UNASSIGNED: Colon capsule endoscopy (CCE) has gained momentum as an alternative modality for the investigation of the lower gastrointestinal tract. Of the few challenges that remain, the comparison and - eventually - matching of polyps at different timestamps leads to the potential for double reporting and can contribute to false-positive findings and inaccuracies. With the impending artificial intelligence integration, the risk of double reporting the same polyp due to the lack of information on spatial orientation underscores the necessity for establishing criteria for polyp matching.
UNASSIGNED: This RAND/University of California, Los Angeles (modified Delphi) process aims to identify the key factors or components used to match polyps within a CCE video. This involves exploring the attributes of each factor to create comprehensive polyp-matching criteria based on international expert consensus.
UNASSIGNED: A systematic qualitative study using surveys.
UNASSIGNED: A panel of 11 international CCE experts convened to assess a survey comprised of 60 statements. Participants anonymously rated statement appropriateness on a 1-9 scale (1-3: inappropriate, 4-6: uncertain and 7-9: appropriate). Following a virtual group discussion of the Round 1 results, a Round 2 survey was developed and completed before the final analysis.
UNASSIGNED: The factors that were agreed to be essential for polyp matching include (1) timestamp, (2) polyp localization, (3) polyp vascular pattern, (4) polyp size, (5) time interval of the polyp appearance between the green and yellow camera, (6) surrounding tissue, (7) polyp morphology and (8) polyp surface and contour. When five or more factors are satisfied, it was agreed that the comparing polyps are likely the same polyp.
UNASSIGNED: This study has established the first complete criteria for polyp matching in CCE. While it might not provide a definitive solution for matching difficult, small and common polyps, these criteria serve as a framework to guide and facilitate the process of polyp-matching.
Creating criteria and standards for matching polyps (abnormal growth in the bowels) on colon capsule video analysis: an international expert agreement using the RAND (modified Delphi process) process Background: Doctors often use colon capsule endoscopy (CCE), a high-tech capsule with two cameras, to record and check for diseases in the small and large bowels as the capsule travels through the intestines. One of the most common conditions in the large bowel is polyps, which are abnormal growths in the lining of the bowel. Comparing and matching polyps in the same video from the capsule can be tricky as they look very similar, leading to the possibility of incorrectly reporting the same polyp twice or more. This can lead to wrong results and inaccuracies. The literature did not have any criteria or standards for matching polyps in CCE before. Aim: Using the RAND/UCLA (modified Delphi) process, this study aims to identify the key factors or components used to match polyps within a CCE video. The goal is to explore each factor and create complete criteria for polyp matching based on the agreement from international experts. Method: A group of 11 international CCE experts came together to evaluate a survey with 60 statements. They anonymously rated each statement on a scale from 1 to 9 (1-3: inappropriate, 4-6: uncertain, and 7-9: appropriate). After discussing the Round 1 results virtually, a Round 2 survey with the same but revised questions was created and completed before the final analysis of their agreement. Results: The main factors for matching polyps are 1) the timing when the polyp was seen, 2) where it is in the bowel, 3) its blood vessel pattern, 4) size, 5) the timing of its appearance between cameras, 6) surrounding tissue features, 7) its shape, and 8) surface features. If five or more of these factors match, the compared polyps are likely the same. Conclusion: This study establishes the first complete criteria for matching polyps in CCE. While it may not provide a definitive solution for matching challenging and small polyps, these criteria serve as a guide to help and make the process of polyp matching easier.

Recently, updated guidelines for post-polypectomy surveillance have been published by the U.S. Multi-Society Task Force (USMSTF), the British Society of Gastroenterology/Association of Coloproctology of Great Britain and Ireland/Public Health England (BSG/ACPGBI/PHE), the European Society of Gastrointestinal Endoscopy (ESGE), the Japan Gastroenterological Endoscopy Society (JGES), and the Korean Multi-Society Taskforce Committee. This review summarizes and compares the updated recommendations of these 5 guidelines. There are some differences between the guidelines for the recommended post-polypectomy surveillance intervals. In particular, there are prominent differences between the guidelines for 1-4 tubular adenomas < 10 mm with low-grade dysplasia (nonadvanced adenomas [NAAs]) and tubulovillous or villous adenomas. The USMSTF, JGES, and Korean guidelines recommend colonoscopic surveillance for patients with 1-4 NAAs and those with tubulovillous or villous adenomas, whereas the BSG/ACPGBI/PHE and ESGE guidelines do not recommend endoscopic surveillance for such patients. Surveillance recommendations for patients with serrated polyps (SPs) are limited. Although the USMSTF guidelines provide specific recommendations for patients who have undergone SPs removal, these are weak and based on very lowquality evidence. Future studies should examine this topic to better guide the surveillance recommendations for patients with SPs. For countries that do not have separate guidelines, we hope that this review article will help select the most appropriate guidelines as per each country\'s healthcare environment.

Cowden syndrome (CS)/PTEN hamartoma tumor syndrome (PHTS) is a rare autosomal dominantly inherited condition caused by germline pathogenesis. It is associated with multiple hamartomatous lesions occurring in various organs and tissues, including the gastrointestinal tract, skin, mucous membranes, breast, thyroid, endometrium, and brain. Macrocephaly or multiple characteristic mucocutaneous lesions commonly develop in individuals in their 20s. This syndrome is occasionally diagnosed in childhood due to the occurrence of multiple gastrointestinal polyps, autism spectrum disorders, and intellectual disability. CS/PHTS can be diagnosed taking the opportunity of multigene panel testing in patients with cancer. Appropriate surveillance for early diagnosis of associated cancers is required because patients have a high risk of cancers including breast, thyroid, colorectal, endometrial, and renal cancers. Under these circumstances, there is growing concern regarding the management of CS/PHTS in Japan, but there are no available practice guidelines. To address this situation, the guideline committee, which included specialists from multiple academic societies, was organized by the Research Group on Rare and Intractable Diseases granted by the Ministry of Health, Labour, and Welfare, Japan. The present clinical guidelines explain the principles in the diagnosis and management of CS/PHTS, together with four clinical questions and the corresponding recommendations, incorporating the concept of the Grading of Recommendations Assessment, Development, and Evaluation system. Herein, we present an English version of the guideline, some of which have been updated, to promote seamless implementation of accurate diagnosis and appropriate management of pediatric, adolescent, and adult patients with CS/PHTS.

Introduction In 2020, the British Society of Gastroenterologists (BSG), the Association of Coloproctology of Great Britain and Ireland (ACPGBI), and Public Health England (PHE) published joint guidelines regarding post-polypectomy surveillance. This study aimed to establish clinician adherence at the Royal Devon University Healthcare NHS Foundation Trust to the 2020 guidelines compared to the now-retired 2010 guidelines. Materials and Methods Data on 152 patients treated under the 2010 guidelines and 133 patients treated under the 2020 guidelines were collected retrospectively from the hospital\'s colonoscopy database. Data were analysed to determine whether patients who had a colonoscopy fulfilled BSG/ACPGBI/PHE guidelines for follow-up. Costs were estimated using the price of colonoscopy in the NHS National Schedule. Results Approximately 41.4% (63/152) of patients were adherent to the 2010 guidelines while 66.2% (88/133) of patients were adherent to the 2020 guidelines. The difference in adherence rate was 24.7% (95% confidence interval 13.5% - 35.9%, p<0.0001). Nearly 37% (35/95) of patients who would have been followed up under the 2010 guidelines did not receive any follow-up as a result of the 2020 guidelines. This represents a cost saving of £36,892.28 per year in our hospital. Approximately 47% (28/60) of patients treated under the 2020 guidelines had surveillance colonoscopy planned when the guidelines recommended no follow-up. If every clinician were fully adherent to the 2020 guidelines, then a further £29,513.82 per year would have been saved. Discussion and Conclusion Following the introduction of the 2020 guidelines, adherence to polyp surveillance guidelines increased in our hospital. However, nearly half of the colonoscopies were performed unnecessarily due to non-adherence. Furthermore, our results demonstrate that the 2020 guidelines have decreased the need for follow-up.

The Japan Gastroenterological Endoscopy Society published the second edition of the \"Guidelines for Colorectal Endoscopic Submucosal Dissection/Endoscopic Mucosal Resection\" in 2019 to clarify the indications for colorectal endoscopic mucosal resection (EMR) and endoscopic submucosal dissection and to ensure appropriate preoperative diagnoses as well as effective and safe endoscopic treatment in front-line clinical settings. Endoscopic resection with electrocautery, including polypectomy and EMR, is indicated for colorectal polyps. Recently, the number of facilities introducing and implementing cold polypectomy without electrocautery has increased. Herein, we establish supplementary guidelines for cold polypectomy. Considering that the level of evidence for each statement is limited, these supplementary guidelines must be verified in clinical practice.

The Japanese Society of Gastroenterology (JSGE) published \'\'Daicho Polyp Shinryo Guideline 2014\'\' in Japanese and a part of this guideline was published in English as \"Evidence-based clinical practice guidelines for management of colorectal polyps\" in the Journal of Gastroenterology in 2015. A revised version of the Japanese-language guideline was published in 2020, and here we introduce a part of the contents of revised version.
The guideline committee discussed and drew up a series of clinical questions (CQs). Recommendation statements for the CQs were limited to items with multiple therapeutic options. Items with established conclusions that had 100% agreement with previous guidelines (background questions) and items with no (or old) evidence that are topics for future research (future research questions: FRQs) were given descriptions only. To address the CQs and FRQs, PubMed, ICHUSHI, and other sources were searched for relevant articles published in English from 1983 to October 2018 and articles published in Japanese from 1983 to November 2018. The Japan Medical Library Association was also commissioned to search for relevant materials. Manual searches were performed for questions with insufficient online references.
The professional committee created 18 CQs and statements concerning the current concept and diagnosis/treatment of various colorectal polyps, including their epidemiology, screening, pathophysiology, definition and classification, diagnosis, management, practical treatment, complications, and surveillance after treatment, and other colorectal lesions (submucosal tumors, nonneoplastic polyps, polyposis, hereditary tumors, ulcerative colitis-associated tumors/carcinomas).
After evaluation by the moderators, evidence-based clinical practice guidelines for management of colorectal polyps were proposed for 2020. This report addresses the therapeutic related CQs introduced when formulating these guidelines.

BACKGROUND: i-Scan is an image enhancement modality, which provides enhanced views of mucosal structures and vascular patterns.
METHODS: A modified Delphi process was used to develop a series of evidence-based statements on the role of high-definition white light (HDWL) and i-Scan for the detection and diagnosis of colorectal neoplasms. Each statement was voted to achieve consensus (i.e. >80% agreement).
RESULTS: Seven proposed statements achieved consensus: (1) HDWL is recommended rather than standard definition (SD) for detection and diagnosis of colorectal neoplasms; (2) HDWL colonoscopy with i-Scan improves polyp and adenoma detection rates when compared with SD colonoscopy; (3) HDWL + i-Scan is superior to HDWL alone for the optical diagnosis of colorectal neoplasms; (4) HDWL + i-Scan in expert hands meets American Society for Gastrointestinal Endoscopy (ASGE) in the Preservation and Incorporation of Valuable Endoscopic Innovations (PIVI) standards for optical diagnosis of diminutive neoplasms; (5) HDWL + i-Scan in non-expert hands does not meet ASGE PIVI standards for optical diagnosis of diminutive neoplasms; (6) optical diagnosis of polyps with i-Scan has a learning curve and needs systematic training; and (7) the performance of i-Scan for the in vivo diagnosis of colorectal neoplasms is similar to Narrow Band Imaging (NBI) and Fuji Intelligent Chromo Endoscopy (FICE).
CONCLUSIONS: Seven proposed statements on the use of HDWL and i-Scan for the detection and diagnosis of colorectal neoplasms achieved consensus.