Digestion最新文献

{"title":"Cost-effectiveness analysis of endoscopic treatment versus medication strategy for proton pump inhibitor-refractory gastroesophageal reflux disease.","authors":"Fumiaki Ishibashi, Sho Suzuki, Kentaro Mochida, Takao Tonishi, Yuichi Ishibashi","doi":"10.1159/000543365","DOIUrl":"https://doi.org/10.1159/000543365","url":null,"abstract":"<p><strong>Introduction: </strong>Potassium-competitive acid blockers are effective against proton pump inhibitor-refractory gastroesophageal reflux disease; however, their long-term use is associated with economic disadvantages. Endoscopic procedures may reduce potassium-competitive acid blocker use. This study aimed to determine the optimal treatment strategy for patients with proton pump inhibitor-refractory gastroesophageal reflux disease from a cost-effectiveness perspective.</p><p><strong>Methods: </strong>Using a Markov state transition model to simulate symptom changes in patients with proton pump inhibitor-refractory gastroesophageal reflux disease, the cost-effectiveness of two strategies was compared: endoscopic treatment (anti-reflux mucosectomy or endoscopic submucosal dissection for gastroesophageal reflux disease) followed by potassium-competitive acid blocker versus medication with high-dose potassium-competitive acid blocker. In both strategies, potassium-competitive acid blocker maintained symptoms at the lowest controllable dose. The time horizon varied from 10 to 50 years. The quality-adjusted life year and incremental cost-effectiveness ratio were calculated. Willingness-to-pay was set at 5,000,000 Japanese yen.</p><p><strong>Results: </strong>The quality-adjusted life years gained were 0.90 and 0.95 for the endoscopic treatment and medication strategies, respectively. The incremental cost-effectiveness ratio varied with the follow-up period after the initial treatment, with the endoscopic treatment strategy being more cost-effective than the medication strategy at ≥50 years of follow-up. A dose reduction success rate of <84.1% for high-dose potassium-competitive acid blocker and an endoscopic treatment success rate of >66.8% were required to determine the superiority of the endoscopic treatment strategy at the 50-year follow-up after treatment.</p><p><strong>Discussion/conclusions: </strong>The endoscopic treatment strategy is not cost-effective unless the patient is followed up for >50 years after the initial treatment.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-26"},"PeriodicalIF":3.0,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142920751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current status of artificial intelligence use in colonoscopy.","authors":"Masashi Misawa, Shin-Ei Kudo","doi":"10.1159/000543345","DOIUrl":"https://doi.org/10.1159/000543345","url":null,"abstract":"<p><strong>Background: </strong>Artificial intelligence (AI) has significantly impacted medical imaging, particularly in gastrointestinal endoscopy. Computer-aided detection and diagnosis systems (CADe and CADx) are thought to enhance the quality of colonoscopy procedures.</p><p><strong>Summary: </strong>Colonoscopy is essential for colorectal cancer screening, but often misses a significant percentage of adenomas. AI-assisted systems employing deep learning offer improved detection and differentiation of colorectal polyps, potentially increasing adenoma detection rates by 8%-10%. The main benefit of CADe is in detecting small adenomas, whereas it has a limited impact on advanced neoplasm detection. Recent advancements include real-time CADe systems and CADx for histopathological predictions, aiding in the differentiation of neoplastic and non-neoplastic lesions. Biases such as the Hawthorne effect and potential overdiagnosis necessitate large-scale clinical trials to validate the long-term benefits of AI. Additionally, novel concepts such as computer-aided quality improvement systems are emerging to address limitations facing current CADe systems.</p><p><strong>Key messages: </strong>Despite the potential of AI for enhancing colonoscopy outcomes, its effectiveness in reducing colorectal cancer incidence and mortality remains unproven. Further prospective studies are essential to establish the overall utility and clinical benefits of AI in colonoscopy.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-13"},"PeriodicalIF":3.0,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142892507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deep Learning-Based Detection of Malignant Bile Duct Stenosis in Fluoroscopy Images of Endoscopic Retrograde Cholangiopancreatography.","authors":"Kien Vu Trung, Marcus Hollenbach, Gregory Patrick Veldhuizen, Oliver Lester Saldanha, Jakob Garbe, Jonas Rosendahl, Sebastian Krug, Patrick Michl, Jürgen Feisthammel, Thomas Karlas, Jochen Hampe, Albrecht Hoffmeister, Jakob Nikolas Kather","doi":"10.1159/000543049","DOIUrl":"https://doi.org/10.1159/000543049","url":null,"abstract":"<p><strong>Introduction: </strong>The accurate distinction between benign and malignant biliary strictures (BS) poses a significant challenge. Despite the use of bile duct biopsies and brush cytology via endoscopic retrograde cholangiopancreaticography (ERCP), the results remain suboptimal. Single-operator cholangioscopy can enhance the diagnostic yield in BS, but its limited availability and high costs are substantial barriers. Convolutional Neural Network (CNN)-based systems may improve the diagnostic process and enhance reproducibility. Therefore, we assessed the feasibility of using deep learning to differentiate BS using fluoroscopy images during ERCP.</p><p><strong>Methods: </strong>We conducted a retrospective review of adult patients (n=251) from three university centers in Germany (Leipzig, Dresden, Halle) who underwent ERCP. We developed and evaluated a deep learning-based model using fluoroscopy images. The performance of the classifier was evaluated by measuring the area under the receiver operating characteristic curve (AUROC) and we utilized saliency map analyses to understand the decision-making process of the model.</p><p><strong>Results: </strong>In cross-validation experiments, malignant BS were detected with a mean AUROC of 0.89 ± 0.03. The test set of the Leipzig cohort demonstrated an AUROC of 0.90. In two independent external validation cohorts (Dresden, Halle), the deep learning-based classifier achieved an AUROC of 0.72 and 0.76, respectively. The artificial intelligence model's predictions identified plausible characteristics within the fluoroscopy images.</p><p><strong>Conclusion: </strong>By using a deep learning model, we were able to discriminate malignant BS from benign biliary conditions. The application of artificial intelligence enhances the diagnostic yield of malignant BS and should be validated in a prospective design.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-24"},"PeriodicalIF":3.0,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Estimation of invasion depth of early colorectal cancer using Endoscopic ultrasonography and Magnifying chromoendoscopy: a meta-analysis.","authors":"Runhua Chen, Yafang Huang, Fusheng Liu","doi":"10.1159/000542620","DOIUrl":"https://doi.org/10.1159/000542620","url":null,"abstract":"<p><p>Introduction magnifying chromoendoscopy (MCE) and Endoscopic ultrasonograpty (EUS) are often used as diagnostic tools to estimate the depth of invasion in early colorectal cancers (CRCs). The aim of this study was to compare MCE with EUS in distinguishing between slight submucosal invasion (invasion depth <1000μm) and massively submucosal invasion in patients with early CRCs, since slight submucosal invasion is currently considered as an indication for endoscopic resection and submucosal cancer with massively submucosal invasion should be surgically treated due to an increased risk of lymph node metastasis. Methods For this meta-analysis, relevant studies were identified from PubMed, Embase and the Cochrane Library databases between the time of the establishment and April 2023.Data on the yield of tumors were extracted, pooled, and analyzed by stata15.0 software. The sensitivity, specificity, positive likelihood ratio and negative likelihood ratio in differentiating massive submucosal invasion from slight submucosal invasion were calculated for both diagnostic modalities. Results Twenty-six studies involving 1,2586 lesions were included: sixteen were studies on MCE and 7 were studies on EUS and 3 were studies on both MCE and EUS. The pooled sensitivity of MCE was 0.78(95%CI 0.72-0.83), the specificity was 0.95（0.95%CI 0.91-0.97）, the positive likelihood ratio was 15.4（0.95%CI 8.7-27.4) and the negative likelihood ratio was 0.23（0.95%CI 0.18-0.30).The pooled sensitivity of EUS was 0.88(95%CI 0.81-0.93), the specificity was 0.87（0.95%CI 0.80-0.91）, the positive likelihood ratio was 6.7（0.95%CI 4.4-10.3) and the negative likelihood ratio was 0.13（0.95%CI 0.08-0.23). Conclusion The sensitivity tended to be higher in EUS than MCE for early CRCs with massively submucosal invasion, whereas the specificity was significantly lower in EUS than in MCE.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-26"},"PeriodicalIF":3.0,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142738788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of a protease inhibitor camostat mesilate on gut microbial function in patients with irritable bowel syndrome: A pilot randomized placebo-controlled study.","authors":"Motoyori Kanazawa, Kentaro Miyamoto, Michiko Kano, Kyoko Inooka, Kentaro Oka, Motomichi Takahashi, Nariyasu Mano, Shin Fukudo","doi":"10.1159/000542758","DOIUrl":"https://doi.org/10.1159/000542758","url":null,"abstract":"<p><strong>Introduction: </strong>Increased fecal protease activity which may induce visceral hypersensitivity has been observed in patients with irritable bowel syndrome (IBS). Serine proteases modulate FK506 binding protein (FKBP)-type peptidylprolyl cis-trans isomerase (PPIase) activity associated with immune and glucocorticoid receptor functions. The aims were to investigate whether camostat mesilate (CM), a serine protease inhibitor, modifies fecal bacterial function associated with FKBP-type PPIases ameliorates in patients with IBS.</p><p><strong>Methods: </strong>Randomly assigned 16 patients with IBS received 200 mg po tid of CM and 16 patients received placebo for 14 days. Self-reported adequate relief (AR) as a primary endpoint, IBS Symptom Severity Scale (IBS-SSS) and colonic motor and pain thresholds to colorectal distention were assessed before and after treatment. The fecal bacterial content was inferred from 16S rRNA gene sequence data using Phylogenetic Investigation of Communities by Reconstruction of Unobserved States (PICRUSt) and the Kyoto Encyclopedia of Genes and Genomes (KEGG) database.</p><p><strong>Results: </strong>CM significantly increased the relative abundance of Streptococcus and the functional abundances of serine protease and FKBP-type PPIase FklB and SlyD more than placebo after treatment. CM treatment was not superior to placebo in proportion of AR although colonic motor response partially changed.</p><p><strong>Conclusion: </strong>CM modulated the fecal microbiome composition and functional potentials that are related to FKBP-type PPIase activity in IBS patients. These findings suggest that protease inhibitors may modify gut microbial function along with abnormal immunological and/or stress responses that underlie pathophysiology of IBS.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-16"},"PeriodicalIF":3.0,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142715455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surveillance after Endoscopic Resection for Colorectal Tumors: A Comprehensive Review.","authors":"Kinichi Hotta, Takahisa Matsuda, Yasushi Sano, Takahiro Fujii, Yutaka Saito","doi":"10.1159/000542665","DOIUrl":"10.1159/000542665","url":null,"abstract":"<p><strong>Background: </strong>The goal of surveillance after the endoscopic resection of colorectal tumors is to reduce colorectal cancer (CRC) incidence and mortality. Considering the effective use of the limited endoscopic capacity and the cost of surveillance, it is desirable to develop a surveillance program that is as minimal as possible. In Europe (European Society of Gastrointestinal Endoscopy [ESGE]) and the USA (Multi-Society Task Force [MSTF]), after the results of the National Polyp Study (NPS) were established, guidelines were developed that stratified risk based on initial endoscopy, and surveillance programs for each risk group were proposed. More than 10 years later, the \"colonoscopy screening and surveillance guidelines\" were developed with the basic principle of \"aiming for zero CRC deaths during surveillance, bowel preservation, and emphasis on patient quality of life\" as the guideline principles in Japan.</p><p><strong>Summary: </strong>Randomized controlled trials to evaluate the appropriate surveillance intervals after endoscopic resection of colorectal tumors, the NPS, the Nottingham Study, and the Japan Polyp Study (JPS), are summarized. The ESGE, USMSTF, and Japanese guidelines compared low-risk adenoma, high-risk adenoma, advanced neoplasia, piecemeal resection, and serrated lesions by category.</p><p><strong>Key messages: </strong>Surveillance guidelines based on risk stratification were developed in Japan. Guidelines are meaningful only when they are effectively utilized in clinical practice. They must also be revised based on new evidence. It is hoped that new knowledge will be accumulated, especially in Japan, on topics that are currently lacking.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-7"},"PeriodicalIF":3.0,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142686425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"DYRK2 regulates epithelial-mesenchymal transition restriction in pancreatic cancer liver metastasis by inhibiting Twist.","authors":"Hang Pan, Yin Liu, Kejiu Bao, Yulin Wang, Yuping Zhang, Lina Zhou","doi":"10.1159/000541039","DOIUrl":"https://doi.org/10.1159/000541039","url":null,"abstract":"<p><strong>Objectives: </strong>To explore the underlying variables and molecular pathways leading to pancreatic cancer liver metastasis.</p><p><strong>Methods: </strong>Hs766T and Hs766T-L3 cells were used to create in vitro and in vivo pancreatic cancer liver metastasis models. DYRK2 involvement in pancreatic cancer metastasis was investigated using cell adhesion assays, wound healing assays, and migration and invasion assays. To examine the link between DYRK2 expression and epithelial-mesenchymal transition, Western blot, quantitative real-time PCR, immunofluorescence assays, and immunoprecipitation (IP) were utilized. We found that mice with DYRK2 overexpression had a lower incidence of liver metastasis compared to controls.</p><p><strong>Results: </strong>DYRK2 expression decreased pancreatic cancer tumorigenic activities, including proliferation, migration, and invasion. By analyzing the expression levels of epithelial-mesenchymal transition markers and IP results after overexpressing DYRK2, we found that DYRK2 decreased Twist levels by increasing Twist ubiquitination, thereby inhibiting epithelial-mesenchymal transition.</p><p><strong>Conclusions: </strong>Our findings provide theoretical and experimental support for the ongoing development of DYRK2-based targeted therapies for pancreatic cancer liver metastases.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-18"},"PeriodicalIF":3.0,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142675321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic Resection for Colorectal Tumors.","authors":"Yuichiro Hirai, Naoya Toyoshima, Yutaka Saito","doi":"10.1159/000541605","DOIUrl":"10.1159/000541605","url":null,"abstract":"<p><strong>Background: </strong>Endoscopic resection techniques for colorectal tumors are constantly evolving with improvements.</p><p><strong>Summary: </strong>Over the past decade, there has been a paradigm shift toward cold polypectomy for the removal of small lesions (<10 mm), known as the \"cold revolution\". In recent years, underwater endoscopic mucosal resection (EMR) has emerged as an alternative to conventional EMR and has been gaining popularity for resection of intermediate and large-sized lesions (≥10 mm). Although colorectal endoscopic submucosal dissection (ESD) requires a high level of advanced skills, improvements in dissection techniques and devices have facilitated the procedure. In Japan, the safety and efficacy of ESD for resecting large lesions (≥20 mm) have been demonstrated in a large-scale, multicenter, prospective cohort study (CREATE-J). ESD is also being increasingly adopted in Western countries. As endoscopic resection continues to advance and include large and more complex defects, a variety of closure techniques and new devices are being developed. Meanwhile, the number of endoscopic resections for T1-colorectal cancer (T1-CRC), including those intended for total excisional biopsy, has been increasing owing to the aging population and improvements in endoscopic technique.</p><p><strong>Key messages: </strong>This review provides a broad summary of endoscopic resection for colorectal tumors including advancements in closure techniques and devices for mucosal defects, as well as the potential role of endoscopic resection for patients with T1-CRC.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-7"},"PeriodicalIF":3.0,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142575600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of Machine Learning Algorithms to Screen for Advanced Liver Fibrosis in Metabolic Dysfunction-Associated Steatotic Liver Disease: An In-Depth Explanatory Analysis.","authors":"Shoham Dabbah, Itamar Mishani, Yana Davidov, Ziv Ben Ari","doi":"10.1159/000542241","DOIUrl":"10.1159/000542241","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to train machine learning algorithms (MLAs) to detect advanced fibrosis (AF) in metabolic dysfunction-associated steatotic liver disease (MASLD) patients at the level of primary care setting and to explain the predictions to ensure responsible use by clinicians.</p><p><strong>Methods: </strong>Readily available features of 618 MASLD patients followed up at a tertiary center were used to train five MLAs. AF was defined as liver stiffness ≥9.3 kPa, measured via 2-dimension shear wave elastography (n = 495) or liver biopsy ≥F3 (n = 123). MLAs were compared to Fibrosis-4 index (FIB-4) and non-alcoholic fatty liver disease (NAFLD) fibrosis score (NFS) on 540 MASLD patients from the primary care setting as validation. Feature importance, partial dependence, and shapely additive explanations (SHAPs) were utilized for explanation.</p><p><strong>Results: </strong>Extreme gradient boosting (XGBoost) achieved an AUC = 0.91, outperforming FIB-4 (AUC = 0.78) and NFS (AUC = 0.81, both p < 0.05) with specificity = 76% versus 59% and 48% for FIB-4 ≥1.3 and NFS ≥-1.45, respectively (p < 0.05). Its sensitivity (91%) was superior to FIB-4 (79%). XGBoost confidently excluded AF (negative predictive value = 99%) with the highest positive predictive value (31%), superior to FIB-4 and NFS (all p < 0.05). The most important features were HbA1c and gamma glutamyl transpeptidase (GGT) with a steep increase in AF probability at HbA1c >6.5%. The strongest interaction was between AST and age. XGBoost, but not logistic regression, extracted informative patterns from ALT, low-density lipoprotein cholesterol, and alkaline phosphatase (p < 0.001). One-quarter of the false positives (FPs) were correctly reclassified with only one additional false negative based on the SHAP values of GGT, platelets, and ALT which were found to be associated with a FP classification.</p><p><strong>Conclusions: </strong>An explainable XGBoost algorithm was demonstrated superior to FIB-4 and NFS for screening of AF in MASLD patients at the primary care setting. The algorithm also proved safe for use as clinicians can understand the predictions and flag FP classifications.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-14"},"PeriodicalIF":3.0,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Screening Colonoscopy to Reduce the Incidence and Mortality of Colorectal Cancer.","authors":"Naoya Tada, Naoto Tamai, Kazuki Sumiyama","doi":"10.1159/000542113","DOIUrl":"10.1159/000542113","url":null,"abstract":"<p><strong>Background: </strong>Colorectal cancer (CRC) is a major concern because of its increasing incidence and mortality worldwide. Therefore, effective screening strategies are necessary to reduce its incidence.</p><p><strong>Summary: </strong>In addition to fecal immunochemical tests and computed tomography colonography, screening colonoscopy is expected to significantly contribute to the reduction of CRC. However, the timing of colonoscopy for CRC screening is not well-defined because of the lack of sufficient data. Additionally, the effectiveness of colonoscopy is affected by various factors known as quality indicators (QIs), such as the performance of the endoscopist; therefore, there are concerns regarding quality assurance. The adenoma detection rate (ADR) is a well-known QI of colonoscopy. Substantial evidence has suggested that improving the ADR could reduce the incidence and mortality of postcolonoscopy CRC.</p><p><strong>Key messages: </strong>Recent technological advancements have led to the development of image-enhanced endoscopy and the incorporation of artificial intelligence, and their ability to improve the ADR has been assessed. This review focused on screening colonoscopies and QIs and their ability to improve the ADR and incidence and mortality of CRC.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-7"},"PeriodicalIF":3.0,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}