Patients with ulcerative colitis (UC) have a high incidence of colorectal neoplasia. Kudo's pit pattern is useful for assessing the depth of colorectal neoplasia in the general population; however, its application in UC-associated neoplasia is limited. Inaccurate preoperative depth diagnosis may lead to positive resection margins and perforation. We aimed to determine whether evaluating lesion-border findings can help identify cases in which pit pattern analysis is useful for depth diagnosis in patients with UC.
Methods
This single-center, retrospective study analyzed 158 colorectal lesions in patients with UC. Lesions were resected endoscopically or surgically after magnifying chromoendoscopy observation and borders were defined as “distinct” or “indistinct.” The predictive value of pit patterns for identifying intramucosal lesions was evaluated.
Results
The lesions included the following macroscopic types: pedunculated (1.9%), sessile (13.3%), superficial elevated (82.3%), and depressed (2.5%). The pathologic diagnoses included serrated lesion (18.4%), dysplasia (62.7%), intramucosal carcinoma (9.5%), T1 cancer (5.1%), and T2 or deeper cancer (4.4%). One hundred eighteen lesions were classified with distinct borders and 40 with indistinct borders. The diagnostic sensitivity, specificity, and accuracy of type II/IIIL pit patterns for intramucosal lesions were 75.5%, 80.0%, and 75.9 for all subjects; 14.3%, 75.0%, and 32.5% for indistinct borders; and 90.4%, 100%, and 90.7% for distinct borders, respectively.
Conclusions
Adding lesion-border findings to pit patterns improved the identification of intramucosal lesions in patients with UC. All lesions with distinct borders and type II or IIIL pit patterns were intramucosal, suggesting lesions suitable for endoscopic resection.
{"title":"Clinical impact of combination of lesion-border findings and pit patterns for identifying invasive versus noninvasive neoplastic lesions in ulcerative colitis","authors":"Yurie Kawabata MD , Shin-Ei Kudo MD, PhD , Yasuharu Maeda MD, PhD , Takanori Kuroki MD , Kazumi Takishima MD , Yuki Takashina MD , Yosuke Minegishi MD, PhD , Taishi Okumura MD, PhD , Tatsuya Sakurai MD, PhD , Yuta Kouyama MD, PhD , Yushi Ogawa MD, PhD , Katsuro Ichimasa MD, PhD , Masashi Misawa MD, PhD , Takemasa Hayashi MD, PhD , Kunihiko Wakamura MD, PhD , Naruhiko Sawada MD, PhD , Toshiyuki Baba MD, PhD , Tetsuo Nemoto MD, PhD , Kazuo Ohtsuka MD, PhD , Noriyuki Ogata MD, PhD","doi":"10.1016/j.gie.2025.07.040","DOIUrl":"10.1016/j.gie.2025.07.040","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Patients with ulcerative colitis (UC) have a high incidence of colorectal neoplasia. Kudo's pit pattern is useful for assessing the depth of colorectal neoplasia in the general population; however, its application in UC-associated neoplasia is limited. Inaccurate preoperative depth diagnosis may lead to positive resection margins and perforation. We aimed to determine whether evaluating lesion-border findings can help identify cases in which pit pattern analysis is useful for depth diagnosis in patients with UC.</div></div><div><h3>Methods</h3><div>This single-center, retrospective study analyzed 158 colorectal lesions in patients with UC. Lesions were resected endoscopically or surgically after magnifying chromoendoscopy observation and borders were defined as “distinct” or “indistinct.” The predictive value of pit patterns for identifying intramucosal lesions was evaluated.</div></div><div><h3>Results</h3><div>The lesions included the following macroscopic types: pedunculated (1.9%), sessile (13.3%), superficial elevated (82.3%), and depressed (2.5%). The pathologic diagnoses included serrated lesion (18.4%), dysplasia (62.7%), intramucosal carcinoma (9.5%), T1 cancer (5.1%), and T2 or deeper cancer (4.4%). One hundred eighteen lesions were classified with distinct borders and 40 with indistinct borders. The diagnostic sensitivity, specificity, and accuracy of type II/III<sub>L</sub> pit patterns for intramucosal lesions were 75.5%, 80.0%, and 75.9 for all subjects; 14.3%, 75.0%, and 32.5% for indistinct borders; and 90.4%, 100%, and 90.7% for distinct borders, respectively.</div></div><div><h3>Conclusions</h3><div>Adding lesion-border findings to pit patterns improved the identification of intramucosal lesions in patients with UC. All lesions with distinct borders and type II or III<sub>L</sub> pit patterns were intramucosal, suggesting lesions suitable for endoscopic resection.</div></div>","PeriodicalId":12542,"journal":{"name":"Gastrointestinal endoscopy","volume":"103 3","pages":"Pages 520-529.e3"},"PeriodicalIF":7.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144803954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-08-18DOI: 10.1016/j.gie.2025.08.011
Xiaocong Zhang MMed , Jianming Dou MSc , Yangming Gong MPH , Chunxiao Wu MPH , Yi Pang MMed , Mengyin Wu PhD , Weiping Luo MD , Hong Zou , Yuhua Huang , Haiying Tang , Jinghong Ye PhD , Yan Xu , Kai Gu MD
Background and Aims
The quantitative fecal immunochemical test (qnFIT) provides details of hemoglobin concentration, allowing for the adjustment of the positivity threshold to align with specific colorectal cancer (CRC) screening objectives. However, the superiority of qnFIT over qualitative fecal immunochemical test (qlFIT) extensively used throughout China is not thoroughly investigated.
Methods
A total of 7097 residents were enrolled for the project, of which 5841 participants aged 50 to 74 years completed both qlFIT and qnFIT. All participants positive with either fecal immunochemical test were referred for colonoscopy. Positivity, uptake of colonoscopy, detection rate (DR) at colonoscopy, positive predictive value (PPV), DR in population, and number needed to scope (NNS) were used to compare screening performance.
Results
Using the conventional 100 ng/mL as cut-off, we found that positivity was 5.87% for qnFIT and 12.86% for qlFIT (P < .001). CRC DR at colonoscopy and PPV for qnFIT were nearly 2-fold of corresponding values for qlFIT (DR 13.29% vs 7.52%, P = .043, PPV 6.12% vs 3.20%, P = .024), but DRs of adenoma and polyp in population with qnFIT were lower. 7.52 colonoscopies were needed to detect one CRC with qnFIT, almost half of that with qlFIT (7.52 vs 13.29, P = .043).
Conclusions
QnFIT exhibited lower positivity, greater DR at colonoscopy and PPV for CRC over qlFIT. Almost one half of colonoscopy resources were saved by qnFIT, although adenoma and polyp were missed in population screening.
{"title":"Performance comparison of quantitative and qualitative fecal immunochemical tests in community-based colorectal cancer screening","authors":"Xiaocong Zhang MMed , Jianming Dou MSc , Yangming Gong MPH , Chunxiao Wu MPH , Yi Pang MMed , Mengyin Wu PhD , Weiping Luo MD , Hong Zou , Yuhua Huang , Haiying Tang , Jinghong Ye PhD , Yan Xu , Kai Gu MD","doi":"10.1016/j.gie.2025.08.011","DOIUrl":"10.1016/j.gie.2025.08.011","url":null,"abstract":"<div><h3>Background and Aims</h3><div>The quantitative fecal immunochemical test (qnFIT) provides details of hemoglobin concentration, allowing for the adjustment of the positivity threshold to align with specific colorectal cancer (CRC) screening objectives. However, the superiority of qnFIT over qualitative fecal immunochemical test (qlFIT) extensively used throughout China is not thoroughly investigated.</div></div><div><h3>Methods</h3><div>A total of 7097 residents were enrolled for the project, of which 5841 participants aged 50 to 74 years completed both qlFIT and qnFIT. All participants positive with either fecal immunochemical test were referred for colonoscopy. Positivity, uptake of colonoscopy, detection rate (DR) at colonoscopy, positive predictive value (PPV), DR in population, and number needed to scope (NNS) were used to compare screening performance.</div></div><div><h3>Results</h3><div>Using the conventional 100 ng/mL as cut-off, we found that positivity was 5.87% for qnFIT and 12.86% for qlFIT (<em>P</em> < .001). CRC DR at colonoscopy and PPV for qnFIT were nearly 2-fold of corresponding values for qlFIT (DR 13.29% vs 7.52%, <em>P</em> = .043, PPV 6.12% vs 3.20%, <em>P</em> = .024), but DRs of adenoma and polyp in population with qnFIT were lower. 7.52 colonoscopies were needed to detect one CRC with qnFIT, almost half of that with qlFIT (7.52 vs 13.29, <em>P</em> = .043).</div></div><div><h3>Conclusions</h3><div>QnFIT exhibited lower positivity, greater DR at colonoscopy and PPV for CRC over qlFIT. Almost one half of colonoscopy resources were saved by qnFIT, although adenoma and polyp were missed in population screening.</div></div>","PeriodicalId":12542,"journal":{"name":"Gastrointestinal endoscopy","volume":"103 3","pages":"Pages 507-517.e2"},"PeriodicalIF":7.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144899149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-07-01DOI: 10.1016/j.gie.2025.06.046
Pin Wang MM , Bixing Ye MD , Guoxin Zhang MD , Lin Lin MD , Liuqin Jiang MD
Background and Aims
Although endoscopic submucosal dissection (ESD) is established for rectal neoplasms, postprocedural anorectal dysfunction (eg, altered bowel habits, urgency, or anal discomfort) remains poorly characterized. This study aimed to determine the incidence, risk factors, and temporal recovery patterns of these symptoms.
Methods
A retrospective analysis was conducted of 296 patients who underwent ESD for rectal lesions from January 2020 to December 2023. Data regarding the ESD procedure and anorectal symptoms were collected, including scores from the Low Anterior Resection Syndrome (LARS), Wexner Fecal Incontinence Score, Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), and Gastrointestinal Quality of Life Index (GIQLI) at 1 week, 3 months, 6 months, and 12 months postoperatively. Patients were categorized into symptomatic and asymptomatic groups, and a comparative analysis of clinical features was conducted.
Results
Among 296 patients, 82 (27.7%) experienced anorectal symptoms, primarily characterized by increased bowel movements, anal discomfort, defecation urgency, and loose stools. The LARS, Wexner, SAS, and SDS scores showed a decreasing trend during the 1-week to 12-month postoperative period, whereas the GIQLI score exhibited an increasing trend. Compared with the asymptomatic group, the symptomatic group had significantly higher LARS, Wexner, SAS, and SDS scores and a lower GIQLI score at 1 week and 3 months postoperatively (P < .05). No significant differences in SAS, SDS, and GIQLI scores were observed between the 2 groups at 6 and 12 months postoperatively (P > .05). Multivariate logistic regression identified lesion location and size as significant predictors. Compared with patients with lesions ≤5 cm from the anal verge, those with lesions 5 to 10 cm and >10 cm from the anal verge had significantly reduced risks of postoperative symptoms (OR 0.202, P < .001; OR 0.100, P < .001). Lesions >4 cm from the anal verge were significantly associated with an increased risk of postoperative symptoms (OR 7.259, P = .003).
Conclusions
The occurrence of anorectal symptoms following rectal ESD is closely related to the location and size of the lesion. The psychological and quality-of-life impairments caused by these symptoms are primarily short-term and can gradually recover over time.
背景和目的：虽然内镜下粘膜下剥离术（ESD）已被用于直肠肿瘤，但术后肛肠功能障碍（如排便习惯改变、急症或肛门不适）的特征仍然很差。本研究旨在确定这些症状的发生率、危险因素和时间恢复模式。方法：回顾性分析2020年1月至2023年12月296例接受直肠病变ESD治疗的患者。收集ESD手术和肛肠症状的数据，包括术后1周、3个月、6个月和12个月的低前切除术综合征（LARS）、Wexner大便失禁量表、自评焦虑量表（SAS）、自评抑郁量表（SDS）和胃肠道生活质量指数（GIQLI）评分。将患者分为有症状组和无症状组，比较分析其临床特征。结果：在296例患者中，82例（27.7%）出现肛肠症状，主要表现为排便增加、肛门不适、排便紧急和便稀。术后1周至12个月期间，LARS、Wexner、SAS、SDS评分呈下降趋势，GIQLI评分呈上升趋势。与无症状组相比，有症状组术后1周和3个月的LARS、Wexner、SAS和SDS评分显著升高，GIQLI评分显著降低（P < 0.05）。两组患者术后6个月、12个月的SAS、SDS、GIQLI评分比较，差异均无统计学意义（P < 0.05）。多因素logistic回归发现病变部位和大小是显著的预测因子。与病灶距肛缘≤5 cm的患者相比，病灶距肛缘5 ~ 10 cm和>10 cm的患者术后出现症状的风险明显降低(OR = 0.202, P < 0.001；Or = 0.100, p < 0.001)。距离肛门边缘bbb40cm的病变与术后症状风险增加显著相关（OR = 7.259, P = 0.003）。结论：直肠ESD后肛肠症状的发生与病变部位及大小密切相关。这些症状引起的心理和生活质量损害主要是短期的，可以随着时间的推移逐渐恢复。
{"title":"Clinical characteristics analysis of anorectal function changes after endoscopic submucosal dissection for rectal lesions","authors":"Pin Wang MM , Bixing Ye MD , Guoxin Zhang MD , Lin Lin MD , Liuqin Jiang MD","doi":"10.1016/j.gie.2025.06.046","DOIUrl":"10.1016/j.gie.2025.06.046","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Although endoscopic submucosal dissection (ESD) is established for rectal neoplasms, postprocedural anorectal dysfunction (eg, altered bowel habits, urgency, or anal discomfort) remains poorly characterized. This study aimed to determine the incidence, risk factors, and temporal recovery patterns of these symptoms.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted of 296 patients who underwent ESD for rectal lesions from January 2020 to December 2023. Data regarding the ESD procedure and anorectal symptoms were collected, including scores from the Low Anterior Resection Syndrome (LARS), Wexner Fecal Incontinence Score, Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), and Gastrointestinal Quality of Life Index (GIQLI) at 1 week, 3 months, 6 months, and 12 months postoperatively. Patients were categorized into symptomatic and asymptomatic groups, and a comparative analysis of clinical features was conducted.</div></div><div><h3>Results</h3><div>Among 296 patients, 82 (27.7%) experienced anorectal symptoms, primarily characterized by increased bowel movements, anal discomfort, defecation urgency, and loose stools. The LARS, Wexner, SAS, and SDS scores showed a decreasing trend during the 1-week to 12-month postoperative period, whereas the GIQLI score exhibited an increasing trend. Compared with the asymptomatic group, the symptomatic group had significantly higher LARS, Wexner, SAS, and SDS scores and a lower GIQLI score at 1 week and 3 months postoperatively (<em>P</em> < .05). No significant differences in SAS, SDS, and GIQLI scores were observed between the 2 groups at 6 and 12 months postoperatively (<em>P</em> > .05). Multivariate logistic regression identified lesion location and size as significant predictors. Compared with patients with lesions ≤5 cm from the anal verge, those with lesions 5 to 10 cm and >10 cm from the anal verge had significantly reduced risks of postoperative symptoms (OR 0.202, <em>P</em> < .001; OR 0.100, <em>P</em> < .001). Lesions >4 cm from the anal verge were significantly associated with an increased risk of postoperative symptoms (OR 7.259, <em>P</em> = .003).</div></div><div><h3>Conclusions</h3><div>The occurrence of anorectal symptoms following rectal ESD is closely related to the location and size of the lesion. The psychological and quality-of-life impairments caused by these symptoms are primarily short-term and can gradually recover over time.</div></div>","PeriodicalId":12542,"journal":{"name":"Gastrointestinal endoscopy","volume":"103 3","pages":"Pages 541-550"},"PeriodicalIF":7.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144559831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-09-24DOI: 10.1016/j.gie.2025.09.039
Ningning You MM, Yandi Lu BN, Yi Chen MM, Jinshun Zhang MD
{"title":"Endoscopic removal of a large esophageal leiomyoma via bilateral longitudinal-transverse tunneling after failed initial resection","authors":"Ningning You MM, Yandi Lu BN, Yi Chen MM, Jinshun Zhang MD","doi":"10.1016/j.gie.2025.09.039","DOIUrl":"10.1016/j.gie.2025.09.039","url":null,"abstract":"","PeriodicalId":12542,"journal":{"name":"Gastrointestinal endoscopy","volume":"103 3","pages":"Pages 615-616"},"PeriodicalIF":7.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145174655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-12-01DOI: 10.1016/j.gie.2025.09.023
Yibai Wang MD , Xiaoyu Huang MD , Yutong Liu PhD , Yaoyao Bian PhD
{"title":"Temporal confounding and application bias in the evaluation of a self-assembling peptide for postendoscopic submucosal dissection bleeding","authors":"Yibai Wang MD , Xiaoyu Huang MD , Yutong Liu PhD , Yaoyao Bian PhD","doi":"10.1016/j.gie.2025.09.023","DOIUrl":"10.1016/j.gie.2025.09.023","url":null,"abstract":"","PeriodicalId":12542,"journal":{"name":"Gastrointestinal endoscopy","volume":"103 3","pages":"Pages 649-650"},"PeriodicalIF":7.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145648189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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