Introduction

The CONECCT classification groups together all the predictive criteria from various classifications, enabling us both to predict the histology of polyps and to propose an appropriate therapeutic strategy. The use of this classification requires specific training for endoscopists.

Aims & Methods

This is a prospective descriptive and analytical study, spanning a period of 1 year between April 2023 and March 2024, on 68 colonic polyps identified in 50 colonoscopies performed for various indications.The CONNECT classification includes: CONECCT IH: hyperplastic polyp, CONECCT IS: sessile scalloped lesion with or without dysplasia, CONECCT IIA: adenoma with low or high grade dysplasia, CONECCT IIC: low- or high-grade dysplastic adenoma or intramucosal or submucosal adenocarcinoma < 1000 microns, CONECCT IIC+ : intramucosal or submucosal adenocarcinoma of any depth, CONECCT III : deep invasive adenocarcinoma > 1000 microns in the submucosa.
The aim of our study is to evaluate the concordance between endoscopic prediction using the CONECCT classification and the definitive histology of lesions.

Results

50 patients with 68 consecutive lesions were included in our study, the mean age of our patients was 59.29 with extremes ranging from 30 to 70 years. Our series was characterized by a male predominance of 73.5%, i.e. a sex ratio (M/F) of 0.73. The mean polyp size was 6.4 mm (3 - 20 mm), with the left colon being the most frequent site (29.4% of cases).All polyps were classified according to CONECCT, including 50 IIa, 10 IH, 4IIc, and 4 Is. Concordance between CONECCT and definitive histology was 70.5%. Correct classification was achieved for 80% of hyperplastic polyps, 75% of scalloped polyps, 68% of low-grade adenomatous polyps and 75% of high-grade adenomatous polyps.

Conclusion

The correlation between histology and CONECCT classification remains insufficient, and further technical and training resources will be required to improve polyp characterization.

Introduction

The indications for colonoscopy are clearly defined and its main objective is to look for neoplasia or lesions at high risk of colorectal neoplasia, even if benign lesions are much more frequent. Common indications for young adults < 50 years include rectal bleeding and diarrhea, while for subjects over 50 years, the indications may be larger given the risk of colorectal cancer, despite the recent increase in neoplastic lesions in young adults.

Aims & Methods

A retrospective descriptive and analytical study, including 1518 patients, was carried out over 3 and a half years. The patients were divided into 2 groups: group A for patients aged less than 50 years, and group B for patients aged greater than 50 years. We compared epidemiological, clinical, and endoscopic data between the two groups. Patients known to have inflammatory bowel disease (IBD) were excluded from our study. The statistical analysis was carried out by the JAMOVI software.
Our study aims to compare the indications and results of colonoscopy between those under and over 50 years old and to determine the indications associated with a risk of neoplastic lesion.

Results

65.1% of patients were over 50 years old, and 34.9% were under 50 years old. The average age was 37.5 ± 9 years in group A and 64.4 ± 9 years in group B. The female gender predominated among those under 50 years old (55.3%), while the male gender predominated among those over 50 years old (56.3%) (p<0.001).
History of colorectal cancer predominated among those over 50 years old at 10.5% (vs 4.4%; p<0.001). The indications for colonoscopy were dominated by constipation in patients in group B at 29.1% (vs 22%; p=0.01) and by diarrhea in patients in group A at 33.3% (vs 19. 3%; p<0.001).
Colonoscopy was pathological in 49.1% of patients in group B vs 32.9% of patients in group A (p<0.001). It was dominated by colitis or rectocolitis (47.9%) in subjects under 50 years old (vs 11.7%; p<0.001), by polyps (61.5% vs 41.3%; p<0.001) and colorectal neoplasia (16% vs 5%; p=0.002) in older patients.
A higher risk of neoplastic lesions was associated with rectal bleeding and constipation (p < 0.001) in subjects > 50 years old, and with constipation in subjects < 50 years old (p = 0.007).

Conclusion

The presence of neoplastic lesions was strongly associated with the presence of constipation in subjects < 50 years old and with rectal bleeding and constipation in subjects > 50 years old. Early screening with colonoscopy might be beneficial for young individuals with these higher-risk lesions of colorectal cancer.

Introduction

Appropriate knowledge of surface features of colorectal polyps is necessary for their adequate management. Data are limited regarding the diagnostic value of surface pattern-based prediction of histology.

Aims & Methods

This nationwide observational cohort study aimed to compare the optical diagnosis based on Kudo’s pit pattern and the histologic result in case of colorectal polyps endoscopically removed during screening colonoscopies.
Data regarding Kudo’s pit pattern of the lesions (Kudo I-V), and the final histological results were obtained from clinical records of screening colonoscopies which were prospectively collected in the registry of Hungarian National Public Health Institute. The level of agreement was characterized by Cohen’s kappa coefficient. The feasibility of optical diagnostics to differentiate neoplastic and non-neoplastic lesions, as well as to identify submucosally invasive cancer (SMIC) were investigated. The potential effects of polyp size and location (left/right colon), and that of timing of colonoscopy (1st period between 2019 and 2021, and 2nd period between 2022 and 2023) were also evaluated.

Results

A total of 8289 polyps removed during screening colonoscopy were registered in the database between 2019 and 2023, from these 7187 were neoplastic (439 SMIC) and 1102 were non-neoplastic. Out of the 1095 serrated polyps 171 contained dysplasia. Non-neoplastic polyps had Kudo I pattern in 7.7%, Kudo II in 48.1%, Kudo III in 40.9%, Kudo IV in 3.2%, and Kudo V in 0.1% of the cases. Neoplastic lesions without submucosal invasion had Kudo I surface pattern in 2.0%, Kudo II in 7.5%, Kudo III in 71.2%, Kudo IV in 17.4%, and Kudo V in 1.7% of the cases, while in case of SMIC, the surface pattern was Kudo I in 0.2%, Kudo II in 0.7%, Kudo III in 15.7%, Kudo IV in 8.9%, and Kudo V in 74.5% of the cases.
Kudo I-II category showed moderate agreement with non-neoplastic lesions (κ=0.440), irrespective of lesion size and location, and timing of screening colonoscopy. The level of agreement was only slight for serrated lesions (κ=0.168). Kudo V category demonstrated substantial agreement (κ=0.722) with SMIC, irrespective of lesion size, location, and timing. SMICs could be identified based on Kudo V category with 74.5% sensitivity, 98.5% specificity, 73.0% positive and 98.6% negative predictive value.

Conclusion

This is the first real-world data obtained from screening colonoscopies of the Hungarian national colorectal screening program. Optical diagnosis might support the differentiation of neoplastic and non-neoplastic lesions and can be especially helpful in identifying SMICs that might require a different management approach.

Clinical Case Summary

- Colorectal endometriosis is a particular form of deep endometriosis. Diagnosis is suspected on the basis of clinical signs, and confirmed by non-invasive imaging. The combined use of pelvic MRI and rectal endoscopy, when concordant, confirms the diagnosis at 100%.
We report the case of a patient admitted to the gastroenterology department for recto sigmoid endoscopic ultra sound (EUS) following suspicion of recto sigmoidal endometriosis.
- Case report: Mrs S.F, aged 39, has been treated for diffuse endometriosis for 2 years.
Following the onset of pelvic pain and cyclic rectal discharge, the patient underwent pelvic MRI, which showed invasion of the recto-sigmoid junction. Recto sigmoidoscopy was performed, with no particular findings.
Complementary radial recto sigmoid endoscopic ultra sound revealed invasion of the anterior sigmoid wall, extending from 15 to 23 cm from the anal margin, from a focus of pelvic endometriosis, involving the sigmoid muscularis, and respecting the mucosa, internal sphincter, external sphinter and muscularis of the other segments of the rectum.
The patient was referred back to gynecology for further management.
- Ultrasound rectal endoscopy is useful for diagnosing colorectal endometriosis, with a VPN of 97.7%, and is now part of the preoperative work-up.
*** (Included Images: Fig 1 : endoscopic ultrasound image showing sigmoid muscularis and hourglass-shaped endometriosis, Fig 2: endoscopic ultrasound image showing an endometriosis nodule, Fig 3: endoscopic ultrasound image showing normal rectal wall)

Introduction

A successful colonoscopy aims to thoroughly visualize the entire colon, including the terminal ileum, to maximize the detection of lesions and effectively screen for colorectal cancer. However, approximately 10% of colonoscopies are incomplete, often due to a combination of technical challenges and patient-related factors. The goal of our study is to identify and analyze the factors that contribute to incomplete colonoscopy procedures.

Aims & Methods

We conducted a retrospective descriptive and analytical study including all patients who underwent a colonoscopy between January 2019 and August 2024. Patients known to have chronic inflammatory bowel disease (IBD) were excluded from our study. An incomplete colonoscopy was defined as non-visualization of the caecum.

Results

Out of 1,518 colonoscopies performed, 105 (11.5%) were deemed incomplete. Factors associated with incomplete colonoscopy included older age (p=0.003), male sex (p=0.026), history of abdominal surgery (p<0.001), constipation (p=0.001), diarrhea (p=0.002), rectal bleeding (p=0.006), and poor bowel preparation (p=0.001). Multivariate analysis revealed that factors linked to incomplete colonoscopy included: a history of abdominal surgery (OR: 13.8, 95% CI: 4.2–45.1, p=0.001), poor preparation (OR: 224, 95% CI: 57–884, p=0.001), presence of diarrhea (OR: 0.2, 95% CI: 0.08–0.5, p=0.002), and constipation (OR: 0.33, 95% CI: 0.1–0.7, p=0.007).

Conclusion

In this study, 11.5% of colonoscopies were incomplete. The factors most strongly associated with incomplete procedures were a poor preparation, a history of abdominal surgery, and the presence of diarrhea or constipation.

Introduction

The indications for colonoscopy are well established, with the primary objective being the detection of neoplasia or lesions that carry a high risk for colorectal cancer, even though benign causes are more commonly encountered. In young adults under 50 years of age, common indications include rectal bleeding and diarrhea. In contrast, individuals aged 50 years and older are screened more broadly due to the increased risk of colorectal cancer, although recent trends show a rising incidence of neoplastic lesions in younger adults as well. ​

Aims & Methods

The aim of our study is to compare the indications and outcomes of colonoscopy between individuals younger and older than 50 years, and to identify which indications are most strongly associated with neoplastic findings.
A retrospective, descriptive, and analytical study was conducted over a period of 3.5 years, involving 1,518 patients. Participants were divided into two groups: Group A included patients under 50 years old, while Group B comprised those aged 50 and above. Epidemiological, clinical, and endoscopic data were compared between the two groups. Patients with a known diagnosis of inflammatory bowel disease (IBD) were excluded from the study. Statistical analysis was carried out using SPSS version 21.0.

Results

Among the patients, 65.1% were over 50 years of age, while 34.9% were under 50. The mean age in group A (under 50) was 37.5 ± 9 years, compared to 64.4 ± 9 years in group B (over 50). Females predominated in the younger group (55.3%), whereas males were more prevalent among older patients (56.3%) (p < 0.001). A personal history of colorectal cancer was more frequent in patients over 50 (10.5% vs. 4.4%; p < 0.001).
Colonoscopy indications varied by age group: constipation was the most common indication in group B (29.1% vs. 22%; p = 0.01), whereas diarrhea predominated in group A (33.3% vs. 19.3%; p < 0.001). Pathological findings on colonoscopy were more frequent in older patients (49.1% in group B vs. 32.9% in group A; p < 0.001).
In patients under 50, the most common pathological findings were colitis or ulcerative colitis (47.9% vs. 11.7%; p < 0.001). In contrast, patients over 50 showed a higher prevalence of polyps (61.5% vs. 41.3%; p < 0.001) and rectocolonic neoplasia (16% vs. 5%; p = 0.002).
Among the colonoscopy indications, constipation in patients under 50 was associated with a higher risk of neoplastic lesions (p = 0.007), while in patients over 50, rectal bleeding and constipation were significantly associated with neoplastic lesions (p < 0.001).

Conclusion

The presence of neoplastic lesions was strongly associated with constipation in individuals under 50 years of age, and with both rectal bleeding and constipation in those over 50. Further studies to better define these indications could help improve the appropriateness of colonoscopy, particularly in younger patients.