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At least 19 recordsLinked to original sources
PubMed2026

Colonoscopy and fecal immunochemical testing versus usual care in diagnostic colorectal cancer screening: the SCREESCO randomized controlled trial.

There is a need to quantify the benefits and harms of colorectal cancer (CRC) screening using primary colonoscopy or fecal immunochemical testing (FIT) compared with usual care with no screening. Guidelines recommend screening in individuals aged 50-75 years using colonoscopy or FIT, and many screening programs use one-sample biennial FIT. Here we compare incidence of diagnosed CRCs and gastrointestinal and cardiovascular events between screening and usual care during the diagnostic phase of the SCREESCO trial. A randomized block method (no masking) assigned 278,280 individuals aged 60 years to once-only colonoscopy, 2 rounds of two-stool FIT with a low cutoff (10 μg g-1 feces) or usual care (control group) in a ratio of 1:6 for colonoscopy versus control and 1:2 for FIT versus control. In the analysis, 31,113 individuals were in the primary colonoscopy arm and 60,267 were in the FIT arm, and there were 186,671 primary colonoscopy controls, of whom 120,521 were also controls for comparison with the FIT arm. After a median follow-up of 4.8 years, the incidence rate of CRC was 107.9 in the colonoscopy arm and 99.9 in controls per 100,000 person-years (incidence rate ratio (IRR): 1.08, 95% confidence interval (CI): 0.91-1.28) and 96.0 in the FIT arm and 103.9 in controls (IRR: 0.92, 95% CI: 0.81-1.05). Rates of stage I-II CRC were higher in the colonoscopy arm (IRR: 1.38, 95% CI: 1.09-1.74) and in the FIT arm (IRR: 1.19, 95% CI: 0.99-1.43) versus controls. Rates of cardiovascular and gastrointestinal events were slightly higher in the intervention arms during the first year and were subsequently more similar to controls. Our findings of an increase in CRC detection implies a benefit of screening while the increase in adverse events suggests some initial harm. ClinicalTrials.gov: NCT02078804 .

Humans↗
PubMed2026

Comparative Efficacy of Different AI Systems for Polyp Detection by Size During Colonoscopy: Systematic Review and Network Meta-Analysis.

BACKGROUND: Colorectal cancer remains a leading cause of death despite being largely preventable through polypectomy. AI systems designed to enhance polyp detection during colonoscopy have shown promise, but the extent to which they improve detection of different-sized polyps remains unclear. OBJECTIVE: This study compared the size-stratified efficacy of AI-assisted colonoscopy vs standard colonoscopy using the Hartung-Knapp-Sidik-Jonkman (HKSJ) method, and generated exploratory rankings while acknowledging all cross-platform comparisons are indirect. METHODS: This systematic review and network meta-analysis (NMA) searched PubMed, Embase, Cochrane CENTRAL, and Web of Science from inception to July 25, 2026, supplemented by citation searching. We included randomized controlled trials (RCTs) comparing AI-assisted vs standard colonoscopy in adults (≥18 years of age), reporting mean polyp detection counts stratified by size (≤5 mm, 6-9 mm, and ≥10 mm). Two reviewers screened studies, extracted data, and assessed risk of bias using the Cochrane Risk of Bias 2.0. We conducted frequentist NMA using the HKSJ method with restricted maximum likelihood estimation, calculated 95% prediction intervals (PIs), and assessed heterogeneity using I2 and τ2. Certainty of evidence was rated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) framework. RESULTS: A total of 13 RCTs (4156 participants) compared 8 AI systems to standard colonoscopy, forming a network without direct AI comparisons. For diminutive polyps (≤5 mm), AI showed a modest advantage (standardized mean difference [SMD] 0.21, 95% CI 0.07 to 0.35, 95% PI -1.12 to 1.54), but substantial heterogeneity (I2=86.6%) and wide PI crossing the null indicated high uncertainty. EndoScreener showed the most consistent evidence (SMD 0.36, 95% CI 0.18-0.54). For small and large polyps, effects were minimal (SMD 0.02, 95% CI -0.02 to 0.06, 95% PI -0.03 to 0.07; SMD 0.01, 95% CI 0.00-0.02, 95% PI -0.01 to 0.03). GRADE certainty was very low for diminutive polyps and low for small and large polyps. Sensitivity analysis excluding Tianjin YuJin did not materially change findings. CONCLUSIONS: AI may modestly enhance diminutive polyp detection, but effects on small and large polyps are minimal, with no platform superiority. Given very low to low certainty, findings are hypothesis-generating. This exploratory NMA provides size-stratified comparisons that can inform future head-to-head trial design. Unlike prior reviews aggregating all polyp sizes, we show the overall AI benefit is driven by diminutive polyp detection, providing a framework for targeted deployment-prioritizing AI for diminutive polyp screening, with limited value for larger lesions. Head-to-head trials are urgently needed. TRIAL REGISTRATION: PROSPERO International Prospective Register of Systematic Reviews CRD420251266932; https://www.crd.york.ac.uk/PROSPERO/view/CRD420251266932.

Colonoscopy↗
PubMed2026

Exploring an Intermediate Colorectal Cancer Screening Test Based on Stool Proteomics and Machine Learning for Optimizing the Selection of Patients for Colonoscopy Identified From FIT.

The fecal immunochemical test (FIT) for detecting fecal occult blood, used alone or in combination with other stool biomarkers, has been demonstrated to be effective in the context of colorectal cancer (CRC) screening programs. However, FIT yields a significant proportion of false positives leading to unnecessary colonoscopies. In this study, we have investigated whether leftover FIT stool samples could be repurposed for proteomics analysis as a triage step for patients before recommending colonoscopy. High-throughput mass spectrometry analyses on a set of 141 FIT-positive samples (50 controls with no lesion, 45 with advanced adenomas and 46 with CRC) in combination with machine learning tools were used. Results showed that with a specificity ≥90%, a large proportion of the false FIT positives could be identified thus providing an efficient strategy for reducing unnecessary colonoscopies. Furthermore, CRC cases were also precisely predicted to be true positives, thus providing an approach for prioritizing patients for colonoscopy. In conclusion, this study demonstrates the feasibility of using proteomics for analysis of leftover FIT stool samples as an intermediate step to triage patients selected for colonoscopy in CRC screening programs.

Humans↗
PubMed1977

A comparison of colonoscopy and roentgenography for detecting polypoid lesions of the colon.

This study compares the effectiveness of the roentgen and colonoscopic examination of the colon for detecting polypoid lesions. We evaluated the findings in 64 patients with suspected or known polypoid lesions who received the same colon cleansing regimen for both examinations, and were studied by examiners of similar expertise. As in other studies, the endoscopist had the advantage of knowing the roentgen findings, and the colonoscopic findings were often taken to indicate whether or not a lesion was present. In about half the patients, however, a second roentgen examination, repeat colonoscopy, or surgical specimen provided additional information for scoring. For example, a filling defect of the same size and location on two roentgen examinations, but not demonstrated at colonoscopy was scored as a false negative colonoscopic finding. The study results indicate that 54% of small polyps less than or equal to 0.9 cm in size were missed on roentgen examination, whereas no proven misses for lesions of this size were shown for colonoscopy. This absence of colonoscopic false-negative findings for small polyps, however, may be partially explained by a relative insensitivity of the roentgen method. For larger lesions greater than or equal to 1.0 cm in size the miss-rate for the two examinations was similar: 15% for roentgen examination and 12% for colonoscopy. We conclude: (1) Colonoscopy is a more sensitive method than roentgen examination for detecting small polyps of the colon, and (2) Performance of the two examinations may be comparable for demonstrating lesions 1.0 cm or larger in size.

Colonic Neoplasms↗
PubMedDate not supplied

Guidelines for use of flexible fiberoptic colonoscopy in management of patients with colorectal neoplasia.

Flexible fiberoptic colonoscopy, to have the maximum effect upon the management of patients having, suspected of, or at risk of having colorectal neoplastic disease, must be applied in accordance with substantial guidelines. Schemes for the application of colonoscopy have been designed for the early and accurate diagnosis of benign and malignant polypoid lesions. Colonoscopy has proven effective in confirming radiographic findings and the removal of pre-malignant and superficially malignant lesions. When applied in accordance with appropriate guidelines, flexible fiberoptic colonoscopy should provide not only secure surveillance in those individuals at high risk, but also should reduce appreciably the morbidity and mortality of colorectal neoplasia.

Colonic Neoplasms↗
PubMed1977

Colonoscopy in clinical practice.

Colonoscopy is a relatively new and important diagnostic modality for evaluation colonic disease. In order to assess its value in the community hospital, all colonoscopies done by me (250 examinations in two hospitals) were reviewed. Colonoscopy was sometimes easy and sometimes long and tedious. It was difficult to reach the cecum consistently, but success improved with experience. Many neoplasma not seen on barium enema were found, including three carcinomas. Twenty-seven polyps were removed with the aid of the colonoscopic snare. No complications occurred. Colonoscopy should probably be restricted to those physicians who have a large enough case load and who can spend enough time learning the procedure to develop expertise.

Adolescent↗
PubMed1979

Colonoscopy in lower gastro-intestinal haemorrhage.

The value of colonoscopy in the diagnosis and management of lower gastro-intestinal haemorrhage was assessed in 107 patients who were examined during a 2-year period. The main indications were to define uncertain radiological findings, to further investigate the cause of bleeding in patients with normal barium studies and to carry out polypectomy. Radiological lesions were confirmed in 27, defined in 12, and refuted in 14 patients. Twenty-eight lesions were demonstrated on colonoscopy which were not diagnosed by barium enema or sigmoidoscopy. A diagnosis was made by colonoscopy in more than two-thirds of the patients with frank blood loss and normal radiographs. In cases of occult bleeding it was farless helpful. Colonoscopy significantly improved diagnosis and management of gastro-intestinal bleeding when the cause was in doubt after standard investigations. In addition, 37 polyps were removed through the colonoscope from 30 patients.

Gastrointestinal Hemorrhage↗
PubMed1979

Extent of inflammatory lesions in ulcerative colitis assessed by radiology, colonoscopy, and endoscopic biopsies.

Radiography of the colon with double-contrast technique was performed directly after total colonoscopy with multiple biopsies in 50 patients with ulcerative colitis. In two-thirds of the series the inflammatory lesions were found to be more widespread at colonoscopy than on radiography. Signs of colitis in an even larger part of the bowel were found on examination of the biopsies in half of the cases. The distribution of characteristic inflammatory changes seen at colonoscopy was also studied. The frequency of the lesions was found to be relatively low in the rectum and highest in the descending and sigmoid parts of the colon.

Adult↗
PubMed1979

Complications of diagnostic and therapeutic colonoscopy in the Federal Republic of Germany. Results of an inquiry.

In April, 1978, we carried out a survey covering 27 hospitals, in which colonoscopy is performed on a routine basis. With respect to the size of the hospital, the equipment available and the level of training of the examiner, this selection may be regarded as representative. A total of 35,892 colonoscopies, 7,365 polypectomies, 58 electrocoagulations and 14 rugectomies were analysed with respect to the nature, localization and treatment of any complications that arose. The rate of complications seen in diagnostic colonoscopy was 0.008% for bleeding and 0.14% for perforation, the mortality rate being 0.02%. As expected, the complication rate for colonoscopic polypectomy was higher. Bleedings were reported in 2.24%, perforations in 0.34% and deaths in 0.1% of the examinations. Of particular importance would seem to be the possibilities of preventing complications. It was shown on the basis of the survey that a good, standardized training of the endoscopist, the strict observance of the contraindications, the non-use of analgesics and general anaesthesia, fluoroscopic control of "difficult" colons and the use of the best instruments and aids presently available, reduce the complication rate to a minimum.

Colon↗
PubMed1977

Colonoscopy in surgical practice.

Colonoscopy is a rewarding new technique with a potential for early and more accurate diagnosis. One hundred and seventy colonoscopies carried out over the past three years showed or confirmed colonic cancer in 14 patients, and solitary or multiple colonic polyps were found in 28 cases, of which 18 were excised endoscopically. A large villous adenoma was diagnosed in one patient, and the absence of a suspected sinister lesion was shown by direct examination and biopsy in 110 cases. There were 17 examination failures, including two perforations of the bowel. Colonoscopy complements rather than supplants barium enema examination and will make diagnostic laparotomy for colonic lesions unnecessary. The use of the diathermy snare allows endoscopic removal of colonic polyps and should greatly reduce the need for formal surgery in these cases. The financial saving to the Health Service will greatly outweigh the expense of the procedure, but it should be undertaken only in well organised centres as a specialist service for selected patients. In skilled hands it is safe, but potential hazards exist for the inexperienced endoscopist.

Colon↗
PubMed1979

Fibreoptic colonoscopy. Indications, results and complications.

Fibreoptic colonoscopy was commenced in the Edward Wilson Colon and Rectum Unit at Sydney Hospital in June, 1973. The experience of the first five years of its use is reported. Six hundred and twenty-six examinations have been performed in 568 patients. Fibreoptic colonoscopy has been of particular value in the diagnosis and treatment of colonic polyps. A total of 318 polyps were removed from 184 patients. Their distribution, size and histological features are recorded. Eight complications occurred in the 628 examinations (1.6%). There were six colonic perforations (1.2%) with one death, and two significant haemorrhages (0.4%). This incidence of complications is acceptably low, especially in view of the great benefits obtained by the patient from fibreoptic colonoscopy. The newer instruments, especially the medium length Olympus MB3 colonoscope, have greatly facilitated the examination and, combined with increasing experience, may significantly lower the incidence of complications in the future.

Adolescent↗
PubMed1979

Complications in colonoscopy.

Colonoscopy, when performed for appropriate indications and by experienced, competent personnel, is a remarkably safe procedure. The occasional complications which occur may be the result of pneumatic, mechanical or electrical injuries to the colon or may develop as secondary disorders involving other organ systems. Most complications can be successfully prevented by adequately preparing both the endoscopist and the patient and by avoiding colonoscopy when specific contraindications are present. Should complications occur, their management generally follows established surgical principles. Even though colonoscopy has made a dramatic impact upon the diagnosis of and therapy for disease of the large intestines, it is important for practitioners to be mindful of its limitations. Future developments, applied rationally, can be expected to extend its usefulness and further improve its safety.

Burns, Electric↗
PubMedDate not supplied

The role of colonoscopy in complicated diverticular disease. A review.

Colonoscopy in complicated diverticular disease may assist the clinician in establishing the diagnosis of associated strictures. A review of the literature shows that carcinoma was identified in 21 (17%) of 125 patients and that an additional diagnosis was made in 40 (32%) patients. Although colonoscopy may be a difficult procedure in patients with diverticular disease the caecum was reached in 27 (61%) of 44 patients and took no longer than routine colonoscopic orpcedures. Further analysis of these results confirms that the barium enema frequently produces both false positive and false negative diagnoses of carcinoma and polyps. The presence of bleeding strongly suggests the presence of a concomitant lesion. Fifteen (11%) carcinomas were identified in a group of 135 patients with persistent rectal bleeding whose barium enema showed only diverticular disease and an additional diagnosis was made in 50 (37%) of these patients. Colonoscopy is an important investigation in patients with complicated diverticular disease.

Aged↗
PubMedDate not supplied

Value of colonoscopy in the detection of sigmoid malignancy in patients with diverticular disease.

Sixty patients with diverticular disease, referred because a barium enema examination could not exclude a co-existing malignanty, were studied in a retrospective manner, to find out the contribution of colonoscopy in the diagnosis of sigmoid carcinoma in such patients. All X-ray studies were blindly reviewed and divided in two categories: a) diverticular disease with malignancy or strong suspicion for malignancy and b) diverticular disease without suspicion for malignancy. The accuracy of the endoscopical examination was evaluated by a follow-up study with a range of 3 months-3 years. Colonoscopy appeared to be accurate in more than 3/4 of the referred patients but was not helpful when there was a severe stenoisis and/or the diseases segment could not be reached for biopsy. The incidence diminished when a small calibre fiberendoscope was used, practically always allowing to reach or to pass the stenotic segment. There were no false positive nor false negative endoscopical results in our study. In a substantial number of patients major surgical exploration could be prevented. We consider colonoscopy therefore a valuable adjunct in detecting or eliminating cancer in colonic diverticular disease. The availability of various fiberendoscopic instruments is a prerequisite for reaching an acceptable success rate and diagnostic accuracy.

Colon↗
PubMed1977

Fiberoptic endoscopy of the gastrointestinal tract in infants and children. II. Fiberoptic colonoscopy and polypectomy in 15 children.

Fiberoptic colonoscopy was performed on 15 patients between the ages of 1 1/2 years and 16 years. Ten patients were hospitalized and five were outpatients. Of 12 with frank or microscopic blood in stools, fiberoptic colonoscopy revealed single polyps in six patients, ulcerative colitis in two and negative results in four with prior nondiagnostic radiographic studies, colonoscopy revealed ulcerative colitis in one, granulomatous colitis in one and negative findings in one. Polypectomy through the colonoscope was accomplished in all six patients with polyps. Perforation of the sigmoid colon during polypectomy with the snare loop was the single complication encountered. Lower intestinal endoscopy should be selectively considered for diagnosis and therapy of unexplained bleeding or recurrent lower abdominal pain in children in whom proctosigmoidoscopic laboratory and radiographic examinations do not achieve a diagnosis.

Abdomen↗
PubMed1979

The management of suspected tumours of the colon: the role of colonoscopy in general surgery.

The role of colonoscopy in the management of 100 cases of suspected large bowel tumour is described. Forty out of 47 patients with an equivocal barium enema examination were satisfactorily examined and the possibility of a tumour being present was either confirmed or refuted. Examination of 30 patients with otherwise unexplained blood loss from the bowel revealed the cause in 50 per cent of them. Twenty-nine patients had pedunculated polyps which were snared and removed, thus avoiding laparotomy and colotomy. The problem of distinguishing tumours from other lesions or retained faeces by radiology arises most often in the sigmoid colon. This segment is easily examined using a short flexible endoscope. General surgeons taking up colonoscopy will find a 1-m single-channel instrument convenient to use and capable of reaching approximately 90 per cent of colonic tumours that require further investigation or endoscopic resection. Facilities for the examination of the whole colon should be available in established endoscopy units.

Adult↗
PubMed1978

Colonoscopy and polypectomy.

An overview of colonoscopy and polypectomy is presented. The merits of this procedure are pointed out, highlighting the newer technics and those technics that have survived. The complications of colonoscopy and polypectomy are reviewed in detail.

Colon↗