30-Second Takeaway
- Colonoscopy and low-threshold FIT increased early-stage CRC detection but did not yet cut incidence versus usual care at 4.8 years.
- A simple lab-based index (MAPI) outperformed standard indirect markers for detecting MetALD/ALD in fatty liver populations.
- ESBD improved duct clearance and reduced early bleeding versus EST alone for small CBD stones, with similar long-term outcomes.
- Histologic and MRI-based fibrosis assessment are emerging tools to risk-stratify Crohn’s surgery patients and guide management.
- Biomarker-based models can refine HCC and CVD surveillance intensity in HBV and IBD, potentially improving yield and resource use.
Week ending February 28, 2026
GI Grand Rounds: Screening, Fibrosis, Microbiota, and Risk Stratification Across the GI Continuum
Colonoscopy and Low-Threshold FIT Increase Early-Stage CRC Detection Without Short-Term Incidence Reduction
In SCREESCO, 278,280 60-year-olds were randomized to once-only colonoscopy, two rounds of low-cutoff FIT, or usual care without screening. After 4.8 years, CRC incidence was similar between screening and usual-care groups for colonoscopy (IRR 1.08) and FIT (IRR 0.92). Both colonoscopy and FIT increased detection of stage I–II CRC versus controls, indicating a stage shift toward earlier disease. Cardiovascular and gastrointestinal events were slightly higher during the first year in screened groups, then approximated control rates.
MAPI: A Routine-Lab Index to Flag Metabolic and Alcohol-Related Steatotic Liver Disease
This study developed the MetALD-ALD Prediction Index (MAPI) to detect excessive alcohol use in steatotic liver disease using common laboratory tests. The derivation cohort included 503 adults with overweight/obesity and MRI-confirmed steatosis who also underwent PEth testing. MAPI incorporated sex, mean corpuscular volume, gamma-glutamyltransferase, HDL cholesterol, and hemoglobin A1c, achieving AUROCs of 0.76 and 0.75 in derivation and validation cohorts. MAPI outperformed existing indirect alcohol biomarkers for identifying MetALD-ALD in both US and Swedish populations.
ESBD Improves Clearance and Reduces Bleeding Versus EST Alone for ≤12 mm CBD Stones
This retrospective cohort compared endoscopic sphincterotomy plus balloon dilation (ESBD) with sphincterotomy alone (EST) for common bile duct stones ≤12 mm. Among 1,067 patients, propensity matching produced 224 ESBD–EST pairs with balanced baseline characteristics. ESBD had higher technical success for complete stone extraction than EST (96.8% vs 91.0%) and required fewer ERCP sessions overall. Early adverse events and bleeding were significantly lower with ESBD (early AE 2.6% vs 9.8%), while late adverse event rates were similar between groups.
Histologic Fibrosis at Lesion and Margins Predicts Postoperative Crohn’s Recurrence
This multicenter cohort assessed whether quantified intestinal fibrosis predicts postoperative recurrence in Crohn’s disease after resection. In 268 patients, collagen proportion from Masson’s trichrome staining was measured at lesion sites and resection margins. Greater transmural fibrosis independently predicted higher endoscopic recurrence risk at both lesion (HR per SD 1.46) and margin (HR per SD 1.35). Fibrosis similarly predicted clinical recurrence, with a particularly strong association at lesion sites (HR per SD 1.95).
References
Numbered in order of appearance. Click any reference to view details.
Additional Reads
Optional additional studies from this edition.