Clinical Gastroenterology and Hepatology最新文献

{"title":"Clinical Outcomes After Ustekinumab Biosimilar Switching in Crohn's Disease: The USBIOS-Italian Group for the Study of Inflammatory Bowel Disease Study.","authors":"Davide Giuseppe Ribaldone, Elisa Tribocco, Franco Scaldaferri, Marco Murgiano, Simone Parello, Federica Di Vincenzo, Angelo Del Gaudio, Pierluigi Puca, Daniele Napolitano, Alfredo Papa, Loris Riccardo Lopetuso, Lucrezia Laterza, Cristina Bezzio, Alessandro Armuzzi, Valeria Farinola, Edoardo Vincenzo Savarino, Fabiana Zingone, Brigida Barberio, Luisa Bertin, Alessia Todeschini, Angela Variola, Anna Maria Carvalhas Gabrielli, Francesca Ferretti, Rosanna Cannatelli, Antonietta Gerarda Gravina, Raffaele Pellegrino, Anna Viola, Clara De Francesco, Fabrizio Bossa, Luca Pastorelli, Carla Felice, Gabriele Dragoni, Daniele Canova, Linda Cingolani, Rocco Spagnuolo, Maria Maddalena Terpin, Alessandra Zilli, Ambra Magiotta, Francesco Segatta, Simone Saibeni, Ana Juverdeanu, Marta Vernero, Gian Paolo Caviglia","doi":"10.1016/j.cgh.2026.08.014","DOIUrl":"10.1016/j.cgh.2026.08.014","url":null,"abstract":"<p><strong>Background & aims: </strong>Controlled real-world evidence on nonmedical switching from reference ustekinumab to biosimilars in Crohn's disease (CD) is limited. We compared 6-month outcomes after switching vs continued reference treatment.</p><p><strong>Methods: </strong>In this prospective observational cohort at 18 Italian centers, adults with CD in clinical remission (Harvey-Bradshaw Index <5) and steroid-free for ≥8 months of reference ustekinumab, underwent a procurement-driven switch to 1 of 3 approved biosimilars or continued reference treatment. The expanded clinical success end point required clinical remission without systemic corticosteroids, anti-interleukin12 or 23 discontinuation, inflammatory bowel disease-related hospitalization, or intestinal surgery. The protocol-specified noninferiority margin was -15%.</p><p><strong>Results: </strong>Among 462 patients, 337 switched and 125 continued reference ustekinumab; only 4 (0.9%) received every-4-week dosing. Expanded clinical success occurred in 306 of 332 switched patients (92.2%) and 114 of 123 controls (92.7%; risk difference, -0.5%, 95% confidence interval, -5.9 to 4.9), meeting the noninferiority criterion. Results were consistent for the protocol-defined 3-component composite and after propensity-score weighting. Biosimilar persistence was 93.7%; switch-back occurred in 1.2%. Two adverse events were reported after switching.</p><p><strong>Conclusions: </strong>In clinically stable CD, the observed 6-month effectiveness and safety after procurement-driven ustekinumab biosimilar switching were similar to continued reference treatment. Longer-term studies, particularly in patients receiving every-4-week dosing, are needed.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148839384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Comparative Evaluation of Fibrosis in Patients With and Without Chronic Pancreatitis Undergoing Pancreatic Surgery.","authors":"Aida A Metri, Mahya Faghih, Elham Afghani, Elizabeth Thompson, Michael Noë, Rifat Mannan, Rita Kalyani, Venkata S Akshintala, Zahra Yousefli, Daniel Warren, Niraj M Desai, Zhaoli Sun, Christi Walsh, Lara Cheesman, Martin A Makary, Ralph H Hruban, Jin He, Atif Zaheer, Dana K Andersen, Vikesh K Singh","doi":"10.1016/j.cgh.2026.08.015","DOIUrl":"10.1016/j.cgh.2026.08.015","url":null,"abstract":"<p><strong>Background & aims: </strong>Fibrosis is considered the gold standard for diagnosing chronic pancreatitis (CP) but has not been systematically studied across a large cohort of patients with and without pancreatitis undergoing different pancreatic surgeries.</p><p><strong>Methods: </strong>Demographic, clinical, and radiologic data for patients undergoing total pancreatectomy with islet autotransplantation for indeterminate CP, recurrent acute pancreatitis (RAP), and definite CP; Whipple/Frey for indeterminate and definite CP; and distal pancreatectomy for serous cystadenoma between 2004 and 2023 were reviewed. Definite and indeterminate CP were defined by M-ANNHEIM criteria; and RAP defined as ≥2 episodes of imaging-documented acute pancreatitis. The Ammann Fibrosis Score (FS) was tabulated for all surgical pathology specimens. Patients with serous cystadenoma were included as controls. Data were summarized as median (interquartile range [IQR]) or number (%).</p><p><strong>Results: </strong>There were 206 patients including 24 controls, 31 with indeterminate CP, 36 with RAP, and 115 with definite CP. The median FS was 0.33 (IQR, 0.2-0.5), 2.8 (IQR, 1-6), 6.5 (IQR, 3.7-8), and 8.5 (IQR, 5.9-11) in controls, indeterminate CP, RAP, and definite CP, respectively. Post hoc Dunn tests with Holm adjustment showed significant differences in total FS across all diagnostic groups, with most component scores also differing significantly between groups. There was no correlation between FS and number of AP episodes; however, patients with genetic or idiopathic RAP with ≥7 episodes of AP had similar FS to genetic or idiopathic CP (P = .08).</p><p><strong>Conclusions: </strong>Fibrosis quantification may provide complementary information to existing clinical, imaging, and functional assessments when evaluating patients across the pancreatitis continuum. Current diagnostic criteria for indeterminate CP are leading to an overdiagnosis of CP if fibrosis remains the criteria standard. Among genetic/idiopathic etiologies, patients with RAP with ≥7 episodes of AP have similar quantities of fibrosis to CP.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148839426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low Metabolic Dysfunction-Associated Steatotic Liver Disease Awareness and Missed Screening Opportunities: Results From a United Kingdom Population and Clinician Survey.","authors":"Damien Leith, Paul N Brennan, Ruairi W Lynch, John F Dillon, Christopher J Byrne","doi":"10.1016/j.cgh.2026.07.028","DOIUrl":"10.1016/j.cgh.2026.07.028","url":null,"abstract":"<p><strong>Background & aims: </strong>Metabolic dysfunction-associated steatotic liver disease (MASLD) affects over 30% of adults but remains under-recognized. Guidelines recommend screening in high-risk groups; however, MASLD awareness among patients and health care practitioners (HCPs) remains poor, with gaps in knowledge and implementation persisting. We undertook 2 national surveys to quantify MASLD awareness and knowledge gaps and explore screening practices among HCPs.</p><p><strong>Methods: </strong>This cross-sectional study comprised 2 online surveys of the general population in Scotland and United Kingdom HCPs (primary and secondary care). Surveys assessed recognition of MASLD and associated conditions, factors influencing awareness (including inequalities), and HCP screening practices.</p><p><strong>Results: </strong>In the population survey (n = 2114), 71% of respondents were aware of 'fatty liver disease,' compared with 5% for MASLD, and 38% for nonalcoholic fatty liver disease (P < .001). Respondents at higher risk of MASLD, aged less than 60 years, with higher educational attainment, and of female sex, were more likely to be \"aware\" (all P < .01). Most population respondents (98%) reacted positively to wanting a MASLD diagnosis if present. Among HCPs (n = 158), the awareness of fatty liver disease (100%) and nonalcoholic fatty liver disease (98%) was significantly higher than that of MASLD (57%; P < .001). Only 44% of HCPs reported screening any patients for MASLD. Barriers cited included a lack of familiarity with guidelines, limited access to recommended screening tools, and unclear specialist referral pathways.</p><p><strong>Conclusions: </strong>Improved awareness and guideline adoption are imperative to facilitate earlier MASLD diagnosis and intervention. Our findings suggest targeted education for awareness and equitable public health strategies are still needed to address knowledge and management gaps in the United Kingdom among both the general population and HCPs.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148825835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Incidence of Esophageal Food Impactions and Risk Factors for Recurrence in a Large, Community-Based Health Care System in Northern California.","authors":"Angela Y Lam, Willa Xie, Mahim Naveed, Janet Song, Nathan M Billett, Omar Bakr, Aaron Oh, Eshandeep S Boparai, Douglas A Stram, Christopher Ma, Jeffrey K Lee","doi":"10.1016/j.cgh.2026.08.012","DOIUrl":"10.1016/j.cgh.2026.08.012","url":null,"abstract":"<p><strong>Background & aims: </strong>Esophageal food bolus impaction (EFBI) is a common gastrointestinal emergency with sparse epidemiologic data. We evaluated the epidemiologic and clinical characteristics of EFBI and risk factors for recurrence in a large, community-based, integrated health care organization.</p><p><strong>Methods: </strong>This was a retrospective study of adults with an emergency department (ED) visit for EFBI between 2010 and 2024. Patients with EFBI confirmed on endoscopy were identified for subgroup analysis. The annual incidence rates were assessed, and trends were evaluated using Poisson regression. We characterized patient demographics, endoscopic utilization, and associated diagnoses. We evaluated EFBI recurrence rates and potential risk factors for recurrence utilizing time-to-event survival analysis and multivariable Cox proportional hazards model.</p><p><strong>Results: </strong>A total of 10,146 ED encounters for EFBI among 8231 unique patients were included, and 3431 patients had an endoscopy confirming EFBI. The annual incidence rates fluctuated from 14.79 (95% confidence interval, 13.55-16.12) to 21.52 (95% confidence interval, 19.90-23.24) per 100,000 during the study period, with an initial rise from 2010 to 2016 followed by a decline from 2016 to 2024. The proportion of patients requiring endoscopy declined from 52.7% (2010-2014) to 42.3% (2021-2014), as did the incidence of endoscopically confirmed EFBI (8.12-6.11 per 100,000 from 2010 to 2024, respectively). The highest 5-year cumulative incidences of recurrence were observed in patients with esophageal malignancy (33.7%), eosinophilic esophagitis (24.0%), and esophageal stricture (23.4%).</p><p><strong>Conclusions: </strong>No sustained trends in EFBI incidence were observed from 2010 to 2024, although the proportion of patients requiring endoscopy slightly declined. Eosinophilic esophagitis and benign esophageal stricture were the most common esophageal diagnoses conferring high disease-specific recurrence rates, underscoring an opportunity to optimize diagnosis and treatment.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148811799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Detection of Potential Metabolic and Alcohol-Associated Liver Disease and Alcohol-Associated Liver Disease Using Phosphatidylethanol in a Large Multicenter Metabolic Dysfunction-Associated Steatohepatitis Trial Screening Cohort.","authors":"Mazen Noureddin, Jörn M Schattenberg, Rashmee Patil, Elizabeth W Brombosz, Gražina Binkauskiene, Michelle Mazuranic, Laura Ladron de Guevara Cetina, Marcelo Kugelmas, Aasim Sheikh, John Poulos, Sudha Kodali, Brian P Lee, Juan Pablo Arab, Naim Alkhouri","doi":"10.1016/j.cgh.2026.08.011","DOIUrl":"10.1016/j.cgh.2026.08.011","url":null,"abstract":"<p><strong>Background & aims: </strong>Accurate distinction between metabolic dysfunction-associated steatotic liver disease (MASLD), alcohol-associated liver disease (ALD), and the overlap metabolic and alcohol-associated liver disease (MetALD) is of utmost importance. Due to the potential for underreporting in alcohol use surveys, phosphatidylethanol (PEth) is increasingly utilized in clinical trials to rule out MetALD or ALD. This study examines the prevalence of elevated PEth and its effectiveness in separating phenotypes with dominant MASLD, MetALD, or ALD in the clinical trial setting.</p><p><strong>Methods: </strong>A multicenter database of patients screened for enrollment in clinical trials for MASLD pharmacologic therapies was reviewed, from which patients with PEth results were identified, then further stratified into low (<20 ng/mL), moderate (20-<100 ng/mL), or high (≥100 ng/mL) alcohol intake groups.</p><p><strong>Results: </strong>Among 2870 patients with baseline PEth data, 2560 (89%) had low, 168 (6%) had moderate, and 142 (5%) had high PEth levels, including 92 with PEth ≥200 ng/mL. Higher hemoglobin A1C was associated with lower PEth (P < .001). Aspartate aminotransferase (P < .001), alanine aminotransferase (P < .001), and γ-glutamyltransferase (P < .001) were elevated in patients with higher PEth results. Indeterminate Fibrosis-4 scores were more prevalent in patients with PEth ≥100 ng/mL (P < .001). In multivariable analysis, PEth ≥20 ng/mL was associated with higher γ-glutamyltransferase (per 10 U/L; adjusted odds ratio, 1.04; 95% confidence interval, 1.03-1.06; P < .001), and lower hemoglobin A1C (adjusted odds ratio, 0.68; 95% confidence interval, 0.60-0.78; P < .001).</p><p><strong>Conclusions: </strong>In this prospective multicenter cohort of participants screened for MASLD clinical trials with systematically collected PEth, 11% had PEth ≥20 ng/mL, suggesting a level of alcohol consumption that may warrant further clinical evaluation for possible MetALD or ALD.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148817772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adenocarcinoma Arising in a Colonic Neo-Esophagus 60 Years After Pediatric Caustic Injury: The Longest Reported Interval.","authors":"Nwal Hadaki, Hassam Cheema, Mohammad Al-Haddad","doi":"10.1016/j.cgh.2026.08.013","DOIUrl":"10.1016/j.cgh.2026.08.013","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148817705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recompensation After Etiologic Cure in United States Veterans With Hepatitis C Virus-Related Decompensated Cirrhosis.","authors":"Daniela Goyes, Anahita Rabiee, Nicolas Chong-Lugon, Catherine Mezzacappa, David E Kaplan, Tamar H Taddei, Guadalupe Garcia-Tsao","doi":"10.1016/j.cgh.2026.08.010","DOIUrl":"10.1016/j.cgh.2026.08.010","url":null,"abstract":"<p><strong>Background & aims: </strong>Recompensation after etiologic cure is increasingly recognized as an achievable state in decompensated cirrhosis, but United States data remain limited. We evaluated the frequency, predictors, and prognostic relevance of recompensation after hepatitis C virus (HCV) cure in United States Veterans with HCV-related decompensated cirrhosis.</p><p><strong>Methods: </strong>We performed a retrospective cohort study using the Veterans Outcomes and Costs Associated with Liver Disease (VOCAL) cohort. Patients with HCV-related cirrhosis, imaging-documented ascites before direct-acting antiviral therapy, and sustained virologic response were included. The primary outcome was recompensation (per Baveno VII criteria) during follow-up. Fine-Gray regression was used for univariable and multivariable analyses of predictors of recompensation, with death or liver transplantation as competing events. A 24-month landmark analysis assessed subsequent all-cause mortality (Cox regression) and hepatocellular carcinoma (Fine-Gray regression). A separate Fine-Gray analysis evaluated time to documented ascites resolution.</p><p><strong>Results: </strong>Among 1213 eligible patients, 163 (13%) achieved recompensation up to 24 months after direct-acting antiviral initiation. In multivariable analysis, higher baseline albumin independently predicted recompensation, whereas platelet count <110 × 10⁹/L and further decompensation were associated with a lower likelihood of recompensation. Recompensation was associated with reduced subsequent all-cause mortality. Predictors of documented ascites resolution were similar to those of recompensation.</p><p><strong>Conclusions: </strong>Recompensation occurs in a meaningful proportion of patients with HCV-related decompensated cirrhosis after sustained virologic response and is associated with improved survival. Patients with preserved liver synthetic function and less severe portal hypertension are more likely to recompensate, whereas further decompensation reduces this likelihood. Ascites resolution alone identified most patients achieving Baveno VII-defined recompensation, suggesting it may serve as a pragmatic clinical marker of recompensation.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148812375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aminosalicylate Use Increases Corticosteroid Exposure and Decreases Biologic Durability in Pediatric Crohn's Disease.","authors":"Perseus V Patel, Jonathan Moses, Sabina Ali, David L Suskind, Brad Pasternak, Jess L Kaplan, Charles Samson, Lauren Manning, Jeremy Adler","doi":"10.1016/j.cgh.2026.08.008","DOIUrl":"10.1016/j.cgh.2026.08.008","url":null,"abstract":"<p><strong>Background & aims: </strong>Despite lack of evidence for efficacy, 5-aminosalicylates (5-ASAs) continue to be prescribed for pediatric Crohn's disease (pCD). There are limited data examining current practice patterns in pCD and the impact of 5-ASAs use on clinical outcomes. We aimed to determine the prevalence of 5-ASAs use in pCD and evaluate its association with biologic durability, corticosteroid exposure, and disease-related complications.</p><p><strong>Methods: </strong>We conducted a prospective, multicenter inception cohort study using data from the Biologic dISContinuation sTudy (BISCUIT). Early therapy (<90 days from diagnosis) groups included biologics, immunomodulators, 5-ASAs, and none of the above. The primary outcome was biologic durability. The secondary outcomes included corticosteroid use, therapy failure, and disease complications. Stabilized inverse probability of treatment weighting and Cox regressions were employed to equate for baseline differences among groups.</p><p><strong>Results: </strong>Of 679 patients, 18% received early 5-ASA monotherapy. Early 5-ASAs were associated with greater systemic corticosteroid use (P = .036) and delayed time-to-biologic (median, ∼11 months), with 58.0% of patients escalating therapy. Among those who escalated, early 5-ASAs increased the risk of biologic discontinuation (hazard ratio, 4.47; 95% confidence interval, 1.28-15.65; P = .029). Furthermore, early 5-ASA and immunomodulator use did not prevent disease complications, whereas early anti-tumor necrosis factor therapy protected against perianal disease (odds ratio, 0.24; 95% confidence interval, 0.06-0.93; P = .039).</p><p><strong>Conclusions: </strong>Early 5-ASAs use in patients with pCD is common, represents undertreatment, and is associated with inferior outcomes, including greater steroid exposure, delayed initiation of effective biologic therapy, and decreased biologic durability, without protection against disease complications. These findings support avoidance of 5-ASAs in patients with pCD and prioritizing early anti-tumor necrosis factor therapy to improve long-term outcomes and reduce perianal disease risk.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148789015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply.","authors":"Derin Celtik, Hyun-Seok Kim","doi":"10.1016/j.cgh.2026.08.009","DOIUrl":"10.1016/j.cgh.2026.08.009","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148789028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Standardized Assessment of Complete Colorectal Polyp Resection for Polyps Less Than Twenty Millimeters: A Delphi Consensus.","authors":"Querijn N E van Bokhorst, Silpa Yarra, Manon van der Vlugt, Heiko Pohl, Evelien Dekker, Aasma Shaukat","doi":"10.1016/j.cgh.2026.07.039","DOIUrl":"10.1016/j.cgh.2026.07.039","url":null,"abstract":"<p><strong>Background & aims: </strong>The incomplete resection of colorectal polyps can lead to polyp recurrence and postcolonoscopy colorectal cancer. At present, standardized methods for assessing the completeness of the resection and calculating the incomplete resection rate (IRR) are lacking. This study aimed to establish an expert consensus on the optimal strategies and protocols for the standardized evaluation of resection completeness for resections of polyps <20 mm in size.</p><p><strong>Methods: </strong>An international modified Delphi consensus process consisting of 3 rounds of anonymized surveys was conducted. A total of 103 gastrointestinal endoscopy experts were invited. Agreement was defined as consensus among ≥80% of the participants for each statement. Based on the expert consensus, standardized assessment protocols were established for daily clinical practice and for quality assurance and research.</p><p><strong>Results: </strong>Sixty-seven experts from 18 countries participated, with 53 (51%) from 16 countries completing all 3 rounds. Consensus was achieved for 18 of 20 statements (90%) after 3 rounds. The key agreements included: (1) the primary assessment of resection completeness using high-definition white-light inspection, supplemented by image-enhanced inspection for polyps 10 to 19 mm; (2) routine postresection photo documentation for polyps 10 to 19 mm; (3) standard histopathologic margin assessment for all nonfragmented 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 to 19 mm.</p><p><strong>Conclusions: </strong>This study presents an international expert consensus on the evaluation of the completeness of resections for colorectal polyps <20 mm in size. The recommendations provided could guide more consistent and standardized evaluation of polyp resections and support the establishment of the IRR as a valuable quality parameter for colonoscopy.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":16.2,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148788964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}