Faculty Bibliography

BACKGROUND/UNASSIGNED:Early-onset colorectal cancer (EOCRC), diagnosed in adults under the age of 50 years, is a significant public health challenge in the United States (US). While traditional colorectal cancer (CRC) incidence in older populations has declined due to screening, rates among younger adults are rising, likely driven by shifting birth cohort exposures to modifiable risk factors. This study aims to quantify the longitudinal burden of EOCRC and evaluates the contribution of dietary and metabolic risks from 1990 to 2023. METHODS/UNASSIGNED:Using data from the Global Burden of Disease (GBD) 2023 study, we analyzed age-specific incidence, mortality, prevalence, and disability-adjusted life years (DALYs) for EOCRC. Trends were evaluated using joinpoint regression to calculate annual percent changes (APCs). Risk factor attribution was performed for dietary, metabolic, and behavioral exposures. Future burdens were projected to 2050 using mixed-effects and autoregressive integrated moving average (ARIMA) models. RESULTS/UNASSIGNED:Between 1990 and 2023, the age-specific incidence rate (ASIR) of EOCRC increased by 47.1%, rising from 8.01 to 11.79 per 100,000. Age-specific mortality rose from 2.48 to 3.00, and DALYs increased from 125.41 to 150.82. Males consistently carried a higher burden, with widening sex disparities in incidence by 2023 (13.10 in males versus 10.44 in females). By 2023, diet high in processed meat (18.4%) surpassed diet low in whole grains (17.6%) as the leading modifiable contributor to EOCRC mortality, followed by high body-mass index and smoking. Under a risk-reduction scenario, projected mortality could decline by more than 50% by 2050 (1.14 per 100,000) compared to the reference trend (2.42 per 100,000). CONCLUSIONS/UNASSIGNED:The EOCRC burden in the US has intensified over three decades. The shifting dominance toward processed meat and metabolic dysfunction highlights a critical need for targeted primary prevention. Achieving significant mortality reductions by 2050 will require population-level interventions addressing dietary quality and metabolic health early in life.

BACKGROUND:Cholecystectomy (CCY) is one of the most commonly performed abdominal surgeries in the USA. However, limited population-level data are available that evaluate the long-term risk of colorectal cancer (CRC) following CCY. In this study, we aimed to assess the association between CCY and the risk of developing CRC. METHODS:We conducted a retrospective cohort study using the TriNetX research network. We identified adult patients (≥ 18 years) with a history of CCY between 2010 and 2024. These patients were matched using propensity score matching with adult patients without a history of CCY. Matching was based on demographics, comorbidities, and CRC risk factors. The primary outcome was the risk of first diagnosis of CRC that occurred after the index event (cholecystectomy). Secondary outcomes assessed included colon cancer, rectal cancer, and subsite-specific cancers involving the right-sided, transverse, and descending/sigmoid colon. Subgroup analyses were performed by gender and age categories. With censoring applied, Kaplan-Meier analysis with adjusted hazard ratios (aHRs) and 95% CIs was used to compare time-to-event rates at daily time intervals. RESULTS:A total of 613,396 patients with a history of CCY were matched 1:1 to controls (mean age 48.5 ± 18.1 years; 68.1% female; 71.2% White). CRC was more common in the CCY group (1.11 vs 0.61%; aHR 2.16, 95% CI 2.08-2.25; p < 0.001). CRC risk was elevated in both sexes, with a stronger association in males (aHR 2.57, 95% CI 2.41-2.73; p < 0.001) than females (aHR 1.93, 95% CI 1.83-2.04; p < 0.001). CRC risk following CCY was elevated across all age groups, with the highest overall CRC risk observed in patients aged 18-45 years (aHR 2.41, 95% CI 2.01-2.87), with a notably elevated risk for right-sided colon cancer (aHR 4.08, 95% CI 2.91-5.74). DISCUSSION/CONCLUSIONS:Our study showed an association between CCY and increased CRC risk, especially right-sided colon cancer. This risk was higher in males and younger adults, but elevated across all age and sex subgroups.

BACKGROUND:Colorectal cancer (CRC) outcomes vary by both race and ethnicity, and screening test use may contribute to this variation. We examined the association of race, ethnicity, and associated factors with CRC screening test use in a setting where financial barriers to screening are mitigated. METHODS:Survey information was gathered from US Veteran participants (N = 50,125) when enrolled into a randomized trial comparing screening colonoscopy to annual fecal immunochemical testing (FIT) in the prevention of CRC mortality. The primary exposures of interest were the participants' self-identified race and ethnicity, with adjustment for variables capturing access to care. Multivariable logistic regression, stratified by site and age, was used to assess the relationship between exposures of interest and prior use of any CRC screening test, prior colonoscopy, and prior fecal occult blood test (FOBT, including FIT) use. RESULTS:Screening test use was common (N = 28,330, 56.5%) with more Veterans reporting prior FOBT (N = 20,386, 40.7%) than prior colonoscopy (N = 12,671, 25.3%). In multivariable analysis, Black participants were more likely (odds ratio (OR), 1.06; 95% confidence interval (CI) 1.01-1.12) to have had any prior screening relative to White persons and this finding was driven by more frequent FOBT use relative to White persons (OR, 1.16; 95% CI 1.10-1.23). There was no association between Hispanic ethnicity (relative to White persons) on the primary outcomes. CONCLUSIONS:In this cohort, prior screening test use was common, with observed variation in overall test use by race, but not ethnicity. Further study of CRC screening test use in diverse populations are needed. CLINICALTRIALS.GOV ID/BACKGROUND:NCT#05612347.

BACKGROUND AND AIMS/OBJECTIVE:Incomplete resection of colorectal polyps can lead to polyp recurrence and post-colonoscopy colorectal cancer. At present, standardized methods for assessing resection completeness and calculating the incomplete resection rate (IRR) are lacking. This study aimed to establish expert consensus on optimal strategies and protocols for standardized evaluation of resection completeness for resections of polyps <20 mm in size. METHODS:An international modified Delphi consensus process consisting of three rounds of anonymized surveys was conducted. A total of 103 gastrointestinal endoscopy experts were invited. Agreement was defined as consensus among >80% of participants for each statement. Based on expert consensus, standardized assessment protocols were established for daily clinical practice, and for quality assurance and research. RESULTS:Sixty-seven experts from 18 countries participated, with 53 (51%) from 16 countries completing all three rounds. Consensus was achieved for 18 of 20 (90%) statements after three rounds. Key agreements included: (1) primary assessment of resection completeness using high-definition white-light inspection, supplemented by image-enhanced inspection for polyps 10-19 mm; (2) routine post-resection photo documentation for polyps 10-19 mm; (3) standard histopathological margin assessment for all non-fragmented and en bloc resected polyps; (4) preferential IRR measurement using extended margin resection; and (5) the need for endoscopists to know and monitor their personal IRR for polyps 10-19 mm. CONCLUSION/CONCLUSIONS:This study presents international expert consensus on evaluation of resection completeness for colorectal polyps <20 mm in size. Provided recommendations could guide more consistent and standardized evaluation of polyp resections and support establishment of the IRR as a valuable quality parameter for colonoscopy.

Adequate bowel preparation is critical to the effectiveness of colonoscopy. Bowel preparations have evolved over the years and now there are many options available to patients. These options fall into three categories of regular volume, low-volume and ultra-low volume preparations. It is important to select a preparation that maximises patient adherence and improves patient experience.

Colonoscopy is the most widely performed endoscopic procedures in the United States and considered as primary screening and surveillance modality for colorectal cancer (CRC) prevention. Effective screening and surveillance requires prompt recognition of colorectal polyps, optical diagnosis of predicted histology and safe and effective polypectomy. We aim to perform a comprehensive review of the current evidence on tools and techniques to improve polyp detection and best practices to optimize endoscopic removal. Utilization of water assisted colonoscopy, artificial intelligence (AI), image enhanced endoscopy (IEE) and distal attachment devices can improve polyp detection. Underwater endoscopic mucosal resection (EMR) has emerged as a popular technique with potentially better outcomes than conventional EMR. Modification of EMR techniques including tip-in EMR and pre-cutting EMR have also been summarized. Endoscopic full thickness resection (EFTR) is an emerging technique other than endoscopic submucosal dissection (ESD) for suitable lesions harboring early submucosal cancer. Further, we also outline the common adverse events associated with polypectomy including bleeding, perforation, post-polypectomy syndrome, and discuss preventative measures to mitigate these adverse events. Eventually, the goal of colonoscopy is to reduce interval CRC incidence and mortality, and the technology that reduces post colonoscopy CRC incidence and techniques that improve safety and recurrence would see earlier adoption in the real world practice.

Stool tests are an essential component of colorectal cancer (CRC) screening. Patients with positive test results are at increased risk of CRC, and a timely follow-up with colonoscopy is recommended. Follow-up colonoscopy rates remain suboptimal. The current article reviews the barriers to timely colonoscopy, highlights evidence-based interventions, and provides actionable recommendations for endoscopists, health systems, and policymakers. By implementing coordinated strategies, including patient navigation, digital tools, and open access colonoscopy, health care organizations can close critical gaps in the CRC screening continuum and decrease CRC incidence and mortality.