Best Practice & Research Clinical Gastroenterology最新文献

{"title":"Evidence-based decision analysis guiding clinical guidelines for an organized population-based screening for colorectal cancer","authors":"Beate Jahn ,&nbsp;Gaby Sroczynski ,&nbsp;Júlia Santamaria ,&nbsp;Ursula Rochau ,&nbsp;Silke Siebert ,&nbsp;Nikolai Mühlberger ,&nbsp;Sibylle Puntscher ,&nbsp;Monika Ferlitsch ,&nbsp;Monika Hackl ,&nbsp;Herbert Tilg ,&nbsp;Friedrich Renner ,&nbsp;Michael Gschwantler ,&nbsp;Irmgard Schiller-Fruehwirth ,&nbsp;Timo Fischer ,&nbsp;Herbert Bachler ,&nbsp;Barbara Fröschl ,&nbsp;Christina Dietscher ,&nbsp;Eva Schernhammer ,&nbsp;Gerald Gartlehner ,&nbsp;Uwe Siebert","doi":"10.1016/j.bpg.2025.102045","DOIUrl":"10.1016/j.bpg.2025.102045","url":null,"abstract":"<div><h3>Background</h3><div>This study includes the long-term benefit-harm analysis of population-wide colorectal cancer (CRC) screening strategies commissioned by the Austrian National Committee for Cancer Screening (ANCCS). In addition, we present the related cost-effectiveness analysis.</div></div><div><h3>Methods</h3><div>Using a validated decision-analytic Markov state transition model, we evaluated 17 by the ANCCS suggested CRC-screening strategies differing in tests (fecal-immunochemical test (FIT), guaiac-based fecal occult blood test (gFOBT), colonoscopy (COL)), age at start (40,45,50 years) and end (COL: 65,70,75 years, FIT/gFOBT 75 years), and intervals (2,5,10 years). Positive FIT/gFOBT tests are followed by colonoscopy. Evaluated outcomes included health benefits (life-years gained (LYG), CRC-cases/CRC-deaths avoided), harms (severe colonoscopy complications, psychological harms due to positive test results (PTR), additional colonoscopies), stepwise evaluated incremental harm-benefit ratios (IHBR), and incremental cost-effectiveness ratios (ICER). We applied the Austrian healthcare system perspective, a lifelong-time horizon and conducted sensitivity analyses.</div></div><div><h3>Results</h3><div>The most effective colonoscopy-based screening strategy is colonoscopy at age 40/50/60/70 (449 LYG per 1000 individuals) with an IHBR of 3 PTR/LYG compared to COL45/55/65 (ICER: 13,032 Euro/LYG vs. COL45/55/65/75). The most effective fecal blood-test-based strategy is annual FIT testing starting at age 40 years (488 LYG per 1000 individuals) and an IHBR of 30 PTR/LYG compared to FIT40+2y (biennial FIT starting age 40). All biennial FIT-based screening strategies represent alternative options on the harm-benefit efficiency frontier with IHBR of PTR/LYG: 2 (FIT50+2y vs. no screening), 5 (FIT45+2y vs. FIT50+2y), and 7 (FIT40+2y vs. FIT45+2y). The cost-effectiveness analyses provided stepwise ICERs ranging from 3391 Euro/LYG (FIT45+2y vs. FIT50+2y) to 47,812 Euro/LYG (FIT40+1y vs. FIT40+2y).</div></div><div><h3>Conclusions</h3><div>Our decision analysis shows benefit-harm and cost-effectiveness trade-offs. In the consensus meeting of the ANCCS, colonoscopy- and FIT-based screening starting at age 45 were selected as suggested screening strategies, accounting for benefit-harm balance, evidence level, and implementation aspects.</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"80 ","pages":"Article 102045"},"PeriodicalIF":4.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147273782","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":"Optical diagnosis of colorectal neoplasms from an Eastern perspective","authors":"Katsuro Ichimasa ,&nbsp;Shin-Ei Kudo ,&nbsp;Yuta Kouyama ,&nbsp;Taishi Okumura ,&nbsp;Yasuharu Maeda ,&nbsp;Takemasa Hayashi ,&nbsp;Kunihiko Wakamura ,&nbsp;Khay Guan Yeoh ,&nbsp;Tetsuo Nemoto ,&nbsp;Masashi Misawa","doi":"10.1016/j.bpg.2025.102016","DOIUrl":"10.1016/j.bpg.2025.102016","url":null,"abstract":"<div><div>This review provides an overview of optical biopsy for colorectal lesions, focusing on the Eastern perspective—particularly recent advancements in Japan. Optical biopsy aims to predict the histopathology<span> of colorectal lesions in real time during colonoscopy<span><span>, distinguishing neoplastic from non-neoplastic lesions and assessing invasion depth. This paper examines various image-enhanced endoscopy<span> techniques: narrow-band imaging (NBI) with the Japan NBI Expert Team classification, pit pattern analysis, and endocytoscopy using NBI and </span></span>methylene blue staining. Additionally, it explores the evolving role of optical diagnosis in guiding expanded endoscopic treatment strategies for T1 and even selected T2 colorectal cancers, outlining future prospects for optical biopsy.</span></span></div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"80 ","pages":"Article 102016"},"PeriodicalIF":4.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147273804","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":"Quality assurance in colonoscopy – how to interpret and implement various quality indicators related to neoplasia detection rates?","authors":"Querijn N.E. van Bokhorst ,&nbsp;Nanette S. van Roermund ,&nbsp;Manon van der Vlugt ,&nbsp;Evelien Dekker","doi":"10.1016/j.bpg.2025.102008","DOIUrl":"10.1016/j.bpg.2025.102008","url":null,"abstract":"","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"80 ","pages":"Article 102008"},"PeriodicalIF":4.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147273812","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":"Developments in the roll-out and performance of CRC screening in Europe","authors":"Giulia Carbotti ,&nbsp;Danica MN. van den Berg ,&nbsp;Andre L. Carvalho ,&nbsp;Carlo Senore ,&nbsp;Eveline AM. Heijnsdijk ,&nbsp;Harry J. de Koning ,&nbsp;Iris Lansdorp-Vogelaar ,&nbsp;CanScreen-ECIS data providers, of ICSN CRC interest group COVID-19 survey data providers and of the EUCanScreen consortium","doi":"10.1016/j.bpg.2025.102043","DOIUrl":"10.1016/j.bpg.2025.102043","url":null,"abstract":"<div><div>The heterogeneous implementation of colorectal cancer screening programs across Europe makes performance comparison challenging.</div><div>This study computed and analyzed seven key indicators of screening performance for eighteen European programs between 2011 and 2022. Trends in colorectal cancer incidence and mortality were also examined in relation to when each screening program was introduced.</div><div>Coverage indicators showed considerable variation across programs but generally increased until the onset of the COVID pandemic. Yield indicators remained stable overall, whereas jumps were associated to protocol changes. In most countries, a decline in incidence followed the introduction of the screening program, whereas the connection of screening with mortality was less evident.</div><div>The analysis of comparable screening performance indicators over time allows for cross-country and longitudinal monitoring of the programs. The observed decline in incidence following the implementation of fully rolled-out programs highlights the importance and effectiveness of well-organized screening in reducing the burden of the disease.</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"80 ","pages":"Article 102043"},"PeriodicalIF":4.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147273792","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":"Role of CADx in colonoscopy: lessons from real-life studies","authors":"Marco Bustamante-Balén","doi":"10.1016/j.bpg.2025.102020","DOIUrl":"10.1016/j.bpg.2025.102020","url":null,"abstract":"<div><div>Screening colonoscopy has significantly reduced colorectal cancer (CRC) incidence and mortality rates. However, its effectiveness relies on the accurate detection and characterization of precursor lesions. Computer-aided diagnosis (CADx) systems leveraging artificial intelligence (AI) have emerged as potential tools to enhance lesion classification and optimize clinical decision-making. This review critically examines the real-world performance of CADx in colonoscopy, highlighting its benefits and limitations in lesion characterization. While early studies demonstrated high sensitivity and negative predictive value (NPV), real-life clinical implementation has shown inconsistencies due to variability in endoscopist experience, lesion morphology, and AI training datasets. Additionally, challenges such as algorithm reliability, human-AI interaction, and integration into clinical workflows persist. This article explores the evolving role of CADx in supporting optical diagnosis, its impact on resect-and-discard strategies, and the future directions required to maximize its clinical utility.</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"80 ","pages":"Article 102020"},"PeriodicalIF":4.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147273910","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":"Mechanical auxiliary devices to expose mucosal surface in colonoscopy","authors":"Sara Schiavone ,&nbsp;Federico Iacopini ,&nbsp;Cesare Hassan ,&nbsp;Giulio Antonelli","doi":"10.1016/j.bpg.2025.102015","DOIUrl":"10.1016/j.bpg.2025.102015","url":null,"abstract":"<div><div>Colonoscopy<span> is a cornerstone of colorectal cancer (CRC) prevention, with adenoma detection rate (ADR) serving as a critical quality metric. However, substantial variability in ADR persists across operators, and a significant proportion of colorectal neoplasia—particularly flat, serrated, and right-sided lesions—continues to be missed. These limitations are often attributable to suboptimal mucosal exposure, especially in anatomical regions hidden behind haustral folds and flexures.</span></div><div>To address this, a variety of mechanical auxiliary devices—collectively termed <em>behind-folds visualizing techniques and technologies</em><span> (BFTs)—have been developed to enhance mucosal exposure during withdrawal. These include both add-on devices (e.g., caps, Endocuff, EndoRings) and integrated technologies (e.g., G-EYE, FUSE, Third Eye), each with varying levels of evidence and practicality.</span></div><div>This review critically appraises current data on BFTs, highlighting their efficacy in improving ADR, particularly among endoscopists with lower baseline performance. Meta-analyses suggest that simple, low-cost devices such as Endocuff and caps offer the most favorable balance of effectiveness, accessibility, and ease of use. Furthermore, emerging data indicate that combining mechanical exposure devices with artificial intelligence-based systems may yield additive benefits.</div><div>BFTs represent pragmatic tools to optimize colonoscopy quality and reduce post-colonoscopy CRC. Their selective implementation—especially in low-performing settings—should be considered a key component of modern endoscopic practice.</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"80 ","pages":"Article 102015"},"PeriodicalIF":4.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147273835","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":"Risk-based screening for early detection of colorectal cancer: an overview","authors":"Chiara C. Brück ,&nbsp;Lucy W. Mwangi ,&nbsp;Francine van Wifferen ,&nbsp;Li Hsu ,&nbsp;Minta Thomas ,&nbsp;Ulrike Peters","doi":"10.1016/j.bpg.2025.102014","DOIUrl":"10.1016/j.bpg.2025.102014","url":null,"abstract":"<div><div>Screening programs for colorectal cancer (CRC) reduce CRC incidence and mortality, while balancing benefits and harms of the population. However, benefits vary widely among individuals. Low-risk individuals may face unnecessary burdens, while high-risk individuals could benefit from more intensive screening. Risk-based screening addresses these issues by tailoring screening strategies using risk factors such as age, sex, race, ethnicity, lifestyle factors, genetic predisposition<span>, and previous screening results. Potential benefits of risk-based screening include improved cost-effectiveness, efficient resource use and reduced unnecessary procedures<span>. Challenges include a lack of validated risk stratification<span> tools, data availability, healthcare capacity, and ethical considerations. Several countries started to evaluate risk-based screening programs with optimistic results. While promising, further research is necessary to address the remaining challenges. Nevertheless, risk-based screening has the potential to enhance patient experiences, optimize the balance of individual-level benefits and harms, and positively impact the overall burden and costs associated with CRC screening.</span></span></span></div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"80 ","pages":"Article 102014"},"PeriodicalIF":4.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147273898","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":"Resect and discard – Is it implementable in the world?","authors":"Roupen Djinbachian ,&nbsp;Daniel von Renteln","doi":"10.1016/j.bpg.2025.102013","DOIUrl":"10.1016/j.bpg.2025.102013","url":null,"abstract":"<div><div>The resect-and-discard strategy for colorectal cancer prevention<span> involves real-time optical diagnosis during colonoscopy<span><span> to eliminate the need for histopathological analysis of diminutive colorectal polyps (1–5 mm). Although endorsed by international </span>gastroenterology societies and supported by extensive evidence of diagnostic accuracy, implementation remains limited due to barriers including clinician confidence, medico-legal concerns, and procedural complexities. The emergence of artificial intelligence (AI)-based diagnostic systems has renewed interest in this strategy by potentially improving accuracy and clinician acceptance. While early real-world data indicate high patient approval and significant cost and environmental benefits, critical questions remain unanswered, including optimal techniques for accurate polyp size estimation and AI-based differentiation of specific histological features. Additionally, uncertainties regarding medico-legal liability and standardization of quality assurance processes require further clarification. This review highlights current evidence, identifies major implementation barriers, and proposes areas of future research necessary to facilitate widespread adoption of the resect-and-discard strategy.</span></span></div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"80 ","pages":"Article 102013"},"PeriodicalIF":4.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147273878","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":"Is blood the new stool? Status of blood tests for CRC screening","authors":"Erin L. Symonds ,&nbsp;Maddison Dix ,&nbsp;Molla M. Wassie ,&nbsp;Norma B. Bulamu ,&nbsp;Graeme P. Young ,&nbsp;Jean M. Winter","doi":"10.1016/j.bpg.2025.102049","DOIUrl":"10.1016/j.bpg.2025.102049","url":null,"abstract":"<div><div>Colorectal cancer (CRC) screening has proven to decrease CRC incidence and mortality, with many countries providing faecal immunochemical tests (FIT) in screening programs. Effectiveness, however, is limited in the setting of low participation rates, which has prompted growing research into blood-based screening. While blood testing is anticipated to improve participation due to greater population acceptability, its readiness for widespread implementation remains unclear, and comparative accuracy data against FIT is needed. This article provides a systematic review and meta-analysis on blood-based CRC screening tests that have been directly compared to FIT, and summarises the evidence for broader program considerations, including analytical quality, consumer preferences, participation rates and cost effectiveness. The findings show that blood tests currently lack the sensitivity and cost-effectiveness to replace FIT in screening programs, and that their use should be limited to individuals unable or unwilling to complete FIT.</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"80 ","pages":"Article 102049"},"PeriodicalIF":4.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147273767","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":"Optical diagnosis of histopathology– is it implementable in the world of artificial intelligence?","authors":"Abraham Z. Cheloff,&nbsp;Prahan Chetlur,&nbsp;Emily B. Kagan,&nbsp;Seth A. Gross","doi":"10.1016/j.bpg.2025.102044","DOIUrl":"10.1016/j.bpg.2025.102044","url":null,"abstract":"<div><div>Colorectal cancer (CRC) remains a leading cause of cancer-related mortality in the United States, with colonoscopy serving as the gold standard for both diagnosis and early intervention. While diminutive polyps (&lt;5 mm) constitute most findings, only a small fraction exhibit advanced histological features. Optical diagnosis, which enables real-time classification of polyp histology through new technologies and the support of new strategies to leave low risk polyps in place (diagnose-and-leave) or resect without sending for formal pathology (resect-and-discard) have been studied as a cost-saving and effective strategy for diminutive polyps. There have been advances in imaging, such as narrow band imaging (NBI), but widespread adoption has yet to occur. The integration of artificial intelligence (AI), particularly computer-aided diagnosis (CADx) systems, has emerged as a promising tool to standardize optical diagnosis, reduce interobserver variability, and improve adherence to surveillance guidelines. However, barriers to widespread implementation persist, including concerns about medicolegal liability, financial disincentives, and skepticism of CADx accuracy. The goal of article is to review the current evidence surrounding optical diagnosis, review diagnostic accuracy, and evaluate the challenges of widespread clinical adoption.</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"80 ","pages":"Article 102044"},"PeriodicalIF":4.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147273790","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}