Saroa is a novel robotic surgical system that can estimate the gripping forces of robotic forceps and convey this information to the console surgeon via a remote-control interface. A patient with a polyp located adjacent to the Bauhin valve was diagnosed with adenocarcinoma with submucosal and vascular invasion after endoscopic resection and subsequently underwent additional surgical resection. Port placement was modified twice intraoperatively due to the limited range of motion of the robotic arms. During the first setting, the ileocolic artery and vein were resected, and the ascending colon was mobilized. During the second setting, the hepatic flexure was mobilized. Further studies are needed to determine whether sensory feedback improves surgical safety and shortens the learning curve compared with other robotic platforms.

Endoscopic procedures play a central role in the diagnosis and management of gastrointestinal (GI) diseases, yet the field lacks large-scale, clinically diverse benchmarks and unified datasets to evaluate vision foundation models. We introduce PanEndoSuite, the first unified ecosystem for endoscopic AI, developed through systematic collaboration between AI researchers and practicing gastroenterologists. PanEndoSuite consists of three complementary components: PanEndoAtlas, PanEndoX, and PanEndoFM. PanEndoAtlas is a harmonized dataset of over 420,000 labeled images from 30 public endoscopy datasets across 13 countries and 26 hospitals, creating a clinically-grounded hierarchical taxonomy that mirrors diagnostic reasoning patterns across 111 GI diseases. PanEndoX is a benchmark of 10 clinically grounded tasks, including hierarchical GI-tree classification, Barrett's esophagus grading, ulcerative colitis scoring, polyp subtyping, Boston Bowel Preparation Scale assessment, multi-organ disease classification, and anatomical landmark identification-designed to probe generalization across anatomical regions, disease presentations, and annotation granularities. PanEndoFM is a foundation model pretrained on a 10 million-image corpus curated from public data sources, spanning the entire GI tract. We benchmark PanEndoFM against two endoscopy-specific foundation models (EndoFM-LV, EndoSSL) and two general-purpose vision models (ViT-B/16, ResNet-50). PanEndoFM achieves the highest macro-AUC on 6 of 10 tasks, demonstrating broad clinical generalization; EndoFM-LV performs best on colon-focused tasks, EndoSSL excels in polyp subtyping, and ViT-B/16 shows strengths on small-intestine conditions. Together, PanEndoSuite establishes a foundation for building robust, generalist AI systems in gastrointestinal endoscopy that bridge current AI capabilities and clinical practice.

Cystic fibrosis (CF) alters gut physiology, yet its impact on microbial communities across colonic regions (ascending, transverse, descending colon) and microhabitats (lumen, mucosa) remains incompletely understood. Here, we applied culturomics to characterize gut microbiota in a small cohort of 32 individuals (22 non-CF, 10 CF). Persons with CF (pwCF) exhibited significantly higher viable bacterial loads than non-CF individuals, particularly in mucosal samples. Anaerobes predominated overall, with relative enrichment of aerobes in the mucosa of pwCF. Alpha diversity was reduced in mucosal samples and aerobic cultures for pwCF, whereas beta diversity was influenced by all the tested variables except the colonic region. Phylum-level analyses revealed enrichment of Proteobacteria and depletion of Actinobacteria, Bacteroidota, and Firmicutes in samples from pwCF, consistent with stool analysis. Random forest models identified selected oral-associated microbes as key predictive taxa and accurately classified polyp status within this cohort. Whole-genome sequencing of Bacteroides fragilis (n = 21) and Escherichia coli (n = 15) isolates, representing a subset of 109 gut bacterial genomes sequenced from this cohort, revealed minimal genomic variation across colonic regions and sample types, indicating intra-individual strain stability. The understandings from this pilot culturome study, after future validation, may help in developing targeted microbial therapeutic approaches to address the gut dysbiosis of CF.

Natural polyamines, such as spermidine and spermine, exert strong anti-inflammatory effects, but their therapeutic benefits are limited by rapid absorption in the small intestine, resulting in low colonic availability. In this study, engineered Citrobacter freundii overexpressing ppk1 (CPP) could significantly enhance both intracellular polyamine synthesis and polyphosphates (PolyP) accumulation. Under a two-step cultivation process, the engineered strain produced substantial amounts of polyamines, including spermidine (145.14 ± 5.11 mg/g) and spermine (175.31 ± 4.2 mg/g). CPP responds to environmental stress by importing large amounts of phosphate for PolyP synthesis. This process further promotes polyamine production, which binds to PolyP to neutralize intracellular charge. The resulting polyamine-polyphosphate granules (PPGs) enhance both binding stability and slow-release properties in vivo. Notably, the oral administration of PPGs increased colonic polyamine levels, alleviated DSS-induced colitis, reduced inflammatory cytokines, and restored gut microbiota balance. Overall, biosynthesized PPGs represent a highly promising material for mitigating colitis.

BACKGROUND Filiform polyposis (FP) is a rare pseudopolyp associated with inflammatory bowel disease (IBD), characterized by elongated mucosal projections. It is found primarily in the colon and rectum, and presentation in the ileum is rare. Despite its benign nature, FP can mask underlying chronic intestinal inflammation. CASE REPORT A 52-year-old woman presented with loose stool but no other gastrointestinal symptoms. She was found to have a branched mucosal mass in the terminal ileum and diffuse ulcerations throughout the colorectum. Initial laboratory tests indicated anemia and elevated inflammatory markers. After 3 months of treatment with mesalazine and adjuvant drugs, the symptom of loose stool had improved, but the colonoscopy and imaging examination results show little change from the initial visit. Colonoscopy, imaging, and histopathology supported a diagnosis of Crohn's disease (CD). The ileal mass was identified as filiform polyposis. After multidisciplinary consultation, she was treated with Ustekinumab, leading to significant symptomatic and endoscopic improvement. The mass was subsequently resected via hybrid ESD and confirmed as an inflammatory polyp. CONCLUSIONS This case reveals that although a patient has no significant symptoms related to CD, FP located at the terminal ileum can initially manifest as CD, highlighting the need for through evaluation to detect underlying IBD. Multidisciplinary collaboration is essential for accurate diagnosis and management. FP can be the "tip of the iceberg" in hidden chronic intestinal inflammation, necessitating careful endoscopic and histologic assessment.

Background and Clinical significance: Cowden syndrome is an autosomal dominant disorder caused by germline loss-of-function mutations in the PTEN tumor suppressor gene. It is characterized by multiple hamartomas and an increased lifetime risk of malignancies affecting the breast, thyroid, endometrium, and gastrointestinal (GI) tract. Pediatric presentations may include macrocephaly, scrotal tongue, and intellectual disability. Gastrointestinal involvement is frequent, with juvenile-like hamartomatous polyps occurring in at least half of patients and distributed throughout the GI tract, posing a risk for malignant transformation. Early diagnosis and surveillance are crucial for improving patient outcomes. Case Presentation: We report a case of a 10-year-old Caucasian female with Cowden syndrome, with a history of a malignant germ cell tumor of the ovary consisting of a yolk sac tumor and low-grade immature teratoma diagnosed at age six, and thyroidectomy at age nine. The patient has mild intellectual disability. Routine radiological surveillance revealed a right colon intraluminal mass, prompting referral for pediatric gastroenterology evaluation. Endoscopy identified multiple polyps throughout the colon, stomach, and small intestine. Polypectomy of larger lesions was performed, and histopathology confirmed juvenile-like hamartomatous polyps without dysplasia or malignancy. This case highlights the necessity of comprehensive gastrointestinal evaluation in pediatric Cowden syndrome patients. Endoscopic surveillance is essential for early detection and management of polyps. Conclusions: Given the multisystem involvement and elevated cancer risk associated with PTEN mutations, a multidisciplinary approach that includes genetic counseling, dermatologic evaluation, and ongoing oncologic monitoring is recommended. Increased awareness of gastrointestinal manifestations enables timely intervention and may reduce morbidity and mortality in this high-risk population.

While juvenile hamartomatous polyps are common pediatric findings, they are almost exclusively restricted to the colon and rectum; their occurrence in the small intestine is exceptionally rare and presents a significant diagnostic dilemma. This case report describes an eight-year-old patient who presented with vague constitutional symptoms, including intermittent vomiting, abdominal pain, and severe weight loss resulting in a Z-score of -3.29. Initial diagnostic investigations, including abdominal ultrasound, computed tomography, upper digestive endoscopy, and contrast bowel studies, failed to identify a clear etiology. Following an exploratory laparotomy, a juvenile hamartomatous polyp was identified in the mid-jejunum, acting as a lead point for intermittent intussusception with secondary vascular congestion of the intestinal loops. The diagnosis was confirmed through anatomopathological analysis after a successful enterectomy. This case demonstrates that in the presence of unexplained malnutrition and cyclical emesis, clinicians must maintain a high index of suspicion for small bowel lesions, as prompt surgical intervention can prevent further complications and lead to complete symptomatic resolution.

An 88-year-old female was admitted with a complaint of melena. Abdominal computed tomography revealed a dense mass and a target sign in the distal ileum, suggesting an intestinal mass and associated intussusception. However, there were no signs of intestinal obstruction or ischemic change. Retrograde single-balloon enteroscopy revealed a lesion in the distal ileum that appeared as a spherical mass in the frontal view, with a long stalk visible posteriorly. Detailed observation was challenging. At that time, intussusception was not observed. Contrast examination revealed a long and slender mass with a hemispherical, dome-shaped head. As the source of bleeding remained unidentified, enteroscopic clipping and tattooing were performed for preoperative marking. Given the patient's stable hemodynamic and respiratory status, single-incision laparoscopic surgery was performed one week later. Intraoperatively, the tattooed section of the ileum, demonstrating evidence of intussusception, was easily identified. The affected segment was exteriorized through the single-incision port, and the intussusception was relieved using the Hutchinson maneuver. Approximately 20cm of the ileum, including the tattooed segment, was resected, followed by reconstruction using a functional end-to-end anastomosis. Gross examination of the resected specimen revealed a 20×90mm polyp with a slender, "worm-like" appearance-typical of an enteric muco-submucosal elongated polyp (EMSEP). Histopathological analysis confirmed the presence of normal mucosa and submucosa with a variably prominent mixture of blood and lymphatic vessels. Although EMSEPs are frequently observed in the colon, they are exceedingly rare in the small intestine. Their detection during routine health screenings is challenging due to their location, and they often manifest as intussusception. Because endoscopic management of small EMSEPs can be challenging, lesion tattooing followed by laparoscopic surgery is a good treatment choice.

To observe the specific changes of auricular points in patients with colorectal polyps (CPs) by auricular assessment. To summarize the clusters of auricular point-specific changes in patients with CPs, and to inform further research into auricular point assisted diagnosis of CPs. A total of 300 participants, with 150 having CPs and 150 having no CPs, were recruited for this case-control study. Auricular assessment included visual inspection, electrical skin resistance measurement, and tenderness testing. The chi-square test and binary logistic regression analysis were used to determine the association between categorical variables. And calculated the sensitivity, specificity, positive predictive value (PPV), and negative predictive value of each acupoint for CPs. Compared with the control group, the polyps group had more significant skin changes in the auricular point "Esophagus," morphological changes in the auricular point "Stomach," color changes in the auricular point "Duodenum," color changes in the auricular point "Shenmen," and shape changes in the auricular point "Rectum" observed on visual examination (P < .05). There was a significant difference in the electrical positive detection rate at 8 auricular acupoints, the "Large Intestine," the "Appendix," the "Small Intestine," the "Kidney," the "Pancreas and Gallbladder," the "Center of Superior Concha," and the "Shenmen" between the 2 groups (P < .05). In the polyps group, 4 auricular acupoints, the "Duodenum," the "Large Intestine," the "Small Intestine," and the "Center of Superior Concha" showed more pronounced tenderness than in the control group. Among these auricular acupoints, the "Large Intestine" also showed the highest PPV of 61.5 on electrical skin resistance measurement, and the highest specificity of 53.3, PPV of 58.3, and negative predictive value of 60.6 on tenderness testing. This study showed that specificity changes in some of the auricular points such as the "Large Intestine," the "Rectum," the "Small Intestine," the "Center of Superior Concha," the "Shenmen," and the "Kidney" are strongly correlated with the prevalence of CPs. Auricular diagnosis has a pre-diagnostic value. It is considered to establish the clusters of auricular point-specific changes to realize the early screening of CPs.