Gastroenterology

Once-only colonoscopy and low-cutoff FIT increase early CRC detection but not short-term incidence vs usual care

In this population-based RCT, 278,280 Swedish 60-year-olds were randomized to once-only colonoscopy, two rounds of low-cutoff FIT, or usual-care controls. After 4.8 years, overall CRC incidence was similar for colonoscopy and FIT versus controls, with incidence rate ratios near 1.0 and confidence intervals crossing 1. Both intervention arms had higher rates of stage I–II CRC than usual care, indicating earlier detection and a favorable stage shift. Gastrointestinal and cardiovascular events were slightly increased during year 1 in screened groups, then approximated control rates. These data support screening at age 60 for earlier CRC detection while highlighting a modest, front-loaded GI and CV adverse-event risk. 1

Higher sessile serrated lesion detection lowers postcolonoscopy CRC risk

This cohort included 328,416 colonoscopies from 226,695 adults in a large integrated health system over two decades. Endoscopists’ sessile serrated lesion detection rate (SSLDR) for screening exams was calculated and categorized into quartiles. Postcolonoscopy CRC incidence declined from 3.9 to 2.4 cases per 10,000 person-years between the lowest and highest SSLDR quartiles. Patients in the highest SSLDR quartile had a 31% lower adjusted hazard of postcolonoscopy CRC, mainly due to fewer proximal cancers. Higher SSLDR was also associated with lower all-cause and CRC mortality in intermediate quartiles, though mortality trends were less consistent. These findings support SSLDR as an independent quality metric, complementing adenoma detection rate, particularly for preventing proximal interval cancers. 2

Gastric ‘indefinite for dysplasia’ lesions frequently harbor cancer, especially in older adults

This meta-analysis pooled 16 studies including 2,226 gastric lesions initially classified as indefinite for dysplasia (IND) on biopsy. With endoscopic or surgical intervention, the pooled gastric cancer diagnosis rate was 66%, indicating frequent under-calling of malignancy on index biopsy. In rebiopsy-only strategies, the pooled cancer diagnosis rate remained 20%, substantial for an indeterminate histologic category. Among patients aged ≥60 years undergoing intervention, the cancer rate reached 75%, underscoring age as a strong risk modifier. Larger size (≥10 mm), surface depression, nodularity, redness, spontaneous bleeding, and multiple lesions were significantly associated with cancer. These data support managing gastric IND as a high-risk category, with early high-quality repeat endoscopy or resection, especially in older patients with suspicious features. 3