Search Results (275)

Objective: To evaluate the extent of intraoperative bacterial and tumour cell spillage during minimally invasive colorectal surgery and to assess the protective value of systematic specimen retrieval using a tear-proof extraction bag. Methods: This multicentre, prospective observational study included patients undergoing conventional or single-port laparoscopic colorectal surgery for adenocarcinoma, premalignant polyps, or chronic diverticulitis. Three intraoperative samples were obtained for microbiological and cytological analysis: after pneumoperitoneum induction (sample 1), after vascular ligation and bowel division (sample 2), and after specimen extraction using a retrieval bag (sample 3). Results: Eighty-eight patients were included. Bacterial contamination increased significantly throughout the procedure occurring in 11.4% of sample 1, 37.5% of sample 2, and 67% of sample 3 (p < 0.001). When sample 1 was positive, sample 2 was positive in 100% of cases; when sample 2 was positive, sample 3 was positive in 79% of cases. In 33 patients (37.5%), bacterial growth was detected exclusively in sample 3. Contamination in sample 2 was significantly associated with surgical approach (p = 0.013), anastomotic technique (p = 0.022), and malignant disease (p = 0.038). A longer hospital stay was significantly associated with contamination in samples 1 and 2 (p = 0.014 and p < 0.001, respectively). No tumour cells were detected in any sample, except for one case showing atypical cells without clinical relevance in sample 3. Conclusions: Intraoperative bacterial contamination progressively increases during minimally invasive colorectal surgery, peaking after specimen extraction. Most clinical and surgical variables did not significantly influence contamination rates. The use of a specimen retrieval bag demonstrated a potential protective effect by containing bacterial spillage. However, no protective effect regarding tumour cell dissemination could be demonstrated based on cytology analysis. Full article

Colonoscopy is central to colorectal cancer (CRC) prevention, and its effectiveness is determined by the quality of mucosal inspection and lesion detection. The adenoma detection rate (ADR) remains the most widely validated quality benchmark due to its strong inverse association with interval CRC. However, reliance on ADR alone is increasingly recognized as insufficient, particularly given the growing understanding of the serrated neoplasia pathway, which contributes up to one-third of sporadic CRCs. This has driven the emergence of complementary metrics, such as the sessile polyp detection rate (SPDR) and adenomas per colonoscopy (APC). Although SPDR offers important advantages for capturing serrated pathology, challenges persist, including interobserver variability, inconsistent pathology thresholds, limited endoscopist training, and the absence of standardized benchmarks. Alongside these evolving metrics, technological advancements such as image-enhanced endoscopy, computer-aided detection, high-definition optics, and distal attachment devices have demonstrated measurable improvements in detecting subtle lesions and reducing operator-dependent variability. Large real-world registries, including GIQuIC, now support the development and validation of composite models that integrate ADR, SPDR, and APC to better reflect the full spectrum of neoplasia detection. As the field advances, redefining colonoscopy quality will require reconciling established metrics with newer indicators that more comprehensively address both conventional adenomas and serrated lesions. Full article

Inorganic polyphosphate is highly conserved, critical, yet poorly understood polymer that regulates diverse cellular functions in mammals. Its importance is well established in coagulation, inflammation, mitochondrial function, and stress responses, though the molecular mechanisms for these effects remain only partly understood. Fundamental questions also persist regarding its physiological concentration, chain-length distributions, and the mechanisms that regulate its behavior in specific cellular compartments. Progress is limited by the absence of a known mammalian polyphosphate-synthesizing enzyme. Despite this, recent studies have broadened the scope of polyphosphate biology, suggesting roles in protein phase separation, ATP-independent chaperone activity, metabolic regulation, and intracellular signaling. Polyphosphate modulates the mitochondrial permeability transition pore through calcium-dependent regulation and activates factor XII in coagulation. Findings have also introduced potential connections between polyphosphate and processes such as neurodegeneration, cancer, and tissue regeneration. Despite this expanding landscape, many biological effects remain difficult to interpret due to incomplete mapping of protein targets and longstanding technical limitations in detecting and quantifying polyP. This review integrates molecular protein-interaction mechanisms with compartment-specific functions and disease physiology, providing a clearer mechanistic framework while identifying key conceptual and methodological gaps and outlining priorities for advancing polyphosphate research in mammalian systems. Full article

Background and Clinical significance: Cowden syndrome is an autosomal dominant disorder caused by germline loss-of-function mutations in the PTEN tumor suppressor gene. It is characterized by multiple hamartomas and an increased lifetime risk of malignancies affecting the breast, thyroid, endometrium, and gastrointestinal (GI) tract. Pediatric presentations may include macrocephaly, scrotal tongue, and intellectual disability. Gastrointestinal involvement is frequent, with juvenile-like hamartomatous polyps occurring in at least half of patients and distributed throughout the GI tract, posing a risk for malignant transformation. Early diagnosis and surveillance are crucial for improving patient outcomes. Case Presentation: We report a case of a 10-year-old Caucasian female with Cowden syndrome, with a history of a malignant germ cell tumor of the ovary consisting of a yolk sac tumor and low-grade immature teratoma diagnosed at age six, and thyroidectomy at age nine. The patient has mild intellectual disability. Routine radiological surveillance revealed a right colon intraluminal mass, prompting referral for pediatric gastroenterology evaluation. Endoscopy identified multiple polyps throughout the colon, stomach, and small intestine. Polypectomy of larger lesions was performed, and histopathology confirmed juvenile-like hamartomatous polyps without dysplasia or malignancy. This case highlights the necessity of comprehensive gastrointestinal evaluation in pediatric Cowden syndrome patients. Endoscopic surveillance is essential for early detection and management of polyps. Conclusions: Given the multisystem involvement and elevated cancer risk associated with PTEN mutations, a multidisciplinary approach that includes genetic counseling, dermatologic evaluation, and ongoing oncologic monitoring is recommended. Increased awareness of gastrointestinal manifestations enables timely intervention and may reduce morbidity and mortality in this high-risk population. Full article

Background: Less than 1% of all colorectal cancers (CRCs) are primary colorectal signet-ring cell carcinomas (SRCCs), which represent an uncommon and aggressive histological subtype. Given their subtle onset and rapid progression, these are often diagnosed in an advanced stage, and can be distinguished by the presence of mucin-producing signet-ring cells. Synchronous colonic metastases at initial diagnosis are rather uncommon. Case presentation: We report the case of a 65-year-old male patient who underwent a routine colonoscopy following a positive fecal immunochemical test (FIT). The patient had no remarkable medical history and was asymptomatic. A 3 cm semi-pedunculated polyp and several smaller depressed lesions, 2 cm maximum in diameter, were observed in the descending colon during the colonoscopy. Multiple biopsies were obtained. The lesions were found to be SRCC according to histopathological examination. There was no sign of extra-colonic metastases on the computed tomography (CT). The patient was referred for extensive hemicolectomy, regional lymphadenectomy, and adjuvant chemotherapy. Conclusions: This article provides a thorough literature review on this uncommon presentation and discussion regarding the current understanding of the pathogenesis, clinical manifestations, and management strategies of SRCC. This case highlights the importance of routine screening in detecting aggressive malignancies like SRCC in asymptomatic individuals. Early identification through colonoscopy can lead to timely intervention, potentially improving prognosis. Full article

Accurate and real-time detection of polyps in colonoscopy is a critical task for the early prevention of colorectal cancer. The primary difficulties include insufficient extraction of multi-scale contextual cues for polyps of different sizes, inefficient fusion of multi-level features, and a reliance on hand-crafted anchor priors that require extensive tuning and compromise generalization performance. Therefore, we introduce a one-stage anchor-free detector that achieves state-of-the-art accuracy whilst running in real-time on a GTX 1080-Ti GPU workstation. Specifically, to enrich contextual information across a wide spectrum, our Cross-Stage Pyramid Pooling module efficiently aggregates multi-scale contexts through cascaded pooling and cross-stage partial connections. Subsequently, to achieve a robust equilibrium between low-level spatial details and high-level semantics, our Weighted Bidirectional Feature Pyramid Network adaptively integrates features across all scales using learnable channel-wise weights. Furthermore, by reconceptualizing detection as a direct point-to-boundary regression task, our anchor-free head obviates the dependency on hand-tuned priors. This regression is supervised by a Scale-invariant Distance with Aspect-ratio IoU loss, substantially improving localization accuracy for polyps of diverse morphologies. Comprehensive experiments on a large dataset comprising 103,469 colonoscopy frames substantiate the superiority of our method, achieving 98.8% mAP@0.5 and 82.5% mAP@0.5:0.95 at 35.8 FPS. Our method outperforms widely used CNN-based models (e.g., EfficientDet, YOLO series) and recent Transformer-based competitors (e.g., Adamixer, HDETR), demonstrating its potential for clinical application. Full article

We report a case of a patient admitted to our coronary intensive care unit with chest pain and elevated cardiac troponin. Coronary angiography showed no obstructive coronary artery disease. The patient had a history of chronic rhinosinusitis and nasal polyps, treated with dupilumab. Laboratory tests revealed marked hypereosinophilia, prompting a cardiac MRI, which showed findings consistent with eosinophilic myocarditis. This diagnosis was later confirmed by endomyocardial biopsy. This case highlights the importance of differential diagnosis in cases of myocardial injury (characterized by increased cardiac troponin) and underscores the value of CMR as the most accurate non-invasive technique for detecting myocarditis. Full article

The presence of subtle mucosal abnormalities makes small bowel Crohn’s disease (SBCD) and other gastrointestinal lesions difficult to detect, as these features are often very subtle and can closely resemble other disorders. Although the Kvasir and Esophageal Endoscopy datasets offer high-quality visual representations of various parts of the GI tract, their manual interpretation and analysis by clinicians remain labor-intensive, time-consuming, and prone to subjective variability. To address this, we propose a generalizable ensemble deep learning framework for gastrointestinal lesion detection, capable of identifying pathological patterns such as ulcers, polyps, and esophagitis that visually resemble SBCD-associated abnormalities. Further, the classical convolutional neural network (CNN) extracts shallow high-dimensional features; due to this, it may miss the edges and complex patterns of the gastrointestinal lesions. To mitigate these limitations, this study introduces a deep learning ensemble framework that combines the strengths of EfficientNetB5, MobileNetV2, and multi-head self-attention (MHSA). EfficientNetB5 extracts detailed hierarchical features that help distinguish fine-grained mucosal structures, while MobileNetV2 enhances spatial representation with low computational overhead. The MHSA module further improves the model’s global correlation of the spatial features. We evaluated the model on two publicly available DBE datasets and compared the results with four state-of-the-art methods. Our model achieved classification accuracies of 99.25% and 98.86% on the Kvasir and Kaither datasets. Full article

Colorectal cancer (CRC) is the second most common global malignancy with high mortality, and timely early polyp detection is critical to halt its progression. Yet, polyp image segmentation—an essential tool—faces challenges: blurred edges, small sizes, and artifacts from intestinal folds, bubbles, and mucus. To address these, we proposed a novel segmentation model with multi-scale feature extraction. Its encoder uses Multiscale Attention-based Pyramid Vision Transformer v2 (PVTv2) for hierarchical features (lower-stage modules expand receptive field), while the decoder adopts a Parallel Multi-level Aggregation structure, plus multi-branch and improved reverse attention modules. Ablation experiments validated key modules. Compared to nine state-of-the-art networks across five benchmarks, the model showed superiority: optimal mDice/mIoU on polyp datasets, 0.2% higher mDice than MEGANet on Kvasir-SEG, and outperformance over UHA-Net and CSCA-U-Net on CVC-ClinicDB. Full article

Background/Objectives: Ulcerative colitis (UC) is a chronic inflammatory bowel disease that significantly increases the colorectal cancer (CRC) risk. This study used nationwide data on intractable diseases to clarify the clinical epidemiology of UC-related CRC in Japan. Methods: Patients diagnosed with UC between FY 2003 and 2011 were included. The relative incidence ratio (RR) was calculated using the standardized incidence ratio from the National Cancer Registry. To compare prognostic factors, outcomes were evaluated using the Cox proportional hazards model analysis for cancer occurrence, and a prognostic prediction model was developed using machine learning. Results: Among 78,556 patients with UC, CRC was identified in 141 patients. The RR of CRC peaked in both males and females in the 25–39 age group. Univariate analysis revealed several risk factors, including pseudo-polyps observed during endoscopy (hazard ratio 2.92, p = 0.001), abnormal crypt architecture (hazard ratio 3.14, p < 0.001), and dysplasia (hazard ratio 11.31, p < 0.001) in biopsy. Conversely, 5-ASA was associated with reduced CRC risk (hazard ratio 0.36, p = 0.003). The machine learning model categorized patients into three groups, demonstrating that the group with the highest number of patients with pancolitis had a significantly higher risk of CRC than did the other groups. Conclusions: Pseudo-polyps and dysplasia represent CRC risk factors in patients with UC. Additionally, machine learning analysis indicates that pancolitis in individuals in their 50s increases the risk of colon cancer, while proctitis in those in their 30s raises rectal cancer risk. These findings aim to enhance early detection and improve prevention efforts for UC-related CRC. Full article

Objectives: Colorectal cancer (CRC) is the second-deadliest cancer globally, with an estimated 52,900 additional deaths expected in the United States by 2025. Early detection through colonoscopy significantly reduces CRC mortality by enabling the removal of pre-cancerous polyps. However, manual visual inspection of colonoscopy images is time-consuming, tedious, and prone to human error. This study aims to develop an automated and reliable polyp segmentation and classification method to improve CRC screening. Methods: We propose a novel deep learning architecture called µ-Net for accurate polyp segmentation in colonoscopy images. The model was trained and evaluated using the Kvasir-SEG dataset. To ensure transparency and reliability, we incorporated Explainable AI (XAI) techniques, including saliency maps and Grad-CAM, to highlight regions of interest and interpret the model’s decision-making process. Results: The µ-Net model achieved a Dice coefficient of 94.02%, outperforming other available segmentation models in accuracy, indicating its strong potential for clinical deployment. Integrating XAI provided meaningful visual explanations, enhancing trust in model predictions. Conclusions: The proposed µ-Net framework significantly improves the Precision and efficiency of automated polyp screening. Its ability to segment, classify, and interpret colonoscopy images enables early detection and supports clinical decision-making. This comprehensive approach offers a valuable tool for CRC prevention, ultimately contributing to better patient outcomes. Full article

Sessile serrated lesions (SSLs) are well-known precursors of colorectal cancer in the general population, but their role in inflammatory bowel disease (IBD) is less clear. This narrative review summarizes what is known about the prevalence, molecular features, endoscopic detection, malignant potential, and management of SSLs in patients with IBD, highlighting where evidence supports action nowadays and where prospective studies are urgently needed. IBD-associated colorectal cancer has long been considered a consequence of the inflammation–dysplasia–carcinoma sequence, distinct from the conventional adenoma–carcinoma pathway. Increasing evidence, however, suggests that the serrated pathway, typically characterized by SSLs and traditional serrated adenomas (TSAs), may also contribute to IBD-related oncogenesis. This review synthesizes histopathological, molecular, endoscopic, and clinical data on SSLs in patients with IBD, with contextual reference to TSAs, sessile serrated lesions with dysplasia, and serrated epithelial change only when relevant to their interpretation or risk stratification. SSLs are now more frequently identified in IBD surveillance, especially in ulcerative colitis and the proximal colon, although prevalence estimates remain heterogeneous due to evolving definitions and significant interobserver variability. Molecular studies indicate that IBD-associated serrated lesions often harbor BRAF mutations but display a lower CpG island methylator phenotype than their sporadic counterparts, suggesting an inflammation-modified biology. While most hyperplastic polyps and non-dysplastic SSLs appear to pose limited neoplastic risk, dysplastic serrated lesions carry a markedly higher likelihood of synchronous or metachronous advanced neoplasia. Advances in high-definition endoscopy and chromoendoscopy improve the detection of these subtle, mucus-capped, flat lesions, while endoscopic resection is nowadays feasible in expert hands. Future priorities should include prospective multicenter cohorts integrating molecular profiling to refine surveillance strategies. Full article

Gastrointestinal disorders, such as colorectal cancer (CRC), pose a substantial health burden worldwide, showing increased incidence rates across different age groups. Detecting and removing polyps promptly, recognized as CRC precursors, are crucial for prevention. While traditional colonoscopy works well, it is vulnerable to specialist errors. This study suggests an AI-based diminutive sessile polyp localization assistant utilizing the YOLO-V8 family. Comprehensive evaluations were conducted using a diverse dataset that was assembled from various available datasets to support our investigation. The final dataset contains images obtained using two imaging methods: white light endoscopy (WLE) and narrow-band imaging (NBI). The research demonstrated remarkable results, boasting a precision of 96.4%, recall of 93.89%, and F1-score of 94.46%. This success can be credited to a meticulously balanced combination of hyperparameters and the specific attributes of the comprehensive dataset designed for the colorectal polyp localization in colonoscopy images. Also, it was proved that the dataset selection was acceptable by analyzing the polyp sizes and their coordinates using a special matrix. This study brings forth significant insights for augmenting the detection of diminutive sessile colorectal polyps, thereby advancing technology-driven colorectal cancer diagnosis in offline scenarios. This is particularly beneficial for gastroenterologists analyzing endoscopy capsule images to detect gastrointestinal polyps. Full article

Video Capsule Endoscopycapsule endoscopy (VCE) has emerged as a minimally invasive diagnostic tool for detecting and monitoring small bowel involvement in polyposis syndromes. VCE is included in the surveillance guidelines of Peutz-Jeghers syndrome. In the remaining familial polyposis syndromes, VCE may facilitate the early detection of polyps, when indicated, particularly in areas beyond the reach of conventional endoscopy, thereby aiding timely detection. Colon capsule endoscopy has been studied in symptomatic, screening and polyp surveillance populations and the second-generation colon capsule has demonstrated excellent detection rates for advanced neoplasia, however its role in colonic polyposis requires further research. The role of the panenteric capsule has not been explored in polyposis syndromes as a panintestinal examination. Despite its advantages, VCE has notable limitations; it may miss small, flat, or hidden lesions and lacks the capability for tissue sampling or therapeutic intervention. In the future, advances in imaging technology, extended battery life, and the integration of artificial intelligence (AI) are expected to further enhance the utility of VCE. Our review aims to focus on the applications of VCE in polyposis syndromes and future perspectives. Full article

Background and aim: The necessity and diagnostic yield of routine gastroscopy in Fecal Immunochemical Test (FIT)-positive patients with normal colonoscopy findings remains controversial and poorly defined. Here, we aimed to investigate the prevalence and clinical significance of upper gastrointestinal lesions detected by gastroscopy in FIT-positive patients, stratified by normal and abnormal colonoscopy findings. Methods: This retrospective study included 38,392 adults (≥18 years) who tested positive for FIT between 2016 and 2022 across eight medical centers in Israel. Of them, 1560 patients underwent routine bi-directional endoscopic evaluation and were included in the final analysis. Comprehensive procedural data were retrieved, including detailed colonoscopic and gastroscopic findings. Colonoscopy outcomes included the detection of neoplastic and precancerous lesions, with the rates of adenoma and polyp detection calculated. Gastroscopy findings, including gastritis, hiatal hernia, esophagitis, duodenitis, peptic ulcer disease, and malignancy, were analyzed and compared between patients with normal and abnormal colonoscopy results. Results: Among 38,392 FIT-positive adults, 1560 underwent bidirectional endoscopy; of these, 632 (40.5%) had normal and 928 (59.5%) had abnormal colonoscopy findings. Gastroscopy revealed upper GI findings in both groups, with gastritis detected in 55.5% (normal colonoscopy) vs. 48.7% (abnormal colonoscopy), hiatal hernia in 15% vs. 14.9%, esophagitis in 9.0% vs. 10.3%, and duodenitis in 6.6% vs. 7.3%. Gastric ulcers were rare, observed in 0.95% of patients with normal colonoscopy and 1.29% with abnormal colonoscopy. No cases of upper gastrointestinal malignancy were detected in either group. Conclusions: Routine gastroscopy in FIT-positive patients demonstrates limited diagnostic yield, with clinically significant upper gastrointestinal lesions being rare. Full article