Introduction

In colorectal epithelial neoplasms, lesions classified as type 2B according to the Japan Narrow Band Imaging (NBI) Expert Team classification (JNET), which are characterized by irregular microsurface or microvascular patterns, are often difficult to diagnose accurately using NBI magnifying endoscopy (ME) alone. Therefore, supplementary pit pattern diagnosis using crystal violet (CV)-stained ME (CV-ME) is recommended. However, CV is potentially carcinogenic, and CV-ME is relatively complex and time-consuming. Acetic acid (AA)-enhanced NBI ME (ANBI-ME) has been proposed as a simpler and safer alternative. Based on our previous study identifying 4.5% AA as the optimal concentration[1], this study prospectively evaluated the diagnostic utility of 4.5% ANBI-ME as a substitute for CV-ME (UMIN registration number: 00045621).

Aims & Methods

From October 2021 to March 2024, colorectal lesions classified as JNET type 2B or 3 during colonoscopy were prospectively enrolled until 300 cases were included. Each lesion underwent ANBI-ME with 4.5% AA, followed by CV-ME. The area of suspected deepest invasion was selected, and one representative image from ANBI-ME and one from CV-ME were independently assessed by two expert endoscopists blinded to histopathology. Intermethod and interobserver agreement were evaluated using Cohen’s weighted kappa. Diagnostic accuracy for each modality was calculated using the individual and consensus diagnoses of the two experts (McNemar’s test). AA whitening duration (AD), representing a reversible mucosal reaction, was measured during ANBI-ME and analyzed by histological depth (low-grade dysplasia [LGD], high-grade dysplasia [HGD], superficial submucosal invasive carcinoma [SMs], and deep submucosal invasive carcinoma [SMd]) using Kaplan–Meier analysis and the log-rank test.

Results

After excluding four unresected lesions, 296 lesions were analyzed. Median lesion size was 18 mm. Locations included the cecum (30), ascending colon (47), transverse colon (69), descending colon (13), sigmoid colon (73), and rectum (64); 122 lesions were elevated and 174 flat. Histological diagnosis included 77 LGD, 145 HGD, 18 SMs, and 56 SMd. Good agreement was observed between modalities (κ = 0.65 and 0.62) and between observers (κ = 0.78 for ANBI-ME, κ = 0.66 for CV-ME). Consensus was reached in 216 ANBI-ME and 192 CV-ME cases. Diagnostic accuracy was significantly higher with ANBI-ME than CV-ME for both observers (81% vs. 76%, p = 0.028; 75% vs. 69%, p = 0.025). Among consensus cases, ANBI-ME also showed higher accuracy (66% vs. 57%, p < 0.01). Median AD (in seconds) was 52 for LGD, 80 for HGD, 132 for SMs, and 107 for SMd, with a significantly shorter duration observed in LGD (p < 0.001).

Conclusion

ANBI-ME demonstrated diagnostic performance equivalent to or superior to CV-ME for colorectal lesions classified as JNET type 2B or 3. In addition, AA whitening duration (AD) may complement the assessment of histological depth of invasion.

References

[1]. Shimizu T, Yamagata T, Kanno Y, et al. A single-center pilot study on the efficacy and safety of acetic acid-enhanced magnifying endoscopy with narrow-band imaging for diagnosis of colorectal epithelial neoplasms. Gastrointest Endosc. 2025;101(2):416-424.

Introduction

Anxiety is a common and significant problem in patients who need to undergo colonoscopy^[1]. ​The efficacy of mindfulness-based stress reduction (MBSR) in alleviating anxiety during the rehabilitation of chronic disease patients has been well-documented^[2]. However, limited evidence exists on the application of brief MBSR in patients with preoperative anxiety undergoing colonic endoscopic submucosal dissection (ESD) and its potential effects on bispectral index (BIS).

Results & Findings

A total of 120 patients scheduled for colonoscopy-assisted colonic ESD at the First Affiliated Hospital of Zhengzhou University from January 2024 to December 2024 were enrolled （Approval No.2024-KY-1063-001）. Patients were randomly divided into two groups (n=60) using a random number table: the brief MBSR group (Group M) and the control group (Group C).
Compared with Group C, Group M exhibited significantly lower APAIS scores (21.28 ± 4.53 vs. 12.36 ± 2.90), reduced BIS values (96.42 ± 10.03 vs. 73.86 ± 3.60), and slower heart rates (HR: 85.52 ± 11.78 vs. 64.22 ± 4.54) at both T1 and T2. At T3, Group M also demonstrated lower APAIS scores (16.90 ± 1.78 vs. 15.30 ± 3.46) and higher patient satisfaction scores (10.00 ± 0.00 vs. 7.94 ± 0.87) (P < 0.05). No statistically significant differences were observed between the groups in SBP, DBP,MAP, postoperative adverse events, or PACU recovery time at any time points (P > 0.05).

Summary & Discussion

Brief Mindfulness-Based Stress Reduction (MBSR) reduces Amsterdam Preoperative Anxiety and Information Scale (APAIS) scores. The underlying mechanism involves enhancing individuals' awareness and acceptance of the present moment^[3], modulating negative emotional responses, and elevating mindfulness levels, thereby alleviating preoperative anxiety.
MBSR reduces the BIS, and the proposed mechanism may involve a shift in dominant EEG activity from beta waves (associated with wakefulness and focused attention, BIS range 85–100) to alpha waves (linked to relaxation and closed-eye states, BIS range 65–85, median 70) and theta waves (observed during light sleep and REM sleep). This aligns with prior studies demonstrating that MBSR enhances alpha and theta wave activity in specific brain regions^[4].
Brief Mindfulness-Based Stress Reduction (MBSR) significantly improved patient satisfaction. By replacing preoperative negative emotions such as tension and anxiety with mindful awareness, the intervention reduced anxiety-related adverse reactions[2]., enhanced procedural comfort and treatment adherence, and fostered a more positive humanistic care experience. These findings suggest that short-term MBSR serves as a valuable psychological adjunct to optimize patient-centered outcomes in clinical settings.

Conclusion

Brief MBSR effectively alleviated preoperative anxiety in patients undergoing colonic ESD, modulated the spectral components and neural oscillatory activity of EEG waves, and reduced BIS values.

References

[1]Chen YS, Feng GH, Yue QQ, Wang YF, Liu M, Zhao KH, Tang T, Huang MT, Yi WT, Yan HL, Yan JH, Zeng Y. Effects of non-pharmacological interventions on anxiety in patients undergoing colonoscopy: A network meta-analysis of randomized controlled trials. J Psychosom Res. 2025 Apr;191:112065. doi: 10.1016/j.jpsychores.2025.112065. Epub 2025 Feb 19. PMID: 40043571.
[2]Xu L, Guan A, Huang Y. Effects of online mindfulness-based interventions on mental and physical health outcomes in cancer patients: A systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore). 2025 Mar 21;104(12):e41870. doi: 10.1097/MD.0000000000041870. PMID: 40128036; PMCID: PMC11936609.
[3]Reilly A, Sharif A, Bhagra O, Dominari A, Katsos K, Nathani KR, Johnson SE, Bydon M. Evaluation of mindfulness-based interventions for pain, anxiety, and depression in spinal cord injury patients: A systematic review and meta-analysis. Clin Neurol Neurosurg. 2025 Apr;251:108839. doi: 10.1016/j.clineuro.2025.108839. Epub 2025 Mar 10. PMID: 40080944.
[4]Lazarou I, Oikonomou VP, Mpaltadoros L, Grammatikopoulou M, Alepopoulos V, Stavropoulos TG, Bezerianos A, Nikolopoulos S, Kompatsiaris I, Tsolaki M; RADAR-AD Consortium. Eliciting brain waves of people with cognitive impairment during meditation exercises using portable electroencephalography in a smart-home environment: a pilot study. Front Aging Neurosci. 2023 May 30;15:1167410. doi: 10.3389/fnagi.2023.1167410. PMID: 37388185; PMCID: PMC10306118.

Disclosure

The authors disclose no conflicts.

Introduction

Since 2029 national curricula for sedation and emergency management in endoscopy has established for endoscopy staff. NAPS are trained in three-day courses. After a baseline assessment in 2013, the effect of the training was evaluated in a survey in 2018.

Results & Findings

The questionnaire was completed by 356 endoscopy departments (95% in hospitals, 6% in private practice).

• Most departments operate in a multidisciplinary manner (85% gastroenterology, 59% TEE, 13% cardiology, 1.12% urology).
• In 52% of departments, 100% of staff have been trained, while 30% have trained 75-100% of staff. Refresher courses are completed every 2-5 years by 77% of units, while annual resuscitation courses are established in 93% od units.
• 98% have examination rooms equipped with BB, pulse oximeter, ECG, and oxygen supply. The second suction is available in 80%, and capnography in 9%. 83% have their own recovery room, 16% use other recovery rooms.
• ASA classification is used in 80% of unit for risk assessment, while Mallampati score is used in 7% only. 38% developed department specific scores. 63% perform the sign-in for all patients, 16% for 75-100% of patients. Only 10% of departments never perform a sign-in.
• 35% of units perform team-time-out (TTO) for all patients, 11% for 75-100% of patients. Only 26% of departments never use TTO.
• In 47% of departments, a dedicated person for patient monitoring and sedation is available. 30% have this person in 75-100% of patients, and 14% have this person in 25-50% of cases.
• Propofol mono sedation by bolus application is used in 88% of units, TCI in 17% of units, combination Propofol and Midazolam is used in 27%.
• In 77% of units, inpatients and outpatient are equally monitored in the recovery area while 21% of units only use the recovery area for outpatients.
• In 73% of units, physicians discharge the patient, in 12% nurses discharge patients.
• In 80% of departments, patients are only allowed to leave the endoscopy with an accompanying person.
• 70% of departments document all complications, but only 42% evaluate the complication rate statistically.
• 42% of units reported to have no problems to establish all requirements for sedation and patient monitoring. 37% reported about staff shortage. 12% could not find new staff, 25% reported about financial problems. 44% reported about resistance in their own department or with hospital management to establish improvements.

Summary & Discussion

• Comparing data from 2013, 2018 and 2024, improvements could be identified in the establishment of riss assessment by using ASA Score and individual checklists, Malampati score is still not well-known. The establishment of TTO increased from 20 to 35% in all patients, but still needs to be improved.
• The availability of a sedating person remains unchanged with 40 to 47% in all patients and 30% in 75-100% of patients. The recovery situation remains unchanged.

Conclusion

Staff shortage and resistance within the own team are the main challenges when establishing safe sedation and patient monitoring in Endoscopy.

Disclosure

no conflict of interest