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Background Although a 1-day low-fibre diet before colonoscopy is currently recommended, some endoscopists prescribe a 3-day diet. Objective The objective of this study was to compare the influence of a 3-day versus a 1-day low-fibre diet on bowel preparation quality, patient tolerability and adherence. Methods Outpatients scheduled for total colonoscopy were randomized in two groups, 3-day versus 1-day low-fibre diet, performing a 4-litre polyethylene glycol split-dose. The primary outcome was a reduction of inappropriate preparations in the 3-day low-fibre diet arm from 15% to 5% (bowel preparation was assessed by the Boston Bowel Preparation Scale). Secondary outcomes were adherence to, difficulty to perform, difficulty to obtain and willingness to repeat the diet. Intention-to-treat (ITT) and per-protocol (PP) analyses were conducted for the primary outcome. Results A total of 412 patients were randomized (206 per group). Bowel preparation quality was similar between groups. On ITT analysis ( n = 412), adequate bowel preparation was 91.7% (3-day diet) versus 94.7% (1-day diet), p = 0.24 and on PP analysis ( n = 400) 93.5% versus 96.5%, respectively, p = 0.16. Difficulty to perform the diet was significantly higher on the 3-day diet, p = 0.04. No differences were found on difficulty to obtain the diet, willingness to repeat the diet, adverse events and intra-colonoscopy findings. Conclusion A 3-day low-fibre diet does not bring benefit to the bowel preparation quality and is harder to perform than a 1-day diet.

Background: To date no scale has been validated to assess bubbles impairing bowel preparation. The use of different descriptions in randomized trials limit clinical interpretation. Therefore, our goal was to develop and determine reliability of a novel scale – the Colon Endoscopic Bubble Scale – CEBuS. Methods: Multicentre prospective observational study with two online evaluation phases (Phase 1 - evaluation by four expert endoscopists; Phase 2 - six expert and 13 non-expert) of 45 randomly distributed still colonoscopy images (15 per scale level). Observers assessed images twice with a 2-week interval both a) using the CEBuS (CEBuS-0 – no or minimal bubbles, covering <5% of the surface; CEBuS-1 – bubbles covering 5-50%; CEBuS-2 – bubbles covering >50%); and b) reporting the clinical action (do nothing; wash with water; wash with simethicone). Results: CEBuS provided high levels of agreement both in phase 1 (experts) and 2 (mix expert/non-expert) with intraobserver reliability – Kappa 0.82 (95%CI 0.75-0.88) vs. 0.86 (0.85-0.88) – and for interobserver agreement – ICC 0.83 (0.73-0.89) vs. 0.90 (0.86-0.94). Previous endoscopic experience had no influence on agreement comparing experts and non-experts intra- and interobserver reliability – Kappa 0.86 (0.80-0.91) vs. 0.87 (0.84-0.89) and – ICC 0.91 (0.87-0.94) vs. 0.90 (0.86-0.94), respectively. Interobserver agreement on clinical action was – ICC 0.63 (0.43-0.78) vs. 0.77 (0.68-0.84). Absolute agreement on clinical action per scale level was – CEBuS-0 85% (82-88), CEBuS-1 21% (16-26), CEBuS-2 74% (70-78). Conclusion: The CEBuS proved to be a reliable instrument to standardise the evaluation of colonic bubbles during colonoscopy. Assessment in daily practice is warranted.

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<b><i>Introduction:</i></b> Hyperplastic polyps represent 30–93% of all gastric epithelial polyps. They are generally detected as innocuous incidental findings; however, they have a risk of neoplastic transformation and recurrence. Frequency and risk factors for neoplastic transformation and recurrence are not well established and are fields of ongoing interest. This study aims to evaluate the frequency of and identify the risk factors for recurrence and neoplastic change of gastric hyperplastic polyps (GHP). <b><i>Methods:</i></b> A single-centre retrospective cohort study including consecutive patients who underwent endoscopic resection of GHP from January 2009 to June 2020. Demographic, endoscopic, and histopathologic data was retrieved from the electronic medical records. <b><i>Results:</i></b> A total of 195 patients were included (56% women; median age 67 [35–87] years). The median size of GHP was 10 (3–50) mm, 62% (<i>n</i> = 120) were sessile, 61% (<i>n</i> = 119) were located in the antrum, and 36% (<i>n</i> = 71) had synchronous lesions. Recurrence rate after endoscopic resection was 23% (<i>n</i> = 26). In multivariate analysis, antrum location was the only risk factor for recurrence (odds ratio [OR] 3.0; 95% confidence interval [CI] 1.1–8.1). Overall, 5.1% (<i>n</i> = 10) GHP showed neoplastic transformation, with low-grade dysplasia in 5, high-grade dysplasia in 4, and adenocarcinoma in 1. In multivariate analysis, a size &#x3e;25 mm (OR 84; 95% CI 7.4–954) and the presence of intestinal metaplasia (OR 7.6; 95% CI 1.0–55) and dysplasia (OR 86; 95% CI 10–741) in adjacent mucosa were associated with an increased risk of neoplastic transformation. Recurrence was not associated with neoplastic transformation (OR 1.1; 95% CI 0.2–5.9). <b><i>Discussion:</i></b> Our results confirmed the risk of recurrence and neoplastic transformation of GHP. Antrum location was a predictor of recurrence. The risk of neoplastic change was increased in large lesions and with intestinal metaplasia and dysplasia in adjacent mucosa. More frequent endoscopic surveillance may be required in these subgroups of GHP.