Introduction

Colorectal cancer (CRC) is the third most common cancer and the second leading cause of cancer death worldwide. While early CRC has a five-year survival rate of 91%, this drops to 14% for advanced CRC. Although endoscopic resection effectively detects and treats precancerous lesions and early CRC (Tis/T1), its invasiveness, cost, and reliance on operator expertise limit its use in large-scale screening. Noninvasive tests such as FIT, stool DNA, and methylated SEPT9—despite FDA approval—show limited sensitivity for advanced adenomas (AA). Plasma proteomics has emerged as a promising alternative, with Proximity Extension Assay (PEA) enabling highly sensitive, multiplex protein detection from minimal samples. In this study, we used PEA to profile plasma proteins in patients with advanced adenomas and early CRC, developed predictive models, and validated their diagnostic potential—offering a promising noninvasive strategy for early detection.

Aims & Methods

We collected plasma samples from patients with AA, early CRC, and healthy controls, and analyzed them using the Olink Explore panel with PEA technology in a discovery (n=80) and validation cohort (n=69). Protein biomarkers were identified in the discovery cohort using multivariate logistic regression adjusted for clinical confounders. Four machine learning algorithms—LASSO, Random Forest, SVM, and XGBoost—were applied to develop diagnostic models for colorectal neoplasia, assessing their performance in detecting early CRC and AA.

Results

Plasma proteomic profiles of AA and early CRC patients were analyzed using PEA technology. In the discovery cohort, multivariate logistic regression identified 15 protein biomarkers that exhibited significant differential expression between AA, ECRC, and control groups. Machine learning models based on these biomarkers demonstrated strong diagnostic performance. Specifically, the LASSO model selected five proteins with an AUC of 0.958, while the Support Vector Machine model achieved an AUC of 0.983 with seven proteins. Random Forest and XGBoost models also showed robust performance, with AUCs of 0.983 and 0.974, respectively. These models demonstrated excellent diagnostic performance for AA and ECRC, with AUCs consistently above 0.90 in the discovery cohort and ranging from 0.908 to 0.923 in the external validation cohort. MMP7 and GDF15 were confirmed as key biomarkers, with ELISA assays showing significant differences (MMP7: R = 0.894, GDF15: R = 0.723). A combined prediction model using MMP7 and clinical factors (age, gender, family history, BMI) achieved an AUC of 0.927, outperforming the clinical model (AUC = 0.863). This study underscores the potential of protein biomarkers and machine learning models for noninvasive early CRC detection.

Conclusion

In summary, to enable early intervention and improve CRC survival, we utilized PEA technology to analyze protein profiles and develop machine learning models for diagnosing early colorectal neoplasia (AA and early CRC). These multi-target models demonstrated superior diagnostic performance in both discovery and validation cohorts compared to previous studies on early lesions, highlighting their potential for early CRC detection and timely endoscopic intervention.

Disclosure

Nothing to disclose.

Introduction

Pelvic floor dysfunction is highly prevalent. Posterior compartment disorders include fecal incontinence (FI) and obstructive defecation syndrome (ODS). Assessment of the sphincter complex's (SC) ability to resist or yield to distension may provide a valuable method for evaluating continence and defecatory function.

Aims & Methods

Women with FI, chronic constipation (CC) and suspected functional defecation disorder (FDD), as well as healthy volunteers (HV) were included. Impedance Planimetry (IP) was performed using the anal functional lumen imaging probe [EndoFLIP^TM System (Medtronic®) with an 8-cm catheter (EF-325N)]. A “stepwise” measurement protocol was applied, with bag filling from 0 to 50ml in 10-ml increments. Distensibility index (DI) was recorded at rest, voluntary squeeze, cough maneuver and during simulated evacuation at 30-, 40- and 50-ml volumes. Simulated defecation was evaluated by calculating the percentage change in the DI relative to resting values at each volume.

Results

Fifteen women were included: 4 HV (26.7%), 7 with FI (46.7%) and 4 with CC (26.7%). Women with FI were older than those in the CC and HV groups (median age: FI 72 years [66–75], CC 55 years [42-63], HV 48 years [ 43–53], p = 0.009. Median BMI was similar among groups [HV 24.0 Kg/m² (21.6 – 25.3), FI 27.0 Kg/m² (24.3 – 30.0) and CC 26.2 Kg/m² (21.5 – 30.5), p=0.367]. The DI was significantly higher in the FI group compared to CC and HV groups at rest, during squeeze and during cough maneuver across 30-, 40- and 50-ml volumes. The percentage change in DI during simulated defecation at 50 ml was significantly reduced in CC compared to HV (p=0.030). When groups were categorized based on suspected FDD (CC vs HV+FI), the percentage change in DI was significantly lower in CC at 40 ml [74% (37 – 109) vs 175% (100 – 250), p=0.037] and at 50 ml [81% (43 – 96) vs 111% (96 – 119), p=0.048].

Conclusion

Impedance planimetry proves to be a valuable tool for distinguishing pelvic floor dysfunctions, as women with FI show higher DI values, whereas those with suspected FDD exhibit reduced DI changes during simulated defecation. These findings support the hypothesis that impaired rectal distensibility is a key feature of FDD, highlighting its role in continence and evacuation disorders.

References

-Leroi AM, Melchior C, Charpentier C, et al. The diagnostic value of the functional lumen imaging probe versus high-resolution anorectal manometry in patients with fecal incontinence. Neurogastroenterol Motil. 2018;30(6):e13291. doi:10.1111/nmo.13291
-O'Connor A, Byrne CM, Vasant DH, et al. Current and future perspectives on the utility of provocative tests of anal sphincter function: A state-of-the-art summary. Neurogastroenterol Motil. 2023;35(7):e14496. doi:10.1111/nmo.14496

Introduction

Post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is the most frequent adverse event following ERCP, with an incidence of 3–10% in the general population and up to 40% in high-risk patients. Risk factors are commonly classified as patient-related (young age, female sex, suspected sphincter of Oddi dysfunction) or procedure-related (precut sphincterotomy, difficult cannulation, pancreatic duct manipulation). However, the impact of specific therapeutic maneuvers—such as stone extraction techniques and biliary drainage—on PEP risk remains uncertain. In particular, the role of mechanical lithotripsy as an independent risk factor is still poorly defined. Moreover whether the systematic use of prophylaxis has actually reduced PEP incidence over time—particularly in high-risk cases—also remains uncertain.

Aims & Methods

This study aimed to retrospectively assess both patient- and procedure-related risk factors for post-ERCP pancreatitis, with a focus on therapeutic interventions whose impact remains uncertain. Findings were also compared with existing literature to refine individual risk profiles and inform preventive strategies.
We retrospectively analyzed 678 consecutive inpatients (49% male, 51% female; mean age 72.7 ± 13.4 years) admitted to our Gastroenterology Unit treated with ERCP for various indications (e.g., choledocholithiasis, pancreatic cancer, biliary strictures) between January 2020 and December 2024. All procedures were performed by experienced interventional endoscopists. PEP incidence was compared across categorical variables using chi-squared or Fisher’s exact tests (significance threshold p < 0.001). Age was compared using the Mann–Whitney U test. Variables significant in univariate analysis were included in a multivariate logistic regression model.

Results

Thirty-six cases of PEP were identified (5.3%), including 58% mild, 34% moderate, and 8% severe. No procedure-related deaths were reported. Patients with PEP were significantly younger (median age 69 vs 76 years, p = 0.01). Independent risk factors included suspected sphincter of Oddi dysfunction (OR = 7.8, p < 0.001) and mechanical lithotripsy (OR = 4.20; 95% CI: 1.38–12.78; p = 0.007), while biliary stenting was protective (OR = 0.17; 95% CI: 0.04–0.67; p = 0.01). Nasobiliary drainage showed a non-significant trend toward protection (OR = 0.67; p = 0.34), and pancreatic stenting was not significantly associated with reduced risk (p = 0.54). No significant associations were found for stone extraction method, periampullary diverticulum, sphincterotomy, or precut. PEP incidence declined from 6.3% in 2020 to 3.8% in 2024 (p = 0.22), possibly reflecting improved prophylaxis.

Conclusion

Suspected sphincter of Oddi dysfunction and younger age were confirmed as significant PEP risk factors. Mechanical lithotripsy emerged as a high-risk maneuver, while biliary stenting appeared protective. These findings suggest procedure-specific risks should be integrated into individual preventive strategies.

Introduction

Endoscopic biliary sphincterotomy is an effective treatment for common bile duct stones. However, its success can be compromised by the presence of large stones or extensive choledochal lithiasis.
The aim of this study was to evaluate the effectiveness of endoscopic retrograde cholangiopancreatography (ERCP) in patients with large obstructive stones (>15 mm) and those with one or two stones or choledochal lithiasis, and to identify factors influencing the success of endoscopic drainage and associated complications in the management of large bile duct stones.

Aims & Methods

This was a retrospective, descriptive, and analytical study conducted over a 19-year period, from April 2006 to February 2025, in our department.
A total of 1,011 patients who underwent ERCP for common bile duct stones were included. Choledochal lithiasis was defined as the presence of more than three stones, and a large stone was defined as an obstructive stone larger than 15 mm. Patients were divided into two groups:

• Group I (n = 143): Patients with a single obstructive stone larger than 15 mm.
• Group II (n = 868): Patients with one or two stones or choledochal lithiasis.

Results

Patients with large stones (Group I) represented 14.1% (n = 143) of the cohort, while Group II included 868 patients (85.9%).
The success rate after a single catheterization was 55.2% in Group I compared to 81% in Group II (p < 0.001). Reintervention was required in 14.7% of Group I patients versus 8% in Group II (p = 0.009). Additional procedures were performed in 46.2% of cases in Group I versus 16.1% in Group II.
The overall success rate after reintervention and/or additional procedures was 88.7% in Group I versus 92.5% in Group II (p = 0.125).
Early complication rates were higher in Group I (10.5%) compared to Group II (5.1%), with a statistically significant difference between groups (p = 0.017).
Univariate analysis identified the following factors as significantly decreasing the overall success rate of endoscopic treatment: older age, acute cholangitis, bile duct stricture, and significant bile duct dilation (diameter >15 mm).
Multivariate analysis, adjusted for age, sex, surgical history, acute pancreatitis, acute cholangitis, periampullary diverticulum, bile duct diameter, and bile duct stricture, showed that only acute cholangitis (OR: 0.295; 95% CI: [0.164 – 0.532]; p < 0.001) and bile duct stricture (OR: 0.53; 95% CI: [0.922 – 1.051]; p = 0.001) were independently associated with a decreased overall success rate of endoscopic treatment.

Conclusion

Our study found no statistically significant difference in the effectiveness of endoscopic treatment between patients with large stones and those with simple lithiasis. However, the presence of acute cholangitis and bile duct strictures appears to be associated with a reduced overall success rate of endoscopic management.

Introduction

Managing hypoxemia during procedural sedation, particularly in patients with obesity or obstructive sleep apnea (OSA), remains a significant challenge in clinical practice. This meta-analysis compared the use of positive airway pressure (PAP) with standard oxygenation therapy for patients at increased risk of hypoxemia undergoing gastrointestinal endoscopic procedures.

Aims & Methods

MEDLINE, Embase, and Cochrane databases were searched for randomized controlled studies comparing PAP systems versus standard oxygenation. Odds ratio (OR) was used for binary outcomes and mean difference (MD) for continuous outcomes with their respective 95% confidence interval (CI). Further research implications were evaluated by a trial sequential analysis (TSA).

Results

Our meta-analysis included six RCTs comprising 606 patients. Compared with standard oxygenation, PAP systems reduced the rate of hypoxemia (OR 0.21; 95%CI 0.12 to 0.38, p<0.001), and severe hypoxemia (OR 0.15; 95%CI 0.05 to 0.49, p=0.002). Additionally, the PAP group experienced fewer arrhythmic events (p=0.04), required fewer airway maneuvers (p=0.002), and had a reduced total propofol dosage (p=0.04). There was no significant difference between the groups in terms of hypotension events (p=0.39), procedure duration (p=0.62), hypoxemia episode duration (p=0.78), anesthesiologist satisfaction (p=0.44), or endoscopist satisfaction (p=0.79).

Conclusion

Overall, the use of PAP systems appears to be a promising strategy for optimizing sedation and enhancing patient safety during gastrointestinal endoscopic procedures for patients at risk of hypoxemia.

Introduction

A new LED endoscopy system featuring advanced noise-reduction technology for enhanced brightness and minimal halation, the EP-8000 with the EC-860ZP colonoscope (Fujifilm), is scheduled to be released.

Aims & Methods

We conducted a multicenter, observational study to evaluate the new system’s potential improvements in image quality compared to a previous system/scope (VP-7000/EC-760ZP). From January 2024 to January 2025, patients undergoing colonoscopy at two institutions were enrolled. Images of the cecum and lesions were captured using white light imaging (WLI), blue light imaging (BLI), and linked color imaging (LCI) under similar conditions about air insufflation, angle, distance, and so on. Participants were divided into three groups: Group 1 (EP-8000+EC-860ZP; 50 cases), Group 2 (EP-8000+EC-760ZP; 50 cases), and Group 3 (VP-7000+EC-760ZP; 50 cases). Cecal images were evaluated for brightness and halation using a four-point scale (1=poor to 4=excellent) by endoscopists and original values by image-analysis software, while lesion images were assessed for brightness, halation, and visibility by endoscopists.

Results

In cecal images, the endoscopists’ scores for WLI in Group 1 were significantly better than in Group 3 for brightness (3.71±0.55 vs. 3.51±0.58, p<0.001) and for halation (3.60±0.51 vs. 3.18±0.59, p<0.001). Similarly, for BLI and LCI, Group 1 achieved higher scores than Group 3 regarding brightness (BLI: 3.15±0.85 vs. 2.23±0.92, p<0.001; LCI: 3.83±0.42 vs. 3.54±0.58, p<0.001) and halation (BLI: 2.99±0.69 vs. 2.71±0.78, p<0.001; LCI: 3.33±0.60 vs. 3.10±0.58, p<0.001). Software analysis confirmed that Group 1 had superior brightness values compared to Group 3 for WLI (122.7±6.6 vs. 110.7±7.7, p<0.001), BLI (99.1±10.9 vs. 69.3±11.5, p<0.001), and LCI (139.4±9.2 vs. 113.1±10.7, p<0.001), as well as lower halation values for WLI (1.34±1.80 vs. 3.35±3.59, p=0.031) and LCI (1.48±0.83 vs. 4.06±3.99, p=0.010). Regarding lesion images, brightness, halation, and visibility for WLI, BLI, and LCI were significantly better in Group 1 than in Group 3.

Conclusion

The new LED system provided marked improvements in brightness, halation, and lesion visibility. The software assessment was consistent with endoscopists assessment objective and can be used for the development and evaluation of new endoscopic systems.

References

Nishizawa T, Toyoshima O, Yoshida S, et al. TXI (Texture and Color Enhancement Imaging) for Serrated Colorectal Lesions. J Clin Med 2021; 11: 119.
Okumura T, Hotta K, Imai K, et al. Efficacy of texture and color enhancement imaging for the visibility and diagnostic accuracy of non-polypoid colorectal lesions. DEN Open 2024; 29; 5: e380.
Antonelli G, Bevivino G, Pecere S, et al. Texture and color enhancement imaging versus high definition white-light endoscopy for detection of colorectal neoplasia: a randomized trial. Endoscopy 2023; 55 :1072-1080.
Yoshida N, Inagaki Y, Inada Y, et al. Additional 30-Second Observation of the Right-Sided Colon for Missed Polyp Detection With Texture and Color Enhancement Imaging Compared with Narrow Band Imaging: A Randomized Trial. Am J Gastroenterol 2024; 119: 539-546.
Aniwan S, Vanduangden K, Kerr SJ, et al. Linked color imaging, mucosal exposure device, their combination, and standard colonoscopy for adenoma detection: a randomized trial. Gastrointest Endosc 2021; 94: 969-977.
Yoshida N, Draganov PV, John S, et al. Comparison of LED and LASER Colonoscopy About Linked Color Imaging and Blue Laser/Light Imaging of Colorectal Tumors in a Multinational Study. Dig Dis Sci 2023; 68: 3943-3952.

Disclosure

Yoshida N and Dohi O received a research grant from Fujifilm Co. Yamamoto H had a consultant relationship with Fujifilm Co. and received honoraria, grants, and royalties from the company. Yano T received a research grant and honoraria from Fujifilm, Japan. The other authors declare no conflicts of interest. Novel endoscopic systems and scopes were lent by Fujifilm Co.