang Wook Choi, M.D. and Ki Ouk Min, M.D.*; Korean J Gastrointest Endosc 2007;35(3):196-200. Published online September 30, 2007

Abstract PDF: Hyperplastic polyps occur either sporadically or as a symptom of polyposis syndrome. When individuals exceed 50 polyps, they are diagnosed with hyperplasic polyposis. Moreover, since such cases are even more sporadic than hyperplastic polyps, the course toward this occurrence has not been properly evaluated. A change to malignancy in hyperplastic polyps is rare; however, when multiple lesions are present, the tendency increases. Colorectal polyposis syndromes with gastric polyps include familial adenomatous polyposis, Gardners syndrome, Peutz-Jeghers syndrome, juvenile polyposis and others with a non-genetic origin. Three cases of multiple colorectal hyperplastic polyposis with gastric hyperplastic polyposis have been reported worldwide; however, a case associated with multiple colonic adenomas has not yet been reported. This study reviews the existing literature and reports our recent experience of a case, in which a 53 year-old man with colorectal and gastric hyperplastic polyposis with associated multiple colonic adenomas. (Korean J Gastrointest Endosc 2007;35:196-200)

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Risk of Adenomatous Polyps in the Proximal Colon according to Age and Gender: Ho Gyun Na, M.D., Chang Hwan Choi, M.D., Sang Kil Lee, M.D., Jong Won Choi, M.D., Tae Il Kim, M.D., Ho-guen Kim, M.D.* and Won Ho Kim, M.D.; Published online February 27, 2005

Abstract PDF: Background
/Aims: Several lines of evidences suggest that the distribution of colorectal adenomatous polyps are different according to age and gender. Therefore, the efficacy of screening sigmoidoscopy for colorectal cancer not considering age and gender necessitates reappraisal. We aimed to evaluate the distributions of colorectal adenomatous polyps according to age and gender. Methods: Total of 1,886 patients (1,322 men, 564 women) who underwent colonoscopy at Severance hospital, Seoul, Korea between July 1995 and September 2002, were included. The proximal colon was defined as the colon proximal to the sigmoid-descending junction. The advanced polyp was defined as the adenomatous polyp with one or more of the following features: (1) 1 cm or larger in diameter, (2) villous histology, (3) high grade dysplasia or adenocarcimoma. Results: The risk of adenomatous polyps in the proximal colon was higher in men than women (OR, 1.63; 95% CI, 1.33∼1.99, p＜0.05), and increased with age (p＜0.05). The risk of advanced polyps in the proximal colon tended to be higher in men than women, and to increase with age, but did not reach statistical significance. Among 1,886 patients with colorectal adenomatous polyps, 587 patients (31.1%) had polyps only in the proximal colon. Among 814 patients with advanced colorectal adenomatous polyps, 217 patients (26.7%) had advanced polyps only in the proximal colon. The risks of adenomatous polyps or advanced polyps found only in the proximal colon were not different according to sex, but tended to increase with age. Conclusions: The risk of adenomatous polyps in the proximal colon was higher in men compared to women and increased with age. About one third of the patients with colorectal adenomatous polyps had polyps only in the proximal colon. Colonoscopy is a better strategy for endoscopic screening for colorectal cancer compared with sigmoidoscopy, especially, in elderly male. (Korean J Gastrointest Endosc 2005;30:66⁣74)

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Characteristics of Early Colon Cancer in Korea: Heung Up Kim, M.D., Young-Ho Kim, M.D., Sang Yong Song, M.D.*, Chung Hwan Chung, M.D., Jong Hyung Kim, M.D., Kyung Hee Kim, M.D., Sang Goon Shim, M.D.^†, Hee Jung Son, M.D., Poong-Lyul Rhee, M.D., Jae J. Kim, M.D. and Jong Chul Rhee, M.D.; Korean J Gastrointest Endosc 2004;29(3):126-132. Published online September 30, 2004

Abstract PDF: Background
/Aims: Recently, early detection and treatment of early colon cancer (ECC) has increased, and the concept of de novo carcinogenesis of colon cancer was introduced. However there were few studies in Korea. So we tried to find the incidence of ECC and the possibility of de novo colon cancer (DCC) in Korea. Methods: From Jun 1995 to Jun 2003, 3072 patients who first treated as colon cancer at Samsung Medical Center were enrolled. We selected ECC by medical record review, and pathologic slides and endoscopic photos were reviewed to evaluate the underlying tissue of cancer focus and morphologic characteristics of ECCs. ECC was defined as the cancer confined to mucosa or submucosa, and DCC was defined as the cancer lesser than 1 cm but had no adenoma component. Results: The 192 patients (6.3%) had 196 cases of ECC. The ratio of mucosal and submucosal (SM) cancers was 36.7%:63.3%. The protruded type was the most frequent type (82.1%). The depressed type was the smallest (12.9⁑6.3 mm), in size and 100% showed and SM involvement. It has significantly higher rate of the cancer without underlying adenoma component (57.1%, p＜0.001). The DCC were 6 cases and all were SM cancer and had 3 cases of protruded and depressed type each other. Conclusions: The most common shape of ECC was protruded type. However, depressed type was smaller and had higher rate of SM involvment and no adenoma component around the cancers. And we found some of DCC although the frequency was very low. (Korean J Gastrointest Endosc 2004;29:126⁣132)

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외래환자의 대장내시경 검사에서 용종제거술: Korean J Gastrointest Endosc 2001;23(5):348-348. Published online November 30, 2000

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대장 내시경을 이용한 용종 절제술의 합병증 ( Complicatian of Colonoscopic Polypectomy ): Korean J Gastrointest Endosc 2000;21(6):917-923. Published online November 30, 1999

Abstract PDF: Background
/Aims: Colonic adenomatous polyp is known as a premalignant lesion. Colonoscopic polypectomy, using for its removal and prevention of primary colon cancer has been considered as a effective and safe method. This study was conducted to assess its complication and safety of colonoscopic polypectomy. Methods: One thousand two hundred ninety three polypectomy were done using colonoscopic hot biopsy, snare polypectomy, endoscopic mucosal resection (EMR) and piecemeal polypectomy in 679 patients from 1983 to 1999, and postpolypectomy complications and its rate were evaluated. Results: 1) Postpolypectomy bleeding occured 18 cases of 1293 polypectomies (1.4%), including 10 cases of initial bleeding and 8 cases of delayed bleeding. In 9 cases (0.7%) of them hemostatic therapy were required. In delayed bleeding most cases (75%) of them occured within 66 hours after polypectomy. 2) Postpolypectomy bleeding occured in 10 cases of 982 polypectomies (1.0%) below 0.9 cm in polyp diameter, 5 cases of 242 polypectomies (2.1%) between 1.0 cm and 1.9 cm in polyp diameter and 3 cases of 69 polypectomies (4.3%) more than 2.0cm in polyp diameter (p<0.05). 3) There were no significant correlation between postpoiypectomy bleeding and polypectomy methods (p=0.06) and between postpolypectomy bleeding and gross type of polyps (p=0.40) statistically. 4) Postpolypectomy perforation occured in 1 case of 1293 polypectomies (0.1%). Estimated overall postpolypectomy complication rate including bleeding and perforation was 1.5%. Conclusions: Colonoscopic polypectomy is a relatively safe method in removing colonic polyp and its complication is related to size of polyp.

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내시경적 용종 절제술을 시행받은 대장용종 125예에 대한 후향적 연구 ( Retrospective Study of 125 Cases Colon Polyp Patients Who Underwent Colonscopic Polypectomy ): Korean J Gastrointest Endosc 2000;21(2):608-613. Published online November 30, 1999

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미세 대장 용종 : 병리조직 및 분포에 대한 임상 고찰 ( Small Colonic Polyps : Histopathology and Spatial Distribution ): Korean J Gastrointest Endosc 1999;19(1):46-50. Published online November 30, 1998

Abstract PDF: Background
/Aims: Our aims in this study were to determine histopathology and distri-bution of small colonic polyps (up to 6 mm). Small polyps were found frequently in the colon and rectum at colonoscopy. The size of polyps which should be removed endo-scopically has been controversial. Methods: Medical reports of all patients undergoing total colonoscopic examination during 8-year period were reviewed. Results: Eight hun-dred thirty-three small (up to 6 mm) colorectal polyps, removed during colonoscopy, have been analyzed. Of the small polyps, 58.8% were neoplastic, 17.7% were hyperplastic, 22.7% were inflammatory; 0.1% contained atypia, 0.1% were carcinoid, 0.6% were xan-thoma, 0.1% were adenocarcinoma. In the colon except rectum, neoplastic polyps were more common than non-neoplastic polyps. The difference in distribution of the major types of polyps in the right colon and transverse colon was significant (p ＜0.0001). Conclusions: Most small polyps proximal to the rectum are neoplastic. All polyps should be removed when encountered during colonoscopy due to the high prevalence of adenoma among small polyps. (Korean J Gastrointest Endosc 19: 46 ∼50, 1999)

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원저 : 내시경적으로 절제된 위용종 126예의 임상적 및 조직학적 고찰 ( Original Articles : Clinical and Histological Analysis of 126 Cases of Gastric Polyps ): Korean J Gastrointest Endosc 1995;15(1):40-45. Published online November 30, 1994

Abstract PDF: The gastrointestinal polyp is a premalignant lesion in varying degree. According to the size, the pathology and the location of polyps, it should be removed. Polyps in the gastrointestinal tract can be removed by surgical excision, electrosurgery, cryotherapy, regional radiotherapy and laser therapy with some limitations. Considerable advance in therapeutic endoscopy as well as in diagnostic endoscopy along with newly developed instruments has now made it possible to excise gastrointestinal polyps by means of high frequency generator. We have underwent endoscopic polypectomy, strip biopsy and "O" ring ligation on gastric polyps in 112 patients who visited in this hospital from July l988 to January 1994, and the clinical characteristics including histopathology has been evaluated. Removed polyps were variable in size from less than 0.5 cm up to 4cm. Finally, we concluded that endoscopic polypectomy is a safe and relativly simple procedure and postpolypectomy complication can be considerably reduced by conservative antiulcer therapy.

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원저 : 비 염증성 장질환에 수반되는 수지상 폴립증 - 5예의 임상-병리학적 분석 - ( Original Articles : Filiform Polyposis in Non-Inflammatory Bowel Disease - A clinicopathologic analysis of five cases - ): Korean J Gastrointest Endosc 1994;14(1):32-36. Published online November 30, 1993

Abstract PDF: Filiform polyposis(FP), an unusual form of inflammatory polyposis, has been recently designated to a lesion characterized by multiple, long slender, finger-like projections of mucosa and submucosa of the gastrointestinal tract. We present 5 cases of FP, of which two were associated with irritable bowel syndrome, two with advanced colon carcinoma, and one with active ileotyphlitis(Behcet's disease). The polyps ranged from 1.0 cm to 3 cm; they were either isolated or aggregated, and their numbers were up to 100. The common microscopic feature was filiform polyps which consisted of central submucosal core covered by intact or minimally inflamed intestinal mucosa, comparable with that in reparative processes and formation of inflammatory(redundant) pseudopolyps. We conclude that awareness of FP in non-inflammatory bowel disease may promote the endoscopists to search its underlying disease and prevent un- necessary surgical procedure. Behcets enterocolitis in the ileocecal junction seems an additional preceding disorder of a localized form of FP.

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대장미소용종 ( 5 mm 이하 ) 의 내시경적 및 조직학적 검토 - 6 mm 이상의 용종과 비교하여 - ( Diminutive Colonic Polyps ( Less than 5 mm in diameter ) : Endoscopic and Histologic Study ): Korean J Gastrointest Endosc 1993;13(4):725-732. Published online November 30, 1992

Abstract PDF: A series of 241 polyps from 127 patients endoscopically removed during the period from march 1991 through July 1992 at our department were analysed. The following items were studied. 1) Incidence, age, and sex distrlbution of the patients 2) Number of the calonic polyps 3) Histologic classification and polyp size 4) Anatomic distribution and polyp size 5) Gross types and polyp size 6) Hietopathologic types and polyp size In conclusion, colonic diminutive polyps should not be ignored or overlooked clinically. The majority were neoplastic polyps. It is suggested that diminutive polyps should be removed endoscopically if possible

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