Risk Factors for Inadequate Bowel Preparation Before Colonoscopy in Patients with Ulcerative Colitis in Clinical and Endoscopic Remission: A Multicenter Retrospective Cohort Study Davide Scalvini, Stiliano Maimaris, Elisa Stasi, Marco Valvano, Daniele Brinch, Mario Romeo, Michele Dota, Marcello Dallio, Virginia Gregorio, Chiara Sophie Sabbione, Marta Vernero, Giovanni Santacroce, Stefano Mazza, Simona Agazzi, Aurelio Mauro, Alessandro Federico, Annalisa Schiepatti, Davide Giuseppe Ribaldone, Marco Vincenzo Lenti, Gianpiero Manes, Antonio Facciorusso, Antonio Di Sabatino, Federico Biagi, Cristina Bezzio, Simone Saibeni, Andrea Anderloni Diagnostics, 2026 Background/Objectives: Adequate bowel preparation (BP) is crucial for effective colorectal cancer (CRC) surveillance in ulcerative colitis (UC). While active inflammation is known to negatively impact cleansing, data regarding predictors of BP quality specifically in UC patients with inactive disease remain limited. This study aimed to investigate risk factors for inadequate BP in UC patients in clinical/endoscopic remission and to compare the efficacy of 1L-PEG-ASC versus 2L-PEG regimens. Methods: A multicentric, retrospective, cohort study was conducted across eight Italian centers. Consecutive adult outpatients with UC undergoing colonoscopy between January-2021 and December-2022 who were in endoscopic and clinical remission were included. Boston Bowel Preparation Scale (BBPS) was assessed in patients undergoing 1L-PEG-ASC or 2L-PEG bowel preparation. Univariable and multivariable logistic regression analyses were performed to identify risk factors for inadequate BP and compare outcomes between PEG regimens. Results: A total of 379 patients were included (58% M, mean age 52.3 ± 15.4 years). The overall rate of adequate BP was 90.5%. Traditional risk factors, including demographic, clinical, and endoscopic characteristics, were not predictive of inadequate preparation in this remission cohort. Comparing regimens, 1L-PEG-ASC yielded significantly higher median total BBPS scores compared to 2L-PEG (8 [IQR 7–9] vs. 6 [IQR 6–8]; p < 0.001) and a higher exam completion rate (99.5% vs. 95.7%; p = 0.02), although the difference in adequate BP rates did not reach statistical significance (92.6% vs. 87.7%; p = 0.12). Multivariable analysis confirmed that 2L-PEG was independently associated with lower odds of achieving higher BBPS scores (OR 0.30; 95% CI 0.20–0.45). Conclusions: In UC patients with clinical and endoscopic remission, BP adequacy rates are high and comparable to the general population, suggesting that traditional IBD-related risk factors are less relevant in the absence of active inflammation. However, the 1L-PEG-ASC regimen demonstrated superior cleansing quality and exam completion rates compared to 2L-PEG. These findings support the prioritization of 1L-PEG-ASC to optimize mucosal visualization during CRC surveillance in this population.
Diagnostic yield and usefulness of terminal ileal intubation in asymptomatic patients undergoing colonoscopy for colorectal cancer screening or postpolypectomy surveillance: a systematic review and meta-analysis Davide Scalvini, Stiliano Maimaris, Alessandro Cappellini, Francesca Lusetti, Claudia Delogu, Michele Puricelli, Simona Agazzi, Stefano Mazza, Aurelio Mauro, Marco Spadaccini, Annalisa Schiepatti, Marco Vincenzo Lenti, Antonio Di Sabatino, Federico Biagi, Lorenzo Fuccio, Alessandro Repici, Andrea Anderloni Gastrointestinal Endoscopy, 2026 BACKGROUND AND AIMS: The role of routine terminal ileal intubation (TII) in asymptomatic patients undergoing colonoscopy for colorectal cancer (CRC) screening or postpolypectomy surveillance is debated. Although considered a quality indicator in some settings, its clinical utility in this population remains unclear. This systematic review and meta-analysis aimed to evaluate the diagnostic yield, clinical utility, and procedural impact of routine TII in patients undergoing CRC screening or postpolypectomy surveillance. METHODS: We conducted a systematic search of PubMed and Embase up to September 2025, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We included studies reporting TII diagnostic yield in asymptomatic adults undergoing CRC screening or postpolypectomy surveillance colonoscopy. Data were synthesized using random-effects models. The primary outcome was the overall diagnostic yield of TII. Secondary outcomes included the diagnostic yield for clinically significant findings, Crohn's disease (CD), and the impact of TII on procedure duration. RESULTS: Eleven studies involving 25,659 patients were included, of whom 13,672 underwent TII. The pooled overall diagnostic yield for any ileal finding was 1.74% (95% CI, 1.18-2.57), with most abnormalities being nonspecific and not requiring clinical action. The diagnostic yield for clinically significant pathology was substantially lower at 0.28% (95% CI, 0.07-1.05), whereas the yield for detecting CD was only 0.1% (95% CI, 0.02-0.44), corresponding to 1 case per 1000 ileoscopies during colonoscopy for CRC screening. CONCLUSIONS: Routine TII in asymptomatic patients undergoing screening or surveillance colonoscopy provides a negligible diagnostic yield for clinically significant pathology, including CD. Our findings do not support performing routine TII during colonoscopy in this patient population.
A multicenter study on bowel preparation in inflammatory bowel disease patients: comparison between 1L-PEG-ASC and 2L-PEG regimens in an outpatient setting Davide Scalvini, Cristina Bezzio, Stiliano Maimaris, Marco Vincenzo Lenti, Lusetti Francesca, Alessandro Cappellini, Carolina Cicalini, Michele Dota, Roberta Muscia, Daniele Brinch, Ignazio Marzio Parisi, Massimo Devani, Mario Schettino, Aurelio Mauro, Simona Agazzi, Stefano Mazza, Laura Rovedatti, Annalisa Schiepatti, Antonio Di Sabatino, Federico Biagi, Gianpiero Manes, Andrea Anderloni, Simone Saibeni European Journal of Gastroenterology and Hepatology, 2025 Background and aims There is a paucity of data on which bowel preparation (BP) to use in an inflammatory bowel disease (IBD) outpatient setting, in particular after the introduction of 1L-PEG-ASC. Thus, we aimed to evaluate the most effective BP between 1L-PEG-ASC and 2L-PEG and to identify risk factors for inadequate BP in this IBD population. Methods This is a multicentric, retrospective, cross-sectional study including IBD patients aged >16 years, who underwent outpatient split-dose colonoscopy between January 2021 and December 2022. Boston Bowel Preparation Scale (BBPS) was used to determine the adequacy of BP. Multivariable logistic regression was fitted to compare BP adequacy between 1L-PEG-ASC and 2L-PEG. Results Overall, 506 patients (F 42.9%, mean age 48.9 ± 15.2 years) were included and BP was adequate in 440 (87.0%). 1L-PEG-ASC was associated with a higher rate of adequate BP compared to 2L-PEG (89.8% vs. 83.8%, P = 0.048) and higher BBPS score [median 8, interquartile range (IQR): 7–9 vs. 6, IQR: 6–8, P < 0.001]. Male sex (P = 0.03), previous ileal/colonic surgery (P = 0.01), and stricturing Crohn’s disease (CD) (P = 0.01) were associated with inadequate BP. At multivariable analysis, 1L-PEG-ASC was a predictor of adequate BP [odds ratios (OR) = 1.70, 95% confidence interval (CI): 1.00–2.90, P < 0.05]; whereas male sex (OR = 0.51, 95% CI: 0.29–0.90, P = 0.02) and previous ileal/colonic surgery (OR = 0.40, 95% CI: 0.21–0.77, P < 0.01) were confirmed as risk factors for inadequate BP. Conclusion Results from this large real-world cohort highlight the efficiency of 1L-PEG-ASC in providing better BP compared to 2L-PEG. However, further studies are needed to validate our retrospective results and confirm the superiority of 1L-PEG-ASC. Male sex and previous ileal/colonic surgery and stricturing CD were related to poor BP.
Diagnostic Accuracy of Contrast-Enhanced Ultrasound Compared with Contrast-Enhanced Computed Tomography in the Follow-Up of Hepatocellular Carcinoma Treated with Radiofrequency Ablation Giulia Gori, Stefano Mazza, Carlo Ciccioli, Erica Bartolotta, Daniele Alfieri, Francesca Torello Viera, Aurelio Mauro, Davide Scalvini, Letizia Veronese, Chiara Barteselli, Carmelo Sgarlata, Marco Bardone, Laura Rovedatti, Simona Agazzi, Elena Strada, Lodovica Pozzi, Alessandro Vanoli, Chandra Bortolotto, Antonio Facciorusso, Antonio Di Sabatino, Valentina Ravetta, Andrea Anderloni Cancers, 2025 Background: Contrast-enhanced computed tomography (CECT) is considered the gold standard for assessing therapeutic response in hepatocellular carcinoma (HCC) following locoregional treatments. More recently, contrast-enhanced ultrasound (CEUS) has emerged as a promising, cost-effective alternative, although evidence supporting its use in this context remains limited. This study aimed to evaluate the diagnostic performance of CEUS compared to CECT in assessing local response of HCC nodules treated with radiofrequency ablation (RFA). Methods: We retrospectively analyzed a consecutively enrolled cohort of patients undergoing RFA for HCC at IRCCS San Matteo Hospital, Pavia, between January 2017 and January 2022. Follow-up imaging included both CEUS and CECT at predefined time points. Imaging follow-up, MRI, and/or histological results were used as the reference standard to compare CEUS and CECT. Results: A total of 55 patients (mean age 74 years, 64% male) with 79 HCC nodules were included. Complete response was observed in 57 nodules (72%), all correctly identified by CEUS, whereas 4 cases were misclassified by CECT. Among the 22 nodules (28%) with residual disease, CEUS correctly identified 15 cases, while 17 were detected by CECT; notably, CEUS identified 4 lesions missed by CECT, which identified 6 missed at CEUS. Combined, the two modalities detected 21 (96%) out of 22 residual tumors. CEUS showed a sensitivity of 68.1%, specificity of 100%, and diagnostic accuracy of 91.1%, compared to 68.0%, 98.1%, and 88.6%, respectively, for CECT, with no significant differences. Conclusions: CEUS is a reliable, non-inferior, and complementary modality to CECT for evaluating treatment response of HCC following RFA. Larger prospective studies are warranted to further define its role in clinical practice.
Strategies to Enhance the Adenoma Detection Rate (ADR) and the Serrated Polyp Detection Rate (SPDR) in Colonoscopy: A Comprehensive Review Davide Scalvini, Simona Agazzi, Stiliano Maimaris, Laura Rovedatti, Daniele Brinch, Alessandro Cappellini, Carlo Ciccioli, Michele Puricelli, Erica Bartolotta, Daniele Alfieri, Elena Giulia Strada, Lodovica Pozzi, Marco Bardone, Stefano Mazza, Aurelio Mauro, Andrea Anderloni Gastroenterology Insights, 2025 Introduction: High-quality colonoscopy is influenced by several factors, with the adenoma detection rate (ADR) being one of the most studied indicators. A strong inverse relationship exists between ADR and the risk of developing post-colonoscopy colorectal cancer (PCCRC), prompting the European Society of Gastrointestinal Endoscopy guidelines to recommend a minimum ADR of 25%. In contrast, there is limited evidence supporting the clinical significance of the serrated polyp detection rate (SPDR), and no specific benchmark was established until a very recent update from the American societies. Main paper: This review examines the factors that influence ADR and SPDR, offering tips to improve these metrics. Effective interventions for enhancing ADR include training, colonoscopy feedback, adequate bowel preparation, longer withdrawal time, water-aided colonoscopy, right colon second look, and chromoendoscopy. The use of cap, devices, and specialized scopes also show promise, though these are often at higher costs. Artificial intelligence has generated great optimism, especially following positive results from early randomized controlled trials; however, its effectiveness has been less pronounced in real-world settings. Conclusions: Many of these approaches require further trials and meta-analyses to establish their ultimate efficacy. Moreover, future clinical head-to-head studies will help to identify the most effective interventions for reducing colorectal cancer incidence and the risk of PCCRC.
Diagnosis and Treatment of Choledochal Cysts: A Comprehensive Review with a Focus on Choledochocele Carlo Ciccioli, Stefano Mazza, Andrea Sorge, Francesca Torello Viera, Aurelio Mauro, Alessandro Vanoli, Marco Bardone, Davide Scalvini, Laura Rovedatti, Lodovica Pozzi, Elena Strada, Simona Agazzi, Letizia Veronese, Chiara Barteselli, Carmelo Sgarlata, Valentina Ravetta, Andrea Anderloni Digestive Diseases and Sciences, 2025
Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction: A Comprehensive Review on Technical Tips and Clinical Outcomes Stefano Mazza, Graziella Masciangelo, Aurelio Mauro, Davide Scalvini, Francesca Torello Viera, Marco Bardone, Letizia Veronese, Laura Rovedatti, Simona Agazzi, Elena Strada, Lodovica Pozzi, Chiara Barteselli, Carmelo Sgarlata, Valentina Ravetta, Pietro Fusaroli, Andrea Anderloni Diagnostics, 2024 Endoscopic ultrasound-guided biliary drainage (EUS-BD) has dramatically spread and improved in the last two decades and is changing the paradigm of drainage in case of malignant biliary obstruction (MBO). EUS-BD can be achieved from different routes, including the common bile duct (choledochoduodenostomy), intrahepatic bile ducts (hepaticogastrostomy), and gallbladder as a rescue (cholecystogastrostomy/cholecystoduodenostomy). EUS-guided hepaticogastrostomy (EUS-HGS) is a valuable option for biliary drainage in MBO when ERCP fails or is not feasible. EUS-HGS has demonstrated high efficacy with a good rate of technical and clinical success. The safety profile is also overall favorable, although severe adverse events may occur in a significant proportion of patients. From a technical perspective, EUS-HGS is considered one of the most demanding procedures in biliopancreatic endoscopy, requiring multiple steps and high technical skills and experience. In this comprehensive review, technical tips and clinical outcomes of EUS-HGS are reviewed according to the latest evidence in the literature.
