Search Results (817)

Colorectal cancer (CRC) develops through both conventional adenoma–carcinoma and serrated neoplasia pathways, yet noninvasive screening still under-detects the advanced precursor lesions that enable true cancer prevention. Stool-based screening reduces CRC mortality, but its preventive impact remains constrained by limited detection of advanced precancerous lesions (APLs), including advanced adenomas and sessile serrated lesions. Next-generation multitarget stool DNA assays (mt-sDNA; e.g., Cologuard Plus) have established high sensitivity for CRC and specificity approaching 94%, leaving improved APL detection as the principal opportunity for innovation. This review presents a consensus framework for a multi-omic stool screening paradigm that integrates host epigenetic markers (DNA methylation) with gut microbiome features using artificial intelligence (AI). Multi-omics capture complementary layers of early tumor biology: epithelial shedding and field effects reflected in host methylation signals together with luminal ecological and inflammatory changes represented by microbial features. Evidence from cross-cohort microbiome studies indicates that microbial signatures provide an additive—rather than standalone—axis of information for CRC and its precursor lesions. Because microbiome-based models are highly susceptible to batch effects arising from collection devices, extraction chemistry, sequencing platforms, and bioinformatic pipelines, practical mitigation strategies are outlined, including harmonized pre-analytics, batch-aware study design, leakage-resistant validation, and computational harmonization. A translational roadmap linking analytical validity, locked-model development, and prospective colonoscopy-verified clinical validation is proposed, aligned with TRIPOD + AI, STARD, PROBAST-AI, SPIRIT-AI, CONSORT-AI, and DECIDE-AI reporting standards. Scenario modeling using BLUE-C prevalence estimates suggests that improving APL sensitivity from approximately 43% to 55–65% at ~94% specificity could translate to detecting roughly 13–23 additional advanced precancerous lesions per 1000 individuals screened, highlighting the potential prevention impact of a multi-omic approach. This framework aims to guide developers and clinical investigators toward next-generation stool tests capable of materially improving precursor-lesion detection while maintaining clinically acceptable specificity. Full article

Background/Objectives: Solitary rectal ulcer syndrome (SRUS) is a rare benign disorder presenting with rectal bleeding, straining, and mucosal discharge. Its pathogenesis likely involves pelvic floor dysfunction, particularly dyssynergic defecation. Although studied in adults, pediatric data—specifically anorectal manometry (ARM) findings—remain limited. We aimed to evaluate dyssynergic defecation in pediatric SRUS using ARM and analyze associated clinical, endoscopic, histopathological, and treatment data. Methods: A retrospective study of 24 children with biopsy-proven SRUS diagnosed between 2016 and 2024 was conducted. Clinical symptoms, colonoscopic, histopathological, treatment, and outcome data were reviewed. ARM was performed in 20 patients unresponsive to conservative treatment to assess anal pressures, rectal sensation, rectoanal inhibitory reflex, and balloon expulsion. Results: The median age was 13 years, with male predominance. Rectal bleeding was the most common symptom (95.8%). Colonoscopy revealed predominantly solitary ulcerative lesions 5–10 cm from the anal verge. Dyssynergic defecation was detected in 60% of patients, and only 25% could expel the balloon. Resting anal pressures were lower than reference values. Treatments included diet, laxatives, and topical agents, with partial or complete clinical response in approximately 60% of patients after 12 months. Conclusions: Pediatric SRUS is strongly associated with dyssynergic defecation. More pediatric-specific manometric studies are needed to optimize diagnosis and guide targeted therapies. Full article

Colorectal cancer, as a malignant tumor with a high incidence rate worldwide, relies on the precise segmentation of polyps during colonoscopy for its early diagnosis. However, clinical colonoscopy images often face challenges such as low contrast, blurred boundaries, large differences in morphological scale, and interference from intestinal wall folds, resulting in insufficient accuracy of traditional segmentation methods. To address the above problems, this paper proposes a PCA-TransUNet model based on the parallel cross-attention mechanism, taking TransUNet as the baseline framework and introducing the parallel cross-attention module in its skip connections. This module consists of two branches: channel cross-attention and spatial cross-attention. The channel branch enhances the semantic feature discrimination through cross-scale channel interaction, while the spatial branch optimizes the boundary positioning accuracy by using long-range dependency relationships. The outputs of the two are adaptively integrated through a dynamic weighted fusion mechanism to form multi-scale enhanced features, significantly improving the segmentation robustness in complex scenarios. Experiments on the CVC-ClinicDB and Kvasir-SEG datasets show that the model proposed in this paper outperforms the comparison models in multiple indicators. PCA-TransUNet achieved mIoU of 92.89% and Dice of 95.79% on CVC-ClinicDB, and 90.81% and 95.25%, respectively, on Kvasir-SEG, providing reliable technical support for clinical auxiliary diagnosis. Full article

Background/Objectives: The use of GLP-1 RAs has dramatically increased with expanded indications for diabetes mellitus and obesity. Delayed gastric emptying due to these medications can lead to increased residual gastric content (RGC). While previous studies have focused on Esophagogastroduodenoscopy (EGD), few have specifically analyzed the impact of GLP-1 RAs on residual gastric content in patients undergoing concurrent colonoscopy with adequate bowel preparation. Methods: A retrospective, case–control study was conducted at Shanghai East Hospital from January 2023 to June 2025. Adult patients with increased RGC were identified as cases. Controls without increased RGC were randomly selected at a 1:2 ratio, matched for age and sex. Multivariable logistic regression was used to assess the independent association between GLP-1 RAs use and increased RGC. Results: Among 131,255 procedures screened, 3746 patients were included (1257 with increased RGC and 2489 controls). GLP-1 RAs users had higher odds of increased RGC in both unadjusted [OR 15.20 (95% CI 5.98–38.61)] and adjusted analyses [aOR = 13.31 (95% CI 5.07–34.93)]. Other significant risk factors for RGC included diabetes-related complications [aOR = 8.89 (3.15–25.12)]. Interestingly, among the enrolled patients who used GLP-1 RAs and underwent concurrent colonoscopy, 19 of the 22 patients (86.4%) exhibited increased RGC, whereas only 3 (13.6%) did not. Conclusions: Perioperative use of GLP-1 RAs is associated with an increased residual gastric content in patients undergoing EGD alone or with concurrent colonoscopy. There was no aspiration event related to residual gastric content. Our study highlights the need for vigilant preoperative assessment and individualized periprocedural management in patients on GLP-1 RAs undergoing endoscopic procedures, despite having standardized adequate bowel preparation. Full article

Foreign material is an uncommon finding in routine gastrointestinal histopathology, but may occasionally contribute to disease pathogenesis or create diagnostic pitfalls. We report two illustrative cases highlighting the diverse clinical and histologic implications of ingested plant material. The first case involves a 10-year-old boy who presented with clinical features consistent with acute appendicitis and underwent appendectomy. Although gross examination revealed a macroscopically unremarkable appendix, histological evaluation demonstrated mucosal ulceration associated with an impacted plant seed within the appendiceal lumen, supporting a diagnosis of obstructive acute appendicitis. The second case describes a 60-year-old woman undergoing a screening colonoscopy, during which a small sessile lesion in the transverse colon was resected. Histologic examination revealed no colonic mucosa; instead, the specimen consisted entirely of plant material, morphologically consistent with a tomato seed, representing an incidental finding mimicking a colonic polyp. These cases underscore that plant seeds, while rare, may act as obstructive agents in appendicitis or simulate true pathological lesions during endoscopic and histologic evaluation. Awareness of the characteristic microscopic features of plant material is essential to avoid misdiagnosis and to recognise their potential clinical and forensic relevance. Full article

Objectives: Disruptions in circadian-related behaviors are emerging as potential risk factors for gastrointestinal cancers. This study investigated the independent and joint associations of nightly fasting duration and sleep duration with the risk of colorectal cancer (CRC) among community-dwelling Chinese older adults. Methods: Participants were drawn from the Guangzhou CRC Screening Program, which used a questionnaire-based investigation, two separate fecal occult blood tests (FOBTs) for risk evaluation, and colonoscopy for high-risk individuals. Of the 347,297 people initially screened, 197,507 individuals were finally included after excluding 100,930 cases with missing eating/sleeping data or unknown/benign lesions via colonoscopy. Among the final sample, 351 CRC cases and 1384 precancerous lesions were diagnosed, while 195,772 individuals had negative results. Habitual times for dinner, breakfast, bedtime, and wake-up were used to define nightly fasting duration (dinner-to-breakfast) and nightly sleep duration (bedtime-to-wake). Multivariable logistic regression, subgroup analyses, and sensitivity analyses were performed to evaluate the associations. Results: In the fully adjusted models, each 1-h increment in nightly fasting duration was associated with a 9.5% (95% CI 1.039–1.153) higher risk of CRC, and the direct association was limited to individuals over 60 years (OR = 1.147, 95% CI 1.073–1.226), while each 1-h increment in nightly sleep duration was associated with a 15.2% (95% CI 0.806–0.893) lower risk of CRC. Consistently, earlier dinner, later breakfast and later bedtime were also associated with a higher CRC risk. Conclusions: In Guangzhou older residents, long nightly fasting duration was a risk factor for CRC, especially among individuals over 60 years old; while long nightly sleep duration was protective. These findings suggest that maintaining adequate sleep and optimizing the nightly fasting window may be viable lifestyle strategies for CRC prevention, emphasizing the need for tailored preventive measures for different age groups. Full article

Background and Aims: Adequate bowel preparation is the cornerstone of high-quality colonoscopy. The Boston Bowel Preparation Scale (BBPS) is the gold standard for assessment, yet its application suffers from inter-observer variability and lacks a fully automated solution for entire video analysis. This study proposes EndoClean, a novel, fully automated deep learning framework designed to compute the full-segment BBPS score from colonoscopy videos, aiming to provide a standardized, objective, and near expert-level assessment. Methods: EndoClean integrates three distinct models: frame selection, anatomical segmentation, and BBPS scoring. Its performance was rigorously evaluated against a reference standard established by senior experts and compared with junior endoscopists. We assessed assessment precision, inter-rater agreement (quadratic weighted Kappa), and consistency across all colonic segments. Results: The EndoClean system demonstrated superior reliability, achieving a global accuracy of 97.8% for the total BBPS score, with satisfying agreement with senior experts (κ = 0.984; 95% CI: 0.976–0.989). Notably, EndoClean performed significantly better than junior endoscopists in overall BBPS agreements (κ: 0.984 vs. 0.949, p < 0.001) and overall accuracy (97.8% vs. 94.6%, p = 0.037). In segment-specific analysis, the EndoClean surpassed junior doctors particularly in the transverse colon (Accuracy: 97.5% vs. 90.4%, p < 0.001) and effectively reduced misclassifications in clinically ambiguous intermediate scores. For binary adequacy classification, the system achieved a sensitivity of 98.2% and a specificity of 97.3%. Conclusions: EndoClean represents a robust solution in automated quality control, demonstrating performance comparable to senior experts in bowel preparation assessment. By significantly reducing the variability seen in junior endoscopists and providing objective, full-video BBPS scoring, this framework offers a viable, standardized, and efficient solution for clinical practice and large-scale quality monitoring. Full article

Background/Objectives: Histological healing, primarily assessed by the absence of neutrophils in mucosal biopsies, is increasingly used to evaluate treatment efficacy in inflammatory bowel disease (IBD) and may identify residual inflammation despite endoscopic mucosal healing. We aimed to quantify histological parameters commonly linked to active disease in patients with endoscopic healing and to explore their association with neutrophil-defined histologic activity in endoscopically healed mucosa. Methods: We assessed 371 colonoscopies from IBD patients with an endoscopic report of mucosal healing at a reference center. For each procedure, we recorded the number of biopsy samples obtained and histologic features according to ECCO consensus/position statements, including neutrophil infiltration, lymphoplasmacytic infiltrate, eosinophil infiltrate, and mucosal lesions. Results: Histologic activity was found in 21/98 (21.4%) procedures with one to three biopsy samples and in 89/273 (32.6%) procedures with more than three samples (p = 0.04). Neutrophils were absent in 207/212 (97.6%) procedures with normal lymphoplasmacytic infiltrate versus 55/159 (34.6%) with increased lymphoplasmacytic infiltrate (p < 0.00001). Eosinophils were below cut-off values in 122/168 (72.6%) procedures with normal lymphoplasmacytic infiltrate versus 90/203 (44.3%) with increased lymphoplasmacytic infiltrate (p < 0.00001). Eosinophils were below cut-off in 148/168 (88.1%) procedures without neutrophils and in 114/203 (56.2%) with neutrophils in the lamina propria (p < 0.00001). Conclusions: In IBD patients with endoscopic healing, the extent of biopsy sampling is associated with the detection of histologic activity. Lymphoplasmacytic and eosinophil infiltrates are strongly associated with neutrophil presence and are associated with neutrophil-defined activity and may serve as supportive indicators prompting closer pathological assessment in endoscopically healed mucosa. Full article

Background: Cancer screening disparities remain understudied, particularly among underrepresented groups at the county level. This study compared the use of preventive breast and colorectal cancer screening services between sexual and gender minority (SGM) adults and cisgender heterosexual adults in Missouri. Methods: The 2022 Missouri County-Level Study, a probabilistic survey of health-related behaviors in each county, was used to estimate breast and colorectal cancer (BC and CRC) screening prevalence. Screening prevalence was calculated using weighted samples, and regression models were used to adjust for demographic composition and age eligibility for both cancer sites. Results: Compared to cisgender heterosexual adults (n = 48,257), SGM adults (n = 2801) were significantly younger and more likely to reside in urban areas and be employed. Statewide, county-representative prevalence of breast cancer screening in the last 2 years was 75.6%, and colorectal cancer screening (i.e., colonoscopy in the last 10 years or sigmoidoscopy in the last 5 years) was 63.1%. In age-adjusted models for BC screening for participants (ages 40–74), age had a curvilinear association, increasing at younger ages but declining in later years. For CR screening (ages 45–75), age showed a strong, stable, positive effect. SGM adults had similar odds of breast cancer screening; however, for CRC, SGM adults had higher odds of ever being screened but similar odds to cisgender heterosexual adults of up-to-date screening. Differences largely reflect eligibility windows and initiation versus maintenance dynamics. Conclusions: In this large sample of Missouri county residents, breast cancer and colorectal cancer screening rates were comparable between SGM adults and cisgender heterosexual adults for up-to-date screening probability. Improving statewide cancer prevention will require addressing the broader structural and regional barriers that suppress screening uptake across Missouri communities. Impact: These findings demonstrate the importance of using age-appropriate, guideline-aligned analyses to accurately assess cancer screening equity and avoid overstating disparities among SGM populations. By identifying where differences do not exist, this work helps focus resources on the structural and regional barriers that continue to limit cancer prevention for all Missourians. Full article

Background: Cytomegalovirus (CMV) reactivation is frequently observed in patients with moderate-to-severe ulcerative colitis (UC), particularly in steroid-refractory cases; however, the clinical significance of tissue CMV DNA detection by polymerase chain reaction (PCR) in the absence of classical histopathological findings remains controversial. Methods: This retrospective cohort study included 110 patients with moderate-to-severe UC who underwent colonoscopy between January 2021 and April 2024 at a tertiary referral center. Tissue and serum samples were analyzed for CMV DNA using PCR. Tissue CMV DNA positivity was defined as ≥250 copies. Endoscopic disease activity was assessed using the Mayo clinical score, Mayo endoscopic score, and the Rachmilewitz Endoscopic Activity Index. Associations between tissue CMV DNA positivity, endoscopic activity scores, inflammatory markers, recent immunosuppressive therapy, and serum CMV PCR results were evaluated. Sensitivity analyses using different tissue CMV DNA thresholds and receiver operating characteristic (ROC) curve analysis for serum CMV PCR were also performed. Results: Tissue CMV DNA positivity was detected in 37.3% of patients. Patients with tissue CMV DNA positivity had significantly higher Mayo clinical scores and Rachmilewitz Endoscopic Activity Index scores compared with CMV-negative patients, whereas Mayo endoscopic scores did not differ significantly between groups. Serum CMV PCR levels were markedly higher in patients with tissue CMV DNA positivity (p < 0.001). Tissue CMV DNA copy number showed a strong correlation with serum CMV PCR levels but did not demonstrate a consistent linear association with endoscopic activity scores. In multivariable logistic regression analysis, recent corticosteroid use was independently associated with tissue CMV DNA positivity, while anti-TNF therapy and endoscopic activity indices were not independent predictors. ROC analysis demonstrated good diagnostic performance of serum CMV PCR for predicting tissue CMV DNA positivity (AUC = 0.82). Conclusions: In patients with moderate-to-severe UC, tissue CMV DNA positivity (≥250 copies) is associated with increased clinical and endoscopic disease activity, even in the absence of classical histopathological evidence of CMV infection. These findings suggest that molecular detection of CMV in colonic tissue may provide clinically relevant information in selected patient populations, particularly those with recent corticosteroid exposure. However, tissue CMV DNA positivity should be interpreted as a molecular association rather than definitive evidence of causality or an indication for antiviral therapy. Prospective multicenter studies are warranted to further clarify the clinical implications of tissue CMV DNA detection in UC. Full article

Background: Acromegaly is a rare, chronic, systemic, and progressive disease characterized by an excess secretion of growth hormone (GH) and increased circulating insulin-like growth factor 1 (IGF-1) concentrations, typically due to a macroadenoma in the pituitary gland. Both GH and IGF-1 are implicated in cancer promotion based on experimental and epidemiological data, but research findings remain conflicting and population-based data are scarce. Although there is a high mortality rate among acromegalic patients due to cardiovascular diseases, cancer is the third leading cause of death. Aim: The aim of the present study was to assess the risk of different types of cancer in acromegaly and the impact of changes in disease control and patient outcomes over time. Methods: Patients diagnosed with acromegaly at the Ankara University Ibn-i Sina Hospital Endocrinology and Metabolic Diseases Department between 2015 and 2019 were included in this study. Data including demographic data, history of cancer, size of adenoma (micro or macro), serum IGF-1 and GH levels at the time of diagnosis, serum prostate-specific antigen (PSA), thyroid ultrasonography, and, if needed, thyroid fine needle aspiration cytology (TFAC), colonoscopy, and mammography results were collected from patient records retrospectively. Results: We screened 83 patients, and 78 patients with the compensatory data (female/male: 39/39, 50%/50%) were included. The mean age of patients was 49.4 ± 11.9 years and 41.7 ± 12.1 years at the time of diagnosis. The median duration of follow-up was 72 (12–420) months. Periodic thyroid ultrasonography was performed in 65/78 (83.3%) of the patients, and a colonoscopy and mammography were also conducted in 27/78 (34.6%) and 32/39 (82%) of the patients at least once over the course of the disease, respectively. Cancer was detected in 17/78 (21.7%) of the patients; 11/78 (14.1%) of them had well-differentiated thyroid cancer and 2/39 (5.1%) had breast cancer. Prostate cancer, renal cell carcinoma, pancreatic cancer, malignant chordoma, schwannoma, and colon cancer were detected in one patient each. The increased cancer risk in acromegalic patients did not correlate with age, sex, age at diagnosis, time to diagnosing acromegaly, duration of acromegaly, GH and IGF-1 levels at diagnosis, pituitary adenoma size, or Ki-67 levels. Conclusions: Cancer was detected in 21.7% of the acromegaly patients, 14.1% of whom had well-differentiated thyroid cancer. In this study, we demonstrated that thyroid cancer is the most common malignancy in Turkish acromegalic patients, consistent with the results of previous studies. The increased cancer risk in acromegalic patients did not correlate with age, sex, age at diagnosis, time to diagnosing acromegaly, duration of acromegaly, or GH and IGF-1 levels at diagnosis. Full article

Background/Objectives: Ampullary adenomas are neoplasms of the gastrointestinal tract with malignant potential. They are thought to develop through pathways similar to those involved in colorectal neoplasia. This study aimed to determine the prevalence of colonic polyps in patients with ampullary adenoma. Methods: This retrospective study included a total of 35 patients with ampullary adenoma diagnosed between 2023 and 2024 and 105 sex-matched controls. Colonoscopic findings of the patient and control groups were compared with respect to polyp prevalence. In addition, the effects of dysplasia grade of the ampullary adenoma and patient age on polyp prevalence were evaluated. Results: The study included 35 patients (57% male) and 105 controls (59% male). The mean age was 67.06 ± 13.32 years in patients and 61.28 ± 8.42 years in controls. Colonic polyps were detected in 13 (57%) patients in the low-grade dysplasia (LGD) group, 6 (66%) patients in the high grade dysplasia (HGD) or adenocarcinoma group, and 54 (51%) patients in the control group (p = 0.02). After adjusting for age, colonic polyps remained significantly more frequent in the adenoma group than in controls (p = 0.05). Polyp prevalence was not associated with dysplasia grade on ampullary biopsy, and no significant differences were observed between groups regarding polyp histopathology, location, or size. Conclusions: In conclusion, our study indicates that colorectal polyp prevalence is increased among patients with ampullary adenomas and that this association may be independent of age as well as dysplasia severity. Therefore, colonoscopic evaluation may be recommended for all patients diagnosed with ampullary adenoma. Full article

Background and Objectives: Colorectal cancer (CRC) is the most common gastrointestinal malignancy in Oman and among the top three cancers nationally, with an increasing burden of early-onset CRC (EOCRC) diagnosed before age 50. Despite national CRC guidelines, the lack of an organized screening program means most cases are detected symptomatically and at advanced stages. This study evaluated age-related differences in colonoscopic findings and advanced neoplasia risk in symptomatic adults to inform early detection and screening strategy development. Materials and Methods: A cross-sectional analysis of 2041 colonoscopies performed at two national tertiary referral centers, Sultan Qaboos University Hospital and Royal Hospital, was conducted (2018–2021). Patients were categorized by age (<50 vs. ≥50 years). Outcomes included adenoma detection rate (ADR), advanced premalignant lesions (APL), colorectal cancer (CRC), and advanced colorectal neoplasia (ACRN; APL and/or CRC). Associations between presenting symptoms and ACRN were analyzed using univariable logistic regression, and diagnostic yield was estimated via number needed to scope (NNS). The cohort was predominantly symptomatic (71.9%), with 15.8% screening and 12.3% surveillance procedures. Results: Of 2041 procedures, 742 (36.3%) were in patients <50 years. ADR, APL, CRC, and ACRN were significantly higher in those ≥50 years (14.9%, 7.5%, 5.8%, and 13.3%) than in younger adults (8.5%, 3.2%, 2.7%, and 5.9%; all p < 0.01). Among younger adults, rectal bleeding (OR 2.17, 95% CI 1.15–4.08, p = 0.026) and abdominal pain (OR 2.14, 95% CI 1.15–3.98, p = 0.022) were significantly associated with ACRN. Diagnostic efficiency (NNS) was highest for loss of appetite in both age groups (4.7 in <50 vs. 2.8 in ≥50 years). Despite lower overall rates, a substantial burden of advanced neoplasia was observed in symptomatic adults <50 years (5.9% ACRN, 2.7% CRC). Conclusions: This bicenter study demonstrates clear age-related disparities in colorectal neoplasia, with a clinically important burden of advanced disease in symptomatic adults under 50 years. These findings highlight the importance of prompt colonoscopic evaluation for younger adults presenting with alarm symptoms, particularly rectal bleeding and abdominal pain, and provide evidence supporting risk-stratified diagnostic approaches. While age-related differences suggest potential value in earlier screening initiation, our predominantly symptomatic tertiary care cohort cannot directly determine optimal screening age thresholds. Prospective screening trials and cost-effectiveness analyses are needed to establish population-based detection rates and inform evidence-based screening policy development in Oman. Full article

Background/Objectives: Adequate bowel preparation (BP) is crucial for effective colorectal cancer (CRC) surveillance in ulcerative colitis (UC). While active inflammation is known to negatively impact cleansing, data regarding predictors of BP quality specifically in UC patients with inactive disease remain limited. This study aimed to investigate risk factors for inadequate BP in UC patients in clinical/endoscopic remission and to compare the efficacy of 1L-PEG-ASC versus 2L-PEG regimens. Methods: A multicentric, retrospective, cohort study was conducted across eight Italian centers. Consecutive adult outpatients with UC undergoing colonoscopy between January-2021 and December-2022 who were in endoscopic and clinical remission were included. Boston Bowel Preparation Scale (BBPS) was assessed in patients undergoing 1L-PEG-ASC or 2L-PEG bowel preparation. Univariable and multivariable logistic regression analyses were performed to identify risk factors for inadequate BP and compare outcomes between PEG regimens. Results: A total of 379 patients were included (58% M, mean age 52.3 ± 15.4 years). The overall rate of adequate BP was 90.5%. Traditional risk factors, including demographic, clinical, and endoscopic characteristics, were not predictive of inadequate preparation in this remission cohort. Comparing regimens, 1L-PEG-ASC yielded significantly higher median total BBPS scores compared to 2L-PEG (8 [IQR 7–9] vs. 6 [IQR 6–8]; p < 0.001) and a higher exam completion rate (99.5% vs. 95.7%; p = 0.02), although the difference in adequate BP rates did not reach statistical significance (92.6% vs. 87.7%; p = 0.12). Multivariable analysis confirmed that 2L-PEG was independently associated with lower odds of achieving higher BBPS scores (OR 0.30; 95% CI 0.20–0.45). Conclusions: In UC patients with clinical and endoscopic remission, BP adequacy rates are high and comparable to the general population, suggesting that traditional IBD-related risk factors are less relevant in the absence of active inflammation. However, the 1L-PEG-ASC regimen demonstrated superior cleansing quality and exam completion rates compared to 2L-PEG. These findings support the prioritization of 1L-PEG-ASC to optimize mucosal visualization during CRC surveillance in this population. Full article

Background: The incidence of colorectal cancer diagnosed before age 50 has been increasing worldwide. However, limited data describe the endoscopic and pathological features of colorectal lesions encountered and treated during routine colonoscopy in younger adults. This study aimed to characterize age-related differences in endoscopically resected colorectal neoplasia. Methods: We conducted a retrospective, single-center observational study of consecutively endoscopically resected colorectal neoplasia at a high-volume academic teaching hospital in Japan. Patient-level and lesion-level characteristics were compared between early-onset (<50 years) and later-onset (≥50 years) groups. Lesions were evaluated for location, morphology, size, histology, resection method, and advanced neoplasia status. Results: A total of 1299 patients with 3399 lesions were analyzed, including 498 early-onset patients with 940 lesions. Early-onset neoplasia showed a left-sided predominance, with higher proportions in the distal colon and rectum. Pedunculated morphology was more frequently observed in early-onset lesions. Early-onset disease was also associated with larger lesion size, a higher prevalence of high-grade tubular adenoma, and increased rates of advanced adenoma and advanced neoplasia, resulting in more frequent use of endoscopic mucosal resection or submucosal dissection. Conclusions: Endoscopically resected colorectal lesions in younger adults exhibit distinct anatomical and morphological features compared with later-onset cases, indicating heterogeneity at the premalignant stage. Full article