Faculty Bibliography

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.

BACKGROUND/UNASSIGNED:Many hereditary gastrointestinal cancer predisposition syndromes (HGCPS), including Lynch syndrome (LS), increase the risk for colorectal cancer (CRC). Sporadic CRC in average-risk individuals has shifted toward younger ages; however, the same trend in patients with HGCPS/LS remains underexplored. We aimed to evaluate temporal trends in age at CRC diagnosis among patients with HGCPS/LS compared with a non-hereditary/average risk cohort in a large national database. METHODS/UNASSIGNED:We used the TriNetX database to identify patients with HGCPS/LS from 2010 to 2024. We compared age at CRC diagnosis between patients with HGCPS/LS and a non-hereditary/average risk cohort. RESULTS/UNASSIGNED:15%; all P<0.01). CONCLUSIONS/UNASSIGNED:CRC is increasingly diagnosed at younger ages among patients with HGCPS/LS, paralleling trends in the average-risk population and likely reflecting combined environmental, lifestyle, and genetic-testing influences. These findings support continued individualized, gene- and family history-based surveillance rather than uniform age thresholds.

BACKGROUND:Inflammatory bowel disease (IBD) and myeloproliferative neoplasms (MPNs) share chronic inflammation and immune dysregulation. AIM/OBJECTIVE:We evaluated the incidence of MPNs among patients with IBD and clinical outcomes of IBD-MPN coexistence. METHODS:Two retrospective cohort analyses were conducted using the TriNetX database. First, adults with ulcerative colitis (UC) or Crohn's disease (CD) were compared with matched non-IBD controls to estimate incident MPN risk. A coexistence second analysis included patients with UC or CD who developed MPNs and then were matched to IBD without MPN controls to assess 5-year outcomes, including IBD-related complications, surgical interventions, colorectal cancer (CRC) and primary sclerosing cholangitis (PSC). Medication subgroup analyses were performed to evaluate associations with MPN risk. RESULTS:After matching, 3873 patients with UC-MPN and 3474 patients with CD-MPN were included. Compared with matched non-IBD controls, incident MPN risk was higher in UC (HR 1.60, p = 0.01) and CD (HR 1.56, p < 0.001). In CD, MPN coexistence was associated with higher risks of CRC (HR 1.52, p = 0.012), intestinal fistula (HR 2.84, p < 0.001), obstruction (HR 2.05, p < 0.001), perforation (HR 2.37, p < 0.001), small bowel resection (HR 3.69, p < 0.001) and colectomy (HR 2.10, p < 0.001). In UC, MPN coexistence was associated with higher risks of CRC (HR 1.50, p = 0.001), PSC (HR 1.75, p = 0.03) and pouchitis (HR 1.68, p = 0.003). Exposure to thiopurines (HR 1.28, p < 0.001) was associated with increased MPN risk, whereas TNF, IL-23 and JAK inhibitors were not. CONCLUSIONS:IBD is associated with increased MPN risk, and IBD-MPNs coexistence is associated with worse IBD-related complications and malignancy risk.

BACKGROUND:Despite the availability of multiple screening options, rates of colorectal cancer (CRC) screening remain suboptimal. With recent approval of a blood test for CRC screening, there is an urgent need to understand screening preferences of populations with low screening rates. METHODS:Between October 2023 and June 2024, we conducted a survey on preferences for CRC screening modalities of stool test, blood test and colonoscopy among adults aged 45-75 at ambulatory primary care clinics across multiple community health centers and federally qualified healthcare centers across the city as well as in community settings regardless of prior screening. RESULTS:A total of 1,014 individuals completed the survey. Respondents were 12.8% Black/African American, 51.6% White, 23.4% Hispanic, 15.8% South Asian, and 4.2% Asian. Overall, the highest test preference was for screening colonoscopy (45.5%) followed by blood test (29.9%). Colonoscopy was preferred by individuals under age 70 (47.5%), while stool-based (20.2%) and blood-based (31.9%) tests were the most preferred among above 70 years (p = 0.0429. Whites (54.6%), Blacks (44.6%), and Hispanics (35.9%, p < 0.001) preferred colonoscopy, while Asians (37.2%) and South Asians (24.4%) favored blood tests. Factors associated with preference for a colonoscopy over other screening tests were younger age: respondents aged below 70 years were more likely to prefer colonoscopy, compared to respondents aged above 70 years (OR 1.72, 95% CI [1.20-2.47], p = 0.003); Nonsmoker compared to former/current smokers (OR 2.04, 95% CI [1.10-3.94], p = 0.028); Having undergone a prior colonoscopy (OR 6.83, 95% CI [4.52-10.6], p = < 0.001) or not having a prior stool test (OR 1.56, 95% CI [1.52-2.11], p = < 0.001). Factors associated with preference for a blood test over other screening tests were education level: respondents without any college experience were more likely to prefer blood test compared to respondents with college experience (OR 1.46, 95% CI 1.02-2.07, p = 0.038); Nonsmoker compared to former/current smokers (OR 1.73, 95% CI [1.00-2.99], p = 0.048); Never undergone a prior colonoscopy (OR 1.76, 95% CI [1.23-2.51], p = 0.002). Factors associated with preference for a stool test over other screening tests were: age over 80 years compared to respondents aged below 80 (OR 3.34, 95% CI 1.67-6.55, p < 0.001); respondents with college experience were more likely to prefer blood test compared to respondents without college experience (OR 1.62, 95% CI 1.02-2.66, p = 0.048). CONCLUSION/CONCLUSIONS:Colonoscopy was the preferred test option, followed by blood test. Preferences for screening test varied by age, race, ethnicity, education and prior screening. The study underscores importance of patient preference in deciding which tests to offer based on the patient characteristics. Nonsmokers, those without any college education and those without prior screening preferred blood test for screening.