Background: Computer-aided detection (CADe) systems for colonoscopy have been shown to increase small polyp detection during colonoscopy in the general population. People with Lynch syndrome represent an ideal target population for CADe-assisted colonoscopy because adenomas, the primary cancer precursor lesions, are characterised by their small size and higher likelihood of showing advanced histology. We aimed to evaluate the performance of CADe-assisted colonoscopy in detecting adenomas in individuals with Lynch syndrome.

Methods: TIMELY was an international, multicentre, parallel, randomised controlled trial done in 11 academic centres and six community centres in Belgium, Germany, Italy, and Spain. We enrolled individuals aged 18 years or older with pathogenic or likely pathogenic MLH1, MSH2, MSH6, or EPCAM variants. Participants were consecutively randomly assigned (1:1) to either CADe (GI Genius) assisted white light endoscopy (WLE) or WLE alone. A centre-stratified randomisation sequence was generated through a computer-generated system with a separate randomisation list for each centre according to block-permuted randomisation (block size 26 patients per centre). Allocation was automatically provided by the online AEG-REDCap database. Participants were masked to the random assignment but endoscopists were not. The primary outcome was the mean number of adenomas per colonoscopy, calculated by dividing the total number of adenomas detected by the total number of colonoscopies and assessed in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, NCT04909671.

Findings: Between Sept 13, 2021, and April 6, 2023, 456 participants were screened for eligibility, 430 of whom were randomly assigned to receive CADe-assisted colonoscopy (n=214) or WLE (n=216). 256 (60%) participants were female and 174 (40%) were male. In the intention-to-treat analysis, the mean number of adenomas per colonoscopy was 0·64 (SD 1·57) in the CADe group and 0·64 (1·17) in the WLE group (adjusted rate ratio 1·03 [95% CI 0·72-1·47); p=0·87). No adverse events were reported during the trial.

Interpretation: In this multicentre international trial, CADe did not improve the detection of adenomas in individuals with Lynch syndrome. High-quality procedures and thorough inspection and exposure of the colonic mucosa remain the cornerstone in surveillance of Lynch syndrome.

Background and objectives: There are few scales with prospective validation forthe assessment

of the upper gastrointestinal mucosal cleanliness during an esophagogastroduodenoscopy (EGD).

The aim of this study was to develop a valid and reproducible cleanliness scale for use during

an EGD.

Methods: We developed a cleanliness scale (Barcelona scale) with a score (0---2 points) of five

segments of the upper gastrointestinal tract with thorough cleaning techniques (esophagus,

fundus, body, antrum, and duodenum). First, 125 photos (25 of each area) were assessed, and a

score was assigned to each image by consensus among 7 experts endoscopists. Subsequently, 100

of the 125 images were selected and the inter- and intra-observer variability of 15 previously

trained endoscopists was evaluated using the same images at two different times.

Results: In total, 1500 assessments were performed. In 1336/1500 observations (89%) there

was agreement with the consensus score, with a mean kappa value of 0.83 (0.45---0.96). In the

second evaluation, in 1330/1500 observations (89%) there was agreement with the consensus

score, with a mean kappa value of 0.82 (0.45---0.93). The intra-observer variability was 0.89

(0.76---0.99).

Conclusions: The Barcelona cleanliness scale is a valid measure and reproducible with minimal

training. Its application in clinical practice is a significant step to standardize the quality of the

EGD.

- The "diagnose and leave in" strategy for diminutive rectosigmoid polyps in Lynch syndrome: a post hoc analysis from a randomized controlled trial.Rivero-Sánchez L, Gavric A, Herrero J and col. Endoscopy. 2022 Jan;54(1):27-34. doi: 10.1055/a-1328-5405.

- Compound Endoscopic Morphological Features for Identifying Non-Pedunculated Lesions ≥20 mm with Intramucosal Neoplasia. João Pedro da Costa-Seixas, María López-Cerón, Anna Arnau et col. Cancers.2021 Oct 22;13(21):5302. doi: 10.3390/cancers13215302.

White-Light Endoscopy Is Adequate for Lynch Syndrome Surveillance in a Randomized and Noninferiority Study, Rivero-Sánchez L, Arnau-Collell C, Herrero J et col. EndoCAR group from Spanish Gastroenterology Association (AEG) and Spanish Society of Digestive Endoscopy (SEED).Gastroenterology. 2020 Mar;158(4):895-904.e1. doi: 10.1053/j.gastro.2019.09.003. Epub 2019 Sep12.PMID: 31520613

- Accuracy of the Narrow-Band Imaging International Colorectal Endoscopic Classification System in Identification of Deep Invasion in Colorectal Polyps, Puig I, López-Cerón M, Arnau A et col. EndoCAR group from the Spanish Gastroenterological Association and the Spanish Digestive Endoscopy Society. Gastroenterology. 2019 Jan;156(1):75-87. doi: 10.1053/j.gastro.2018.10.004. Epub 2018 Oct 6.PMID: 30296432

- Endocuff-assisted colonoscopy for surveillance of serrated polyposis syndrome: a multicenter randomized controlled trial, Rivero-Sánchez L, López Vicente J, Hernández Villalba L et col. EndoCAR group from the Spanish Gastroenterology Association and the Spanish Society of Digestive Endoscopy. Endoscopy. 2019 Jul;51(7):637-645. doi: 10.1055/a-0925-4956. Epub 2019 Jun 7.PMID: 31174224 

- Panchromoendoscopy Increases Detection of Polyps in Patients With Serrated Polyposis Syndrome, López-Vicente J, Rodríguez-Alcalde D, Hernández L y col. Endoscopy for High Risk Cancer Conditions group of the Spanish Gastroenterological Association and Spanish Digestive Endoscopy Society. Clin Gastroenterol Hepatol. 2019 Sep;17(10):2016-2023.e6. doi: 10.1016/j.cgh.2018.10.029. Epub 2018 Oct 24.PMID: 30366156

Endoscopic ultrasound-guidedfine-needle aspirationof portal vein thrombosis in patients with chronic liverdisease and suspicion of hepatocellular carcinomaAntonio Z. Gimeno Garciaa, Jose R. Apariciob, Angel Barturenc, Miguel Morenoa, David Nicolas-PerezaandEnrique QuinteroaBackgroundDifferentiation between benign and malignant portal vein thrombosis (PVT) in the setting of a hepatocellularcarcinoma (HCC) is of paramount importance. Histological analysis is usually not carried out because of potential severe sideeffects of the percutaneous approach. Endoscopic ultrasound-guidedfine-needle aspiration (EUS-FNA) may be safer and mayguide the clinical management of patients with HCC.ObjectiveTo describe the feasibility of the EUS-FNA in a series of patients with HCC and PVT.Materials and methodsA chart review of patients with PVT was performed from 2014 to 2016 in three tertiary care hospitals ofSpain. Patients with chronic liver disease and PVT with a suspicion of HCC referred for EUS-FNA were included. The impact ofthe EUS-FNA was assessed by comparing staging following the Barcelona Clinic Liver Cancer algorithm (BCLC) before and afterEUS-FNA.ResultsOf 104 patients with PVT and chronic liver disease, 23 were considered candidates for EUS-FNA. Eight patients werereferred for EUS-FNA. The technique was feasible in seven patients and FNA was positive in six patients. No side effects werereported. EUS-FNA upstaged six out of seven (85.7%) patients: one patient BCLC stage B, two patients BCLC stage A, andthree patients in whom the HCC was not diagnosed before EUS-FNA of the PVT. A benign PVT was found in the explant of theonly patient with a negative PVT.ConclusionEUS-FNA is a valuable technique in selected patients with chronic liver disease with PVT. It is feasible, safe, andmay alter the clinical management in these patients. Eur J Gastroenterol Hepatol 00:000–000Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

Córdova H, Argüello L, Loras C, et al. Rate of adverse events of gastroduodenal snare polypectomy for non-flat polyps is low: a prospective and multicenter study. W J Gastroenterol 2017;23:8405-14