Introduction

Colorectal cancer (CRC) remains the second most common cause of cancer-related mortality worldwide (1). The introduction of the Danish national CRC screening program in 2014 aimed at reducing mortality rates (2) has marrkedly increased colonoscopies and polypectomies (3,4). A a comprehensive description of the lesions removed has not yet been investigated.

Aims & Methods

Nationwide, cross‑sectional study of all colorectal lesions resected endoscopically in patients ≥18 years between January 2014 and December 2021. Data were obtained from the Danish National Patient Register, Pathology Register and Screening Database. Prevalence of histological sub‑types and predictors of high‑grade dysplasia (HGD) and adenocarcinoma were analyzed with multivariable logistic regression.

Results

Among 663,624 individuals undergoing 1,074,236 colonoscopies or sigmoidoscopies, 194,941 patients (median age 67 years, 58.6% male) had a total of 504,386 lesions removed. Tubular adenomas (TA) accounted for 66.8% of lesions.
The proportion of advanced colorectal polyps—defined as lesions ≥10 mm, adenomas with high-grade dysplasia, or sessile serrated lesions with any dysplasia—declined from 22.7% in 2014 to 10.2% in 2021.
High-grade dysplasia (HGD) was strongly associated with size ≥10 mm (OR 27.1 for 10–19 mm; OR 71.1 for 30–39 mm), and in diminutive lesions (1–5 mm), with tubulovillous or villous histology (OR 6.09).
Adenocarcinoma was identified in 0.65% of lesions and was predominantly left-sided (83.9%), with highest odds observed in the sigmoid colon (OR 6.33) and rectum (OR 6.00), compared to the caecum.
Sex was significantly associated with the risk of adenocarcinoma at the lesion level, but this effect was age-dependent. At age 40, women had significantly higher odds than men (adjusted OR 1.48), but the difference diminished with increasing age, and from age 75 onward, no statistically significant difference between sexes was observed.

Conclusion

Lesion size was the strongest predictor of high-grade dysplasia, outweighing histologic subtype once lesions exceeded 10 mm. At lesion level, the risk of malignancy was higher in younger women than in men of the same age, with the difference progressively diminishing with age. The introduction of the screening programme coincided with a marked reduction in advanced lesions over time. The high predominance of left-sided cancerous lesions highlights the need to optimize the detection of right-sided neoplasia.

References

1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin [Internet]. 2021 May 1 ;71(3):209–49. Available from: https://onlinelibrary.wiley.com/doi/full/10.3322/caac.21660
2. Kanth P, Inadomi JM. Screening and prevention of colorectal cancer. BMJ [Internet]. 2021 Sep 15;374. Available from: https://www-bmj-com.ez.statsbiblioteket.dk/content/374/bmj.n1855
3. Adamsen S, Mosbach KKT, Milliam PB, Hansen OH. Injuries by colonoscopy and sigmoidoscopy requiring laparotomy. Claims to the Patient Insurance Corporation. Ugeskr Laeger. 2007 May 7;169(19):1788–93.
4. Baatrup G. Lokal resektion af tidlige kolorektale cancere - og hvad gør vi så?. Ugeskr Laeger. 2021 Jun 28;183(26).

Introduction

Sedation is integral to gastrointestinal (GI) endoscopy to enhance procedural tolerance and efficiency [1]. Traditional agents like midazolam and propofol, while effective, present limitations related to recovery time, safety, and need for anesthesiologist supervision. Remimazolam, a novel benzodiazepine with rapid onset and offset, may enable effective non-anesthesiologist-administered sedation (NAAS) in routine endoscopy [2].

Aims & Methods

A prospective, multicenter, real-world study was conducted between November 2024 and March 2025. Adult patients undergoing elective upper or lower gastrointestinal (GI) endoscopy under procedural sedation-analgesia (PSA) without the presence of an anesthesiologist were enrolled. Inclusion criteria were: age ≥18 years, American Society of Anesthesiologists (ASA) physical status I–III, and a body mass index (BMI) between 18 and 51 kg/m². Exclusion criteria included: known allergy to anesthetic drugs or a history of anesthesia-related adverse reactions; glucose-6-phosphate dehydrogenase deficiency; severe respiratory disease; and pregnancy. All patients undergoing emergency or urgent GI endoscopy were excluded.The primary outcomes were the sedative efficacy and safety of remimazolam during endoscopy. Efficacy was defined as successful completion of the procedure without interruption due to inadequate sedation. Adverse events (AEs) were recorded and classified by severity (major or minor) and type (e.g., hypotension, hypoxia, bradycardia, nausea, vomiting, and injection site pain). Remimazolam was administered by trained endoscopists: induction was achieved with 5–7 mg intravenously, titrated based on individual risk factors, with 2.5 mg supplemental doses as needed (maximum cumulative dose: 33 mg).

Results

A total of 182 patients (EGD n=75; colonoscopy n=112) were included. Procedure completion was achieved in 175 cases (96.3%), with success rates of 97.3% for EGD and 95.5% for colonoscopy. All sedation failures (n=7) were attributed to inadequate sedation and not to ASA class. No serious AEs were reported. Minor AEs included hypotension (n=4), bradycardia (n=1), nausea (n=1), vomiting (n=4), and hiccups (n=1), all managed conservatively. Median cumulative remimazolam doses were 10.9 mg (colonoscopy) and 10.0 mg (EGD), with median recovery times of 6.25 and 5.9 minutes, respectively. No patients required flumazenil or rescue sedation. Among obese patients (BMI >40), remimazolam was both effective and safe.

Conclusion

Remimazolam provides a highly effective and safe sedation alternative for GI endoscopy in real-world NAAS settings, ensuring rapid recovery and minimal AEs, even in patients with elevated ASA status or obesity. This study was prospective real-world and had several limitations. First the number of patients was too small to accurately assess rare adverse events. Further randomized controlled trials with larger populations are recommended to confirm these results.

References

1. Lin OS. Sedation for routine gastrointestinal endoscopic procedures: a review on efficacy, safety, efficiency, cost and satisfaction. Intest Res 2017;15:456-66. doi: 10.5217/ir.2017.15.4.456.
2. Hu Q, Liu X, Wen C, et al. Remimazolam: an updated review of a new sedative and anaesthetic. Drug Des Devel Ther 2022;16:3957-74. doi: 10.2147/DDDT.S384155.

Clinical Case Summary

Materials and methods: 24-year-old man with an episode of nausea, anorexia and loss of 4-5 kg in a week, which resolved spontaneously without drugs. During the episode had hyperchromic urine, yellowing of skin and eyes.After 1 month small increase of serum transaminases x 1.5. Regular bowel function. No clinical signs. US regular. Anti-HbsAg and HCV-Ab negative. After another month he had highly increase of serum transaminases with AST x 27 and ALT x50 GGT x3, Total bilirubin 2.85. Negative ANA, AMA, LKM, IgA anti TTG, anti EBV, anti CMV, alpha1 anti trypsian slight increase. He performed a new serum analysis with increase of anti-TTG IgA. He subsequently performed genetics for celiac disease and confirmed homozygous DQ2.Performs EGDS for suspected celiac disease which documents nodularity in bulb and DII scalloping. Histological examination shows Marsh 3B.After 150 g gluten daily intake had IgA anti TTG x 4. A diagnosis of celiac disease is made and he started GFD with serum transaminases x 2After 2 months with good adherence to GFD has AST x20 and ALT x 50. He denies alcohol abuse.Negative hemochromatosis mutations. Stable weight, Regular bowel function. We perform liver biopsy. The histological examination documents Histological Activity index acc. Knodell modified by Ishak: 7 Grading.
Results: Diagnosis is moderately active chronic autoimmune hepatitis.Therapy is started with prednisone 40 mg daily. With AST x10 and ALT x 20After 15 days of therapy AST x 5 and ALT x9, therefore values halving and normal bilirubin. Currently under follow-up in our Hospital
Conclusions: Although the history is still unknown and the histological exam is compatible but not certain, the good response to steroid therapy is a positive factor that proves the correctness of the diagnosis. This diagnostic difficulty leads us to always evaluate the autoimmune cause in a young patient without risk factors with a small increase in transaminases.

References

University of Salerno

Introduction

Nonalcoholic fatty liver disease (NAFLD) is a widespread metabolic disorder associated with intestinal dysbiosis, low-grade systemic inflammation, and small intestinal bacterial overgrowth (SIBO). Targeting the gut-liver axis through microbiome-modulating therapies may represent a promising approach to disease management.

Aims & Methods

The aim was to investigate gut microbiota alterations in NAFLD patients and assess the efficacy of microbiota-based therapy on metabolic, inflammatory, and structural liver parameters. The study included 152 NAFLD patients and 47 controls. Gut microbiota composition was evaluated using qRT-PCR, and SIBO was diagnosed via hydrogen breath testing. The therapeutic protocol included rifaximin (200 mg TID for 14 days), Saccharomyces boulardii CNCM I-745 (1 capsule BID for 30 days), and essential phospholipids (600 mg TID for 30 days). Liver function tests, inflammatory markers, and steatometry were assessed before and after treatment.

Results

Alterations in gut microbiota composition indicative of dysbiosis—including increased Firmicutes/Bacteroides ratio and Actinobacteria abundance—were identified in NAFLD. Strong correlations emerged between the F/B index and triglycerides (r = 0.78), TNF-α (r = 0.77), and between Actinobacteria and hsCRP (r = 0.66). SIBO rates declined significantly post-treatment (51% → 17%). Liver enzymes, inflammatory markers, and steatometric parameters improved substantially (p<0.05).

Conclusion

Microbiota-targeted therapy combining rifaximin, S. boulardii, and phospholipids effectively corrected dysbiosis, reduced inflammation, improved metabolic parameters, and promoted liver structural recovery in NAFLD patients. These findings support incorporating microbiome-focused interventions into routine clinical practice for NAFLD. ​