Introduction

Despite the availability of various image-enhanced endoscopy (IEE) techniques, direct comparisons of their performance in detecting lower gastrointestinal lesions are scare.

Aims & Methods

This systematic review and network meta-analysis aims to compare the diagnostic performance of different IEE modalities on detection of colorectal lesions. We conducted a systematic search of PubMed, EMBASE, and Web of Science for randomized controlled trials (RCTs) published up to January 1, 2025, which compared the diagnostic accuracy of various IEE in detecting colorectal lesions. The primary outcomes were rate-based metrics including polyp (PDR), adenoma (ADR), advanced adenoma (AADR), and serrated lesion detection rate (SLDR). Additionally, count-based measures were compared, including mean polyp per patient (MPP) and mean adenoma per patient (MAP). Narrow-band imaging (NBI) techniques were classified into two categories: old generation (e.g., EVIS LUCERA Spectrum or EXERA II) and new generation (e.g., EVIS EXERA III or LUCERA ELITE). To rank the performance of each modality, we employed the Surface Under the Cumulative Ranking curve (SUCRA). For binary outcomes, odds ratios (ORs) were calculated; and for continuous outcomes, mean differences (Δ) were determined with all results reported alongside their respective 95% confidence intervals (CIs).

Results

IEE modalities(PDR)	SURCA	Probaility of being the best	Mean Rank
CE	92.6	55.8	1.6
TXI	79.2	34.7	2.7
LCI	60.5	0.8	4.2
NBI(New generation)	60.2	2.1	4.2
IEE modalities(ADR)	SURCA	Probability of being the best	Mean Rank
TXI	96.9	89.3	1.2
LCI	79.7	6.7	2.4
CE	55.4	1.5	4.1
NBI(New generation)	48	0.5	4.6

A total of 45 RCTs involving 55,165 participants were included. Linked color imaging (LCI) and new-generation NBI were the most frequently evaluated IEE modalities. For PDR, the highest SUCRA are seen with chromoendoscopy (CE, 92.6), texture and color enhancement imaging (TXI, 79.2), and LCI (60.5). For ADR, TXI showed the best performance (SUCRA: 95.9), followed by LCI (79.7) and CE (55.4). In advanced adenoma detection, TXI (76.4) and CE (69.4) performed best. Compared to white light imaging (WLI), LCI (Δ: 0.71, 95% CI: 0.55–0.92) and TXI (Δ: 0.58, 95% CI: 0.34–0.96) significantly increased PDR. CE was the only technique significantly superior to WLI in both ADR (Δ: 0.80, 95% CI: 0.64–0.99) and AADR (Δ: 0.66, 95% CI: 0.45–0.97). For continuous outcomes, LCI (SUCRA: 75.3) and new-generation NBI (74.7) performed best for MPP; and new-generation NBI (82.1) and TXI (80.2) ranked highest for MAP. Few studies reported detection rates of serrated lesion and no significant differences were found among IEE methods due to limited data.

Conclusion

This network meta-analysis demonstrates that TXI, new-generation NBI, LCI, and CE all exhibit better performance than WLI in detecting colorectal lesions. TXI demonstrated consistent efficacy in both polyp and adenoma detection. The new-generation NBI and LCI showed significant advantages in terms of lesion yield per patient. However, the diagnostic benefit of IEE for serrated lesions remains uncertain due to insufficient evidence. Additional head-to-head studies are necessary to further confirm these findings.

Introduction

Endoscopic submucosal dissection (ESD) is being increasingly adopted worldwide for the treatment of colorectal neoplastic lesions. However, its role in patients with inflammatory bowel disease (IBD) remains debatable, particularly due to the increased risk of submucosal fibrosis from chronic inflammation, which can theoretically impact the clinical outcomes of this technique. This study aimed to assess the efficacy and safety of ESD for colorectal neoplastic lesions in IBD patients, comparing Asian and Western settings.

Aims & Methods

A systematic review was conducted by searching MEDLINE and Web of Science until January 2025, in accordance to MOOSE guidelines. We included primary studies reporting ESD performance in IBD patients. We performed random-effects meta-analysis for several outcomes, including en-bloc, R0, and curative resection rates, frequency of adverse events (post-procedural bleeding and perforation), local recurrence and need for additional surgery after ESD. Certainty of evidence was assessed using GRADE.

Results

We included 20 studies (565 patients and 732 lesions). The meta-analytical frequencies of en-bloc, R0, and curative resection rates were 95.7% (95%CI=93.5-97.9%; I²=60.1%), 84.6% (95%CI=79.4-90.1%; I²=68.9%), and 83.9% (95%CI=76.3-92.4%; I²=75.9%), respectively. Bleeding and perforation occurred in 7.0% (95%CI=4.4-11.2%; I²=16.9%) and 7.9% (95%CI=5.3-11.9%; I²=2.4%) of cases, respectively. Local recurrence frequency was 5.3% (95%CI=3.5-7.9%; I²=0%). The meta-analytical need for additional surgery was 13.3% (95%CI=9.5-18.1%; I²=42.5%). No differences were found between Asian and Western studies for any outcome. The certainty of evidence was considered "low" in 4 outcomes and "very low" in the remaining outcomes.

Conclusion

ESD appears feasible and safe for treating IBD-associated colorectal neoplasias. Similar results were observed between Asian and Western studies.

Introduction

Recent advances in large language models, such as GPT-4.0 and GPT-4.5, have increased the accessibility of artificial intelligence (AI) in clinical settings. However, its role in decision-making remains unclear.

Aims & Methods

This study compares the appropriateness of esophagogastroduodenoscopy (EGD) prescriptions across ten clinical scenarios, as evaluated by gastroenterology specialists, residents, general practitioners, and five AI systems (ChatGPT-4.0, ChatGPT-4.5, Gemini, Claude, and OpenEvidence), using ESGE and ASGE guidelines as the reference standard. A cross-sectional survey was developed using 10 real-world clinical vignettes in gastroenterology, each with three response options: appropriate, inappropriate, or uncertain. The vignettes were developed based on real-world clinical practices by three expert gastroenterologists, and then reviewed by the authors.The final questionnaire was hosted on Google Forms and simultaneously distributed—without prior notice—to gastroenterology specialists, residents, and general practitioners across Italy to minimize external influence. The same clinical scenarios were then submitted to five AI systems (ChatGPT-4.0, ChatGPT-4.5, Gemini, Claude, and OpenEvidence) using the same multiple-choice format. AI responses were collected on April 22, 2025.

Results

A total of 122 healthcare professionals participated in the study (61% male; mean age 39.7 ± 13.6), including 41 gastroenterology specialists, 31 residents, and 50 general practitioners. Most participants were from northern Italy (76%), with additional representation from central (14%) and southern regions (10%), covering a total of 10 regions. The majority had less than 5 years of clinical experience (66%) and were employed in public hospitals (49%). Only 30% reported prior use of AI in clinical practice. All respondents considered the clinical scenarios realistic.
The average accuracy rate was highest among gastroenterologists (65.6% ± 11.6) and residents (64.8% ± 10.0), compared to general practitioners (56.8% ± 11.0), with statistically significant differences (p < 0.001 and p < 0.005, respectively).
Among AI systems, OpenEvidence and Gemini outperformed all human groups (80% and 80%, p < 0.001), while ChatGPT-4.0 (70%) and Claude (60%) showed comparable performance to clinicians. Notably, ChatGPT-4.5 (50%) underperformed relative to all human categories.

Conclusion

This study highlights significant variability in the appropriateness of upper GI endoscopy prescriptions among different medical professionals, with gastroenterologists performing better than general practitioners. Emerging AI models, particularly OpenEvidence and GEMINI, demonstrated promising performance in clinical decision-making, outperforming all human groups in certain scenarios. These AI systems could serve as valuable tools to support gastroenterologists and other healthcare professionals, enhancing adherence to evidence-based practices and facilitating more direct consultation of clinical guidelines. Further research is needed to explore the integration of AI into clinical workflows and its potential to refine decision-making in gastroenterology.

References

1) Chang PW, Amini MM, Davis RO, et al. ChatGPT4 Outperforms Endoscopists for Determination of Postcolonoscopy Rescreening and Surveillance Recommendations. Clin Gastroenterol Hepatol. 2024 Sep;22(9):1917-1925.e17. doi: 10.1016/j.cgh.2024.04.022. Epub 2024 May 9. PMID: 38729387.
2) Maida M, Celsa C, Lau LHS, et al. The Application of Large Language Models in Gastroenterology: A Review of the Literature. Cancers (Basel). 2024 Sep 28;16(19):3328. doi: 10.3390/cancers16193328. PMID: 39409948; PMCID: PMC11475222.

Introduction

The necessity and diagnostic yield of routine gastroscopy in Fecal Immunochemical Test (FIT)-positive patients with normal colonoscopy findings remains controversial and poorly defined.

Aims & Methods

Here, we aimed to investigate the prevalence and clinical significance of upper gastrointestinal lesions detected by gastroscopy in FIT-positive patients, stratified by normal and abnormal colonoscopy findings.
This retrospective multicenter study included 38,392 adults (≥18 years) who tested positive for FIT between January 2016 and December 2022 across eight medical centers in Israel. Of them,1,560 patients underwent routine bi-directional endoscopic evaluation and were included in the final analysis. Comprehensive procedural data were retrieved, including detailed colonoscopic and gastroscopic findings. Colonoscopy outcomes included detecting neoplastic and precancerous lesions, with adenoma detection rate (ADR) and polyp detection rate (PDR) calculated. Gastroscopy findings such as gastritis, hiatal hernia, esophagitis, duodenitis, peptic ulcer disease, and malignancy were analyzed and compared between patients with normal and abnormal colonoscopy results.

Results

Among the 1,560 patients undergoing both procedures, 40.5% (n = 632) had normal colonoscopy findings, while 59.5% (n = 928) had abnormal colonoscopy findings. Gastroscopy revealed upper GI findings in both groups, with gastritis detected in 55.1% (normal colonoscopy) vs. 48.7% (abnormal colonoscopy), hiatal hernia in 14.8% vs. 14.9%, esophagitis in 9.0% vs. 10.3%, and duodenitis in 6.6% vs. 7.3%. Clinically Significant findings, such as gastric ulcers, were rare, observed in 0.95% of patients with normal colonoscopy and 1.29% with abnormal colonoscopy. No cases of upper gastrointestinal malignancy were detected in either group.

Conclusion

Routine gastroscopy in FIT-positive patients demonstrates limited diagnostic yield, with clinically significant upper gastrointestinal lesions being rare. Therefore, gastroscopy should be selectively considered based on individual clinical assessment and patient-specific risk factors.

Introduction

Lynch syndrome (LS) is associated with an increased risk of upper gastrointestinal (GI) cancers. While upper GI surveillance is recommended in several guidelines, there remains international variability and ongoing debate regarding its implementation, timing, and extent. This study evaluated the incidence of gastric (GC), duodenal (DC), and jejunal cancers (JC) in LS patients using data from the German Consortium for Familial Intestinal Cancer (GCFIC). In addition, the diagnostic yield of esophagogastroduodenoscopy (EGD) and push enteroscopy (PE), performed at a tertiary care center, was retrospectively analyzed.

Aims & Methods

A total of 960 endoscopic procedures (494 EGD, 466 PE) were retrospectively analyzed in 349 LS patients documented at a tertiary care center. Push enteroscopy (PE) was performed using a colonoscope to allow deeper insertion into the small intestine, enabling inspection of the proximal jejunum. Clinically relevant findings included intestinal metaplasia, Barrett’s esophagus, adenomas, and carcinomas. These findings were systematically compared between EGD and PE to evaluate diagnostic yield. The GCFIC database was evaluated to determine cancer incidence by genotype.

Results

In the GCFIC cohort (n=2859), the majority of GC (2.2%), DC (2.1%), and JC (1.9%) occurred in high-risk pathogenic variant carriers (PGV) (MLH1, MSH2, EPCAM). However, a small proportion of cancers was also observed in low-risk PGV carriers: GC in two MSH6 carriers, DC in five patients with MSH6 or PMS2, and JC in seven low-risk carriers (MSH6: 3, PMS2: 4). In the NZET cohort, 22% of procedures and 50 % of patients revealed relevant findings. Gastric adenomas were found in 3.7%, gastric cancer in 1.1%, and intestinal metaplasia in 28% of patients. Duodenal adenomas were found in 3.7% and cancer in 0.9%. Jejunal neoplasia was detected exclusively by PE (adenomas 1.7%, cancer 0.6%).

	EGD (n= 499)		PE (n= 468)		all examinations (n= 964)		per patient (n= 349)		p- value	significant (p < 0.05)
Intestinal metaplasia	54	10.9%	78	16.7%	132	13.8%	98	28.1%	0.014	yes
Gastric adenoma	7	1.4%	4	0.9%	11	1.1%	9	2.6%	0.529	no
Dysplastic fundic gland	1	0.2%	3	0.6%	4	0.4%	4	1.1%
Gastric cancer	4	0.8%	0	0%	4	0.4%	4	1.1%
Duodenal adenoma	8	1.6%	7	1.5%	15	1.6%	13	3.7%	0.828	no
Duodenal cancer	2	0.4%	1	0.2%	3	0.3%	3	0.9%
Jejunal adenoma	0	0%	7	1.7%	8	0.8%	7	2%
Jejunal cancer	0	0%	2	0.4%	2	0.2%	2	0.6%
Clincally relevant findings	92	19%	118	25%	209	22%	175	50.1%	0.02	yes

Conclusion

Upper gastrointestinal surveillance is essential in patients with Lynch syndrome. Push enteroscopy (PE) provides diagnostic value beyond conventional esophagogastroduodenoscopy (EGD), particularly in detecting jejunal neoplasia, and should be considered in high-risk surveillance protocols.

Disclosure

Robert Hüneburg was funded by Deutsche Krebshilfe (DECADE), and Wilhelm-Sander-Stiftung.
Jacob Nattermann was funded by Wilhelm-Sander-Stiftung.

Introduction

Minocycline is considered the most potent semi-synthetic tetracycline, demonstrates promising pharmacokinetic and antimicrobial properties against Helicobacter pylori (H. pylori). While previous studies suggested the efficacy of minocycline-containing bismuth quadruple therapy for H. pylori eradication, real-world evidence remains limited.

Aims & Methods

his study aimed to evaluate the clinical efficacy, safety, and cost-effectiveness of minocycline-containing bismuth quadruple therapy in routine clinical practice.This multicenter, real-world observational study was conducted at 25 hospitals in Fujian China between January and March 2025. Patients diagnosed with H. pylori infection received one of three 14-day bismuth-containing quadruple regimens with b.i.d. esomeprazole 20 mg and bismuth 220 mg, plus amoxicillin 1000 mg b.i.d. and clarithromycin 250 mg b.i.d. (PBAC), or minocycline 100 mg b.i.d. and clarithromycin 250 mg b.i.d. (PBMC), or minocycline 100 mg twice b.i.d. and levofloxacin 500mg q.d. (PBML). The primary outcome was the H. pylori eradication rate, secondary outcomes included the frequency of adverse events, patient compliance, and cost-effectiveness.

Results

A total of 347 patients were enrolled, with 110 patients completing treatment in each group. In the intention-to-treat (ITT) analysis, eradication rates were 77.4% (PBAC), 85.5% (PBMC), and 84.3% (PBML). In the per-protocol (PP) analysis, eradication rates were 80.9%, 90.9%, and 88.2%, respectively. Although the differences among the three regimens were not statistically significant, minocycline-based regimens achieved numerically higher eradication rates. Adverse event incidence was 32.73%, 20.91%, and 23.64% in the three groups, respectively. Compliance rates exceeded 94% across all groups. Cost-effectiveness analysis showed PBML had the lowest cost-effectiveness ratio (5.38 CNY per 1% eradication), followed by PBAC (5.41 CNY) and PBMC (6.06 CNY).

Conclusion

H. pylori eradication, with favorable patient compliance and pharmacoeconomic profiles. These regimens present a viable alternative to traditional amoxicillin-or tetracycline-based therapies. Further large-scale randomized controlled trials are warranted to confirm these findings.