Aims To prospectively evaluate the clinical feasibility as well as diagnostic performances of AI-alone and AI-assisted OD of DCPs in a real-life setting.

Abstract Background Linked color imaging (LCI) is a newly developed image-enhancing endoscopy technology that provides bright endoscopic images and increases color contrast. We investigated whether LCI improves the detection of neoplastic lesions in the right colon when compared with high definition white-light imaging (WLI). Methods Consecutive patients undergoing colonoscopy were randomized (1:1) after cecal intubation into right colon inspection at first pass by LCI or by WLI. At the hepatic flexure, the scope was reintroduced to the cecum under LCI and a second right colon inspection was performed under WLI in previously LCI-scoped patients (LCI–WLI group) and vice versa (WLI–LCI group). Lesions detected on first- and second-pass examinations were used to calculate detection and miss rates, respectively. The primary outcome was the right colon adenoma miss rate. Results Of the 600 patients enrolled, 142 had at least one adenoma in the right colon, with similar right colon adenoma detection rates (r-ADR) in the two groups (22.7 % in LCI–WLI and 24.7 % in WLI–LCI). At per-polyp analysis, double inspection of the right colon in the LCI–WLI and WLI–LCI groups resulted in an 11.8 % and 30.6 % adenoma miss rate, respectively (P < 0.001). No significant difference in miss rate was found for advanced adenomas or sessile serrated lesions. At per-patient analysis, at least one adenoma was identified in the second pass only (incremental ADR) in 2 of 300 patients (0.7 %) in the LCI – WLI group and in 13 of 300 patients (4.3 %) in the WLI – LCI group (P = 0.01). Conclusions LCI could reduce the miss rate of neoplastic lesions in the right colon.

Background and study aims: Narrow-band imaging (NBI) has shown promising results in discriminating adenomatous from non-adenomatous colonic polyps. In patients with small polyps (< 10 mm), the application of NBI within a “resect and discard” strategy, might allow post-polypectomy surveillance intervals to be determined independently from histopathology. The aim of the present study was to assess the feasibility and safety of this approach in routine clinical practice. Patients and methods: Consecutive colonoscopy outpatients with one or more polyps smaller than 10 mm were prospectively included. Each polyp was categorized by the endoscopist as adenoma or non-adenoma according to simplified NBI criteria, and future post-polypectomy surveillance interval was assigned accordingly. Following histopathology, post-polypectomy surveillance interval was subsequently re-assigned, and the accordance between endoscopy- and histology-directed surveillance strategies was calculated. Results: Among 942 colonoscopy patients, 286 (30.4 %) with only small polyps were included. In total, 511 small polyps were evaluated; 350 (68.5 %) were adenomas and 18 of these (5.1 %) had histologic features of advanced neoplasia. For the in vivo diagnosis of adenoma, NBI sensitivity, specificity, accuracy, and positive and negative likelihood ratios were 94.9 %, 65.8 %, 85.7 %, 2.80, and 0.08, respectively. The endoscopy-directed surveillance strategy was in accordance with the histology-directed strategy in 237 of 286 patients (82.9 %). In 9.8 % and 7.3 % patients, the endoscopy-directed approach would have resulted in early and delayed surveillance, respectively. Conclusions: The resect and discard strategy seems to be a viable, safe, and cost-effective approach for the management of patients with small polyps. However, caution in the application of the strategy should be advocated for patients with polyps 6 – 9 mm in size and those with right-sided lesions, due to their malignant potential. The study was registered on Clinicaltrials.gov (NCT01462123).

Capsule Endoscopy (CE) is the cornerstone for the evaluation of the small bowel. The efficacy of this technique depends on the ability of the readers in recognizing and reporting mucosal abnormalities. At present data about possible strategies for improving the diagnostic ability of readers in reviewing CE videos are lacking. to verify whether a training, similar to that proposed by the ASGE for credentialing and granting privileges for CE, is effective in improving both detection rate and interobserver agreement among CE readers with different experience in reading CE videos. 17 readers have been involved in the study. Of them, 6 had previously evaluated less than 50 CE videos, six 50-99 videos and 5 more than 100 videos. For the study all readers reviewed 30 CE videos, divided into two sets of 15 each, reporting small bowel findings (SBF) by means of the CE Structured Terminology. These videos were also reviewed by 3 experts, who represented the reference standard (RS) and categorized SBF as "clinically significant" (class A) or "not clinically significant" (class B). After reviewing all 30 videos, during an 8 hour meeting, the SBF identified by the readers in the first set of 15 videos were collectively discussed and compared with those identified by the RS (training session-TS). After the TS the readers reviewed again the second set of videos. The number of findings identified before and after the training session were compared by means of Wilcoxon test for paired and unpaired data; the evaluation of the agreement between each reader and the RS was performed by means of Cohen's kappa statistic. In the second set of 15 videos the RS identified 89 SBF. Before the TS each reader identified a mean±SD of 74±45 SBF; a mean+SD of 35+11 of these SBF matched those identified by the RS. There was no difference among readers with different experience (p=0.9). After the TS both the overall number of SBF per reader (mean±SD: 85±47) and the mean number of SBF matching those identified by the RS (mean±SD: 38±12) slightly increased, although not significantly (p=0.1 and p=0.2 respectively). This figure remains the same even after stratifying readers according the experience or taking into account only class A findings. The overall agreement with the RS in describing SBF was low and remains closely similar before and after the TS; (k=0.14; CI 95%: 0.12-0.16 and k=0.15; CI 95%: 0.12-0.17 respectively). Moreover no difference was found even after stratifying readers according the experience or taking into account only class A findings (before: k=0.33; after k=0.34). a training strategy combining hands-on practice and experts' tutorial, does not improve the detection rate or the interobserver agreement in describing SBF identified during CE, regardless of the previous experience in reading CE videos.