Search Results (206)

Background/Objectives: In routine practice, colonoscopy findings are saved as unstructured free text, limiting secondary use. Accurate named-entity recognition (NER) is essential to unlock these descriptions for quality monitoring, personalized medicine and research. We compared named-entity recognition (NER) models trained on real, synthetic, and mixed data to determine whether privacy preserving synthetic reports can boost clinical information extraction. Methods: Three Spark NLP biLSTM CRF models were trained on (i) 100 manually annotated Romanian colonoscopy reports (ModelR), (ii) 100 prompt-generated synthetic reports (ModelS), and (iii) a 1:1 mix (ModelM). Performance was tested on 40 unseen reports (20 real, 20 synthetic) for seven entities. Micro-averaged precision, recall, and F1-score values were computed; McNemar tests with Bonferroni correction assessed pairwise differences. Results: ModelM outperformed single-source models (precision 0.95, recall 0.93, F1 0.94) and was significantly superior to ModelR (F1 0.70) and ModelS (F1 0.64; p < 0.001 for both). ModelR maintained high accuracy on real text (F1 = 0.90), but its accuracy fell when tested on synthetic data (0.47); the reverse was observed for ModelS (F1 = 0.99 synthetic, 0.33 real). McNemar χ² statistics (64.6 for ModelM vs. ModelR; 147.0 for ModelM vs. ModelS) greatly exceeded the Bonferroni-adjusted significance threshold (α = 0.0167), confirming that the observed performance gains were unlikely to be due to chance. Conclusions: Synthetic colonoscopy descriptions are a valuable complement, but not a substitute for real annotations, while AI is helping human experts, not replacing them. Training on a balanced mix of real and synthetic data can help to obtain robust, generalizable NER models able to structure free-text colonoscopy reports, supporting large-scale, privacy-preserving colorectal cancer surveillance and personalized follow-up. Full article

Background/Objectives: The effectiveness of 1 L PEG-ASC preparation in inflammatory bowel disease (IBD) patients is still unclear. The aim of this study was to determine the efficacy and safety of 1 L PEG-ASC in a series of IBD patients. Methods: Data from a study conducted on a series of 284 patients collected in three centers between 2020 and 2025 were analyzed. The primary outcome was cleansing success whereas success in the right colon, polyp detection, adverse events, and patient reported outcomes were secondary endpoints. Results: The mean age was 43.28 ± 12.21 years and 170 (59.8%) patients were male. Out of 141 ulcerative colitis (UC) patients, 45 (32%) presented with a Mayo score of 3. The Mean Simple Endoscopic Score Crohn’s Disease (SES-CD) score in CD patients was 7.2 ± 7.04. Overall and right colon cleansing success were reported in 267 patients (94.2%), of which 134 CD (93.9%) and 133 UC (94.6%) patients (p = 0.81). The overall BBPS score was 7.47 ± 1.44, specifically 7.52 ± 1.23 in CD and 7.40 ± 1.62 in UC patients (p = 0.76). Overall, 19 patients (6.7%) were diagnosed with polyps with a mean number of polyps per colonoscopy of 0.08 ± 0.03. The preparation was completely taken by 264 (92.9%) patients, and 247 patients (86.9%) declared their willingness to repeat the bowel preparation. Severe nausea was observed in 1 (0.3%) patient and no other severe adverse events were recorded. Conclusions: The 1 L PEG-ASC preparation is well-tolerated and safe in IBD patients. Full article

Background/Objectives: White light imaging (WLI) of colonoscopy has a 26% adenoma miss rate. We aimed to evaluate the effectiveness of an additional 30 s (Add-30s) observation of the right-sided colon using a novel system (EVIS X1; Olympus Co.) with texture and color enhancement imaging (TXI). Methods: We reviewed 515 patients who underwent colonoscopy with Add-30s TXI between February 2021 and December 2023 at three affiliated hospitals. After initial right-sided colon observation with WLI, the colonoscope was reinserted into the cecum, and the right-sided colon was re-observed with Add-30s TXI. Adenoma and sessile serrated lesion (SSL) detection rate (ASDR) and adenoma detection rate (ADR) were examined. Multivariate analysis identified factors influencing lesion detection using the Add-30s TXI. The difference in WLI and TXI between the novel and previous scopes was performed using propensity score matching (PSM). The efficacy of WLI with the novel system was compared to that of the previous system. Results: Among the 515 cases, Add-30s TXI observation increased right-sided ADR and ASDR by 7.4% and 9.5%, respectively. The multivariate analysis showed novel scope as an independent factor for adenoma and SSL detection (odds ratio: 2.41, p < 0.01). Right-sided ADR and ASDR for Add-30s TXI were significantly higher in the novel scope than the previous scope (ADR, 25.2% vs. 15.3%; p = 0.04; ASDR, 32.4% vs. 18.9%; p = 0.02). ASDR for WLI observation was significantly higher in the novel system than the previous system (34.8% vs. 25.9%; p < 0.01). Conclusions: Add-30s TXI significantly improved the detection of missed adenomas and SSLs in the right-sided colon. Full article

The gut microbiota has emerged as a key area of biomedical research due to its integral role in maintaining host health and its involvement in the pathogenesis of many systemic diseases. Growing evidence supports the notion that gut dysbiosis contributes significantly to diseases and their progression. An example would be inflammatory bowel disease (IBD), a group of conditions that cause inflammation and swelling of the digestive tract, with the principal types being ulcerative colitis (UC) and Crohn’s disease (CD). Another notable disease with significant association to gut dysbiosis would be colorectal cancer (CRC), a malignancy which typically begins as polyps in the colon or rectum, but has the potential to metastasise to other parts of the body, including the liver and lungs, among others. Concurrently, advances in nanomedicine, an evolving field that applies nanotechnology for disease prevention, diagnosis, and treatment, have opened new avenues for targeted and efficient therapeutic strategies. In this paper, we provide an overview of the gut microbiota and the implications of its dysregulation in human disease. We then review the emerging nanotechnology-based approaches for both therapeutic and diagnostic purposes, with a particular focus on their applications in IBD and CRC. Full article

Enterotoxigenic Bacteroides fragilis (ETBF) promotes colitis-associated cancer through the Bacteroides fragilis toxin (BFT), which induces colonic inflammation that can be exacerbated by external stimuli. We found that BALB/c mice infected with ETBF and treated with azoxymethane and dextran sodium sulfate (DSS) developed numerous distal colon polyps more rapidly than B6 mice, suggesting strain differences in ETBF-induced tumorigenicity. Using a bft gene-deficient ETBF strain, we confirmed BFT’s crucial role in ETBF-promoted tumorigenesis and inflammation. While both 1% and 2% DSS induced comparable polyp formation, 1% DSS minimized mortality, proving sufficient for maximizing polyp development. Mechanistically, BFT-mediated tumorigenesis involves NF-κB/CXCL1 signaling in colonic epithelial cells exposed to BFT and DSS, a pathway known to be critical for inflammation and cancer progression. This model provides a valuable platform for dissecting ETBF’s colitis-associated cancer-promoting mechanisms, particularly those involving BFT, and for evaluating BFT-targeted therapeutic interventions. Full article

Background: Synthetic and pseudosynthetic images can be used to extend colonoscopy datasets, which, in turn, are used to train AI-detection models, yet their clinical acceptability depends on whether medical professionals can still recognize non-real content. Aim: To quantify the ability of practicing gastroenterologists to discriminate real, pseudosynthetic, and synthetic polyp images and to determine how training level and synthesis method impact detection. Materials and Methods: A total of 32 Romanian gastroenterologists (18 residents and 14 seniors) reviewed 24 images (8 real, 8 augmented, 4 CycleGAN, and 4 diffusion) via an online form. Classification accuracy, 95% confidence intervals (CI), class sensitivity and precision, 3 × 3 confusion matrices, and Fleiss’ κ were calculated. Resident vs. senior differences were tested with Pearson χ²; CycleGAN versus diffusion detectability was analyzed with the Wilcoxon signed-rank test (α = 0.05). Results: Overall accuracy was 61.2% (95% CI 57.7–64.6). Residents and seniors performed similarly (62.3% vs. 59.8%; χ²₁ = 0.38, p = 0.54). Sensitivity/precision were 70.7%/62.2% for real, 51.6%/58.9% for augmented, and 61.3%/62.1% for synthetic images. Collapsing to “real vs. non-real” yielded 70.7% sensitivity and 78.5% specificity for real images. CycleGAN images were always recognized as synthetic (128/128; 97.1–100% CI), whereas diffusion images were correctly classified only 22.7% of the time (16.3–30.6%; Wilcoxon p < 0.001). The training level did not impact detection performance (χ²₂ < 1.2, p > 0.5). Inter-rater agreement was fair (κ = 0.30, 95% CI 0.15–0.43). Conclusions: Clinicians detect non-real colonoscopy images only slightly above chance, irrespective of experience. The diffusion synthesis method creates images that escape human scrutiny, suggesting the need for automated authenticity safeguards before synthetic datasets are applied in clinical or AI-validation contexts. Full article

Background: Colon capsule endoscopy (CCE) or panenteric capsule endoscopy (PCE) offers a promising, non-invasive diagnostic approach for patients with iron deficiency anaemia (IDA). However, high rates of conversion to conventional colonoscopy (CCC) following capsule procedures reduce cost-effectiveness and patient satisfaction. Optimising the faecal immunochemical test (FIT) threshold may improve patient stratification and reduce unnecessary conversions in future applications within the IDA diagnostic pathway. Methods: The CLEAR IDA study was a multicentre, retrospective observational study conducted across four UK hospitals. Data were collected over a six-month study period and included patients referred via the two-week-wait (2WW) cancer pathway for iron deficiency, with or without anaemia, over a 12-month timeframe. Colonoscopy findings were analysed and extrapolated using NHS England’s CCE-to-colonoscopy referral criteria to assess the predictive value of FIT for colorectal cancer (CRC), polyp burden, and CCC using ROC curve analysis. The optimal FIT threshold was identified through three complementary approaches: threshold-based analysis, decision curve analysis, and cost–benefit modelling. Results: A total of 1531 patients were analysed; only 1.6% underwent small bowel capsule endoscopy. The diagnostic accuracy (AUC) of FIT for predicting CRC, polypoidal lesions, and CCC was 0.78, 0.58, and 0.69, respectively. Threshold-based analysis identified FIT = 15 µg/g as the lowest level at which CCC rates significantly increased (p = 0.02; OR = 1.87; 95% CI: 1.07–3.14). Decision curve analysis showed a maximum net benefit at FIT = 17.6 µg/g, while cost–benefit modelling identified 9 µg/g as the most cost-effective. Raising the threshold to 10 µg/g resulted in a net loss of GBP –294.4 per patient. An optimal cost-effective FIT threshold range was identified between 10 and 17.6 µg/g. The threshold selection should be tailored to local service capacity and resource availability. Conclusions: While FIT alone is an imperfect triage tool, optimising thresholds between 10 and 17 µg/g may enhance cost-effectiveness and guide appropriate PCE use in IDA. Full article

A recent comprehensive pan-cancer study indicated the high translational potential of the transcript PHF19-207 as a biomarker for colon cancer. This study aimed to analyze the expression of PHF19-207 in colon tissue samples from two different settings to evaluate its clinical utility for diagnosis and screening. Surgical samples of colon tumor and non-tumor tissue were analyzed to determine the diagnostic value of PHF19-207 and its potential correlation with tumor characteristics. Additionally, biopsied samples from individuals undergoing national colorectal cancer screening were examined to assess the potential use of PHF19-207 in early detection. PHF19-207 expression levels were measured in all samples using Real-Time Polymerase Chain Reaction. A statistically significant difference was observed between tumor and non-tumor tissue (p = 0.002) and between tumor tissue and healthy mucosa samples (p < 0.001). Furthermore, polyp samples exhibited significantly higher PHF19-207 expression compared to healthy mucosa (p = 0.035). Receiver operating characteristic (ROC) analysis indicated that PHF19-207 can effectively differentiate malignant from healthy tissue, with an AUC value of 0.9044. Considering the increasing incidence of colorectal cancer in younger populations and the need for improved early detection, PHF19-207 expression could be explored as the basis for a relatively simple and efficient test, enabling a more comprehensive and affordable screening strategy. Full article

The gut microbiota plays an important role in the development of colorectal tumors. However, the underlying mechanisms remain unclear. In this study, we examined the effects of fecal microbiota transplantation (FMT) on azoxymethane (AOM)-induced colorectal tumors in obese mice. We divided the study subjects into the following five groups: high-fat diet (HFD), normal diet (ND), ND+exercise (Ex), HFD+FMT from ND-alone donor (HFD+FMT(ND alone)), and HFD+FMT from ND+Ex donor (HFD+FMT(ND+Ex)). The Ex group performed treadmill exercise for 15 weeks. Thereafter, fecal and colonic mucus samples were extracted for microbiome analysis. The deoxyribonucleic acid sample was collected from the feces and colonic mucosa, and V3–V4 amplicon sequencing analysis of the 16S rRNA gene was performed using MiSeq. The number of polyps was significantly lower in the ND (6.0 ± 1.6) and ND+Ex (1.8 ± 1.3) groups than in the HFD group (11.4 ± 1.5). The ND+Ex group had significantly fewer polyps than the ND group. The HFD+FMT(ND alone) (5.2 ± 0.8) and HFD+FMT(ND+Ex) (2.8 ± 2.6) groups also had significantly fewer polyps than the HFD group. The IL-15 mRNA levels in the colonic tissues were significantly higher in the HFD+FMT(ND alone) group than in the ND group. Fecal ω-muricholic acid concentrations were significantly higher in the HFD+FMT(ND alone) group than in the ND group and in the HFD+FMT(ND+Ex) group than in the ND+Ex group. The ND, ND+Ex, HFD+FMT(ND alone), and HFD+FMT(ND+Ex) groups had a significantly higher abundance of Lacyobacillaceae than the HFD group. In the FMT group, Erysipelotrichaceae and Tannerellaceae were significantly less abundant. Compared with the HFD group, the ND, ND+Ex, HFD+FMT(ND alone), and HFD+FMT(ND+Ex) groups had a significantly higher abundance of Muribaculaceae and a significantly higher abundance of Lactobacillaceae and Rikenellaceae in common among the ND and ND+Ex groups. The common and significantly less common species were Bacteroidaceae in the FMT group and Lactobacillaceae and Rikenellaceae in the ND alone and ND+Ex groups. Bacteroidaceae and Lachnospiraceae were significantly less common in the FMT group. We found that FMT inhibited AOM-induced colorectal tumorigenesis in obese mice. Furthermore, the fecal concentrations of short-chain fatty acids, bile acids, microbiota, and mucosa-associated microbiota differed between the FMT and diet/EX groups, suggesting that the inhibitory effect of FMT on colorectal tumorigenesis may be due to mechanisms different from those of ND alone and ND+Ex. Full article

Purpose: The aim of this review is to provide a contemporary update on the current management approaches and options with specific considerations in malignant rectal polyps. Methods: A literature review was carried out in PubMed, Embase and Cochrane databases using the keywords “malignant” and “polyp*”. Only publications in English language were included. Results: Histopathological features including margins, depth of invasion, tumour grade, LVI and tumour budding determines the risk of lymph node metastasis in malignant polyps. Rectal malignant polyps should be considered differently compared to their colonic counterpart. A low threshold should be considered for utilising transrectal excision to fully excise the polyp and to assess the margins. The rates of complete pathological response associated with total neoadjuvant therapy as well as the advent of “watch and wait” adds to the complexity of managing malignant rectal polyps. Conclusions: The management of malignant colorectal polyps lies in risk-stratifying patients who will benefit from an oncological resection. Full article

Colorectal cancer (CRC) remains one of the leading causes of cancer-related death worldwide. The precursor of CRC is a colorectal polyp, of which adenoma is the most common histological type. The initial step in CRC development is the gradual accumulation of a series of genetic and epigenetic alterations in the normal colonic epithelium. Genetic alterations play a major role in a subset of CRCs, but the pathophysiological contribution of epigenetic aberrations has recently attracted attention. Epigenetic marks occur early in cancer pathogenesis and are therefore important molecular hallmarks of cancer. This makes some epigenetic alterations clinically relevant for early detection not only of CRC but also of precancerous polyps. In this review we focus on three types of non-coding RNAs as epigenetic regulators: miRNA, lncRNA, and lncRNAs, highlighting their biomarker potential. Full article

Staphylococcus aureus (S. aureus) colonizes the nasal cavities of both healthy individuals and patients with chronic rhinosinusitis (CRS) with (CRSwNP) and without (CRSsNP) nasal polyps. Treatment-resistant S. aureus biofilms and intracellular persistence are common in CRS patients, requiring the expression of specific virulence factor genes to transition into these forms. We hypothesized that S. aureus isolates from non-diseased controls, CRSsNP patients, and CRSwNP patients would exhibit distinct virulence factor patterns contributing to persistence and intracellular survival in CRS patients. Nasal swabs from seventy-seven individuals yielded S. aureus cultures in eight non-diseased controls, eight CRSsNP patients, and five CRSwNP patients. Whole-genome sequencing analyzed stress, antimicrobial resistance, and virulence genes, including plasmids and prophages. Four virulence factor gene patterns emerged: a core set (hlgA, icaC, hlgB, hlgC, hld, and aur) present in all isolates, and accessory sets, including the enterotoxin gene cluster (seo, sem, seu, sei, and sen) and a partial/complete invasive virulence factor set (splE, splA, splB, lukE, and lukD) (p = 0.001). CRSwNP isolates exhibited incomplete carriage of the core set, with frequent loss of scn, icaC, and hlgA (p < 0.05). These findings suggest that S. aureus has clusters of virulence factors that may act in concert to support the survival and persistence of the bacteria, resulting in enhanced pathogenicity. This may manifest clinically with resistant disease and refractoriness to antibiotics. Full article

Microplastics have emerged as a pervasive marine contaminant, with extreme concentrations reported in deep-sea sediments (e.g., 1.9 million particles/m²) and localized accumulations near Antarctic research stations. Particular concern has been raised regarding their synergistic effects with co-occurring antibiotics, which may potentiate toxicity and facilitate antibiotic resistance gene dissemination through microbial colonization of plastic surfaces. To investigate these interactions, a 185-day controlled exposure experiment was conducted using Aurelia aurita polyps. Factorial combinations of microplastics (0, 0.1, 1 mg/L) and tetracycline (0, 0.5, 5 mg/L) were employed to simulate environmentally relevant pollution scenarios. Microbiome alterations were characterized using metagenomic approaches. Analysis revealed that while alpha and beta diversity measures remained unaffected at environmental concentrations, significant shifts occurred in the relative abundance of dominant bacterial taxa, including Pseudomonadota, Actinomycetota, and Mycoplasmatota. Metabolic pathway analysis demonstrated perturbations in key functional categories including cellular processes and environmental signal transduction. Furthermore, microplastic exposure was associated with modifications in polyp life-stage characteristics, suggesting potential implications for benthic–pelagic population dynamics. These findings provide evidence for the impacts of microplastic–antibiotic interactions on cnidarian holobionts, with ramifications for predicting jellyfish population responses in contaminated ecosystems. Full article

Objectives: Inflammatory fibroid polyps, also known as Vanek’s tumors, are rare benign lesions of the gastrointestinal tract. Although the exact cause remains unclear, several theories suggest an association with inflammatory processes and genetic factors. This study aims to present the largest cohort of inflammatory fibroid polyp cases to date, analyzing their clinical presentation, diagnostic methods, and treatment approaches. Materials and methods: A retrospective multicentric analysis was conducted on 67 patients diagnosed with inflammatory fibroid polyps between 2013 and 2023 across four hospitals. Clinical data regarding tumor location, size, symptoms, and treatment were collected. Non-parametric statistical tests, including the chi-square test, Cramér’s V coefficient, and the Mann–Whitney U test, were used to identify association between tumor characteristics, location, and treatment outcomes. Results: The cohort included 67 patients (58.2% female, median age 60 years). The stomach was the most common tumor site (47.8%), followed by the colon (32.8%), and small intestine (10.4%). The majority of patients (73.1%) were asymptomatic, while 9% experienced intestinal obstruction, all of which were located in the small intestine. Endoscopic resection was successful in 77.6% of cases, but surgical intervention was more frequently required for tumors in the small intestine. A significant association was found between larger tumor size, emergency presentation, intestinal location, and the need for surgery. Conclusions: Inflammatory fibroid polyps are commonly managed with endoscopic resection, particularly in gastric and colonic locations. However, small intestinal tumors more often need surgical treatment, especially when presenting with complications like intestinal obstruction. Full article

Background/Objectives: Artificial intelligence (AI) integration in colon polyp detection often exhibits high sensitivity but notably low specificity in real-world settings, primarily due to reliance on publicly available datasets alone. To address this limitation, we proposed a semi-automatic annotation method using real colonoscopy videos to enhance AI model performance and reduce manual labeling labor. Methods: An integrated AI model was trained and validated on 86,258 training images and 17,616 validation images. Model 1 utilized only publicly available datasets, while Model 2 additionally incorporated images obtained from real colonoscopy videos of patients through a semi-automatic annotation process, significantly reducing the labeling burden on expert endoscopists. Results: The integrated AI model (Model 2) significantly outperformed the public-dataset-only model (Model 1). At epoch 35, Model 2 achieved a sensitivity of 90.6%, a specificity of 96.0%, an overall accuracy of 94.5%, and an F1 score of 89.9%. All polyps in the test videos were successfully detected, demonstrating considerable enhancement in detection performance compared to the public-dataset-only model. Conclusions: Integrating real-world colonoscopy video data using semi-automatic annotation markedly improved diagnostic accuracy while potentially reducing the need for extensive manual annotation typically performed by expert endoscopists. However, the findings need validation through multicenter external datasets to ensure generalizability. Full article