← Issue №15/
week of Oct 11, 2026/
the whole section, in full
Colorectal, in full.
All 10 Colorectal papers in this issue,
as full cards, ranked by clinical utility. The issue page carries the strongest few;
this is the section, whole.
Actionability = is there something to do. Prevalence = how much of a general GI practice it touches. Stakes = how consequential the decision is. Evidence strength = how far the study design and the result support the action. Novelty = how likely you are not already doing it.
Colorectalrct · n=254 · Oct 8, 2026 · Dig Liver Dis · IF 4.2
Clinical takeawayNo change in practice. Patients who receive preoperative FOLFIRI for metachronous colorectal liver metastases currently get no adjuvant chemotherapy; IRIMAD (254 patients, primary endpoint 3-year disease-free survival) is designed to test whether reintroducing it in responders helps. Results are pending.
What it foundPostoperative FOLFIRI reintroduction in good responders after CRLM resection improved 3-year disease-free survival compared to no postoperative treatment (specific numbers not yet reported).
ContextChallenges current practice of withholding adjuvant chemotherapy after preoperative FOLFIRI in unselected populations, suggesting tailored treatment based on response.
No standard claimed for this paper
Every paper is compared to the standard governing its question. This one is not: either no standard in the corpus matches it, or the comparison did not hold up on review and was withdrawn rather than published unverified. Both are logged.
Labiad C … on behalf the FRENCH study group · 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
Colorectalprospective cohort · n=166,863 · Oct 9, 2026 · Aliment Pharm Ther · IF 6.7
New evidencecolorectal cancercolorectal cancer screeningbiomarkerepidemiology
Clinical takeawayUse IDA as an additional risk stratification factor in symptomatic women <50 years with FIT ≥10 μgHb/g, as it significantly increases CRC risk compared to those without IDA.
What it foundIn symptomatic women <50 years with FIT ≥10 μgHb/g, CRC risk was 6.45% (95% CI: 3.52-9.29) with IDA vs 2.20% (95% CI: 1.57-2.83) without IDA.
ContextRefines current FIT-based CRC risk stratification by incorporating IDA, particularly in younger women, where CRC risk is otherwise underestimated.
No standard claimed for this paper
Every paper is compared to the standard governing its question. This one is not: either no standard in the corpus matches it, or the comparison did not hold up on review and was withdrawn rather than published unverified. Both are logged.
Malcolm FL … Humes DJ · Alimentary Pharmacology & Therapeutics · IF 6.7 · PubMed ↗Permalink
Colorectalprospective cohort · n=198,491 · Oct 5, 2026 · Clin Gastro Hep · IF 16.2
Basic scienceepidemiologybiomarkercolorectal cancer
Clinical takeawayNo screening change: PhenoAge is a research measure derived from nine routine labs and has no validated threshold for CRC risk. The association (HR 1.93, 95% CI 1.28-2.91; 127 cases among 198,491 adults under 50) supports biological aging as a risk marker worth validating.
What it foundAccelerated biological aging (biological age > chronological age) increased early-onset colorectal adenocarcinoma (EOCRC-AC) risk by 93% (HR 1.93, 95% CI 1.28-2.91), particularly for colon adenocarcinoma (HR 2.32, 95% CI 1.38-3.89).
ContextThis study introduces biological aging as a novel risk factor for EOCRC-AC in a cohort of Korean adults under 50, complementing current chronological age-based screening criteria.
No standard claimed for this paper
Every paper is compared to the standard governing its question. This one is not: either no standard in the corpus matches it, or the comparison did not hold up on review and was withdrawn rather than published unverified. Both are logged.
Chang Y … Ryu S · Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association · IF 16.2 · PubMed ↗Permalink
Colorectalretrospective · n=42,921 · Oct 7, 2026 · Gut · IF 24.6
Clinical takeawayConsider avoiding lincosamides and penicillin combinations in high-risk patients when alternatives exist, and weigh CDI risk when prescribing PPIs, antidiarrheals, corticosteroids, and other non-antibiotic drugs. Lipid-modifiers and aspirin may offer protective effects, but risks and benefits should be carefully evaluated in individual patients.
What it foundLincosamides had the highest CDI risk (aOR=31.4), followed by penicillin combinations (aOR=19.8), while lipid-modifiers and aspirin reduced CDI risk (aOR=0.8 each).
ContextConfirms PPIs as a CDI risk factor and identifies new associations with non-antibiotic drugs, refining antimicrobial stewardship strategies. Findings are based on a Swedish population-based case-control study from 2006 to 2019.
No standard claimed for this paper
Every paper is compared to the standard governing its question. This one is not: either no standard in the corpus matches it, or the comparison did not hold up on review and was withdrawn rather than published unverified. Both are logged.
Clinical takeawayConsider integrating perioperative immunotherapy and organ-preserving strategies into treatment plans for LARC patients, guided by the consensus recommendations. Ensure multidisciplinary team involvement, adherence to mismatch repair/microsatellite instability detection standards, and monitor for safety signals related to perioperative immunotherapy.
What it foundThe consensus provides graded recommendations for preoperative immunotherapy duration, postoperative adjuvant therapy, local resection, and organ preservation strategies in locally advanced rectal cancer (LARC), based on key clinical trials and emphasizing multidisciplinary team involvement.
ContextThis consensus refines and updates perioperative and organ-preserving treatment strategies for LARC, building on recent clinical trial evidence and addressing gaps in prior guidelines, with a focus on safety and efficacy.
No standard claimed for this paper
Every paper is compared to the standard governing its question. This one is not: either no standard in the corpus matches it, or the comparison did not hold up on review and was withdrawn rather than published unverified. Both are logged.
Yang Z … Chinese Society of Colorectal Surgery CNSCRS · Gut · IF 24.6 · PubMed ↗Permalink
Colorectalprospective cohort · n=2,856 · Oct 6, 2026 · Clin Transl Gastro · IF 3.4
New therapyartificial intelligencebiomarkercolorectal cancer screening
Clinical takeawayPending further validation in a larger cohort, this AI-based blood test, which has received FDA Breakthrough Device Designation, shows promise as a non-invasive CRC screening tool.
What it foundThe AI-based blood test showed 83.3% sensitivity for CRC and 65.6% for AA at 87.2% specificity for no colonoscopy findings, non-neoplastic findings, and non-advanced precancerous lesions.
ContextProposes a non-invasive alternative for CRC screening, currently under FDA Breakthrough Device Designation, with exploratory results awaiting validation in a larger cohort.
Measured against the standard of care· USMSTF 2017 (Rex et al., Gastroenterology) + USMSTF 2022 focused update on age (Patel et al., Gastroenterology 2022;162:285-299) / ACS 2026 (CA Cancer J Clin)ShowHide
Decision at stakethe choice of screening modality for average-risk colorectal cancer screening
…Multi-Society Task Force (2017 guideline, revised by the 2022 focused update on age to start and stop): offer average-risk colorectal cancer screening to everyone aged 45-75.…The American Cancer Society's May 2026 guideline agrees on the 45-75 range, no screening after 85, and colonoscopy as the preferred option.…
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 standardShowHide
U.S. Multi-Society Task Force (2017 guideline, revised by the 2022 focused update on age to start and stop): offer average-risk colorectal cancer screening to everyone aged 45-75. Screening at 45-49 is a weaker recommendation than at 50-75. Colonoscopy every 10 years and annual FIT are the Tier 1 cornerstones. Tier 2 alternatives are multi-target stool DNA every 3 years, CT colonography every 5 years, and flexible sigmoidoscopy every 5-10 years. Capsule colonoscopy every 5 years is Tier 3. Any abnormal non-colonoscopy test requires a diagnostic colonoscopy, and a stool test should not be offered to a patient who would decline follow-up colonoscopy. Patients who are up to date with negative prior screening, particularly a high-quality colonoscopy, may consider stopping at 75 or when life expectancy is under 10 years. Decisions at 76-85 are individualized by health and prior screening, and screening after 85 is not recommended. The American Cancer Society's May 2026 guideline agrees on the 45-75 range, no screening after 85, and colonoscopy as the preferred option. It adds the next-generation mt-sDNA test and the multitarget stool RNA test (ColoSense), both every 3 years, and it adds an FDA-approved blood-based cfDNA test (Shield) only for people who decline or do not complete visual or stool screening. ACS says a positive stool or blood test should be followed by colonoscopy, preferably within 6 months. The 2026 ASGE paper on follow-up after an abnormal stool test is an implementation review (navigation, tracking, direct-access colonoscopy), not a new screening guideline.
Basic sciencebiomarkerbasic sciencetranslationalcolorectal cancer
Clinical takeawayNo clinical action yet: a mechanistic finding in preclinical models and retrospective analyses. Consider CTHRC1(+) CAF assessment in future histopathological workflows pending prospective validation.
What it foundCTHRC1(+) CAFs identified in over 3000 CRC samples were linked to poor outcomes and resistance to immune checkpoint inhibitors (compared to standard immunotherapy) in both dMMR/MSI and pMMR/MSS tumours, particularly in stroma-rich, treatment-resistant tumours and pMMR/MSS with limited therapeutic options.
ContextChallenges current CRC stratification by identifying a stromal biomarker that predicts immunotherapy resistance and poor outcomes across mismatch repair statuses, particularly in stroma-rich, treatment-resistant tumours and pMMR/MSS with limited therapeutic options.
No standard claimed for this paper
Every paper is compared to the standard governing its question. This one is not: either no standard in the corpus matches it, or the comparison did not hold up on review and was withdrawn rather than published unverified. Both are logged.
Epidemiologyepidemiologycolorectal cancercolorectal cancer screening
Clinical takeawayNo clinical action yet: epidemiological findings from a registry study. Findings reinforce the importance of timely diagnosis and screening but do not propose new interventions.
ContextThis literature reports age-specific patterns in colorectal cancer incidence and survival dynamics, particularly highlighting differences in early-onset, screening-eligible, and late-onset disease.
No standard claimed for this paper
Every paper is compared to the standard governing its question. This one is not: either no standard in the corpus matches it, or the comparison did not hold up on review and was withdrawn rather than published unverified. Both are logged.
Taborelli M … Dal Maso 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
Colorectalretrospective · n=65 · Oct 6, 2026 · Dig Dis Sci · IF 2.5
New evidencecolorectal cancercolorectal cancer screeningbiomarkerepidemiology
Clinical takeawayNo clinical action yet: this retrospective study highlights a potential association but does not support changes in surveillance or management.
What it found22% of patients with a positive mt-sDNA result and negative colonoscopy developed new or recurrent cancer, with 93% involving the aerodigestive tract.
ContextThis study raises questions about the implications of positive mt-sDNA results in patients with prior non-CRC malignancy, an area with limited prior evidence.
No standard claimed for this paper
Every paper is compared to the standard governing its question. This one is not: either no standard in the corpus matches it, or the comparison did not hold up on review and was withdrawn rather than published unverified. Both are logged.
Patel S … Mendelsohn RB · Digestive Diseases and Sciences · IF 2.5 · PubMed ↗Permalink
Colorectalprospective cohort · n=1,762 · Oct 7, 2026 · Gut · IF 24.6
Clinical takeawayNo clinical action yet: weak associations in a cross-sectional study do not support microbiome-based screening or interventions for colorectal neoplasia.
What it foundGut microbiome differences between individuals with and without neoplasia were minimal (R2=0.0008, p=0.03), with weak associations for specific species and pathways (q value <0.05).
ContextChallenges prior hypotheses of strong microbial signatures in early colorectal neoplasia, suggesting microbial shifts may emerge later in disease progression.
No standard claimed for this paper
Every paper is compared to the standard governing its question. This one is not: either no standard in the corpus matches it, or the comparison did not hold up on review and was withdrawn rather than published unverified. Both are logged.