Background:Real-world comparative outcomes of endoscopic retrograde cholangiopancreatography-based endoscopic therapy vs. pancreatic surgery in chronic pancreatitis (CP) remain incompletely defined. Methods:We performed a retrospective comparative effectiveness study using the TriNetX US Collaborative Network. Adults with CP undergoing endoscopic therapy or pancreatic surgery were identified, and propensity score matching generated 1451 patients in each cohort. Outcomes were assessed from 1-1095 days after the index event, using risk-based analyses as the primary comparative summaries and Kaplan-Meier analyses as secondary time-to-event summaries. Outcomes included chronic opioid prescriptions, opioid use disorder (OUD), celiac plexus block/neurolysis, pain codes, acute pancreatitis, exocrine and endocrine pancreatic insufficiency, emergency visits, and all-cause mortality. Results:Mean follow up was 771.494 days for endoscopy and 827.285 days for surgery. New chronic opioid prescriptions occurred in 146/1092 (13.4%) endoscopic vs. 79/1032 (7.7%) surgical patients (odds ratio [OR] 1.862, 95% confidence interval [CI] 1.396-2.484; P<0.001; hazard ratio [HR] 1.861, 95%CI 1.415-2.448). Acute pancreatitis occurred in 167/530 (31.5%) vs. 65/565 (11.5%) patients (OR 3.539, 95%CI 2.578-4.858; P<0.001; HR 3.341, 95%CI 2.506-4.453). Exocrine pancreatic insufficiency occurred in 200/1213 (16.5%) vs. 132/1206 (10.9%) patients (OR 1.606, 95%CI 1.269-2.034; P<0.001; HR 1.585, 95%CI 1.272-1.975). Endocrine pancreatic insufficiency, mortality, emergency visits, and OUD did not differ significantly between cohorts. Conclusions:Endoscopic therapy was associated with higher chronic opioid prescribing, acute pancreatitis, celiac plexus block/neurolysis, and exocrine pancreatic insufficiency. These findings are associative and should be interpreted in the context of residual confounding and coding-based outcome ascertainment.
Hepatic encephalopathy (HE) represents a neuropsychiatric continuum arising from cirrhosis and portosystemic shunting, where metabolic toxicity, neuroinflammation and impaired cerebral autoregulation progressively disrupt cortical network function. Minimal hepatic encephalopathy (MHE), its first and not overt stage, has been recognized as a major cause of impaired quality of life and has been associated with reduced functioning and heightened risk of progression to overt HE and mortality. Current diagnostic tools, primarily psychometric tests, capture only clinical manifestations, and lack the ability to directly examine neuronal dysfunction. Electroencephalography (EEG) provides a real-time tool to quantify brain activity, allowing the identification of subtle neural alterations long before clinical symptoms appear. Quantitative EEG (qEEG) indices, such as reduced mean dominant frequency, increased slow-wave activity and disrupted spectral ratios, consistently reflect early cognitive impairment in studies, and are correlated with liver disease severity and neurological performance. These markers not only enhance the early diagnosis of MHE, but also carry important prognostic implications: several EEG parameters have independently predicted future progression of the disease, hospitalization and mortality, and may enhance established risk models when integrated into multicomponent indices such as model for end-stage liver disease (MELD)-EEG. Collectively, evidence suggests that EEG could be used as a multidimensional and objective assessment of neural dysfunction that complements psychometric, biochemical, and imaging-based methods. Our study aimed to examine the diverse electrophysiological findings clarifying the diagnostic and prognostic importance of EEG-based markers, and to examine their possible role in early diagnosis, risk stratification and future clinical applications for patients with HE.
Healthcare maintenance plays a vital role in the long-term management of patients with inflammatory bowel disease (IBD), particularly those receiving immunosuppressive therapies. This review emphasizes the importance of maintaining up-to-date vaccinations, regular bone and mental health assessments, and appropriate cancer screening in this population. It also highlights the added complexity of preventive care in immunosuppressed patients, outlining specific modifications to vaccination and screening strategies required to ensure safe and effective disease management. Gastroenterologists and other clinicians involved in IBD care should remain familiar with current guidelines and consistently integrate preventive health measures into routine clinical practice.
Background:Cystic duct anatomy is clinically significant for surgery and stone formation, yet the literature lacks a systematic analysis linking variations to common bile duct stones. This study investigated their prevalence and risk for choledocholithiasis. Methods:We systematically searched PubMed, Embase, Web of Science and Scopus for studies on cystic duct morphology and choledocholithiasis. Pooled prevalence, risk ratios (RRs), and odds ratios were calculated using R; heterogeneity and bias were assessed via AQUA and Peter's tests. Results:High (17.2%) and posterior (13.8%) insertions were most prevalent. Factors significantly associated with choledocholithiasis included a long cystic duct (RR 1.50, 95% confidence interval [CI] 1.18-1.90), low insertion (RR 1.46, 95%CI 1.06-1.76), spiral course (RR 1.41, 95%CI 1.06-1.86), and posterior insertion (RR 1.32, 95%CI 1.07-1.60). Lithiasis patients exhibited wider cysto-choledochal angles (47.1° vs. 40.8°). Geographic analysis revealed a high prevalence of low insertion in African populations (21.8%) and spiral ducts in East Asians. Conclusions:Cystic duct variations significantly increase susceptibility to choledocholithiasis and pose surgical challenges. As these complex anatomical courses and configurations are often missed, preoperative imaging is essential. Early identification enables safer surgical planning, reduces biliary injury risk, and can guide tailored strategies to prevent lithiasis in high-risk groups.
Background:Colectomy with ileorectal anastomosis (IRA) or proctocolectomy with ileal pouch-anal anastomosis (IPAA) are the 2 standard prophylactic surgical options for patients with familial adenomatous polyposis (FAP). We aimed to compare the functional and long-term outcomes of IRA and IPAA among FAP patients. Methods:We searched large databases to identify studies evaluating the functional outcomes of prophylactic surgical modalities for FAP. The primary outcomes of interest were the functional outcomes of IRA with IPAA, including fecal incontinence, fecal urgency, use of pads for defecation, and use of antidiarrheal drugs. Secondary outcomes included the social outcomes of the 2 procedural modalities, early postoperative adverse events, and long-term adverse events. Results:Compared with IPAA, FAP patients who underwent IRA had a lower frequency of fecal incontinence (odds ratio [OR] 0.56, 95% confidence interval [CI] 0.41-0.76; P<0.001), but were more likely to have fecal urgency (OR 1.53, 95%CI 1.08-2.15; P=0.02). There was no difference in the use of pads and antidiarrheals between the 2 groups (OR 0.55, 95%CI 0.27-1.11; P=0.09; and OR 0.83, 95%CI 0.57-1.22; P=0.35, respectively). Moreover, there was no difference in social outcomes or perioperative adverse events (OR 1.19, 95%CI 0.53-2.68; P=0.68; and OR 0.73, 95%CI 0.50-1.06; P=0.10, respectively). Lastly, IRA had lower long-term complications than IPAA (OR 0.78, 95%CI 0.63-0.97; P=0.03). Conclusion:IRA has better functional outcomes regarding fecal incontinence, a better prophylactic intervention profile, and fewer long-term complications.
Background Quality assessment is a priority in gastroenterology. Data on adherence to endoscopy quality standards in Greece remain limited. This study examined Greek gastroenterologists' compliance with endoscopic quality indicators. Methods This survey collected data on the quality of upper and lower gastrointestinal endoscopy in Greece. Hellenic Society of Gastroenterology members were invited to complete an electronic survey that included validated endoscopic quality indicators. Results In total, 164 gastroenterologists participated, of whom 107 (65%) were male. Gastroscopy duration was not recorded by 116 (71%), whereas 102 (62%) used photodocumentation. Use of Prague and Los Angeles classifications was high (156/95% and 159/97%). Complications were recorded by 103 (63.58%) after gastroscopy and 90 (55.56%) after colonoscopy. In colonoscopy, 140 (90.85%) used the Boston Bowel Preparation Scale and 158 (96.34%) achieved cecal intubation. An adenoma detection rate >25% was achieved by 117 (71.78%), and 103 (62.8%) used the Paris classification. Overall compliance with upper and lower endoscopy quality indicators was 87 (53%) and 75 (46%), respectively. Multivariate analysis showed that experience (odds ratio [OR] 2.25, 95% confidence interval [CI] 1-5.06; P=0.049), video recording (OR 2.55, 95%CI 1.23-5.28; P=0.012), and high-resolution endoscope use (OR 2.92, 95%CI 1.39-6.09; P=0.004) were associated with better compliance during upper endoscopy. For lower endoscopy significant predictors included video recording (OR 2.20, 95%CI 1.11-4.33; P=0.023), age (OR 4.33, 95%CI 1.67-11.24; P=0.003) and high-resolution endoscope use (OR 2.67, 95%CI 1.34-5.3; P=0.005). Conclusion In this survey, discrepancies were observed in Greek endoscopists' compliance with endoscopic quality indicators, underscoring the need for further improvement.
Background:The aim of this study was to evaluate the likelihood of acute diverticulitis and its severity in patients with common variable immunodeficiency (CVID) compared to matched controls among those who presented to the emergency room and underwent computed tomography (CT) imaging for abdominal pain. Methods:This was a multicenter, retrospective study comparing adult patients with a diagnosis of CVID, who had CT imaging for abdominal pain between the years 2015-2024, to a control cohort of adult patients without CVID. Mann-Whitney U and chi-square tests were performed to compare baseline characteristics between cases and controls. Mantel-Haenszel tests and conditional logistic regression were used to evaluate associations between CVID, diverticulitis and selected variables. Results:A total of 1392 patients were included in the analysis (696 with CVID and 696 without CVID). Of these patients, 72% were female, 96% were white, their median age was 57 years, and their median body mass index was 27.8 kg/m2. CVID was associated with lower odds of diverticulitis (odds ratio [OR] 0.41, 95% confidence interval 0.27-0.63; P<0.001). There was no difference between the rates of complicated diverticulitis. Among patients with CVID who were diagnosed with diverticulitis, 51.4% (vs. 45%, OR 1.27, 95%CI 0.57-2.81; P=0.563) required inpatient treatment, 22.9% required surgical intervention (vs. 16.5%, OR 1.50, 95%CI 1.50 (0.56-4.04); P=0.418), and 31.4% (vs. 24.1%, OR 1.45, 95%CI 0.60-3.49; P=0.411) had recurrent diverticulitis. Conclusion:Patients with CVID presenting to the emergency department have lower odds of acute diverticulitis among those who underwent CT imaging for abdominal pain.
Background Liver biopsy remains essential for diagnosing and managing pediatric liver diseases, despite advances in noninvasive techniques. However, data on the current indications, diagnostic yield, and safety of ultrasound-assisted percutaneous liver biopsy in children are limited. Methods We retrospectively analyzed 60 pediatric patients who underwent ultrasound-assisted percutaneous liver biopsy at Agia Sofia Children's Hospital between January 2018 and September 2025. Data collected included demographics, laboratory values, biopsy indications, histopathology and complications. Biopsies were performed under anesthesia using an 18-G Tru-Cut needle with real-time ultrasound guidance. Hemoglobin and hematocrit were measured pre-procedure and at 4 and 24 h post-procedure. Specimen adequacy was assessed by core length and number of complete portal tracts (CPTs). Results The mean patient age was 8.6 years (range 1 month to 17 years), with weights from 2.9-65 kg. Indications included persistent hypertransaminasemia, cholestasis, autoimmune and metabolic liver disease, and post-transplant evaluation. Mean biopsy length was 1.12 cm (range 0.5-2 cm), with a mean of 11 CPTs (range 4-17). Histopathology revealed autoimmune hepatitis (AIH) in 38.3%, AIH with primary sclerosing cholangitis in 13.3% of patients with inflammatory bowel disease, and other diagnoses in the remainder. No major complications or postprocedural bleeding occurred. Hemoglobin and hematocrit remained stable, and all specimens were adequate for histologic assessment. Conclusions Ultrasound-assisted percutaneous liver biopsy with an 18-G needle is safe, and yields sufficient tissue for diagnosis in pediatric patients. It continues to be indispensable for the definitive diagnosis, staging, and management of diverse liver diseases in children.
Background Lipid profile alterations have been reported in patients with inflammatory bowel disease (IBD). Our aim was to systematically investigate all relevant evidence on the association between lipoprotein (a) [Lp(a)] and IBD. Methods We searched PubMed and Cochrane Library databases (up to 30 December 2024) for studies with evidence on Lp(a) in patients with IBD. A meta-analysis was performed to evaluate the mean differences (MD) in Lp(a) between patients with Crohn's disease (CD) or ulcerative colitis (UC), and healthy controls (HC). Results The literature search identified 11 studies (2687 participants) investigating the lipid profile of patients with IBD; however, only 6 studies were used for the meta-analysis. Overall, 1978 participants were included in the meta-analysis, of whom 1196 were IBD patients and 782 were HC. The pooled analysis from 4 studies showed that CD patients had significantly higher Lp(a) levels compared to HC (MD 18.36 mg/dL, 95% confidence interval [CI] 14.53-22.20; P<0.001). Similarly, a pooled analysis from 4 studies showed that UC patients had higher Lp(a) levels compared to HC (MD 7.32 mg/dL, 95% CI 2.85-11.79; P=0.001). A pooled analysis of 3 studies revealed a non-significant difference in Lp(a) levels between CD and UC patients. In subgroup analyses based on disease activity, CD patients with active disease exhibited significantly higher Lp(a) levels compared to those with inactive disease. No significant difference was observed in UC patients stratified by disease activity. Conclusions Lp(a) levels are significantly higher in both CD and UC patients compared to HC. Therefore, Lp(a) evaluation is advisable when assessing IBD patients.
Background Endoscopic submucosal dissection (ESD) allows for en bloc endoscopic resection of T1 esophageal adenocarcinoma arising on Barrett's esophagus (BE). Although the safety of the procedure is well established, the oncological adequacy of the procedure and the long-term follow up of the patients have not been prospectively studied. Methods We conducted a prospective, multicenter study involving 9 French and Belgian centers. We included patients treated with ESD for a visible endoscopic lesion of more than 15mm documented with dysplasia, with a 3-year follow up. The primary endpoint was the histologically complete resection rate for adenocarcinoma and high-grade dysplasia (HGD). Results A total of 141 patients were included in the study between December 2016 and January 2019. The R0 resection rate was 85% for adenocarcinoma and HGD, and 81% for invasive adenocarcinoma. The complication rate was 17%, of which 5% were early complications and 12% were late complications, mainly esophageal strictures. During a median follow-up length of 36.3 months, recurrence was observed in 15% of the patients and was endoscopically manageable in 44%. Eight patients (6%) underwent esophagectomy for a high-risk adenocarcinoma. Overall, 14 patients (12%) died during follow up, 3 of them (2.5%) from esophageal adenocarcinoma. Conclusion Endoscopic resection by ESD is a safe and effective technique to treat T1 esophageal adenocarcinoma, allowing avoidance of esophagectomy in 94% of the patients.
Our understanding of the structures and functions of the lymphatic system in colorectal cancer (CRC) has advanced dramatically in recent years. This review aims to outline the information regarding lymphatic drainage of the colon and rectum, as well as our current knowledge of molecular determinants of lymphangiogenesis (e.g., vascular endothelial growth factor-C/-D) and the evaluation of the clinical significance of lymphatic microvessel density in cancer. The review also addresses controversies and innovations in CRC staging, including the impact of lymphovascular invasion on indications for adjuvant chemotherapy, especially in early-stage cancer. A review of current developments in the surgical treatment of CRC (transanal total mesorectal excision and lateral pelvic lymph node dissection) was also conducted, with special reference to the oncological relevance of lymphatic drainage. Knowledge of the complex structures of the lymphatic network is required to establish an individualized risk assessment, and to select the most appropriate surgical strategy in order to optimize the treatment of patients with CRC.
Background Inflammatory bowel disease (IBD) is associated with comorbidities, including psychiatric disorders. However, evidence on concomitant addictions among IBD patients is lacking. Methods This prospective multicenter cross-sectional analysis investigated the prevalence of the most common addictions (alcohol, nicotine, drugs, food and gambling) in patients with IBD in Germany, with a focus on differences between Crohn's disease (CD) and ulcerative colitis (UC). Adult patients completed questionnaires covering addictive behavior, IBD-related and general information. Data were analyzed using standard statistical tests and correlation analyses (significance level P<0.05). Results The study was conducted from April to October 2018, and 202 patients were included in the analysis (67.3% CD; 32.7% UC). Overall addictive behavior and nicotine addiction were more frequent in CD than in UC patients (overall: 41.2% vs. 24.3%; nicotine: 23.5% vs. 9.1%). Alcohol addiction was found in 4.9% of patients, with similar rates in CD and UC. Nicotine addiction was more frequent among females, alcohol addiction among males. Drug, food and gambling addictions were less common (5.0%, 2.0% and 0.5%) and presented only in CD patients. Significant associations were found between addictive behaviors and small intestine involvement, between nicotine addiction and educational qualification, as well as between alcohol addiction and cardiovascular risk factors, comorbidities and body mass index. Conclusions Over a third of IBD patients exhibit addictive behaviors, with smoking being most prevalent, especially among CD patients. These findings support the recent literature, and highlight the need for interventions to address addiction risks and improve outcomes in CD and UC.
Background Pembrolizumab is a monoclonal antibody that targets the programmed cell death-1 (PD-1) protein. Blocking this pathway alters T-cell activity, and has been approved for the treatment of several malignancies, including microsatellite instability-high (MSI-H) and mismatch repair-deficient (dMMR) colorectal cancers. The aim of this study was to evaluate the effect of pembrolizumab on colonic anastomotic healing in a rat model. Methods Sixty male Wistar rats were randomly divided into 2 groups of 30: a control group, and an experimental group receiving pembrolizumab. Each group was further divided into 3 subgroups of 10 rats, sacrificed on postoperative day (POD) 3, 7 or 14. All animals underwent laparotomy, a 1-centimeter segmental colectomy, and an end-to-end colonic anastomosis. Postmortem evaluation included measuring anastomotic bursting pressure, tissue hydroxyproline levels, and histopathological assessment. Results Statistically significant differences in bursting pressure (P=0.019) and rupture site (P=0.033) were observed between the groups on POD 7. Tissue hydroxyproline levels were significantly lower in the pembrolizumab-treated subgroups on POD 7 (P=0.003), and POD 14 (P=0.001). Histopathological analysis demonstrated significant differences on POD 3, in neovascularization (P=0.026), fibroblast ingrowth (P=0.005), and collagen deposition (P=0.030), suggesting impaired inflammatory-phase healing. Conclusions This experimental study suggests that a high single dose of pembrolizumab may negatively affect colonic anastomotic healing in rats. Further studies are necessary to determine the safety of intestinal anastomosis in both emergency and elective clinical settings.
Background Pancreatitis outcomes vary significantly depending on etiology. We compared biliary, alcoholic and drug-induced pancreatitis, focusing on mortality, complications and healthcare resource utilization to inform etiology-specific management strategies. Methods A nationwide retrospective analysis was conducted using the National Inpatient Sample (NIS) database from 2016-2021. Patients with biliary, alcoholic and drug-induced pancreatitis were identified using International Classification of Diseases, 10th Revision (ICD-10) codes. Logistic regression models were used to compare mortality, complications and healthcare utilization, with biliary pancreatitis as the reference. Adjusted odds ratios (aORs) and regression coefficients were calculated. Results A total of 287,050 biliary, 451,730 alcoholic, and 27,465 drug-induced pancreatitis hospitalizations were identified. Patients with alcoholic pancreatitis were younger and predominantly male, while those with drug-induced pancreatitis had higher comorbidity burdens, including diabetes, dyslipidemia and hypertension. Mortality was higher in alcoholic pancreatitis (aOR 1.19, 95% confidence interval [CI] 1.06-1.41; P=0.05), whereas drug-induced pancreatitis showed no significant difference. Alcoholic pancreatitis was associated with greater odds of pseudocyst formation (aOR 3.54, 95%CI 3.32-3.79), bleeding (aOR 1.52, 95%CI 1.41-1.63), and mechanical ventilation (aOR 2.06, 95%CI 1.84-2.31), all with P<0.001. In contrast, drug-induced pancreatitis was linked to lower odds of bleeding (aOR 0.69, 95%CI 0.57-0.84; P<0.001) and percutaneous drainage (aOR 0.23, 95%CI 0.09-0.63; P=0.004). Both alcoholic and drug-induced pancreatitis had shorter hospital stays and lower total charges compared with biliary pancreatitis. Conclusions Alcoholic pancreatitis is associated with higher mortality and complication rates, while drug-induced pancreatitis demonstrates fewer complications but greater comorbidity. These findings highlight the importance of etiology-based management in optimizing pancreatitis outcomes.
Background Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) delay gastric emptying, raising concerns about potential aspiration risk during upper gastrointestinal (GI) endoscopy. We conducted a systematic review and meta-analysis to evaluate the effect of GLP-1 RA therapy on procedural outcomes in patients undergoing upper GI endoscopy. Methods We searched Medline and Cochrane library up to July 2025 without restrictions. Eligible studies evaluated patients undergoing upper GI endoscopy, comparing those taking GLP-1 RAs with those who were not. Outcomes of interest were the incidence of retained gastric contents (RGC), bronchopulmonary aspiration, and procedure discontinuation. Pooled estimates are expressed as odds ratios (ORs) with 95% confidence intervals (CIs), using a random-effects metaanalysis with inverse variance weighting. Results Twenty-four observational studies, predominantly retrospective, met the inclusion criteria: these comprised 184,707 participants, of whom 59,095 were taking GLP-1 RAs. Mean age was 58.7 years, 48.8% were women, and 51.2% had type 2 diabetes. Use of GLP-1 RAs was associated with higher rates of RGC (OR 4.82, 95%CI 3.66-6.35) and procedure discontinuation (OR 3.93, 95%CI 2.42-6.39) compared with control treatment. In contrast, the incidence of aspiration events was similar between groups (OR 1.1, 95%CI 0.84-1.48). Results remained consistent in a sensitivity analysis based on propensity score matching to control for confounders. Conclusions GLP-1 RA therapy is associated with a greater incidence of RGC and higher rates of endoscopy termination, but not with a higher risk of aspiration. Adjusting the fasting duration, rather than routinely discontinuing GLP-1 RAs, may represent a reasonable management approach.
Background:Solid pseudopapillary epithelial neoplasm (SPEN) of the pancreas is an indolent tumor of rare occurrence seen predominantly in young females in the 2nd to 4th decade. These tumors tend to grow large, producing a mass effect, or may show local invasiveness. Method:This is a retrospective analysis of a prospectively maintained database of SPEN cases operated at a tertiary care hospital in India from 2011-2023. Results:The cohort consisted of 29 patients with a male: female ratio of 1:8.6, and a median age of 24 years. The majority of the lesions were in the body and tail of the pancreas (65.5%). Mean tumor diameter was 6.1±1.9 cm. Pancreatic resection (9 distal pancreatectomies, 7 Whipple'spancreaticoduodenectomies, 2 central pancreatectomies) was undertaken in the majority of cases (62.1%), while 11 patients (37.9%) underwent enucleation. Additional resections included splenectomy (n=4), segmental colonic resection (n=2), and 1 non-anatomical liver wedge resection for solitary liver metastasis. Mean operative time and blood loss were 222.1±106.1 min and 115.5±85.9 mL, respectively. Minor complications were seen in 7 (24.1%) patients, while 1 patient had a major complication. At a median follow up of 37 months, 28 (96.6%) patients were alive, 1 of whom had local recurrence. Conclusions:SPEN represents an indolent, low-grade malignant tumor that is reasonably diagnosed preoperatively by cross-sectional imaging. The majority of cases are cured by surgical resection, the extent of which is dictated by the location of the tumor and its relation to surrounding structures. Excellent outcomes, both short- and long-term, can be achieved.
Background Colorectal cancer (CRC) is a leading cause of cancer death worldwide, however, the risk of newly-diagnosed CRC and its related mortality after polypectomy have not been conclusively determined. Methods Prospective cases with polypectomy were identified in the UK Biobank. The age- and sexstandardized incidence ratio (SIR) and standardized mortality ratio (SMR) were calculated to assess the risk of CRC between the removal group and both the non-index-colonoscopy group (no record of diagnostic colonoscopy) from the UK Biobank and the general population in England. We also estimated the effect of removal compared with the polyp-free group using a competing risk model. Results During a median follow up of 10 (1-44) years (51,136 person-years), 78 incident CRCs (153/100,000 person-years), and 16 CRC-specific deaths (31/100,000 person-years) were identified in the removal group. Compared with the general population in England, the removal group had a similar risk of incident CRC (SIR 0.81, 95% confidence interval [CI] 0.64-1.01; P=0.060), whereas the CRC-specific mortality was 52% lower (SMR 0.48, 95%CI 0.28-0.78; P=0.004). Compared with the non-index-colonoscopy group, CRC-specific deaths after polyp removal were not significantly different (SMR 1.64, 95%CI 0.94-2.66; P=0.050). Compared with the polyp-free group, the risks of incidence and mortality in the removal group were both greater (incidence: adjusted hazard ratio [HR] 6.17, 95%CI 4.36-8.74; P<0.001; mortality: adjusted HR 3.25, 95%CI 1.65-6.41; P<0.001). Conclusion Polypectomy reduced but not eliminated the risk of CRC for polyp-positive participants to the level of the general population, reinforcing the importance of procedural quality and tailored surveillance strategies.
