← Issue №12/ week of Sep 20, 2026/ the whole section, in full

Colorectal, in full.

All 3 Colorectal papers in this issue, as full cards, ranked by clinical utility. The issue page carries the strongest few; this is the section, whole.

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most clinically useful first · the 1 the issue led with is ruled in green
Colorectal rct · n=10,799 · Sep 17, 2026 · NEJM · IF 84.5

Colonoscopy Intervals and Colorectal Cancer Incidence after Adenoma Removal.

Practice-changingcolorectal cancercolorectal cancer screeningadenoma
Clinical takeawayConsider extending the first surveillance colonoscopy interval to 5 years (vs 3 years) for patients with high-risk adenomas (≥1 adenoma ≥10 mm, high-grade dysplasia, villous growth, or 3-10 adenomas), pending final 10-year results.
What it found5-year cumulative incidence of colorectal cancer was 0.77% with 5-year surveillance vs 0.82% with 3-year surveillance (difference -0.05 percentage points; noninferiority margin 0.7 percentage points).
ContextChallenges current guideline recommendations for 3-year surveillance in high-risk adenoma patients, suggesting noninferiority of a 5-year interval in this interim analysis.
Emergingsuggested applicable standard· US Multi-Society Task Force on Colorectal Cancer (Gupta S, et al.), "Recommendations for Follow-Up After Colonoscopy and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer," Gastroenterology, 2020

After polyp removal, assign the next colonoscopy surveillance interval using USMSTF 2020 based on polyp number, size, and histology (e.g., 1-2 tubular adenomas <10 mm 7-10 years; 3-4 tubular adenomas <10 mm 3-5 years; 5-10 tubular adenomas <10 mm, any adenoma ≥10 mm, or adenoma with tubulovillous/villous histology or high-grade dysplasia 3 years; >10 adenomas 1 year with polyposis evaluation; and for serrated polyps, 1-2 sessile serrated lesions <10 mm 5-10 years, 3-4 sessile serrated lesions <10 mm or a hyperplastic polyp ≥10 mm 3-5 years, and a sessile serrated lesion ≥10 mm or with dysplasia or a traditional serrated adenoma 3 years), and apply the shortest interval indicated when findings are mixed.

From our summary of this standard, unedited — the part the paper bears on. marks omitted text. Our wording, not the guideline's; read the source for its own text.

Our full summary of this standard

After polyp removal, assign the next colonoscopy surveillance interval using USMSTF 2020 based on polyp number, size, and histology (e.g., 1-2 tubular adenomas <10 mm 7-10 years; 3-4 tubular adenomas <10 mm 3-5 years; 5-10 tubular adenomas <10 mm, any adenoma ≥10 mm, or adenoma with tubulovillous/villous histology or high-grade dysplasia 3 years; >10 adenomas 1 year with polyposis evaluation; and for serrated polyps, 1-2 sessile serrated lesions <10 mm 5-10 years, 3-4 sessile serrated lesions <10 mm or a hyperplastic polyp ≥10 mm 3-5 years, and a sessile serrated lesion ≥10 mm or with dysplasia or a traditional serrated adenoma 3 years), and apply the shortest interval indicated when findings are mixed. Confirm complete resection and adequate prep before applying an interval, and use site-check/tumor-board pathways for piecemeal resection and malignant (T1) polyps. Refer for genetic evaluation when Lynch, FAP/AFAP/MAP, or serrated polyposis syndrome criteria are met.

US Multi-Society Task Force on Colorectal Cancer (Gupta S, et al.), "Recommendations for Follow-Up After Colonoscopy and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer," Gastroenterology, 2020 · reviewed 2026-07-23 ↗
Jover R … EPoS Study Group · New England Journal of Medicine · IF 84.5 · PubMed ↗Permalink
Colorectal retrospective · n=6,697 · Sep 14, 2026 · Dig Liver Dis · IF 4.2

The influence of tumor side, sex, and screening on colon cancer stage and survival: a 25-year population-based study.

New evidenceepidemiologycolorectal cancercolorectal cancer screeningdysplasia
Clinical takeawayConsider prioritizing FIT-based screening for older patients, particularly women, and men with advanced-stage disease, given the increased incidence and worse prognosis of right-sided colon cancer in these groups.
What it foundRight-sided colon cancer incidence increased with aging (p ≤ 0.001) and was associated with female sex (OR 1.40, 95% CI 1.27-1.54), advanced stage in men (node-positive: OR 1.54, 95% CI 1.17-2.02; metastatic: OR 1.47, 95% CI 1.06-2.03), and worse prognosis in men (HR 1.16, 95% CI 1.01-1.34) compared to left-sided colon cancer.
ContextConfirms and refines prior evidence on the divergent behavior of right- and left-sided colon cancer, emphasizing the role of tumor side, sex, and screening impact in stage and survival outcomes in older patients, women, and men with advanced-stage disease.
Refinessuggested applicable standard· U.S. Multi-Society Task Force on Colorectal Cancer (Rex DK, Boland CR, Dominitz JA, et al.), "Colorectal Cancer Screening: Recommendations for Physicians and Patients From the U.S. Multi-Society Task Force on Colorectal Cancer," Gastroenterology, 2017

Decision at stakethe choice of colorectal cancer screening modality

Begin average-risk colorectal cancer screening at age 45 using a patient-centered shared-decision modality choice, colonoscopy every 10 years (preferred) or annual FIT as Tier 1 options, with multi-target stool DNA every 3 years, CT colonography every 5 years, or flexible sigmoidoscopy every 5 to 10 years as Tier 2 alternatives. A positive stool-based test requires diagnostic colonoscopy, and stool tests should not be ordered for patients who would decline follow-up colonoscopy. Generally stop at age 75 with individualized decisions for ages 76-85 and no screening beyond 85.

U.S. Multi-Society Task Force on Colorectal Cancer (Rex DK, Boland CR, Dominitz JA, et al.), "Colorectal Cancer Screening: Recommendations for Physicians and Patients From the U.S. Multi-Society Task Force on Colorectal Cancer," Gastroenterology, 2017 · reviewed 2026-07-23 ↗
Kayali S … Laghi L · Digestive and Liver Disease : Official Journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver · IF 4.2 · PubMed ↗Permalink
Colorectal retrospective · n=2,606,347 · Sep 21, 2026 · Aliment Pharm Ther · IF 6.7

Medication Use and Risk of Microscopic Colitis: A Propensity-Matched Analysis of US Adults ≥ 50 Years (2014-2024).

New evidenceepidemiologybiomarker
Clinical takeawayIn patients ≥50 with new-onset chronic diarrhea, consider reviewing NSAID, PPI, or SSRI use as potential contributors to microscopic colitis, particularly when there is a temporal relationship between drug introduction and symptom onset.
What it foundNSAIDs (HR 1.15), PPIs (HR 1.36), and SSRIs (HR 1.52) were associated with increased risk of microscopic colitis over 2 years in adults ≥50, while ACEIs, ARBs, and statins showed no association.
ContextConfirms and quantifies prior associations of NSAIDs, PPIs, and SSRIs with microscopic colitis risk in a large, propensity-matched cohort of adults ≥50, while ruling out associations with ACEIs, ARBs, and statins.
Reinforcessuggested applicable standard· United European Gastroenterology (UEG) & European Microscopic Colitis Group (EMCG), "European guidelines on microscopic colitis: United European Gastroenterology and European Microscopic Colitis Group statements and recommendations" (Miehlke et al.), 2021, Recommendation 1.8

Decision at stakewithdrawal of implicated drugs in microscopic colitis

First step is withdrawal of implicated drugs (PPIs, NSAIDs, SSRIs, and other suspected culprits such as statins/ARBs), but only for agents with a suspected chronological (temporal) relationship between drug introduction and onset of diarrhea, and only when discontinuation is clinically safe and an appropriate alternative exists, rather than reflexive class-wide withdrawal (the European UEG/EMCG guideline suggests considering withdrawal of any drug with such a temporal relationship, and notes PPI-switch data contradict a strict class effect), together with smoking-cessation counseling.

From our summary of this standard, unedited — the part the paper bears on. marks omitted text. Our wording, not the guideline's; read the source for its own text.

Our full summary of this standard

Diagnose microscopic colitis on colonoscopy with biopsies from at least two colonic segments (proximal/ascending and distal/descending, ~3 biopsies per segment in separate jars, avoiding rectum-only sampling since it can miss >20% of cases), plus celiac serology (tTG-IgA) and an infectious workup before treatment. First step is withdrawal of implicated drugs (PPIs, NSAIDs, SSRIs, and other suspected culprits such as statins/ARBs), but only for agents with a suspected chronological (temporal) relationship between drug introduction and onset of diarrhea, and only when discontinuation is clinically safe and an appropriate alternative exists, rather than reflexive class-wide withdrawal (the European UEG/EMCG guideline suggests considering withdrawal of any drug with such a temporal relationship, and notes PPI-switch data contradict a strict class effect), together with smoking-cessation counseling. For symptomatic disease, AGA's guideline recommends budesonide 9 mg once daily for 6-8 weeks as induction, preferred over mesalamine (budesonide gave nearly double the remission rate in head-to-head RCTs); when budesonide is not feasible AGA suggests mesalamine, bismuth subsalicylate, or prednisone/prednisolone as second-line alternatives, the European UEG/EMCG guideline is stricter and recommends against mesalamine outright (not superior to placebo in trials). Maintenance uses budesonide tapered to the lowest effective dose (typically 4.5-6 mg/day) individualized to the patient, since roughly 80% relapse after stopping. Budesonide non-/partial responders should be evaluated for bile acid diarrhea (cholestyramine trial can reduce budesonide dependence), celiac disease, and SIBO before escalating refractory disease to thiopurines (azathioprine/6-MP) or biologics (anti-TNF, vedolizumab).

United European Gastroenterology (UEG) & European Microscopic Colitis Group (EMCG), "European guidelines on microscopic colitis: United European Gastroenterology and European Microscopic Colitis Group statements and recommendations" (Miehlke et al.), 2021, Recommendation 1.8 · reviewed 2026-07-23 ↗
Kilani Y … Madi MY · Alimentary Pharmacology & Therapeutics · IF 6.7 · PubMed ↗Permalink
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