Clinical implications of computer-aided real-time size estimation of colorectal polyps during colonoscopy: a prospective study Giulio Antonelli, Federico Desideri, Sara Schiavone, Nicolò Bevilacqua, Andrea Dequarti, Rosanna Sossi, Piercarlo Farris, Federico Iacopini, Cesare Hassan Endoscopy, 2026 Accurate polyp size estimation during colonoscopy is crucial for clinical decision making, follow-up, and implementation of cost-saving strategies. Objective sizing methods are lacking, and interobserver variability is high. This prospective, multicenter, study evaluated the accuracy of a novel artificial intelligence (AI)-based algorithm for polyp size estimation.Patient aged ≥18 years undergoing colonoscopy for colorectal cancer (CRC) screening or surveillance were enrolled across three centers. Polyp size was initially assessed by operators using forceps/snare comparison (ground truth). Procedures were recorded, and AI-based polyp size estimates were obtained offline. The primary outcome was AI accuracy in size class determination (diminutive ≤5 mm, small 6–9 mm, large ≥10 mm). Secondary outcomes included size estimation in mm and impact on clinical management strategies.Among 465 polyps (307 diminutive, 107 small, 51 large) from 217 patients (mean age 61.9 [SD 10.4] years, 51.6% female), AI accuracy for size class determination was 85.8% (95%CI 82.5–88.8). Accuracy for diminutive, small, and large polyps was 93.3%, 74.6%, and 55.1%, respectively. The AI tool assigned 90.8% of patients to correct surveillance intervals and achieved mean absolute error of 1.13 mm and root mean square error of 1.40 mm for polyps ≤10 mm.The AI model performed similarly to expert endoscopists in clinically relevant size-related outcomes, potentially improving the accuracy and efficiency of CRC screening.
Inflammatory Bowel Disease Patients with a History of Cancer: Safety of Immunomodulators in a Multicenter Study Roberto Mancone, Benedetto Neri, Clara De Francesco, Livio Bonacci, Mariasofia Fiorillo, Sara Concetta Schiavone, Anna Galbusera, Alba Sparacino, Anna Testa, Ambrogio Orlando, Emma Calabrese, Irene Marafini, Stefano Festa, Fabiana Castiglione, Walter Fries, Giovanni Monteleone, Livia Biancone Cancers, 2025 Introduction: The risk of new or recurrent cancer in inflammatory bowel disease (IBD) patients with a history of cancer treated with immunomodulators (IMMs), including conventional immunosuppressors (ISSs), biologics or small molecules is undefined. The primary aim was to assess the frequency of new or recurrent cancer in IBD patients treated with IMMs after first cancer. The secondary aim was to evaluate risk factors for new/recurrent cancer in the same IBD population. Methods: In a retrospective multicenter study, all IBD patients using any IMM after first (index) cancer were enrolled. Inclusion criteria: Crohn’s disease (CD) or ulcerative colitis (UC), history of any cancer, detailed clinical history, and follow-up after cancer of ≥6 months. Exclusion criteria: IMM use for ≤3 months. Results: In total, 122 IBD patients (84 CD, 38 UC) treated with IMMs after first cancer were enrolled (age 59.5 [26–89] years). Index cancer included (n = [%]) genitourinary tract cancer (18 [14.8]), non-melanotic skin cancer (NMSC) (17 [13.9]), breast cancer (15 [12.3]), thyroid cancer (13 [10.7]), melanoma (14 [11.4]), colorectal cancer (CRC) (11 [9.0]), hematopoietic cancer (9 [7.4]), prostatic cancer (8 [6.6]), neuroendocrine cancer (4 [3.3]), head and neck cancer (3 [2.5]), liver cancer (3 [2.5]), endometrium cancer (2 [1.6]), lung cancer (1 [0.8]) and others (3 [2.5]). ISSs after cancer included (n = [%]) thiopurines (10 [37]), methotrexate (MTX) (14 [51.9]) and others (3 [11.1]) Biologics included (n = [%]) TNF-inhibitors (36 [32.4]), vedolizumab (60 [53.6]), ustekinumab (45 [40.2]), small molecules (9 [7.3]) and others (6 [5.4]). In a median follow-up of 8 [1–45] years after index cancer, 12/122 (9.8%) patients using IMMs after cancer developed new or recurrent cancer. No risk factors for new/recurrent cancer (i.e., age at diagnosis of cancer, smoke, gender, IBD type, IMM use, duration before or after cancer) were identified. Conclusions: In a multicenter study, ISSs or biologics after cancer were not identified as risk factors for new or recurrent cancer in IBD. However, IMMs were used after a long-term interval from index cancer.
Safety of artificial intelligence-assisted optical diagnosis for leaving colorectal polyps in situ during colonoscopy (PRACTICE): a non-inferiority, randomised controlled trial Giulio Antonelli, Federico Desideri, Patrizio Scarozza, Gianluca Andrisani, Giulia Zerboni, Manuele Furnari, Nicolò Bevilacqua, Marta Cossignani, Michela Di Fonzo, Fabrizio Cereatti, Giulia Navazzotti, Claudia Antenucci, Francesco Maria Di Matteo, Gerolamo Bevivino, Anna Caruso, Marco Spadaccini, Sara Schiavone, Cristina Grossi, Tommy Rizkala, Michele Comberlato, Michael Bretthauer, Prateek Sharma, Daniel Von Renteln, Douglas K Rex, Loredana Correale, Alessandro Repici, Yuichi Mori, Federico Iacopini, Cesare Hassan Lancet Gastroenterology and Hepatology, 2025
Clinical outcome after entero-enteric anastomosis for Crohn’s disease: a case-control study Benedetto Neri, Sara Concetta Schiavone, Roberto Mancone, Mariasofia Fiorillo, Antonio Fonsi, Emma Calabrese, Lorenzo Perugini, Gaspare Piccione, Francesco Maria Di Matteo, Irene Marafini, Elisabetta Lolli, Giuseppe Sigismondo Sica, Giovanni Monteleone, Livia Biancone Journal of Crohn S and Colitis, 2025 Background and Aims The outcome of Crohn’s Disease (CD) patients with entero-enteric anastomosis (EEA) after small bowel resection is undefined. The primary aim of the present case-control study was to compare the clinical recurrence rate within the first 5 years after surgery in CD patients with small bowel EEA (Cases) versus age-matched patients with ileo-colonic anastomosis (ICA, Controls). Methods All CD patients with EEA were matched for age at diagnosis (±5 years) and smoking habits with two Controls with ICA. Inclusion criteria were: (1) age ≥18 years; (2) EEA or ICA for CD; (3) ≥5 years of follow-up after surgery. Exclusion criteria were: (1) missing data; (2) ostomy; (3) stricturoplasty. Results The study population included 51 CD patients with EEA and 102 matched Controls with ICA. During the first 5 years after surgery, clinical recurrence and CD-related hospitalizations were more frequent in Cases (34 [66.7%] vs 43 [42.2%], P = .007; 25 [49%] vs 23 [22.5%], P = .001). During the same period, use of corticosteroids, immunosuppressors, and biologics were also more frequent in Cases (26 [50.9%] vs 18 [17.6%], P < .0001; 21 [41.2%] vs 24 [23.5%], P = .03; 23 [45.1%] vs 15 [14.7%], P = .03). Survival time from clinical recurrence and hospitalization were shorter in Cases (2.36 [1.29-4.35], P = .003; 1.71 [1.06-2.77], P = 0.02). EEA and use of immunosuppressors before surgery were risk factors for clinical recurrence and CD-related hospitalization at 5 years (2.68 [1.11-6.45], P = .02; 2.61 [1.21-5.6], P = .01; 2.53 [1.05-6.09], P = .03; 2.44 [1.18-5], P = .01). Conclusions The clinical outcome is more severe in CD patients with EEA than in those with ICA, being associated with a higher rate of clinical recurrence and hospitalization after surgery.
Malignant Bowel Occlusion: An Update on Current Available Treatments Benedetto Neri, Nicolò Citterio, Sara Concetta Schiavone, Dario Biasutto, Roberta Rea, Margareth Martino, Francesco Maria Di Matteo Cancers, 2025 Malignant bowel obstruction (MBO) is a critical complication occurring in patients with advanced malignancy. Current treatments are both surgical and non-surgical, the latter including medical, endoscopic, and percutaneous approaches. Surgery is still the treatment of choice for MBO. However, almost 50% of patients are unfit for surgery because of poor performance status. Given the high post-operative mortality rate and the frailty of MBO patients, the least invasive surgical intervention is recommended. Therefore, recent multidisciplinary recommendations have suggested considering less invasive interventions instead of palliative surgery. Medical therapy, aiming to alleviate symptoms, is usually only a part of the therapeutic strategy when managing patients with MBO. Percutaneous techniques, including both interventional radiology and endoscopic procedures, are safe and effective for symptom relief, but often do not allow oral diet resumption. Endoscopic techniques are achieving a more relevant role for MBO treatment, as supported by the widening of the indication to colonic intraluminal stenting in the latest update of the European guidelines. Current data support the use of colonic stenting as both a bridge to surgery and the definitive treatment of malignant colonic obstruction. The development of endoscopic ultrasound-guided anastomotic techniques may offer the possibility of widening its applications to endoscopic treatment of MBO, allowing stenosis to be overcome, and reestablishing the continuity of the gastrointestinal tract in small bowel obstructions as well. The introduction of new interventional endoscopic techniques and their progressive diffusion will add the possibility to adopt minimally invasive solutions to treat a critical condition such as MBO.
Colitis-Associated Dysplasia in Inflammatory Bowel Disease: Features and Endoscopic Management Sara C. Schiavone, Livia Biancone, Mariasofia Fiorillo, Andrea Divizia, Roberto Mancone, Benedetto Neri Cancers, 2025 Patients with long-standing inflammatory bowel disease (IBD) involving the colon are at higher risk of developing colorectal dysplastic or neoplastic lesions. While from sporadic colorectal cancer follows an “adenoma-carcinoma” sequence, IBD colitis-associated carcinogenesis is mainly related to an “inflammation-dysplasia-carcinoma” sequence. Currently, specific endoscopic surveillance strategies involving dye spray and virtual chromoendoscopy have been standardized, aiming for early CRC diagnosis. When detected, colitis-associated dysplasia should be classified according to standard classification, thus allowing for better treatment. Indeed, most IBD-associated dysplastic lesions can be treated with endoscopic resection, even though available procedures are usually more challenging than those in the general population. The higher frequency of severe submucosal fibrosis and the difficulty in the definition of lesions’ margins account for this issue. Current endoscopic resection techniques include polypectomy, endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD). Recent evidence suggests the relevance of en bloc resection, as this may be associated with lower rates of recurrence. Therefore, particularly for larger (>20 mm) lesions, ESD should be preferred, even though it is considered the most difficult technique due to frequent severe submucosal fibrosis. Considering the growing number of new endoscopic resective techniques, including underwater EMR or ESD, which in the general population have been suggested to lower procedure-related risks and may also allow a larger spread of advanced endoscopic resection in IBD. However, additional data are needed to assess the medium- and long-term efficacy of endoscopic resection of visible dysplasia in IBD patients, which are burdened by a high risk of local and, more importantly, metachronous recurrence.
Obesity and Clinical Characteristics of Inflammatory Bowel Disease Roberto Mancone, Livia Biancone, Sara Concetta Schiavone, Mariasofia Fiorillo, Chiara Menna, Stefano Migliozzi, Benedetto Neri Obesity Facts, 2025 Background. The frequency of obesity and possible correlations with characteristics and outcome of inflammatory bowel disease (IBD) are undefined. Primary aim was to assess the Body Mass Index (BMI) distribution in IBD patients in follow-up. Secondary aim was to compare clinical characteristics and course of IBD in normal weight versus overweight or obese patients. Methods. Adult IBD patients in regular follow-up were prospectively enrolled and BMI was recorded during outpatient visits. Comparisons were assessed by Student t-test, Mann-Whitney u-test and Chi-square test, as appropriate. Results. In the 300 IBD patients enrolled (150 Crohn’s Disease, CD, 150 Ulcerative Colitis, UC), BMI distribution included: 16 (5.3%) underweight, 170 (56.7%) normal weight, 92 (30.7%) overweight, 22 (7.3%) obese patients. For the secondary aim, the 16 underweight patients were excluded, thus leaving 284 patients for the analysis (141 [49.6%] CD; 143 [50.4%] UC). Among these, 114 (40.2%) were overweight/obese and 170 (59.8%) normal weight. CD group included 89 (63.1%) normal weight and 52 (36.9%) overweight/obese patients. Perianal disease and refractoriness to biologics were more frequent in overweight/obese than normal weight CD patients (9 [10.1%] vs 12 [23%], p=0.03; 0 [0%] vs 4 [23.4%], p=0.01). In UC group, there were 81 (56.6%) normal weight and 62 (63.4%) overweight or obese patients. Conclusions. In IBD patients in follow up, the proportion of underweight patients is low. Overweight and obese CD patients showed a higher frequency of perianal disease and refractoriness to biologics. BMI may influence phenotype and responsiveness to biologics in CD.
Efficacy and Safety of Janus Kinase-Inhibitors in Ulcerative Colitis Benedetto Neri, Roberto Mancone, Mariasofia Fiorillo, Sara Concetta Schiavone, Stefano Migliozzi, Livia Biancone Journal of Clinical Medicine, 2024 Background: Janus kinase-inhibitors (JAK-i) have recently been approved for treating patients with Ulcerative Colitis (UC); therefore, further information is needed, particularly regarding efficacy and safety. Objectives: To provide a comprehensive review regarding the efficacy and safety of currently available JAK-i in UC. Methods: The PubMed and Scopus databases were considered, searching for ‘JAK’, ‘JAK-inhibitor’, ‘Janus Kinases’, ‘Tofacitinib’, ‘Filgotinib’, ‘Upadacitinib’, individually or in combination with ‘IBD’, ‘Ulcerative Colitis’, ‘safety’, ‘efficacy’, ‘study’ and ‘trial’. The search was focused on full-text papers published in English, with no publication date restrictions. Results: The efficacy and safety of JAK-i approved for treating patients with UC have been summarized. These included Tofacitinib, Filgotinib and Upadacitinib. Findings from both clinical trials and real-life studies in UC were reported, with particular regard to their efficacy in inducing clinical response and remission, steroid-free remission and endoscopic and histological healing. Overall, JAK-i proved to be effective and safe in selected subgroups of patients with UC. The rapid onset of action and the oral route of administration represent the most relevant characteristics of these drugs. Safety concerns using Tofacitinib in subgroups of patients (infections, hypercholesterolemia, venous thromboembolism and cardiovascular events) were initially raised. More recently, all JAK-i for UC showed an overall satisfactory safety profile. However, indication should be carefully given. Conclusions: The use of JAK-i UC is promising, although no predictive markers of response are currently available. Optimizing their use, as monotherapy or combined with other immunomodulators, may increase their efficacy in appropriately selected subgroups of patients with UC.
Inflammatory Bowel Disease and Endometriosis: Diagnosis and Clinical Characteristics Mariasofia Fiorillo, Benedetto Neri, Roberto Mancone, Consuelo Russo, Federica Iacobini, Sara Concetta Schiavone, Elena De Cristofaro, Stefano Migliozzi, Caterina Exacoustos, Livia Biancone Biomedicines, 2024 Background/Objectives: Endometriosis and inflammatory bowel disease (IBD) share some epidemiological, clinical and pathogenetic features. A differential diagnosis between pelvic endometriosis and IBD may be challenging, even for expert clinicians. In the present review, we aimed to summarize the currently available data regarding the relationship between endometriosis and IBD and their possible association. Methods: The PubMed and Scopus database were considered, by searching the following terms: “Crohn’s Disease”, “Ulcerative Colitis”, “Endometriosis”, “Adenomyosis”, and “Inflammatory Bowel Disease”, individually or combined. Full-text papers published in English with no date restriction were considered. Results: Few studies have researched the possible association between endometriosis and IBD. Both conditions are characterized by chronic recurrent symptoms, which may be shared (abdominal pain, fatigue, infertility, menstrual irregularities, diarrhea, constipation). Deep infiltrating endometriosis (DIE) can cause bowel symptoms. In a large Danish study, a 50% increased risk of IBD was observed in women with endometriosis. A missed diagnosis of endometriosis and an increased risk of endometriosis has been reported in IBD. Current evidence does not support an association between endometriosis and IBD characteristics. However, IBD may be associated with DIE, characterized by pelvic symptoms (dyschezia, dyspareunia). Preliminary observations suggest an increased IBD risk in patients with endometriosis treated with hormonal therapy. Conclusions: Current findings suggest that a careful search is needed for concomitant endometriosis in subgroups of patients with IBD showing compatible symptoms and vice versa. A multidisciplinary approach including dedicated gastroenterologists and gynecologists is required for a proper search for IBD and endometriosis in subgroups of patients. This approach may avoid diagnostic delays or overtreatments for these conditions.
