Strategies for Colorectal Cancer Screening

Effectiveness of health promotion interventions to increase faecal occult blood test uptake rates among older adults with an average-risk of colorectal cancer: A systematic review and meta-analysis

Objective

This review aims to examine the effectiveness of interventions in increasing faecal occult blood test (FOBT) uptake rates among older adults with an average-risk of colorectal cancer (CRC) and to identify essential components of such interventions based on current evidence.

Methods

Five databases were included in a systematic literature search for studies reporting randomized controlled trials (RCT) and interventions aimed at increasing FOBT uptake rates among average-risk individuals aged 50-75. Review Manager 5.4.1 was used for conducting meta-analyses and subgroup analyses.

Results

A meta-analysis of the 20 included studies demonstrated that health promotion interventions led to significant increases in FOBT uptake rates (odds ratio [OR] ​= ​1.55, 95% confidence interval (CI) ​= ​1.30-1.85; I 2 ​= ​95%). Provision of information, mailing of FOBT outreach, and reminders were identified as core components of promotion interventions to increase FOBT uptake rates. Among the different significant reminder strategies, a digital message (via text) plus telephone calls (automated and navigator-initiated) had a larger effect size than a telephone call alone. In addition, there was no significant evidence that financial incentives were associated with FOBT uptake. Most studies included a diverse mixture of components, but only a few studies utilized theoretical framework-based interventions.

Conclusions

Future studies with rigorous methodologies are warranted to examine the effectiveness and understand the mechanisms of theoretical framework-based multi-component educational programmes aimed at increasing FOBT uptake rates.

Systematic review registration

PROSPERO CRD42024520859.

Applying machine learning to predict bowel preparation adequacy in elderly patients for colonoscopy: development and validation of a web-based prediction tool

BACKGROUND

Adequate bowel preparation is crucial for effective colonoscopy, especially in elderly patients who face a high risk of inadequate preparation. This study develops and validates a machine learning model to predict bowel preparation adequacy in elderly patients before colonoscopy.

METHODS

The study adhered to the TRIPOD AI guidelines. Clinical data from 471 elderly patients collected between February and December 2023 were utilized for developing and internally validating the model, while 221 patients' data from March to June 2024 were used for external validation. The Boruta algorithm was applied for feature selection. Models including logistic regression, light gradient boosting machines, support vector machines (SVM), decision trees, random forests, and extreme gradient boosting were evaluated using metrics such as AUC, accuracy, sensitivity, and specificity. The SHAP algorithm helped rank feature importance. A web-based application was developed using the Streamlit framework to enhance clinical usability.

RESULTS

The Boruta algorithm identified 7 key features. The SVM model excelled with an AUC of 0.895 (95% CI: 0.822-0.969), and high accuracy, sensitivity, and specificity. In external validation, the SVM model maintained robust performance with an AUC of 0.889. The SHAP algorithm further explained the contribution of each feature to model predictions.

CONCLUSION

The study developed an interpretable and practical machine learning model for predicting bowel preparation adequacy in elderly patients, facilitating early interventions to improve outcomes and reduce resource wastage.

Applying Deep-Learning Algorithm Interpreting Kidney, Ureter, and Bladder (KUB) X-Rays to Detect Colon Cancer

Early screening is crucial in reducing the mortality of colorectal cancer (CRC). Current screening methods, including fecal occult blood tests (FOBT) and colonoscopy, are primarily limited by low patient compliance and the invasive nature of the procedures. Several advanced imaging techniques such as computed tomography (CT) and histological imaging have been integrated with artificial intelligence (AI) to enhance the detection of CRC. There are still limitations because of the challenges associated with image acquisition and the cost. Kidney, ureter, and bladder (KUB) radiograph which is inexpensive and widely used for abdominal assessments in emergency settings and shows potential for detecting CRC when enhanced using advanced techniques. This study aimed to develop a deep learning model (DLM) to detect CRC using KUB radiographs. This retrospective study was conducted using data from the Tri-Service General Hospital (TSGH) between January 2011 and December 2020, including patients with at least one KUB radiograph. Patients were divided into development (n = 28,055), tuning (n = 11,234), and internal validation (n = 16,875) sets. An additional 15,876 patients were collected from a community hospital as the external validation set. A 121-layer DenseNet convolutional network was trained to classify KUB images for CRC detection. The model performance was evaluated using receiver operating characteristic curves, with sensitivity, specificity, and area under the curve (AUC) as metrics. The AUC, sensitivity, and specificity of the DLM in the internal and external validation sets achieved 0.738, 61.3%, and 74.4%, as well as 0.656, 47.7%, and 72.9%, respectively. The model performed better for high-grade CRC, with AUCs of 0.744 and 0.674 in the internal and external sets, respectively. Stratified analysis showed superior performance in females aged 55-64 with high-grade cancers. AI-positive predictions were associated with a higher long-term risk of all-cause mortality in both validation cohorts. AI-enhanced KUB X-ray analysis can enhance CRC screening coverage and effectiveness, providing a cost-effective alternative to traditional methods. Further prospective studies are necessary to validate these findings and fully integrate this technology into clinical practice.

Diagnostic value of genetic and epigenetic biomarker panels for colorectal cancer detection: a systematic review

PURPOSE

Exploration of effective screening methods is imperative to improve current screening for colorectal cancer (CRC). Our aim was to systematically search the literature to identify and assess the diagnostic accuracy of both genetic and epigenetic biomarker panels for CRC detection using liquid biopsies for circulating tumour DNA (ctDNA) from stool, blood, or urine.

METHODS

A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) with searches in Medline, Embase, CENTRAL, and Web Of Science from inception up to March 20, 2025, using pre-defined keywords. Study quality assessment was performed using QUADAS-2 tool (Quality Assessment for Diagnostic Accuracy Studies 2). Primary and secondary outcomes were panel performance (sensitivity and specificity) for CRC, advanced precancerous lesions (APL), and staging of disease.

RESULTS

Forty-four studies were included. Exceptional performance for both CRC (sensitivity and specificity) and APL (sensitivity) was displayed by biomarker panels including methylated SDC2 with methylated SFRP1/2 (CRC: 91.5%/97.3%, APL: 89.2%) or methylated TFPI2 (CRC: 94.9%/98.1%, APL: 100%), and a 5-biomarker panel of mutational targets APC, Bat-26, KRAS, L-DNA, and p53 (CRC: 91.0%/93.0%, APL: 82.0%). Suboptimal APL sensitivities up to 57.0% were exhibited by Cologuard and variant panels (including KRAS, methylated BMP3, methylated NDRG4, FIT), and 47.8% for combinations including methylated SEPT9.

CONCLUSIONS

High-performance, candidate ctDNA biomarker panels with exceptional diagnostic accuracy for both CRC and APL have been identified. Further work should focus on the development of large-scale studies to justify their clinical implementation.

Validity and reliability of the Turkish version of the health belief model scale for colorectal cancer screening

BACKGROUND

Colorectal cancer ranks second among the most prevalent and deadly cancer types for both sexes. Despite having a high mortality rate, colorectal cancer is simultaneously identifiable and preventable through early diagnosis. This study was intended to assess the validity and reliability of the Turkish version of the Health Belief Model Scale for Colorectal Cancer Screening.

METHODS

This methodological study evaluated the 45-item five-point Likert-type Health Belief Model Scale for Colorectal Cancer Screening. Data collection forms were administered via convenience sampling to 649 participants selected from individuals seeking health services at primary healthcare institutions. The scale's reliability and validity were evaluated via item analyses, content and construct validities, exploratory and confirmatory factor analyses, Cronbach's alpha, McDonald's omega, the Spearman-Brown formula, and test-retest reliability coefficients. The data set was randomly divided into two subsamples. EFA, reliability analyses (Cronbach's alpha, McDonald's omega, Spearman-Brown Coefficient) and item-total statistics were conducted in sample 1 (n = 324). CFA was conducted in sample 2 (n = 325). Item and scale means and, discriminant validity were calculated and tested using the total sample (N = 649).

RESULTS

According to the resulting four-dimensional structure, the factor loads of the subscale items were 0.48-0.89, and subscales explained 49% of the total variance. The Cronbach's alpha coefficients of the subscales were 0.804-0.923. The confirmatory factor analysis revealed good fit indices (χ2/df = 2.05; RMSEA = 0.06; CFI = 0.95; IFI = 0.95; GFI = 0.80; RMR = 0.08; NFI = 0.91). The subscale means ranged from 2.23 ± 0.72 to 3.60 ± 0.70 while the item means ranged from 1.95 ± 0.81 to 3.80 ± 0.91.

CONCLUSION

The Turkish version of the Health Belief Model Scale for Colorectal Cancer Screening is a valid and reliable measuring tool for Turkish people. Except for barrier scale items, those with low means suggest opportunities for improvement. This scale can be applied in Turkey when measuring individuals' health belief perceptions regarding colorectal cancer screening.

Housing Status and Cancer Screening in US Veterans

BACKGROUND

Cancer is a leading cause of death in people experiencing homelessness, who are more commonly diagnosed with late-stage disease and have poorer survival after diagnosis than housed.

OBJECTIVE

To characterize the incidence and timeliness of colorectal and breast cancer screening in a national sample of Veterans.

DESIGN

Retrospective, matched cohort study from 2011 to 2021 in a national sample of Veterans receiving care from the Veterans Health Administration (VA).

PARTICIPANTS

Each Veteran experiencing homelessness was matched to three housed Veterans with the same age, gender, clinic location, and month and year of outpatient clinic appointment.

EXPOSURE

We classified Veterans as homeless if they had any homeless indicator at the matched clinic visit or in the 12 months prior and all others as housed.

MAIN MEASURES

Our primary outcomes were being up to date on screening, receiving a biopsy following a positive screen and timeliness of biopsy. We assessed the association between housing status and our outcomes using conditional Poisson regression models with generalized estimating equations, adjusting for race, ethnicity, marital status, Charlson Comorbidity Index, smoking status, and mental health comorbidities.

KEY RESULTS

Our sample included 2,580,640 Veterans, with 1,935,480 housed and 645,160 experiencing homelessness. Patients experiencing homelessness had a 16% lower adjusted incidence rate ratio (aIRR) of being up to date with colorectal cancer screening when compared to housed (aIRR 0.84, 95%CI 0.83-0.84; p<0.001) and a 13% lower aIRR for breast cancer (aIRR 0.87, 95%CI 0.86-0.88; p<0.001). Following a positive stool-based test, patients experiencing homelessness had a 12% lower aIRR of undergoing diagnostic colonoscopy compared to housed (aIRR 0.88, 95%CI 0.84-0.92; p<0.001). Time to biopsy was similar between groups for both cancer types.

CONCLUSIONS

Veterans experiencing homelessness were less commonly screened for cancer than a matched housed cohort. However, screening rates in this group were higher than in non-Veteran homeless populations. The VA system may offer insights into providing preventative care for this population.

mSEPT9 performs better than CEA in NAT response and MRD assessment and recurrence prediction of stage III CRC

AIMS

This study aimed to investigate the capability of methylated SEPT9 (mSEPT9) assay in assessing the neoadjuvant therapy (NAT) response,the minimal residual disease (MRD) and predicting the recurrence of stage III colorectal cancer (CRC).

MATERIALS & METHODS

We prospectively recruited 124 stage III CRC patients. All patients received pre-surgical NAT and subsequent curative surgery, and were followed up to 627 days. Blood samples were collected before NAT, after NAT and after surgery. Measurements of mSEPT9 and CEA were performed.

RESULTS

mSEPT9 exhibited a positive detection rate (PDR) of 82.6% for stage III CRC, significantly higher than that of the carcinoembryonic antigen (CEA) (60.3%,p < 0.001). The levels of mSEPT9 and CEA significantly decreased after NAT. This can be observed for patients with complete response (CR), partial response (PR), stable disease (SD) and tumor regression grade (TRG) 1-3 in mSEPT9 and patients with PR, SD and TRG 2-3 in CEA. Stepwise percentage decrease of marker levels was more prominent in mSEPT9 than in CEA following NAT and surgical treatment. Kaplan-Meier analysis suggested that mSEPT9 significantly stratified the patient recurrence-free survival(RFS) before NAT, after NAT and after surgery. In contrast, CEA significantly stratified RFS after NAT and after surgery, while CEA levels before NAT did not significantly stratify RFS.

CONCLUSION

mSEPT9 exhibits better applicability than CEA in assessment in terms of patient coverage, sensitivity and the pre-NAT recurrence prediction.

Clinical Trial: Effect of Abdominal Vibration Combined With Walking Exercise Programme on Bowel Preparation in Older Patients With Constipation

BACKGROUND

Older patients with constipation are at an increased risk of inadequate bowel preparation.

AIM

To assess the effectiveness of an abdominal vibration combined with walking exercise (AVCWE) programme compared to walking exercise (WE) and standard preparation regimens for bowel preparation in older patients with constipation.

METHODS

This three-arm randomised controlled trial involved 271 older patients with constipation scheduled for colonoscopy. Patients assigned to the AVCWE group were asked to walk independently for at least 5500 steps and received two cycles of moderate-intensity abdominal vibrations. Patients in the WE group were required to walk independently for at least 5500 steps, whereas patients in the control group received only the standard regimen. The primary outcome was the rate of adequate bowel preparation, defined as a total score of ≥ 6 on the Boston Bowel Preparation Scale.

RESULTS

The rate of adequate bowel preparation in the AVCWE group (92.2%) was significantly higher than in the WE group (78.9%) and the control group (60.4%) (p < 0.001). Additionally, the AVCWE group had statistically significant increases in adenoma detection rate (p = 0.003) and patient satisfaction (p < 0.001), and a reduced incidence of bloating (p = 0.016). Logistic regression analysis identified first colonoscopy (OR = 2.329), laxative use ≥ 3 times per week (OR = 2.675) and poor dietary compliance (OR = 2.249) as risk factors for inadequate preparation.

CONCLUSION

This provides empirical evidence suggesting that AVCWE may help improve bowel preparation quality among older patients with constipation.

TRIAL REGISTRATION

Chinese Clinical Trial Registry, Number: ChiCTR2300067667.

Downregulating FGGY carbohydrate kinase domain containing promotes cell senescence by activating the p53/p21 signaling pathway in colorectal cancer

Carbohydrate kinases serve an oncogenic role in several types of cancer; however, the function of FGGY carbohydrate kinase domain containing (FGGY) in colorectal cancer (CRC) remains unknown. The present study investigated the function and possible molecular mechanisms of FGGY in CRC. The results showed that elevated levels of FGGY mRNA and protein were observed in CRC tissues, and a higher expression of FGGY was associated with advanced N stage and reduced overall survival time in patients with CRC. Silencing FGGY inhibited the viability of CRC cells by inducing cell cycle arrest and promoting apoptosis in vitro, thereby attenuating tumor growth in a xenograft mouse model. FGGY knockdown also enriched the senescence‑associated heterochromatin foci (SAHF) pathway and p53 pathway, as further confirmed by enhancing senescence‑associated β‑galactosidase (SA‑β‑gal) activity, with increased levels of SAHF‑associated proteins HP1γ and trimethylation of H3K9 (H3k9me3) in CRC cells, as well as upregulation of p53 and its downstream protein p21. Furthermore, p53 knockout rescued FGGY knockdown‑mediated reductions in cell viability, SA‑β‑gal activity, and the levels of HP1γ and H3k9me3 in CRC cells. These findings indicated that FGGY could act as a newly identified potential oncogene in CRC, partially through regulating the p53/p21 signaling pathway and altering cell senescence.

Analysis of the effect of fecal SDC2, ADHFE1 and PPP2R5C gene methylation test for screening colorectal cancer in the Otog Front Banner

OBJECTIVE

The incidence of colorectal cancer (CRC) is gradually increasing, making the prevention and early detection of CRC a global priority. The purpose of this study is to evaluate the effect of fecal SDC2, ADHFE1, and PPP2R5C gene methylation on the screening of early CRC in the Otog Front Banner.

METHODS

This is a retrospective study that collected and analyzed data from the early colorectal cancer screening program conducted in five community health centers in the Otog Front Banner, from January 2023 to October 2023. The study collected stool samples from subjects meeting the inclusion and exclusion criteria, extracted genomic DNA from the feces, and modified it with sulfite. Methylation-specific polymerase chain reaction (MSP) was then used to detect the methylation status of the SDC2, PPP2R5C, and ADHFE1 genes, completing the early screening for colorectalcancer. Individuals with positive screening outcomes were advised to undergo a colonoscopy, and ultimately, all participants completed the questionnaire on high-risk factors for colorectal cancer . The chi-square test was utilized to analyze the positive rates of fecal SDC2, ADHFE1, and PPP2R5C gene methylation screenings, colonoscopy compliance, the positive predictive value of intestinal lesions, and to assess the risk factors associated with cancer.

RESULTS

A total of 9,135 effective screeners were included in this study, and 636 of them tested positive during the initial screening, yielding a positive rate of 6.9%. The positive predictive value was 50.9% for all intestinal lesions, 1.4% for colorectal cancer , and 9.7% for advanced adenoma.

CONCLUSION

Fecal SDC2, ADHFE1, and PPP2R5C gene methylation detection methods can serve as primary screening tools, supplemented by colonoscopy, to effectively detect colorectal cancer and precancerous lesions. This strategy may prove to be an effective approach for conducting large-scale colorectal cancer screening in average-risk populations.

Rising Incidence and Mortality of Early-Onset Colorectal Cancer in Young Cohorts Associated with Delayed Diagnosis

Background and Aims: Prior data showed an increasing incidence of early-onset colorectal cancer (EO-CRC) in the US. However, there are limited comprehensive data on recent EO-CRC incidence and mortality per different age cohorts and tumor characteristics. We aimed to evaluate EO-CRC incidence and mortality in different populations. Methods: Age-adjusted EO-CRC incidence rates were calculated from the USCS database between 2001 and 2021. Age-adjusted EO-CRC mortality rates were calculated from the NCHS database between 2000 and 2022 and the SEER database between 2004 and 2021. The age groups were 20-44 years and 45-54 years. Tumors were categorized by anatomical location (right, transverse, left, and proximal) and stage at diagnosis (early and late). The annual and average annual percentage changes (AAPC) were estimated using joinpoint regression. Age-specific pairwise comparison was conducted. Results: A total of 474,601 patients were diagnosed with EO-CRC between 2001 and 2021. The EO-CRC incidence increased in patients aged 20-44 years faster than in those aged 45-54 years (AAPC = 1.51 vs. 0.73; AAPC difference = 0.78, p = 0.001). This was most notable in proximal colon tumors (AAPC difference = 0.88, p < 0.001). While the incidence of early-stage tumors decreased in recent years across all anatomical locations, late-stage tumors increased, mostly in the proximal colon (AAPC = 2.44). A total of 147,026 patients died from EO-CRC between 2000 and 2022. Mortality increased in patients aged 20-44 years faster than in patients aged 45-54 years, who had a stable trend (AAPC difference = 0.85, p < 0.001). The increase in mortality was noted in both early- and late-stage tumors. Conclusions: Our study provides epidemiologic evidence showing an alarming increase in EO-CRC incidence and mortality among patients aged 20-44 years compared to those aged 45-54 years, which is associated with delayed diagnosis, and mostly in proximal colon tumors. Expanding screening efforts to younger populations and addressing healthcare disparities are essential for improving early detection and outcomes for younger patients.

CHOICE: A Comprehensive and Coordinated Colorectal Cancer Screening Program in a Large Urban Health System

OBJECTIVE

To develop a coordinated colorectal cancer (CRC) screening program within a large urban health system, with the ultimate goal of increasing system-wide screening rates of eligible patients and reducing no-show rates while increasing colonoscopy completion rates.

STUDY SETTING

A large urban academic health system comprising 8 hospitals and over 400 ambulatory practices.

STUDY DESIGN

The CHOICE Program combined patient navigation, electronic medical record (EMR) optimization, and system-wide practice changes to improve CRC screening completion by colonoscopy. The program incorporates provider and patient education, standardization of documentation and protocols, increased outreach by navigators, and streamlining of patient scheduling. The primary outcome is colonoscopy completion.

DATA COLLECTION

All health system patients between the ages of 45 and 75 and at average risk of CRC are the target population for the intervention. A review of screen-eligible patients' completion of colonoscopy was performed to assess program success.

PRINCIPAL FINDINGS

During a 2-year period (March 2022 to February 2024), 18,119 people were referred into the program, and 79% of scheduled patients completed the colonoscopy. The CHOICE program operationalized and standardized the CRC screening efforts of a large health system and offers a template that can be implemented or adapted by other hospital systems and provider networks.

Aberrant protein glycosylation in the colon adenoma-cancer sequence: Colorectal cancer mechanisms and clinical implications

Colorectal cancer (CRC) is a leading contributor to global cancer-related morbidity and mortality. Glycosylation is a common post-translational protein modification. Aberrant protein glycosylation is a hallmark of cancer, affecting biological processes and driving malignant CRC phenotypes. Specifically, abnormal N-glycosylation manifests as structural alterations in high mannose, sialylated, and fucosylated structures, collectively promoting cancer stemness and invasiveness. Concurrently, O-GlcNAcylation facilitates tumorigenesis through metabolic reprogramming and oncogene activation. Dysregulated mucin-type O-glycans (e.g., Core-1/Core-3 imbalance) and elevated SLex/SLea antigen expression are significantly correlated with tumor adhesion, metastatic dissemination, and adverse clinical outcomes. Furthermore, protein glycosylation contributes to chemoresistance through anti-apoptotic mechanisms, aberrant signaling activation, and pro-angiogenic pathways. This review systematically examines the dynamic evolution of protein glycosylation during CRC progression from normal mucosa to adenoma to adenocarcinoma. It also evaluates the CRC diagnostic and therapeutic implications of glycoproteins and glycans. This review can provide a molecular understanding for advancing CRC diagnostics and treatment.

Effectiveness of single-target fecal DNA methylation test in regional mass screening for colorectal cancer and precancerous lesions in China

Background

Colorectal cancer (CRC) is the third-most-common malignancy and the second-leading cause of cancer-related deaths worldwide and current screening methods such as guaiac-based fecal occult blood test (gFOBT), fecal immunochemical test (FIT), and colonoscopy have their own pros and cons. This study aimed to assess the effectiveness of a fecal DNA methylation test by using methylated SDC2 (mSDC2) as the epigenetic biomarker for detecting CRC in a screening-naïve population.

Methods

Fecal mSDC2 test and FIT were simultaneously performed on eligible 40- to 74-year-old adults of a regional township in China. Subjects with positive results were recommended for colonoscopy. Data of positivity rates, positive predicted values (PPVs), and detection rates associated with clinical characteristics were analysed.

Results

The positivity rate of mSDC2 was 7.6% for 10,578 participants with valid results from both fecal mSDC2 test and FIT. With an adherence rate of 63.8% to colonoscopy referral, 25 CRCs, 189 advanced adenomas (AAs), and 165 non-advanced adenomas (NAAs) and polyps were detected. The PPVs of mSDC2 were 4.93%, 37.28%, and 32.54% for CRC, AA, and non-advanced lesions, respectively. When the CRCs and AAs were counted as positive findings, the fecal mSDC2 test showed a higher detective rate than FIT (relative risk [RR], 1.313 [1.129-1.528], P < 0.001). When NAAs and polyps were also specified as treatable lesions, the mSDC2 test was more effective in detecting these benign growths (RR, 1.872 [1.419-2.410]; P < 0.001). A combination of mSDC2 and FIT detected 29 CRCs, 298 AAs, and 234 NAAs and polyps. Overall, the fecal mSDC2 test had a higher detection rate for both advanced and non-advanced colonic lesions. The false-positive rate of the fecal mSDC2 test was comparable to that of FIT (RR, 1.169 [0.974-1.403]; P = 0.113).

Conclusions

The single-target stool-based mSDC2 test can effectively and accurately detect CRC and precancerous lesions in a large-scale CRC-screening program.

Trial registration number

NCT05374369.

Advanced disease at presentation for Canadian patients with colorectal cancer despite provincial screening programs: A call to action

ObjectiveWe sought to evaluate the presentation and outcomes of patients with a diagnosis of colorectal cancer (CRC) at an academic Canadian center to identify strategies to improve the existing screening system for CRC.SettingRoyal Alexandra Hospital, Edmonton, Alberta, Canada.MethodsWe performed a prospective cohort study. Data collected included: patient demographics, presentation, treatment, and outcomes 1 year after study completion.ResultsOne hundred consecutive patients were included with a median age of 68 years (SD = 13.3). Most (58%) participants were male and 25% had a first-degree family history of CRC. Only 26% of CRC presentations were identified through screening. Of the screened patients, 81% had stage 0-2 disease, all underwent surgery and there were no deaths in this group 1 year after recruitment.In contrast, 74% of patients presented with symptoms, including bleeding (26%), anemia (22%), and obstruction (19%). Thirty-six (49%) received elective surgery, 33 (45%) underwent emergency surgery, and 5 (7%) did not receive surgery. One year after recruitment, 21 patients (28%) in this group were deceased. Within the symptomatic cohort, 55% of patients were outside the age range recommended for screening, 22% did not have a family physician, and 50% had not been offered regular screening.ConclusionsDespite an established screening program, a significant proportion of patients diagnosed with CRC at our center were not diagnosed via screening. Patients presenting with symptoms were more likely to have advanced disease, require more urgent surgeries, and experience worse outcomes compared to their screened counterparts. The current provincial approach to screening for CRC needs to be improved.

Utilizing Quality Improvement Methodology to Address Disparities in Colorectal Cancer Screening Between Faculty and Resident Physicians

Health system data from a large academic medical center revealed a 14% lower rate of colorectal cancer (CRC) screening in resident patient panels compared to faculty patient panels. This resident-led quality improvement (QI) work identified causes for disparities in CRC screening and implemented an innovative panel management intervention to reduce CRC screening disparities. Analysis was conducted across two academic primary care clinics at a single institution. Residents engaged key stakeholders in the CRC screening process to identify causes for disparities and potential solutions in the CRC screening process. A novel interprofessional panel management protocol was implemented to guide residents on how to perform population health strategies to increase CRC screening and to streamline the navigation process. The effectiveness of each intervention in improving CRC screening was analyzed. After four months of protocol implementation, CRC screening for resident patient panels improved from 62 to 68% based on analysis done on a run chart. The difference in CRC screening between faculty and resident patient panels decreased from 14 to 10%, reducing the disparity by 29%. This interprofessional panel management protocol significantly increased the CRC screening rates among patients receiving primary care from resident physicians. This further highlights the importance of multipronged interventions to improve disparities in CRC screening and to improve overall screening rates.

A Blood-Based Assay for Detection of Patients with Advanced Adenomas

SIGNIFICANCE

Blood-based screening for colorectal cancer could improve testing uptake and outcomes. We propose novel methods to detect AAs in plasma using cfDNA fragmentation patterns, cancer-associated proteins, and aneuploidy with high specificity. Larger studies are needed to validate clinical utility.

Efficacy and safety of oral sulfate solution versus polyethylene glycol for colonoscopy: A systematic review and meta-analysis of randomized controlled trials

Background

Colonoscopy is the gold standard for early detection and monitoring of colorectal cancer. Procedural effectiveness is dependent on optimal bowel preparation. Traditional polyethylene glycol (PEG) solutions are difficult to tolerate, whereas newer low-volume alternatives, including PEG with ascorbic acid and oral sulfate solutions (OSS), offer improved efficacy and tolerability. The meta-analysis was performed to evaluate the efficacy and safety of OSS compared to PEG for bowel preparation in colonoscopy.

Methods

Studies were identified by searching PubMed, Embase, Cochrane CENTRAL, and clinicaltrials.gov from inception until June 2024. Only randomized controlled trials comparing OSS with PEG were included. Data was analyzed using R version 4.4.0 using a random effects model to calculate risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs).

Results

Twenty-one studies with 6346 participants met the inclusion criteria. OSS significantly improved adenoma detection (RR, 1.13; 95% CI, 1.04-1.22; p-value <0.01; I2 = 0%) and polyp detection rates (RR, 1.16; 95% CI, 1.06-1.26; p-value <0.01; I2 = 0%), and had a higher Boston Bowel Preparation Scale (BBPS) score (MD, 0.31; 95% CI, 0.13-0.50; p-value <0.01; I2 = 81%). PEG was associated with more sleep disturbances (RR, 0.45; 95% CI, 0.25-0.82; p-value = 0.03; I2 = 0%). However, other adverse effects were similar between both solutions.

Conclusion

OSS demonstrated superior adenoma and polyp detection rates. When compared to PEG, patients utilizing OSS achieved higher BBPS scores. Data gleaned support enhanced cleansing efficacy and safety of OSS as a bowel preparation regimen.

Characteristics of Postpolypectomy Colorectal Cancer Events and Deaths

INTRODUCTION

Postpolypectomy colorectal cancers (PPCRCs) are diagnosed after a cancer-negative colonoscopy with polypectomy. Analyzing PPCRC characteristics informs prevention and early detection strategies. We investigated interval types and etiologies of PPCRCs using World Endoscopy Organization guidelines.

METHODS

PPCRCs were identified in a retrospective cohort of US Veterans who underwent colonoscopy with polypectomy from 1999 to 2016. We classified PPCRCs into interval, noninterval type A, and noninterval type B, defined as cancers diagnosed before, at, and after next recommended surveillance examination, respectively. A root cause analysis was conducted to determine the most plausible etiology.

RESULTS

We identified 396 PPCRC events and 90 PPCRC deaths over a median follow-up of 3.9 and 4.2 years, respectively. Among PPCRC events, 55% (95% confidence interval [CI] 50%-60%) were interval, 12% (95% CI 9%-15%) noninterval type A, and 33% (95% CI 29%-38%) noninterval type B. Interval cancers were more likely to be diagnosed at stage 4 than noninterval cancers (16% interval vs 2.1% noninterval type A, 8.3% noninterval type B, P = 0.003). Most interval cancers were due to possible missed lesions with adequate examinations (60%, 95% CI 53%-66%), whereas most noninterval cancers were likely new CRCs (type A: 48%, 95% CI 34%-62%; type B: 84%, 95% CI 77%-90%). Similar results were found for PPCRC deaths.

DISCUSSION

Most PPCRC events and deaths were diagnosed before the next recommended examination, largely because of procedural factors, underscoring the need to optimize quality of baseline colonoscopy and polypectomy. Many PPCRCs were diagnosed after recommended examination, suggesting the need to improve patient adherence to recommended surveillance intervals.

Fecal bacterial biomarkers and blood biochemical indicators as potential key factors in the development of colorectal cancer

The incidence of colorectal cancer (CRC) has been increasing in recent decades. Current methods for CRC screening have their own drawbacks, thus there is an urgent need to identify the key microbes that drive the development of CRC for wider application in the early detection and prevention of CRC. To address this issue, we performed fecal microbiome analysis by high-throughput sequencing of 16S rRNA gene combined with blood biochemical indicators in patients with CRC stages I, II, III, and IV, healthy people, and patients with polyps. Fecal microbiota of patients with CRC was disturbed, as evidenced by significantly reduced α-diversity in patients with CRC stage IV and markedly different β-diversity. The random forest model identified the top 25 genera from 174 training data, resulting in a diagnostic accuracy of 87.95%. Further, by combining with differential genera analysis, we screened out 11 biomarkers that significantly changed in different groups. Peptostreptococcus, Parvimonas, Shewanella, Oscillibacter, Eggerthella, and Gemella associated with the development of CRC were significantly enriched, while Fenollaria, Staphylococcus, Ezakiella, Finegoldia, and Neisseria associated with the remission of CRC were significantly suppressed in patients with CRC. Importantly, carcinoembryonic antigen (CEA) was significantly correlated with these 11 microbial biomarkers, and carbohydrate antigen 19-9 (CA 19-9) was markedly correlated with Oscillibacter. Notably, co-occurrence network analysis at the genus level exhibited that the microbial co-occurrence network of CRC IV was the most complex and stable. These results suggested that CEA, CA 19-9 and 11 microbial biomarkers may be co-biomarkers for the disease occurrence and development, and non-invasive diagnosis of CRC.

IMPORTANCE

Identifying the key microbes that drive the development of colorectal cancer (CRC) has been important in this field. We delved into the research on the association between CRC and fecal microbiota in this study, providing a detailed analysis of the characteristics of fecal microbiota during the transition from normal intestine to polyps to cancer. Fecal bacterial biomarkers and blood biochemical indicators may be co-biomarkers in the development of CRC.

Accuracy evaluation of preoperative indocyanine green tattooing and intraoperative colonoscopy in determining surgical resection margins for left-sided colorectal cancer: a retrospective study in Korea

Purpose

We aimed to evaluate the precision of preoperative colonoscopic tattooing and intraoperative colonoscopic tumor localization in determining distal surgical margins for left-sided colorectal cancer surgery.

Methods

This retrospective study included 30 patients who underwent laparoscopic colorectal surgery, preoperative colonoscopic tattooing, and intraoperative colonoscopic localization for colorectal cancer at our center between July 2020 and March 2024. Clinical data were collected, and the precision of these methods was assessed by measuring the differences between the target resection margin and the actual pathological resection margin.

Results

In four patient cases, the indocyanine green tattoo was not visible in the laparoscopic surgical field. The average stained length of the tattoo was 2.89 cm, with a mean distance of 1.18 cm between the low margin of the tattoo and the cancer. The difference between the target distal resection margin by intraoperative colonoscopic localization and the actual pathological resection margin was 0.88 cm. No complications related to the intraoperative colonoscopy were observed.

Conclusion

Preoperative tattooing showed limitations, such as spreading and occasional invisibility. Intraoperative colonoscopic localization proved to be an effective method for achieving more precise distal surgical margins in left-sided colorectal cancer surgery.

Colorectal cancer early screening: Dilemmas and solutions

Colorectal cancer (CRC) is a prevalent malignancy worldwide, posing a significant public health concern. Mounting evidence has confirmed that timely early screening facilitates the detection of incipient CRC, thereby enhancing patient prognosis. Obviously, non-participation of asymptomatic individuals in screening programs hampers early diagnosis and may adversely affect long-term outcomes for CRC patients. In this letter, we provide a comprehensive overview of the current status of early screening practices, while also thoroughly examine the dilemmas and potential solutions associated with early screening for CRC. In response to these issues, we proffer a set of recommendations directed at governmental authorities and the general public, which focus on augmenting financial investment, establishing standardized screening protocols, advancing technological capabilities, and bolstering public awareness campaigns. The importance of collaborative efforts from various stakeholders cannot be overstated in the quest to enhance early detection rates and alleviate the societal burden of CRC.

Multicancer Detection (MCD) Testing in Gastrointestinal Cancers: An Evolving Tool for Early Diagnosis

PURPOSE OF REVIEW

The current review aims to summarize the benefits and limitations of the novel multicancer detection tests (MCD) for diagnosing gastrointestinal (GI) malignancies.

RECENT FINDINGS

Traditional cancer screening methods can reduce deaths in malignancies involving the GI tract. For GI cancers, screening options vary by type and often involve invasive techniques with limited sensitivity. MCDs offer a promising, non-invasive (simple blood draw) alternative by analyzing biomarkers such as cell-free DNA and RNA using advanced techniques and machine learning to detect cancers across multiple organ sites. Large studies like the PATHFINDER trial and THUNDER study have demonstrated the feasibility and accuracy of MCD assays in identifying cancer signals, with high sensitivity and specificity in some GI organs that lack routine screening tests (e.g., liver, pancreas, and stomach). Despite these advancements, MCD testing faces challenges, including high costs, lack of FDA approval, false positives, and limited data on clinical utility in reducing cancer-specific mortality. MCD should not be a substitute for age-appropriate cancer screenings but may complement existing methods, particularly for cancers with no current screening tools, such as cholangiocarcinoma and pancreatic cancer. Clinicians need to discuss the limitations of MCDs, including the potential for overdiagnosis, patient anxiety, and financial burden due to insurance coverage gaps. MCD is a promising, non-invasive test that can augment traditional cancer screening. As the role of MCD in cancer detection evolves, further research is essential to establish how it will be integrated into clinical practice, ensuring informed, shared decision-making with patients.

A Stool DNA-Based SDC2 Methylation Test for the Early Detection of Colorectal Cancer in an Asymptomatic, High-Risk Population: A Multicenter Prospective Randomized Trial

INTRODUCTION

Noninvasive stool DNA-based methylation testing has emerged as an effective strategy for the early colorectal cancer (CRC) detection. Syndecan-2 ( SDC2 ) methylation frequently occurs in all stages of CRC; therefore, the aim of this study was to evaluate the clinical performance of a stool DNA-based SDC2 methylation test for detecting CRC in asymptomatic or high-risk CRC populations.

METHODS

This multicenter prospective study was conducted to determine the clinical performance of the SDC2 methylation test on stool DNA using real-time polymerase chain reaction. Stool samples were collected from asymptomatic individuals before colonoscopy, and the test results were independently analyzed through comparison with colonoscopic findings and pathological outcomes as reference standards.

RESULTS

Of the 1,124 evaluable participants, 20 had CRC, 73 had advanced adenomatous polyps (≥1.0 cm), 469 had nonadvanced adenomatous polyps (<1.0 cm), 178 had non-neoplastic polyps, and 384 had negative colonoscopy results. The stool SDC2 methylation test had a sensitivity and specificity of 95.0% and 81.5%, respectively, for detecting CRC, while the sensitivity for detecting advanced adenomatous polyps and CRC was 58.1%. The rate of adenoma detection increased with polyp size ( P < 0.01), and sensitivity was not associated with CRC stage ( P = 0.864).

DISCUSSION

The stool DNA-based SDC2 methylation test attained a high sensitivity for CRC detection in an asymptomatic high-risk population. Further large-scale clinical studies are required to validate the clinical utility of this test as a population-based CRC screening tool.

Level of Information and Awareness About Colorectal Cancer and Its Screening Program in Türkiye: A Community-Based Cross-Sectional Study

OBJECTIVE

Colorectal cancer (CRC) has high mortality if it is detected in advanced stages, persons can lower their risk of CRC by adopting a healthy lifestyle that may lead to prevention. Screening is the most powerful public health tool to reduce mortality, considering the challenges of making substantial lifestyle changes or implementing widespread primary prevention strategies to lower the risk of CRC. This study aims to find out the levels of information and awareness about CRC and its screening program in individuals living in Türkiye.

DESIGN

This study was a community-based cross-sectional.

SAMPLE

This study was performed from November 2019 to November 2022 with a web-based survey circulated through social media and communication platforms. The research was conducted with 4146 participants.

MEASUREMENTS

The "Survey Form" was used in the data collection. Descriptive statistics and logistic regression were used in the data analysis.

RESULTS

The study found that 43.3% of participants had information about CRC and its screening program. Among all participants, 94.7% had never undergone CRC screening, and 55.6% were aware of a CRC awareness month. The study also revealed that participants who were knowledgeable about CRC screening were more likely to have a family history of cancer, a personal history of cancer, prior awareness of CRC, and previous information about the disease. Additionally, they were more likely to have undergone CRC screening before and to believe that CRC screening is necessary.

CONCLUSION

It was found that the majority of participants had no information on CRC and its screening program and never underwent CRC screening before. More studies should be performed to find out the factors negatively affecting the participation of individuals in the CRC screening program.

GPSM1 interacts and cooperates with MMP19 to promote proliferation and EMT in colorectal cancer cells

Among patients with colorectal cancer (CRC), metastasis accounts for the majority of deaths, and epithelial-mesenchymal transition (EMT) is important in the metastatic process. However, the mechanism underlying the correlation between the two in CRC is unknown. Here, we verified that a receptor-independent protein, G-protein signaling modulator 1 (GPSM1), was increased in CRC and had a significant positive correlation with matrix metalloproteinase 19 (MMP19). GPSM1 and MMP19 knockdown or overexpression decreased and increased proliferation, migration and invasion of CRC cells, respectively. In addition, overexpression or knockdown of GPSM1 and MMP19 upregulated and inhibited EMT, respectively. Interfering with MMP19 reversed EMT activation via GPSM1 overexpression. Apoptosis was induced by GPSM1 and MMP19 knockdown and activated the caspase3/Bcl-2/Bax signaling pathway. In conclusion, these results support the role of GPSM1 and MMP19 in CRC progression.

Cost Effectiveness of Colorectal Cancer Screening Strategies in Middle- and High-Income Countries: A Systematic Review

BACKGROUND AND AIM

Colorectal cancer (CRC) is a significant global health burden, and screening can greatly reduce CRC incidence and mortality. Previous studies investigated the economic effects of CRC screening. We performed a systematic review to provide the cost-effectiveness of CRC screening strategies across countries with different income levels.

METHODS

We searched relevant scientific databases (PubMed, Embase, Ovid, Web of Science, Scopus) from January 1, 2010, to December 31, 2023. We selected English-language studies related to model-based economic evaluations of CRC screening strategies. Information such as the characters of screening tests, model characteristics, and key cost-effectiveness findings were collected. The net monetary benefit approach was used to compare the outcomes of various strategies.

RESULTS

A total of 56 studies were identified, including 46 from high-income countries (HICs), 6 from upper-middle-income countries (UMICs), and 4 from lower-middle-income countries (LMICs). Most annual fecal occult blood tests and fecal immunochemical tests were cost-saving, and colonoscopy every 10 years was cost-saving. Other strategies involving multitarget fecal FIT-DNA detection, computed tomography colonography, and flexible sigmoidoscopy were cost-effective compared with no screening. Newer strategies such as magnetic resonance colonography every 5 years, annual urine metabolomic tests, and fecal bacterial biomarkers were cost-effective compared with no screening.

CONCLUSION

In our updated review, we found that common CRC screening strategies and magnetic resonance colonography continued to be cost-effective compared with no screening. Areas for further development include accurately modeling the natural history of colorectal cancer and obtaining more evidence from UMICs and LMICs.

What is the current state of anxiety and its related factors in Chinese patients undergoing colonoscopy? A cross-sectional study

BACKGROUND

Anxiety in patients undergoing colonoscopy may also result in adverse effects, including altered vital signs such as elevated heart rate and blood pressure, exacerbation of symptoms like bloating and gastrointestinal discomfort, a decline in cooperation and satisfaction, and even colonoscopy failure. However, limited studies have explored the level of anxiety, factors that influence it, and its specific causes.

METHODS

A cross-sectional study was conducted, recruiting 825 patients undergoing colonoscopy in Hunan Province between January and July 2023 using stratified sampling. The Spielberger State-Trait Anxiety Inventory (STAI), a self-designed demographic characteristics questionnaire, and a colonoscopy patient anxiety influencing factor questionnaire were used. The data were analyzed in SPSS (version 26) using Mann-Whitney U, Kruskal-Wallis, and multiple regression analysis tests.

RESULTS

The final study included 825 participants, of whom 19.8% exhibited mild anxiety, 37.0% exhibited moderate anxiety, and 43.2% exhibited severe anxiety. The results indicated that insomnia (β=-0.080, p = 0.013), no comorbidities (β=-0.147, p < 0.001), not smoking or drinking (β=-0.158, p < 0.001), and poor health (moderate: β=-0.183, p < 0.001; poor: β=-0.164, p < 0.001) were negatively associated with anxiety levels. In contrast, marital status (β = 0.177, p < 0.001), education level (β = 0.204, p < 0.001), age (β = 0.114, p = 0.007), medical insurance (Basic Medical Insurance for Urban Residents β = 0.204, p < 0.001; Commercial medical insurance: β = 0.112, p < 0.001), care provided by relatives (β = 0.102, p = 0.002), diarrhoea (β = 0.089, p = 0.005), occupation (farmers: β = 0.099, p = 0.009; self-employed: β = 0.082, p = 0.014), and paternal upbringing (β = 0.067, p = 0.034) were positively correlated with anxiety. Several factors had a greater impact on the anxiety level of the patients: education level (β = 0.204), health status (moderate: β=-0.183; not good: β=-0.164), and marital status (β = 0.177). It probably because higher education levels may increase awareness of potential risks associated with colonoscopy, contributing to greater anxiety. The five common reasons for anxiety included the presence of bloody faeces, enemas, need for further treatment, lack of timely feedback from the physician, lack of an accurate diagnosis.

CONCLUSION

The level of anxiety experienced by patients during the colonoscopy phase was more severe and should be alleviated with targeted interventions based on the cause of anxiety, such as pre-procedural counseling, patient education materials, and enhanced communication with healthcare providers.

Fecal Immunochemical Testing for Colorectal Cancer Prevention in Two Public Hospitals

INTRODUCTION

The fecal immunochemical test (FIT) is highly effective in reducing colorectal cancer (CRC) mortality, but patient adherence to the screening process remains questionable. We present preliminary findings from a quality improvement (QI) initiative, in order to assess screening adherence and findings.

METHODS

All FIT specimens in a 30-month period were retrospectively examined. Patients with positive results were included, and information was collected via electronic medical record, including QI measures such as colonoscopy completion and findings. All data were de-identified. Patients were divided into "asymptomatic group" and "symptomatic group" based on clinical manifestations. Adherence and findings were analyzed.

RESULTS

FIT results were positive in 174 out of 2400 specimens. Colonoscopy was performed in 47.6% of all FIT-positive cases after a median interval of 5.5 (interquartile range, IQR 3-10) months, with 10% having CRC, 51.3% having adenomas, and 17.5% having advanced adenomas. Of all nine patients who had CRC, seven were in the symptomatic group. All five advanced cancers were found in the symptomatic group. Patients who actually completed colonoscopy were significantly younger than those who did not (median 61.5 years, IQR 56.5-69 years, vs. 64.5 years, IQR 59-71 years, P = 0.048). Patient-related reasons, primarily refusal, accounted for 65.9% of unperformed colonoscopies. No significant difference was found in adherence and yield between asymptomatic and symptomatic groups.

CONCLUSION

Prevalence of colorectal adenomas and cancers is high in FIT-positive patients. A substantial number of CRCs and potentially preventable CRCs must have been missed because of low adherence rate, especially in older patients. Improving adherence to CRC screening in public hospitals requires enhanced patient engagement.

Risk factors, prevention and screening of colorectal cancer: A rising problem

Colorectal cancer (CRC) is the third most commonly diagnosed cancer and the second leading cause of cancer death worldwide. The leading risk factors for CRC include male gender, age over 50, family history, obesity, tobacco smoking, alcohol consumption, and unhealthy diet. CRC screening methods vary considerably between countries and depend on incidence, economic resources and healthcare structure. Important aspects of screening include adherence, which can vary significantly across ethnic and socioeconomic groups. Basic concepts of CRC screening include pre-stratification of patients by identifying risk factors and then using fecal immunochemical test or guaiac-based fecal occult blood test and/or colonoscopy or radiologic imaging techniques. Technological capabilities for CRC screening are rapidly evolving and include stool DNA test, liquid biopsy, virtual colonography, and the use of artificial intelligence. A CRC prevention strategy should be comprehensive and include active patient education along with targeted implementation of screening.

Circ_0070934 Regulates the Proliferation, Metastasis, and Epithelial-Mesenchymal Transition of Colorectal Cancer Cells by Targeting miR-203a-3p/HOXA13 Axis

The present work explored the functions of circ_0070934 in regulating malignant phenotype of colorectal cancer (CRC) cells and its underlying mechanisms. Gene expression data set was acquired based on Gene Expression Omnibus (GEO) database for examining circ_0070934 levels within CRC cells and tissues through quantitative reverse transcription-polymerase chain reaction (qRT-PCR). Kaplan-Meier curve and log-rank test were adopted for assessing CRC patient prognosis based on circ_0070934 level. Functional assays including Cell Counting Kit (CCK)-8, EdU incorporation, Transwell invasion, and scratch assays were conducted to determine CRC cell malignancy. Molecular interactions were predicted using circInteractome and StarBase databases, and validated through luciferase reporter assay. Circ_0070934 was upregulated within CRC cells and tissues, which was related to a dismal prognostic outcome in CRC patients. Knocking down circ_0070934 inhibited CRC cell proliferation, epithelial-mesenchymal transition (EMT), and migration. Further, we identified miR-203a-3p as a target miRNA of circ_0070934, and miR-203a-3p negatively regulated Homeobox A13 (HOXA13) expression. miR-203a-3p/HOXA13 axis mediates the function of circ_0070934 in modulating CRC cell malignancy. These data revealed that circ_0070934 was important for maintaining the malignant phenotype of CRC cells, and circ_0070934 knockdown undermined CRC cell malignancy. Targeting circ_0070934/miR-203a-3p/HOXA13 axis is the promising intervention approach for managing CRC.

Risk-Adapted Starting Ages of Colorectal Cancer Screening for People With Diabetes or Metabolic Syndrome

BACKGROUND

Individuals with diabetes and metabolic syndrome have an increased risk of colorectal cancer (CRC), suggesting earlier screening than the average-risk population may be warranted.

AIMS

To derive risk-adapted starting ages of CRC screening for people with diabetes or metabolic syndrome.

METHODS

We determined 5-year cumulative risks of CRC at individual ages between 30 and 50 across Europe (overall and individually for Germany, France, the UK and Italy) and North America (the United States and Canada) based on the GLOBOCAN 2022 database. Using risk estimates from meta-analyses (2020-2023), we derived the ages at which individuals with diabetes or metabolic syndrome reach the same CRC risk as the average-risk population at age 50 (aCR50) or 45 (aCR45).

RESULTS

Individuals with diabetes were estimated to reach aCR50 at age 47 (95% confidence interval, 45-49) in Europe and 46 (42-49) in North America. For metabolic syndrome, the corresponding ages were 47 (47-48) in Europe and 46 (46-47) in North America. Disparities across countries were minimal, with deviations of up to no more than one year. For screening programmes starting at age 45, corresponding risk-adapted starting ages for people with diabetes or metabolic syndrome were estimated to be 42 (41-44) and 43 (42-43) for Europe and 41 (38-44) and 41 (41-42) for North America, respectively.

CONCLUSIONS

People with diabetes or metabolic syndrome reach risk levels comparable to the average risk population three to four years earlier. Our results offer empirical guidance for defining risk-adapted starting ages of CRC screening for these high-risk groups.

IPNet: An Interpretable Network With Progressive Loss for Whole-Stage Colorectal Disease Diagnosis

Colorectal cancer plays a dominant role in cancer-related deaths, primarily due to the absence of obvious early-stage symptoms. Whole-stage colorectal disease diagnosis is crucial for assessing lesion evolution and determining treatment plans. However, locality difference and disease progression lead to intra-class disparities and inter-class similarities for colorectal lesion representation. In addition, interpretable algorithms explaining the lesion progression are still lacking, making the prediction process a "black box". In this paper, we propose IPNet, a dual-branch interpretable network with progressive loss for whole-stage colorectal disease diagnosis. The dual-branch architecture captures unbiased features representing diverse localities to suppress intra-class variation. The progressive loss function considers inter-class relationship, using prior knowledge of disease evolution to guide classification. Furthermore, a novel Grain-CAM is designed to interpret IPNet by visualizing pixel-wise attention maps from shallow to deep layers, providing regions semantically related to IPNet's progressive classification. We conducted whole-stage diagnosis on two image modalities, i.e., colorectal lesion classification on 129,893 endoscopic optical images and rectal tumor T-staging on 11,072 endoscopic ultrasound images. IPNet is shown to surpass other state-of-the-art algorithms, accordingly achieving an accuracy of 93.15% and 89.62%. Especially, it establishes effective decision boundaries for challenges like polyp vs. adenoma and T2 vs. T3. The results demonstrate an explainable attempt for colorectal lesion classification at a whole-stage level, and rectal tumor T-staging by endoscopic ultrasound is also unprecedentedly explored. IPNet is expected to be further applied, assisting physicians in whole-stage disease diagnosis and enhancing diagnostic interpretability.

A glucan from the stems of Acanthopanax senticosus: Structure and anticolorectal cancer activity

ASPN-1, a novel glucan with a molecular weight of 33.31 kDa, was purified from Acanthopanax senticosus stems, characterized in structure, and evaluated for antitumor potential. The analysis of the structure of ASPN-1 revealed that it consisted of a backbone constructed from →4)-α-D-Glcp-(1 → glucosyls, branched at the O-3 position by an α-D-Glcp-(1 → residue and at the O-6 positions with α-D-Glcp-(1 → 6)-α-D-Glcp-(1 → and/or α-D-Glcp-(1 → residues. Surface morphological analysis revealed that ASPN-1 is an archetypal amorphous powder with an irregular network architecture composed of lamellar thin layers, filaments, and spherical particles. In vivo anti-tumor experiments indicated that ASPN-1 exerted inhibitory effects on CT26.WT mouse tumors by preserving immune function, elevating the production of IL-2, IFN-γ and TNF-α, and reducing production of TGF-β and IL-10. These findings indicated that ASPN-1, derived from A. senticosus, could potentially be used to treat colorectal carcinomas, acting through its immunomodulatory actions.

Early Detection and Quality Indicators: Assessing the Clinical Impact and Effectiveness of Lowering the Colorectal Cancer Screening Age

Objective With colorectal cancer (CRC) being a leading cause of cancer-related deaths globally, early detection through screening is critical for improving survival rates. Recent guidelines recommend lowering the initial screening age from 50 to 45 years based on increasing CRC incidence among younger adults. Methodology This retrospective study evaluates the impact of this adjustment on adenoma detection rates (ADR), a validated quality indicator of screening colonoscopies. We conducted a retrospective analysis of 2,792 patients who underwent colonoscopy screening at a major healthcare institution. Patients were categorized into three age groups: 45-49, 50-59, and 60-75 years. We compared ADR across these groups with a focus on evaluating the consistency of ADR in the newly included younger age group against established benchmarks. Result The ADRs for the 45-49 age group were 51.2% (105/205) in male patients and 38.5% (116/301) in female patients, closely mirroring those of the 50-59 age group at 51.08% (188/368) in male patients and 34.80% (133/382) in female patients, with no significant reduction in detection rates. Gender-specific analysis revealed higher ADR in male patients across all age groups. These findings were statistically significant when comparing procedure type with age group and gender (p < 0.05). Conclusion The study supports maintaining the already established ADR for the new age group of 45-49 as the ADR was comparable to those in the older groups. Similar polyp biopsy +/- removal rates in the 45-49-year-old age group (43.6%; 221/506) compared to the older age group (42.7%; 320/750) is also an indirect measure of the effectiveness of early screening for colon cancer.

Global, regional, and national burden of very early-onset colorectal cancer and its risk factors from 1990 to 2019: A systematic analysis for the global burden of disease study 2019

AIMS

Very early-onset colorectal cancer (EOCRC) was defined as CRC diagnosed before the age of 35 proposed by the latest EOCRC management guideline. Until now, the disease burden of very EOCRC has never been reported. This study aimed to explore the burden of very EOCRC across the past three decades.

METHODS

We extracted the data from Global Burden of Disease Study to analyze the disease burden of very EOCRC. Risk factors for the burden of deaths and disability-adjusted life years (DALYs) due to very EOCRC were also explored in this study. Additionally, decomposition analysis and frontier analysis were also conducted.

RESULTS

Despite regional and gender variations, the global very EOCRC incidence cases increased from 21,874 (95 % UI: 20,386-23,470) to 41,545 (95 % UI: 37,978-45,523). Besides, the deaths cases also increased from 11,445 (95 % UI: 10,545-12,374) to 15,486 (95 % UI: 14,289-16,803), and the DALYs cases increased from 718,136 (95 % UI: 659,858-778,283) to 961,460 (95 % UI: 886,807-1,042,734). Decomposition analysis revealed the epidemiological change contributed most to the incidence burden of very EOCRC. Countries or regions with Sociodemographic Index (SDI) between 0.4 and 0.8 had greater disease burden improvement potential through frontier analysis. Diet low in milk, diet low in calcium, alcohol use, and high body-mass index were the main contributors to deaths and DALYs.

CONCLUSIONS

The increase in CRC burden among populations younger than 35 years globally requires vigilance from policy makers, physicians, and young individuals themselves, especially those regions experiencing faster growth burden of very EOCRC.

Human immune system: Exploring diversity across individuals and populations

The immune response is an intricate system that involves the complex connection of cellular and molecular components, each with distinct functional specialisations. It has a distinct capacity to adjust and mould the immune response in accordance with specific stimuli, influenced by both genetic and environmental factors. The presence of genetic diversity, particularly across different ethnic and racial groups, significantly contributes to the impact of incidence of diseases, disease susceptibility, autoimmune disorders, and cancer risks in specific regions and certain populations. Environmental factors, including geography and socioeconomic status, further modulate the variety of the immune system responses. These, in turn, affect the susceptibility to infectious diseases and development of autoimmune disorders. Despite the complexity of the relationship, there remains a gap in understanding the specificity of immune indices across races, immune reference ranges among populations, highlighting the need for deeper understanding of immune diversity for personalized approaches in diagnostics and therapeutics. This review systematically organizes these findings, with the goal of emphasizing the potential of targeted interventions to address health disparities and advance translational research, enabling a more comprehensive strategy. This approach promises significant advancements in identifying specific immunological conditions, focusing on personalized interventions, through both genetic and environmental factors.

The Development and Optimisation of a Urinary Volatile Organic Compound Analytical Platform Using Gas Sensor Arrays for the Detection of Colorectal Cancer

The profile of Volatile Organic Compounds (VOCs) may help prioritise at-risk groups for early cancer detection. Urine sampling has been shown to provide good disease accuracy whilst being patient acceptable compared to faecal analysis. Thus, in this study, urine samples were examined using an electronic nose with metal oxide gas sensors and a solid-phase microextraction sampling system. A calibration dataset (derived from a previous study) with CRC-positive patients and healthy controls was used to train a radial basis function neural network. However, a blinded analysis failed to detect CRC accurately, necessitating an enhanced data-processing strategy. This new approach categorised samples by significant bowel diseases, including CRC and high-risk polyps. Retraining the neural network showed an area under the ROC curve of 0.88 for distinguishing CRC versus non-significant bowel disease (without CRC, polyps or inflammation). These findings suggest that, with appropriate training sets, urine VOC analysis could be a rapid, low-cost method for early detection of precancerous colorectal polyps and CRC.

Highly specific multiplex DNA methylation detection for liquid biopsy of colorectal cancer

BACKGROUND

Circulating tumor DNA (ctDNA) has emerged as a useful biomarker for cancer detection and prognosis. In this study, we developed a strategy for developing a highly specific multiplex qPCR assay to detect methylated ctDNA in the blood of colorectal cancer (CRC) patients and investigated the potential use for the detection and prognosis of CRC.

METHODS

Bisulfite conversion and amplicon sequencing were used to confirm potential CRC-specific DNA methylation markers. The selected DNA methylation candidates were validated by qMSP. The six best-performing markers were used to develop a new single-tube multiplex quantitative methylation-specific PCR assay (mqMSP). The mqMSP assay was applied to analyze plasma samples from 114 CRC patients, 47 patients with advanced adenoma, 45 patients with benign polyps, and 57 healthy controls. The clinical performance of the assay and associations with clinical outcomes were assessed.

RESULTS

Six DNA methylation biomarkers were confirmed to be specifically hypermethylated in CRC tumor tissues. The newly developed mqMSP assay detected CRC with extremely high specificity (specificity of 98.2 %, with sensitivity of 67.5 %). The detection rate of ctDNA was significantly correlated with tumor size and clinical stage, with ctDNA methylation levels in the blood markedly increased with larger tumor size, poor differentiation, and advanced stage. Moreover, high preoperative methylated ctDNA level was associated with worse recurrence-free survival and overall survival.

CONCLUSION

We provided a strategy for identification of multiple highly-specific DNA methylation markers for designing multiplex DNA methylation assays for liquid biopsies of CRC. The newly developed assay has potential for CRC early detection, and prognosis.

Modeling and the Use of Surrogate Endpoints: Is This a Valid Approach?

BACKGROUND

Development of novel colorectal cancer (CRC) screening tests is a dynamic field. Decision analytic modeling based on inputs derived from rigorous prospective studies informs CRC screening guidelines. Exploratory modeling may have a place in early phases of test development.

METHODS

We explored whether (1) surrogate endpoints for long-term, programmatic effectiveness, and cost-effectiveness could be potentially informative in early stages of test development and (2) whether rapid exploratory modeling with a web-based tool would be feasible.

RESULTS

First, based on comparisons with published estimates for reductions in CRC mortality with various screening tests in four established decision analytic models of CRC screening, the surrogate endpoint of the number needed to colonoscope to detect one CRC or advanced precancerous lesion (APL) in round 1 of screening appears to hold promise as a measure of clinical effectiveness. Similarly, based on comparisons with published estimates for cost/quality-adjusted life-year gained with screening in the four models, the surrogate endpoint of cost to detect one CRC or APL in round 1 of screening appears to hold promise as a measure of cost-effectiveness. Second, exploration of the impact of lowering the screening initiation age in Israel from age 50 to 45 with the web-based EU-TOPIA tool, compared with the results of a recently published comprehensive modeling study, suggests that exploratory modeling of programmatic screening may be feasible with relatively low time demand vs. that required for typical full-length modeling publications.

CONCLUSION

Further validation in other models and with a broader set of test performance characteristics is prudent before surrogate endpoints or rapid modeling are incorporated into the novel test development process.

Dysregulation of DNA methylation in colorectal cancer: biomarker, immune regulation, and therapeutic potential

Colorectal cancer (CRC) is one of the most prevalent malignancies worldwide, with morbidity and mortality ranking third and second among all cancers, respectively. As a result of a sequence of genetic and DNA methylation alterations that gradually accumulate in the healthy colonic epithelium, colorectal adenomas and invasive adenocarcinomas eventually give rise to CRC. Global hypomethylation and promoter-specific DNA methylation are characteristics of CRC. The pathophysiological role of aberrant DNA methylation in malignant tumors has garnered significant interest in the last few decades. In addition, DNA methylation has been shown to play a critical role in influencing immune cell function and tumor immune evasion. This review summarizes the most recent research on DNA methylation changes in CRC, including the role of DNA methylation-related enzymes in CRC tumorigenesis and biomarkers for diagnosis, predictive and prognostic. Besides, we focus on the emerging potential of epigenetic interventions to enhance antitumor immune responses and improve the CRC clinical practice.

Colorectal Cancer Screening Participation and Health Belief Levels of Public Hospital Patients in Türkiye

Colorectal cancer can be diagnosed early with screening tests; therefore, patients' beliefs regarding colorectal cancer screening are closely related to clinical and pathological disease stages at the time of diagnosis. This study aimed to determine participation in colorectal cancer screening programs and health beliefs related to protection from colorectal cancer among patients aged 40-70 years and evaluate factors affecting their participation in such screening programs. This descriptive study was conducted in a state hospital in Türkiye between May 2021 and December 2021 with the participation of 1,016 patients. Study data were collected through face-to-face interviews using a questionnaire consisting of an "Introductory Information Form" and the "Health Belief Model Scale for Prevention of Colorectal Cancer." Signed voluntary consent was obtained from all participants, as well as ethics committee approval and institutional permission from the hospital. The mean age of the participants was 50.12 ± 9.29 years, 54% were 40-50 years old, 55.5% were female, 87.3% were married, 6.8% had a primary education or below, and 39.3% were employed. The internal consistency was low for the health motivation subscale and relatively high for other subscales of the Health Belief Model Scale for Prevention of Colorectal Cancer.

Serum biomarkers REG1A and REG3A combined with the traditional CEA represent a novel nomogram for the screening and risk stratification of colorectal cancer

BACKGROUND

To develop and validate a serum protein nomogram for colorectal cancer (CRC) screening.

METHODS

The serum protein characteristics were extracted from an independent sample containing 30 colorectal cancer and 12 polyp tissues along with their paired samples, and different serum protein expression profiles were validated using RNA microarrays. The prediction model was developed in a training cohort that included 1345 patients clinicopathologically confirmed CRC and 518 normal participants, and data were gathered from November 2011 to January 2017. The lasso logistic regression model was employed for features selection and serum nomogram building. An internal validation cohort containing 576 CRC patients and 222 normal participants was assessed.

RESULTS

Serum signatures containing 27 secreted proteins were significantly differentially expressed in polyps and CRC compared to paired normal tissue, and REG family proteins were selected as potential predictors. The C-index of the nomogram1 (based on Lasso logistic regression model) which contains REG1A, REG3A, CEA and age was 0.913 (95% CI, 0.899 to 0.928) and was well calibrated. Addition of CA199 to the nomogram failed to show incremental prognostic value, as shown in nomogram2 (based on logistic regression model). Application of the nomogram1 in the independent validation cohort had similar discrimination (C-index, 0.912 [95% CI, 0.890 to 0.934]) and good calibration. The decision curve (DCA) and clinical impact curve (ICI) analysis demonstrated that nomogram1 was clinically useful.

CONCLUSIONS

This study presents a serum nomogram that included REG1A, REG3A, CEA and age, which can be convenient for screening of colorectal cancer.

Relationship Between Adenoma Detection Rate and Respective Withdrawal Time in Different Colon Segments: A Retrospective, Single-Center Study

Background and Aims

The 6-min withdrawal time for colonoscopy is widely considered the standard of care. However, there may not be appropriate if the 6-min is equally divided into various colon segments. Since the adenoma detection in each colon segment is not the same, there may be differences with the withdrawal time in different colon segments. Our objective was to evaluate the relationships between adenoma detection rate (ADR) and respective withdrawal time in different colon segments.

Methods

Outpatients, age range 18-75 years, undertaking complete colonoscopy were enrolled in this study from November 2019 to November 2020 in the digestive endoscopy center. The entire colon was divided into four different segments: ascending colon, transverse colon, descending colon and rectosigmoid colon. The respective withdrawal time and ADR in each colon segment were recorded respectively.

Results

A total of 586 outpatients (279 males, 307 females) enrolled in this study and the general ADR was 38.2%. The positive withdrawal time (adenomas detected) was longer than negative withdrawal time (non-adenomas detected) (334.04 ± 24.21 s vs. 303.65 ± 5.20 s, t = 1.26, p < 0.001). ADR in ascending colon, transverse colon, descending colon and rectosigmoid colon were respectively 30.5%, 2.9%, 3.1% and 7.5%. While all of their positive withdrawal time were longer than negative withdrawal time (94.34 ± 33.76 s vs. 70.40 ± 41.84 s, t = 3.31, p = 0.001; 85.40 ± 49.76 s vs. 71.66 ± 36.87 s, t = 1.95, p = 0.025; 80.29 ± 39.85 s vs. 69.73 ± 35.96 s, t = 1.40, p = 0.016;100.95 ± 55.92 s vs. 80.96 ± 42.87 s, t = 3.61; p < 0.001, respectively). The withdrawal time threshold in the ascending colon, transverse colon, descending colon, rectosigmoid colon determined by receiver operating characteristic (ROC) curve were 77, 61, 56 and 109 s, respectively. In the ascending colon, ADR was significantly higher (47.0% vs. 33.1%, p < 0.001) when the colonoscopy withdrawal time was ≥ 77 s. When the withdrawal time was ≥ 61 s in the transverse colon (42.7% vs. 32.7%, p = 0.013), ≥ 59 s in the descending colon (42.3% vs. 29.9%, p = 0.004) and ≥ 109 s in rectosigmoid colon (52.2% vs. 33.9%, p < 0.001), ADR was also significantly higher. After adjusting for age, sex and BMI, Logistic regression analysis showed that withdrawal time ≥ 77 s in the ascending colon (OR, 1.796; 95% CI, 1.273-2.532; p < 0.001), ≥ 61 s in the transverse colon (OR, 1.535; 95% CI, 1.094-2.155; p = 0.013), ≥ 56 s in the descending colon (OR, 1.722; 95% CI, 1.193-2.486; p = 0.004) and ≥ 109 s in the rectosigmoid colon (OR, 2.134; 95% CI, 1.446-2.350; p < 0.001) were independent risk factors for the increase of ADR.

Conclusions

ADR and withdrawal time are all various in individual colon segments. During the operation of colonoscopy, withdrawal time in the ascending colon may be shortened appropriately. The adenomas in the rectosigmoid colon are more likely to be detected and do not take longer withdrawal times. We need to choose the appropriate time according to different colon segments.

Diagnostic and Therapeutic Advances of RNAs in Precision Medicine of Gastrointestinal Tumors

Gastrointestinal tumors present a significant challenge for precision medicine due to their complexity, necessitating the development of more specific diagnostic tools and therapeutic agents. Recent advances have positioned coding and non-coding RNAs as emerging biomarkers for these malignancies, detectable by liquid biopsies, and as innovative therapeutic agents. Many RNA-based therapeutics, such as small interfering RNA (siRNA) and antisense oligonucleotides (ASO), have entered clinical trials or are available on the market. This review provides a narrative examination of the diagnostic and therapeutic potential of RNA in gastrointestinal cancers, with an emphasis on its application in precision medicine. This review discusses the current challenges, such as drug resistance and tumor metastasis, and highlights how RNA molecules can be leveraged for targeted detection and treatment. Additionally, this review categorizes specific diagnostic biomarkers and RNA therapeutic targets based on tissue type, offering a comprehensive analysis of their role in advancing precision medicine for gastrointestinal tumors.

ERCPMP: an endoscopic image and video dataset for colorectal polyps morphology and pathology

This dataset contains demographic, morphological and pathological data, endoscopic images and videos of 191 patients with colorectal polyps. Morphological data is included based on the latest international gastroenterology classification references such as Paris, Pit and JNET classification. Pathological data includes the diagnosis of the polyps including Tubular, Villous, Tubulovillous, Hyperplastic, Serrated, Inflammatory and Adenocarcinoma with Dysplasia Grade & Differentiation.Objectives: Today the most important challenge of developing accurate algorithms for medical prediction, detection, diagnosis, treatment and prognosis is data. ERCPMP is an Endoscopic Image and Video Dataset for Recognition of Colorectal Polyps Morphology and Pathology. This dataset can be used for developing deep learning algorithms for polyps detection, classification, and segmentation.Data description: Images were captured with Olympus colonoscope and are presented in RGB format, JPG type with the resolution of 368 * 256 pixels and 96 dpi. The name of each file (image or video) includes pathological diagnosis, grade and JNet classification of the related polyp.

A preliminary study of further attempt at the development, testing and application of an auxiliary equipment for electronic colonoscopy

Colonoscopy is a valuable tool for colorectal cancer screening and health checkups, with increasing utilization annually. Assisted entry is a standard procedure during electronic colonoscopy. In China, most clinically assisted colonoscopy procedures involve a nurse directly applying abdominal pressure to the patient's abdomen. This maneuver provides a fulcrum for the physician performing the procedure, facilitating smoother access to the colon. To reduce labor, optimize resource utilization, and enhance efficiency, this preliminary study aimed to develop and evaluate an adjunctive pressurized removable lap band for colonoscopy. This prospective randomized controlled trial randomized participants into control and experimental groups for observational comparison during follow-up, mitigating retrospective bias. Data were collected from 150 participants in a tertiary hospital endoscopy department between March and September 2023. Participants were evenly divided into groups using a randomized number table. Demographic data, including gender, age, height, weight, and abdominal circumference, were collected to ensure group representativeness and comparability. No significant pre-test differences were found between the groups. The experimental group demonstrated a significant reduction in examination-only insertion time compared to the control group (p < 0.001), median respectively 2.5, 3. Additionally, compared with control group (41.3%), the experimental group (24%) required fewer nurse assistance (p = 0.024). No significant differences were observed in systolic and diastolic blood pressure changes between the groups (p = 0.07, p = 0.43). However, compared with control group (0.89 ± 1.17), the experimental group (2.19 ± 0.94) reported lower pain scores (p < 0.001). Overall, this preliminary study validates the adjunctive pressurized removable lap band as an effective tool for improving colonoscopy efficiency, reducing patient pain, and conserving medical resources.Trial registration: Registration Authority: Chinese Clinical Trial Registry (ChiCTR). Number: ChiCTR2400082664.

Plasma mutation profile of precursor lesions and colorectal cancer using the Oncomine Colon cfDNA Assay

BACKGROUND

Colorectal cancer (CRC) is the second leading cause of cancer death worldwide. Early detection of precursor lesions or early-stage cancer could hamper cancer development or improve survival rates. Liquid biopsy, which detects tumor biomarkers, such as mutations, in blood, is a promising avenue for cancer screening.

AIM

To assess the presence of genetic variants in plasma cell-free tumor DNA from patients with precursor lesions and colorectal cancer using the commercial Oncomine Colon cfDNA Assay.

MATERIAL AND METHODS

Cell-free DNA (cfDNA) samples from the plasma of 52 Brazilian patients were analyzed. Eight patients did not have any significant lesions (five normal colonoscopies and three hyperplastic polyps), 24 exhibited precursor lesions (13 nonadvanced adenomas, 10 advanced adenomas, and one sessile serrated lesion), and 20 patients with cancer (CRC). The mutation profile of 14 CRC-associated genes were determined by next-generation sequencing (NGS) using the Oncomine Colon cfDNA Assay in the Ion Torrent PGM/S5 sequencer.

RESULTS

Thirty-three variants were detected in eight genes (TP53, PIK3CA, FBXW7, APC, BRAF, GNAS, KRAS, and SMAD4). No variants were detected in the AKT1, CTNNB1, EGFR, ERBB2, MAP2K1 and NRAS genes. All variants were considered pathogenic and classified as missense or truncating. The TP53 gene harbored the most variants (48.48%), followed by the KRAS gene (15.15%) and the APC gene (9.09%). It was possible to detect the presence of at least one pathogenic variant in cfDNA in 60% of CRC patients (12/20) and 25% of precursor lesions (6/24), which included variants in three patients with nonadvanced adenoma (3/13 - 23.08%) and three with advanced adenomas (3/10 - 30%). No variants were detected in the eight patients with normal findings during colonoscopy. The detection of mutations showed a sensitivity of 60% and a specificity of 100% for detecting CRC and a sensitivity of 50% and a specificity of 100% for detecting advanced lesions.

CONCLUSION

The detection of plasma NGS-identified mutations could assist in early screening and diagnostic of CRC in a noninvasive manner.

Water-assisted colonoscopy in inflammatory bowel diseases: From technical implications to diagnostic and therapeutic potentials

Water-assisted colonoscopy (WAC) application in inflammatory bowel diseases (IBD) endoscopy offers significant technical opportunities. Traditional gas-aided insufflation colonoscopy increases patient discomfort, presenting challenges in the frequent and detailed mucosal assessments required for IBD endoscopy. WAC techniques, including water immersion and exchange, provide superior patient comfort and enhanced endoscopic visualisation. WAC effectively reduces procedural pain, enhances bowel cleanliness, and increases adenoma detection rates, which is crucial for colorectal cancer screening and disease-related evaluations in IBD patients. Additionally, underwater techniques facilitate basic and advanced endoscopic resections, such as polypectomy and endoscopic mucosal and submucosal resections, often required for resecting IBD-associated neoplasia.