Introduction

It is well known that inpatients more frequently undergo inadequate bowel preparation for colonoscopy, mainly due to factors such as old age, comorbidities and polypharmacy. we therefore aimed to investigate factors associated to inadequate bowel preparation in a group of hospitalized patients.

Aims & Methods

We prospectively enrolled inpatients at University Hospital Policlinico of Bari, who underwent colonoscopy in the last year. Outpatients undergoing colonoscopy represented a control group. For each patients we collected data about age, diseases and drugs consumed. all patients received a 4-L polyethilenglycole (PEG) based preparation in a split regimen, and colonoscopies were performed in the morning. Inadequate preparation was defined if Boston bowel preparation scale (BBPS) was total <6 or <2 in at least one colonic segment. Continuous and discrete variables were respectively compared by t-test and chi-square test. Binomial logistic regression was used to find factors associated to inadequate preparation and estimate of risk was defined as odds ratio (OR).

Results

We recruited 167 hospitalized patients and 167 controls. Inpatients were more commonly bedridden (p<0.001) or had chronic kidney disease (p=0.004) and were older than controls (64.7 ± 16.3 versus 50.9 ±18.6, p<0.001). Adequate preparation was attained only in the 73.6% of hospitalized patients versus the 88.0% of outpatients (p=0.001), and the BBPS was lower in inpatients (6.8 ± 1.7 versus 5.8 ± 2.5, p<0.001). Adequate preparation was more often achieved if patients was admitted in Gastroenterology units than in other units (81.6% versus 67.7%, p=0.04). Adenoma detection rate was higher when preparation was adequate (28.5% versus 13.6%, p=0.05). At multivariate analysis, inadequate preparation was associated with admission in a ward other than Gastroenterology (OR=1.88).

Conclusion

Our results confirm that hospitalization negatively impact on the quality of bowel preparation for colonoscopy. Interestingly, admission in Gastroenterology Unit allows a better preparation, maybe due to a better care of medical and nurse personnel.

Introduction

Steatotic liver disease (SLD) encompasses a spectrum of conditions, including metabolic dysfunction-associated SLD (MASLD), alcohol-related liver disease (ALD), and the overlapping category of MetALD. SLD affects more than a third of adults globally, but the majority remain undiagnosed, partially due to its lack of symptoms and limited awareness among patients and physicians. Adults undergoing screening colonoscopy, typically aged ≥50 years, represent a key population for targeted SLD detection, as they have a higher prevalence of cardiometabolic risk factors and is already engaged with preventive healthcare.

Aims & Methods

We examined 610 consecutive individuals aged ≥50 years with no known history of chronic liver disease who were referred for a colonoscopy for colorectal cancer screening. The protocol included sonographic assessment of liver steatosis and point shear wave elastography (pSWE) for liver fibrosis quantification, anthropometric measurements, biochemistry, medical history and alcohol intake evaluation. From the collected data, non-invasive fibrosis scores were calculated and used for aetiological and risk stratification.

Results

A total of 543 patients were included in the final analysis, after excluding patients with an invalid pSWE measurement (5.3%, n=29) and then excluding patients with incomplete results (n=38). The median age was 64 years (IQR 57-70) and 54.0% were male. The median BMI was 28.7 kg/m² (IQR 25.8–31.4) in males and 28.3 kg/m² (IQR 24.2-31.5) in females. SLD was identified in 63.4 % (n=344) of participants. Elevated liver stiffness (pSWE ≥ 1.30 m/s) was found in 26.9 % (n=146), and 4.8% (n=26) had values ≥1.70 m/s, suggestive of compensated advanced chronic liver disease. Among patients with pSWE ≥ 1.30 m/s, MASLD was the predominant aetiology (69.9%, n=102), followed by MetALD (15.8%, n=23), ALD (1.4%, n=2), cryptogenic (11.6%, n=17) and other etiologies (1.4%, n=2). Preselection using EASL-EASD-EASO criteria (i.e. presence of type 2 diabetes or central obesity plus ≥1 cardiometabolic risk factor and elevated liver enzymes) would have detected 365 at-risk individuals (67.2% of the cohort) of whom 55.9% (n=204) had a FIB-4 index ≥1.30. This approach would have identified only 30.4% (n=38) of all the patients with MASLD/MetALD with elevated liver stiffness (n=125).

Conclusion

Opportunistic screening for SLD in patients undergoing screening colonoscopy could be a useful strategy for detecting asymptomatic and potentially progressive liver disease. This approach identified a high prevalence of SLD (63.4%) and elevated liver stiffness (26.9%) in this population, primarily due to MASLD and MetALD. The integration of ultrasound and elastography added minimal burden to the existing workflow while enabling early risk stratification without the need for additional patient visits or referrals.

References

1 Tacke F, Horn P, Wong VWS, Ratziu V, Bugianesi E, Francque S, et al. EASL–EASD–EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). Journal of Hepatology [Internet]. 2024 Jun 7;81(3):492–542.
2 Lazarus JV, Miralles-Sanchez JE, Agirre-Garrido L, Brachowicz N, Nicolàs A, Armenta A, et al. A call to action to address the steatotic liver disease public health threat in Barcelona. The Lancet Regional Health - Europe [Internet]. 2025 Mar 22;52:101272.
3 Barr RG, Wilson SR, Rubens D, Garcia-Tsao G, Ferraioli G. Update to the Society of Radiologists in Ultrasound Liver Elastography Consensus Statement. Radiology [Internet]. 2020 Jun 9;296(2):263–74.

Introduction

Clostridioides difficile infection (CDI) is among of the most common causes of nosocomial diarrhea with high morbidity and mortality. Recurrent and refractory disease courses in particular represent a special challenge in the management of these patients. The identification of patients at risk for recurrent courses could improve management, e.g. through the use of new and effective therapies in patients with CDI.

Aims & Methods

The aim of this study was to investigate the relationship between the presence of different comorbidities and the course of CDI.
In a retrospective, monocentric cohort study of a tertiary centre over a period of 10 years, patients with CDI-related hospitalizations were examined. The study included 336 patients with available information on comorbidities (diverticulosis, biliary diseases (cholecysto-, docholithiasis, cholecystitis, cholangitis or cholangiectasis) inflammatory bowel diseases (IBD), liver cirrhosis and malignancies) and the diagnosis of the recurrent CDI (rCDI) vs. non-recurrent course of CDI (nrCDI). Patients on dialysis or immunosuppressed patients were also considered as comorbid.

Results

Among 336 patients included in the study, 227 (67.6%) presented with at least one comorbidity. The most common were malignancy (30.4%), biliary diseases (19.4%), diverticulosis (15.8%), liver cirrhosis (14.3%), and inflammatory bowel disease (IBD, 8.9%). rCDI occurred more frequently in patients with diverticulosis and biliary disease. Diverticulosis was present in 24.4% of rCDI cases vs. 12.6% in nrCDI cases (OR 2.24, 95% CI 1.22–4.17). Biliary diseases were observed in 26.7% of rCDI vs. 16.7% of nrCDI patients (OR 1.82, 95% CI 1.01–3.26). No significant associations with rCDI were found for IBD (OR 0.66, 95% CI 0.27–1.65), malignancy (OR 1.13, 95% CI 0.67–1.88), or liver cirrhosis (OR 0.79, 95% CI 0.38–1.61).

Conclusion

These findings suggest diverticulosis and biliary disease may be independent risk factors for rCDI, whereas other common comorbidities are not significantly associated with recurrence. Structured assessment of risk conditions may help to select patients for tailored management to prevent rCDI disease course.

Introduction

Both endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are treatment options for gastric neoplastic lesions and intervention of choice in Asia for superficial gastric cancer, yet comparative studies between the two approaches in the Western world remain sparse. Prior Western studies, mainly meta-analyses, primarily focused on the differences in en bloc resection rate, curative resection rate, and other clinical outcomes. However, little is known regarding the depth of resection by EMR versus ESD, which may critically determine the efficacy of resection.

Aims & Methods

This retrospective study aims to systemically evaluate the depth of resection following EMR and ESD procedures by histological measurement. The standardized and reproducible assessment provides important insights that may be valuable for future research and clinical practice. Ultimately, the findings from this study will contribute to a better understanding of the most effective yet less traumatic treatment modalities for gastric lesions. Gastric EMR and ESD specimens from 20 patients in the past 5 years were analyzed microscopically for pathology. Tissue sections with intact inked deep resection margins were selected for measurement. The maximum and average depth of resection were recorded and calculated for each patient, defined as depth from muscular mucosa to inked resection margin. The normality of the data for each group was assessed using the Shapiro-Wilk test. An unpaired t-test was then performed to compare the resection depths between the two groups. Other clinical and pathological features were compared between the two groups.

Results

The mean maximum resection depth is 4.53 mm for ESD and 2.33 mm for EMR (p=0.0049). The difference in average resection depth between the 2 groups is not statistically significant (p=0.132). However, ESD resulted in a higher en bloc resection rate (85.7%) as compared to EMR (69.2%). As could be expected, a larger proportion of ESD specimens (42.8%) were for malignant lesions as compared to EMR cases (15.3%). In addition, the lesion size is significantly larger in the ESD group than in the EMR group (p=0.0031), with a mean lesion size of 41.86 mm for ESD cases and 16.89 mm for EMR cases. There were no significant differences in age or gender between the 2 groups.

Conclusion

Our study provides a detailed and objective evaluation of the depth of resection achieved by ESD and EMR techniques for gastric neoplasms in a Western population. We have shown a significantly higher en bloc resection rate and greater maximum resection depth achieved with ESD. Thus, ESD may be the preferred technique for lesions requiring a greater resection depth and those with a larger size. Furthermore, ESD allows for accurate assessment of the T stage of the gastric neoplasm and evaluation of the resection margins, which is crucial in ensuring the curative resection of the lesion. However, the decision to choose between ESD and EMR should be made on a case-by-case basis, considering the individual patient and lesion characteristics and the expertise of the endoscopist. In conclusion, our findings suggest that ESD provides a deeper and more complete resection of gastric lesions as compared to EMR, similar to the results obtained in Asia.

Introduction

Low-volume polyethylene glycol plus ascorbic acid (PEG-Asc) reduces the dosage of colonoscopic bowel preparation (BP) solution, but is still poorly tolerated. Recent studies reported that adding laxatives to the BP solution reduced the volume of fluid required, without affecting the quality. Senna, one of the anthraquinone stimulant laxatives commonly used for chronic constipation, is reported to be useful as a BP adjunctive agent. However, the appropriate dose and combination of senna and BP solutions are unclear.

Aims & Methods

This study aimed to compare 1-L PEG-Asc plus 24 mg senna (1L-PEG/AS) and conventional 2-L PEG-Asc (2L-PEG/A) regimens on BP quality and patient tolerability. A single-center, randomized, investigator-blinded, non-inferiority trial was performed between June and August 2022. Outpatients scheduled for colonoscopy were randomized (1:1) to the 1L-PEG/AS or 2L-PEG/A group. Boston Bowel Preparation Scale (BBPS) was used to evaluate the quality of BP, and adequate BP was defined as a total score ≥6 and each segmental score ≥2. The rate of adequate BP was assumed as 90% in both groups with a noninferiority margin of 10%. Compliance, adverse events and tolerability were surveyed using questionnaires. Exploratory subgroup analyses were conducted based on the potential predictor of inadequate BP (with Bonferroni correction to adjust for multiple comparisons, P<0.05/20=0.0025 was considered significant).

Results

Overall, 344 patients received either 1L-PEG/AS or 2L-PEG/A regimens. The baseline characteristics of the two groups were comparable. The 1L-PEG/AS group showed non-inferior adequate BP rates compared with the 2L-PEG/A group (88% vs. 89%, P=1.00); the overall BBPS was 7.1±1.5 and 7.2±1.5, respectively (P=0.39). More patients in the 2L-PEG/A group took <80% of solution compared to those in the 1L-PEG/AS group (17% vs. 3%, P<0.01). Nausea, vomiting, abdominal pain and discomfort, and quality of sleep, were comparable between the two groups. Higher willingness to repeat the BP was observed in the 1L-PEG/AS group (85% vs. 62%, P<0.01), and more patients in the 2L-PEG/A were unwilling to repeat BP than those in the 1L-PEG/AS group due to larger volumes of PEG-Asc consumed (49% vs. 18%, P<0.01). Exploratory subgroup analyses for adequate BP found no significant difference between the two regimens for all subgroups.

Conclusion

The 1L-PEG/AS regimen was comparable to the 2L-PEG/A regimen in terms of BP adequacy, requiring lesser BP solution volumes, with better patient tolerance. Thus, it may be a suitable alternative to the conventional BP solution for colonoscopy.

Disclosure

Nothing to disclose.

Introduction

Endoscopy is essential for the early detection and management of upper gastrointestinal (UGI) tumors, yet variability in diagnostic expertise and workload-related fatigue often compromise the quality of report documentation. These challenges underscore the urgent need for innovative technological approaches to assist endoscopists in optimizing the report generation process.
Multimodal large language models (MLLMs) enable the synergistic integration of visual and semantic representations, demonstrating significant clinical value in medical text generation. This study introduces MERGS, an innovative endoscopy report generation system powered by MLLM. MERGS annotates medical terminology and generates natural language descriptions based on endoscopic images, ultimately producing structured reports that conform to clinical standards.

Aims & Methods

MERGS is built on the pre-trained MLLM Qwen-VL-2.5-7B. It adopts a multimodal architecture integrating visual encoding and cross-modal alignment to enable medical term annotation and natural language generation from endoscopic images. A pathological classification module further enhances lesion characterization. The language model synthesizes image-derived descriptions to generate a comprehensive report with a diagnostic conclusion.
UGI endoscopy reports were collected from the Sun Yat-sen University Cancer Center between 2019 and 2021. A standardized terminology dictionary was developed based on clinical guidelines, supporting a three-tier annotation framework: endoscopic image → standardized medical terminology → natural language text. Model-assisted pre-annotation combined with expert validation substantially reduced manual effort. The resulting dataset was split into training and test sets at an 8:2 ratio.
Model performance was assessed via multi-label classification metrics (accuracy, specificity, F1-score), as well as semantic similarity measures (Jaccard index) to evaluate its ability to recognize anatomical sites and endoscopic features. Natural language generation quality was assessed using BLEU-2 and ROUGE-L scores, and expert satisfaction ratings were collected for 100 randomly sampled outputs to assess readability and clinical relevance. A human–AI comparison was conducted on 50 test reports, comparing system-generated outputs with those authored by experienced endoscopists.

Results

A multimodal dataset was constructed after quality control, comprising 22,373 reports and 135,503 associated images from 21,619 patients. Internal validation demonstrated that MERGS achieved robust performance in automated image interpretation, with 97.3% accuracy and 98.6% specificity for standard anatomical site recognition. In feature identification, it showed high clinical relevance (F1 scores: smooth mucosa 0.915, polyp 0.857, tumor 0.878, erythematous mucosa 0.766).
Generated reports showed strong alignment with reference reports (BLEU-2 = 0.587, ROUGE-L = 0.661) and received high expert satisfaction ratings (mean score: 4.34 ± 0.63 on a 5-point scale). In a human–AI comparison, MERGS-generated reports were considered non-inferior to those authored by endoscopists (scores: MERGS 4.52 ± 0.81 vs. manual 4.68 ± 0.72), with the upper limit of the one-sided 95% CI (0.37) below the non-inferiority margin (0.5, p = 0.0045).

Conclusion

This study developed an automated system for UGI endoscopy reporting powered by an MLLM. Both internal and clinical validation demonstrated the system's high performance in endoscopic image feature recognition and report generation, underscoring its strong potential for clinical deployment.

References

Luo H, Xu G, Li C, He L, Luo L, Wang Z, Jing B, Deng Y, Jin Y, Li Y, Li B, Tan W, He C, Seeruttun S R, Wu Q, Huang J, Huang D W, Chen B, Lin S B, Chen Q M, Yuan C M, Chen H X, Pu H Y, Zhou F, He Y, Xu R H. Real-time artificial intelligence for detection of upper gastrointestinal cancer by endoscopy: a multicentre, case-control, diagnostic study[J]. Lancet Oncol, 2019,20(12):1645-1654.