Gastroenterology

Is AI the Game-Changer for Polyp Detection in Colon Capsule Endoscopy? Insights from the CESCAIL Study (2025)

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Type of publication:

Conference abstract

Author(s):

Lei I.I.; Parisi I.; Bhandare A.; Perez F.P.; Lee T.; Shehkar C.; McStay M.; Anderson S.; Watson A.; Conlin A.; Badreldin R.; Malik K.; Jacob J.; Dixon A.; *Butterworth J.; Parson N.; Koulaouzidis A.; Robertson A.; Treceno P.; Arasaradnam R.

Citation:

Gut. Conference: BSG Annual Meeting, BSG LIVE 2025. Glasgow United Kingdom. 74(Supplement 1) (pp A9-A10), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Background Colon Capsule Endoscopy (CCE) provides a noninvasive alternative to colonoscopy for evaluating the lower gastrointestinal (LGI) tract. However, its widespread use has been limited by prolonged reading times and variability in diagnostic accuracy, often affected by factors such as bowel preparation quality and completion rates. In recent years, artificial intelligence (AI) has demonstrated potential in overcoming these limitations, particularly in small bowel CE, by enabling clinicians to achieve high diagnostic accuracy with significantly reduced reading times. The CESCAIL multi-centre study aims to evaluate a Computer-Aided Detection (CADe) system (AiSPEEDTM) to enhance polyp detection efficiency in CCE. Objective The primary aim is to assess AI-assisted CCE readings' diagnostic accuracy and non-inferiority in detecting polypoid lesions compared to standard readings using a per-patient analysis. The secondary objective focuses on mean reading time to evaluate the efficiency of each approach. Methods Patients aged 18 years or older, referred under urgent cancer or post-polypectomy surveillance pathway to one of the 14 CESCAIL participating centres across the UK, were prospectively enrolled in the study. Participants underwent CCE examinations, which were analysed using the AiSPEEDTM system, a convolutional neural network designed for automated polyp detection. Clinicians conducted initial manual readings, followed by AI-assisted readings, which involved an AI-automated first read, a review and annotation by a pre-reader, and a clinician assessment of selected images to create a report. Results Between February 2022 and September 2024, 673 patients were included in the final analysis. The overall completion rate was 77.1%, with adequate bowel preparation achieved in 78.1% of the standard pathway and 74.9% of the AI-assisted pathway (McNemar p=0.1). In the standard pathway, 403 patients (59.9%) required further investigation, including 243 (36.1%) colonoscopies and 138 (20.5%) flexible sigmoidoscopies. In the per-patient analysis, the diagnostic yield for polyp detection leading to a follow-up colonoscopy was 71.9% (484/673) for AI-assisted reading and 63.6% (428/ 673) for standard reading, confirming non-inferiority (p<0.0001). The diagnostic accuracy was 0.96 (95% CI: 0.95-0.98) for AI-assisted reading and 0.91 (95% CI: 0.89- 0.93) for standard reading (McNemar p<0.0001). The mean clinician reading time per video was 8.7 (SD=11.3) minutes for AI-assisted reading, compared to 47.3 (SD=24) minutes for standard reading, with a 5-fold reduction. Conclusion AI-assisted reading using AiSPEEDTM demonstrated significantly higher detection yield with improved diagnostic accuracy coupled with reduced reading time for polyp detection in CCE compared to standard clinician readings. These findings emphasise AI's potential to enhance efficiency and scalability in CCE, supporting its broader adoption for LGI investigations in clinical practice.

DOI: 10.1136/gutjnl-2025-BSG.14

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Decoding the Strength of AI-Assisted Reading in Colon Capsule Endoscopy: Factors Influencing Accuracy in Polyp Detection; CESCAIL Study's Interim Result (2025)

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Type of publication:

Oral presentation

Author(s):

Lei I.I.; Parisi I.; Bhandare A.; Perez F.P.; Lee T.; Shekhar C.; McStay M.; Anderson S.; Watson A.; Conlin A.; Badreldin R.; Malik K.; Jacob J.; Dixon A.; *Butterworth J.; Parsons N.; Robertson A.; Koulaouzidis A.; Arasaradnam R.

Citation:

Gut. Conference: BSG Annual Meeting, BSG LIVE 2025. Glasgow United Kingdom. 74(Supplement 1) (pp A48-A49), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Background Artificial Intelligence (AI) assisted reading in Small Bowel Capsule Endoscopy (SBCE) has recently been shown to achieve comparable and potentially superior accuracy compared to standard clinician reading. In Colon Capsule Endoscopy (CCE), AI algorithms have also demonstrated some promising results.1 However, the extent of AI-assisted reading's advantage remains unclear, particularly regarding its performance across different polyp sizes, morphologies, locations, and non-polyp-related factors. Understanding this is essential for optimising AI performance and clinical integration. Objective(s) This CESCAIL sub-analysis evaluates the per-polyp diagnostic accuracy of AI-assisted versus standard clinician reads (pathways) and identifies key factors influencing AIassisted accuracy using AiSPEEDTM. Methods A total of 1,803 polyps from 673 patients were analysed at the per-polyp level to assess diagnostic accuracy in terms of sensitivity and PPV, as well as the factors influencing the improved accuracy of AI-assisted readings compared to standard clinician readings. Factors examined included polyp size, morphology, location, patient demographics (age and sex), bowel preparation quality, capsule excretion rates, comorbidities, medications, reading time, and video duration. Statistical methods included, McNemar's test, superiority and noninferiority analyses, Generalised Estimating Equations, and generalized linear models with interaction terms, were employed to identify key predictors of enhanced diagnostic accuracy in both AI-assisted and standard readings. Results AI-assisted reading demonstrated significantly higher sensitivity with clear superiority for smaller polyps (<10 mm) compared to larger ones (>=10 mm) (OR 2.27 vs 0.88, p<0.0001). While there was no observed difference in diagnostic accuracy between pathways for polyps >=10 mm, noninferiority was established. AI accuracy remained consistent between polyps measuring 6-9 mm and <=5 mm (p=0.64). The most notable improvement was observed with hyperplastic polyps (OR 5.4, p<0.0001), particularly in the rectal region (OR 5.7, p<0.0001). No significant differences were identified for pedunculated, subpedunculated, LST, or SSL polyps. Furthermore, AI-assisted readings were significantly more accurate for left-sided polyps compared to right-sided ones (OR 2.36 vs 1.66, p<0.0001), although AI-assisted reads outperformed standard reads in both locations. Conclusion This study highlights the strengths of AI-assisted reading, particularly for detecting smaller adenomas and hyperplastic polyps, with notable accuracy in the left colon. Next-generation AI should focus on distinguishing significant from diminutive polyps and enhancing polyp characterisation, especially for right-sided lesions.

DOI: 10.1136/gutjnl-2025-BSG.72

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From Capsule to Scope: Predicting Colon Capsule Endoscopy Conversion to Optical Endoscopy - Insights from the CESCAIL Study (2025)

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Type of publication:

Poster presentation

Author(s):

Lei I.I.; Parisi I.; Bhandare A.; Perez F.; Lee T.; Shehkar C.; McStay M.; Anderson S.; Watson A.; Conlin A.; Badreldin R.; Malik K.; Jacob J.; Dixon A.; *Butterworth J.; Parsons N.; Koulaouzidis A.; Arasaradnam R.

Citation:

Gut. Conference: BSG Annual Meeting, BSG LIVE 2025. Glasgow United Kingdom. 74(Supplement 1) (pp A269-A270), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Background Colon capsule endoscopy (CCE) has emerged as a non-invasive alternative to traditional colonoscopy for low-risk patients. However, its adoption is limited by low completion rates and the inability to perform biopsies or polyp removal, often resulting in CCE-to-conventional colonoscopy conversion (CCC). This conversion carries financial implications, contributes to patient dissatisfaction due to repeated procedures, and imposes a potential environmental burden from increased hospital visits. Objective(s) The aim is to identify the factors that predict issues with bowel cleansing, capsule excretion rates, pathology detection, and the need for CCC. Methods In this prospective analysis of the CESCAIL study (November 2021-June 2024), 603 patients who underwent CCE were included. Predictive factors-including patient demographics, comorbidities, medications, and laboratory results-were analysed across symptomatic and surveillance groups. Statistical techniques such as LASSO regression, linear regression, and logistic regression were applied. Results Among the 603 participants analyzed, elevated f-Hb levels (OR=1.48, 95% CI: 1.18-1.86, p=0.0002) and smoking (OR=1.44, 95% CI: 1.01-2.11, p=0.047) were significantly associated with CCE-to-conventional colonoscopy conversion (CCC). However, an AUC of 0.62 after adjusting for confounders suggests f-Hb is a weak predictor of CCC. Diabetes was linked to poor bowel preparation (OR=0.40, 95% CI: 0.18-0.87, p=0.022). Alcohol use (p=0.004), smoking (p=0.003), and psychological conditions (p=0.001) were significantly associated with an increased polyp count, while haemoglobin levels (p=0.046) showed a marginal negative association with polyp numbers. Additionally, antidepressants (p=0.003) were associated with larger polyps, whereas betablockers (p=0.001) were linked to smaller polyps. Conclusion Non-smokers with lower f-Hb levels are less likely to require CCC. Effective patient selection criteria are essential for minimising conversion rates and improving the efficiency of CCE services. These findings highlight the need for validation across diver

DOI: 10.1136/gutjnl-2025-BSG.428

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Enhancing Sustainability in Endoscopically Assisted Naso-Jejunal Tube Insertion - A Novel Approach (2025)

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Type of publication:

Poster presentation

Author(s):

Bhargava K.; Bhargava C.; Dimitriadis S.; Sawyer M.; *Desai K.; Shekhar C.

Citation:

Gut. Conference: BSG Annual Meeting, BSG LIVE 2025. Glasgow United Kingdom. 74(Supplement 1) (pp A287), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Introduction Due to the high caseload and heavy reliance on plastic predominant equipment in endoscopy, single use consumables remain a significant contributor to endoscopy related CO2 emissions (CO2e). Naso-jejunal tube (NJT) is a flexible tube that enables post-pyloric feeding. Conventionally, NJT insertion is performed endoscopically utilising consumables (e. g. single use laryngoscopes). We aimed to calculate and compare the CO2e of the standard NJT insertion process (SNIP) and a proposed innovative NJT insertion process (INIP). Method We dismantled each consumable used in the SNIP and INIP and calculated their associated CO2e by multiplying their weights by pre-established greenhouse gas emission factors published by the government of the United Kingdom. We further contacted relevant manufacturers to include emissions related to packaging, travel and transport, where possible. Results The SNIP emitted 1.327kg CO2e, while the INIP emitted 0.113kg CO2e – yielding an 11-times lower carbon footprint. The most significant contributor to SNIP emissions was the utilisation of the single use laryngoscope (0.838kg CO2e). In contrast, the INIP enabled NJT insertion, independent of conventional single-use instrumentation. Conclusion Implementing the INIP approach for NJT insertions for hospital and community-based patients would provide a sustainable alternative to existing procedural standards. Based on current data, utilising the INIP as standard practice would reduce 5827.2kg of NJT associated CO2e per year, in the UK. Further epidemiological research on populations receiving enteral feeding is required to more accurately evaluate the INIP's environmental impact.

DOI: 10.1136/gutjnl-2025-BSG.454

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Evaluating the Referral Pathway for Colonoscopy in a District General Hospital (2025)

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Type of publication:

Conference abstract

Author(s):

*Lakshmipathy G.R.; *Zaman H.; *Ball W.; *Smith M.

Citation:

British Journal of Surgery. Conference: 49th ASiT Annual Surgical Conference. Belfast United Kingdom. 112(Supplement 10) (pp x109-x110), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Objectives: We aim to evaluate: Method, urgency and appropriateness of colonoscopy referrals. Colonoscopies repeated within two years. Reasoning behind procedure modification or cancellation on the day Method: Data was collected between 5/1/24 and 28/2/24 using questionnaires completed by endoscopists. 112 colonoscopies in 51% (57) males and 49% (55) females were included. Result(s): The most common to least common referral sources are: Colorectal CNS telephone clinic 29(26%), consultant surgeon face-to-face Clinic 28(25%), triage system 14(12.5%), consultant surgeon telephone clinic 13(11.6%), others 13(11.6%), gastroenterology consultant face-to-face clinic 11(9.8%) and gastroenterologist telephone clinic 1(0.8%). Majority of referrals were two-week wait or urgent 97 (86.5%). Endoscopists were 18-week team 70(62.5%) followed by trust-employed consultant surgeons 26(23%). Four patients had repeat colonoscopies in last two years. 9(8%) scopes were modified or cancelled. Conclusion(s): Except for one scope, repeat scopes within two years had valid indications. Majority of the modified or cancelled scopes originated from telephone consultation referrals. Reasons for cancellation on the day included lack of fitness for scopy, ineffective bowel preparation, patient factor like uncontrolled atrial fibrillation on the day and no indication for colonoscopy. Modifications included switching from requests for flexible sigmoidoscopy to colonoscopy; colonoscopy to CTVC and vice versa. In light of this study, we aim to provide face-to-face appointments for patients referred through the urgent suspected cancer pathway. We plan to expand this study to evaluate the popularity of CTVC use as an alternative modality when colonoscopy is not possible.

DOI: 10.1093/bjs/znaf128.znaf128.438

Survey of the current experience of colonoscopy training for colorectal surgical trainees in the UK (2025)

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Type of publication:

Journal article

Author(s):

Siggens K.; Williams S.; Yiu A.; El Sayed C.; Fletcher J.; Mills S.; Yeadon K.; Reza L.; Rabie M.; Drami I.; Green S.; Tamanna R.; Couderq D.; Javanmard-Emamghissi H.; Argyriou O.; Okocha M.; Khasawneh F.; Kat-Zsummercorn A.; Shakir T.; Anya L.; Bramwell C.; Haji A.; Johnston R.; Joshi H.; Oliphant R.; Piramanayagam B.

Citation:

Frontline Gastroenterology. (no pagination), 2025. Date of Publication: 2025.[epub ahead of print]

Abstract:

Introduction: The primary aim was to understand the current experience of colonoscopy training among general surgical trainees with a subspeciality interest in colorectal surgery. Method(s): An electronic survey was developed and disseminated by members of the Dukes' Club (colorectal trainees network) and Association of Coloproctologists of Great Britain and Ireland colonoscopy subcommittee between February and April 2024 to assess key themes identified through formal and informal feedback from colorectal trainees of endoscopy training experience. Result(s): The survey was completed by 196 participants. This included 13.3% from core trainee (CT) 2-speciality trainee (ST) 4, 28.6% from ST5-ST6, 36.5% from ST7-ST8, 13.3% from post-certificate for completion of training fellows, senior clinical fellows and speciality and specialist (SAS) doctors and 8.7% from early years consultants. The median number of colonoscopies performed by respondents was 121.6 (range 0-8000). Only 33.7% (66/196) reported having one dedicated training list per week, and 56.6% (111/196) were not allocated to any regular training list. The barriers to training were service provision (71.9%), lack of dedicated training lists (69.9%) and access to training lists due to other trainees or healthcare professionals (42.3%). Only 25% of respondents had experience of immersion training, but they consistently reported high numbers of colonoscopy during these periods, with 40% achieving more than 30 colonoscopies. Conclusion(s): There is an urgent need to improve access to colonoscopy training. Regular endoscopy training lists and funding of academies and immersion training centrally are likely to greatly improve the experience of colonoscopy training. Senior colorectal trainees should be prioritised to avoid delay in the completion of training.

DOI: 10.1136/flgastro-2025-103106

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Survival outcomes in basaloid squamous cell carcinoma of the anorectal region: A Surveillance, Epidemiology, and End Results (SEER) database analysis (2025)

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Type of publication:

Conference abstract

Author(s):

*Arunachalam J.

Citation:

Annals of Oncology. Conference: The ESMO Gastrointestinal Cancers Congress. Barcelona Spain. 36(Supplement 1) (pp S87), 2025. Date of Publication: 01 Jul 2025.

Abstract:

Background: Basaloid squamous cell carcinoma (BSCC) of the anorectal region is a rare and aggressive variant of squamous cell carcinoma, arising primarily in the transitional zone of the anal canal and lower rectum. Historically referred to as cloacogenic carcinoma, BSCC is characterized by distinctive histological features. Chemoradiation remains the standard of care. Given its rarity, data on survival outcomes and demographic disparities are limited. We aimed to assess clinical characteristics and survival outcomes using a large U.S. population-based dataset. Method(s): We conducted a retrospective analysis using the SEER database (2000-2021) to identify patients with BSCC, defined by ICD codes 8083/3 and 8124/3, located in C21.0, C20.9, C21.1, C21.2, and C21.8. Variables extracted included age, sex, race, tumor stage, and treatments. Kaplan-Meier survival analyses were used to assess overall survival (OS) and cancer-specific survival (CSS). Group comparisons were evaluated using the log-rank test. Result(s): A total of 3,446 patients were identified. At diagnosis, 54% were under 65 years, 75% were female, and 80% were White. Metastatic disease was present in 11%. Median OS (mOS) was 120 months. The 1-, 3-, and 5-year CSS rates were 91.1%, 78.9%, and 73.3%, respectively; 10- and 20-year CSS rates were 67.4% and 61.5%. Male patients had poorer survival (mOS 66 months) compared to females (mOS 143 months; p < 0.0001; HR 1.595, 95% CI 1.420-1.791). Patients aged >=65 had a mOS of 72 months versus 219 months for those <65 (p < 0.0001; HR 2.124, 95% CI 1.926-2.342). Median OS by stage was 25 months (metastatic), 124 months (regional), and 175 months (localized) (p < 0.0001). Patients undergoing surgery had a mOS of 154 months, and those receiving radiation therapy had a mOS of 134 months. Lack of chemotherapy was associated with worse survival (mOS 50 months; HR 1.780, 95% CI 1.570-2.020; p < 0.0001). Race was not significantly associated with survival differences. Conclusion(s): Favorable outcomes were associated with younger age, female sex, early stage, and chemotherapy. Future studies should refine treatment strategies and explore targeted therapies in BSCC to guide precision medicine. Legal entity responsible for the study: The authors. Funding(s): Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

DOI: 10.1016/j.annonc.2025.05.230

Prognostic impact of microsatellite instability and survival disparities in rectal cancer: A SEER-based retrospective analysis (2025)

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Type of publication:

Conference abstract

Author(s):

*Arunachalam J.; Nabeta G.; Naagendran M.S.; Hegde U.;

Citation:

Annals of Oncology. Conference: The ESMO Gastrointestinal Cancers Congress. Barcelona Spain. 36(Supplement 1) (pp S97), 2025. Date of Publication: 01 Jul 2025.

Abstract:

Background: Microsatellite instability (MSI), a molecular marker of defective DNA mismatch repair (MMR), is observed in ~7% of rectal cancers. MSI-high (MSI-H) tumors, arising from sporadic or germline MMR deficiency, are highly responsive to immune checkpoint inhibitors. We aimed to evaluate the prognostic significance of MSI in rectal cancer in the era of immunotherapy and to explore demographic disparities in survival using real-world data from the U.S. Method(s): We analyzed data from the Surveillance, Epidemiology, and End Results (SEER) cancer database for patients diagnosed with rectal cancer between 2018 and 2021. We assessed cancer-specific survival (CSS) across MSI subtypes-MSI-H, MSI-low (MSI-L), and microsatellite stable (MSS)-and evaluated survival differences by age, gender, race, and stage. Analyses were performed using R. Kaplan-Meier curves visualized survival outcomes, and group comparisons were done using the log-rank test. <br/>Result(s): Among 17,487 patients, 3.6% were MSI-H (n=637), 1.9% MSI-L (n=332), and 94.5% MSS (n=16,518). Overall 1-year and 3-year CSS were 90% and 75%, respectively. In metastatic patients, median CSS (mCSS) was 25 months, increasing to 36 months in those with MSI-H tumors. By MSI status, 1- and 3-year CSS were 90.6% and 77.7% for MSI-H, 89.9% and 74.9% for MSS, and 84.8% and 68.6% for MSI-L (p=0.0087). Racial disparities were evident: 1- and 3-year CSS were 92% and 80% in White patients, 88% and 70% in Black patients, and 90% and 75% in Hispanic patients (p<0.0001). Age impacted survival significantly: 1- and 3-year CSS were 91% and 74% in patients <65 years vs. 86% and 61% in those >=65 (p<0.0001). Females had better long-term survival than males, with 3-year CSS under 80% for both, but significantly higher in females (p<0.0001). Conclusion(s): MSI-H status is associated with improved survival, reinforcing its role as a favorable prognostic biomarker in rectal cancer and highlighting the importance of routine MSI testing to guide treatment decisions. Worse outcomes among older adults, males, and Black patients reflect persistent disparities in rectal cancer care. These findings underscore the urgent need to identify and address the drivers of these differences to ensure equitable outcomes. Legal entity responsible for the study: The authors. Funding(s): Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

DOI: 10.1016/j.annonc.2025.05.261

Factors predicting conversion from colon capsule endoscopy to conventional optical endoscopy-findings from the CESCAIL study (2025)

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Type of publication:

Journal article

Author(s):

Lei, Ian Io; Parisi, Ioanna; Bhandare, Anirudh; Perez, Francisco Porras; Lee, Thomas; Shehkar, Chander; McStay, Mary; Anderson, Simon; Watson, Angus; Conlin, Abby; Badreldin, Rawya; Malik, Kamran; Jacob, John; Dixon, Andrew; *Butterworth, Jeffrey; Parsons, Nicholas; Koulaouzidis, Anastasios; Arasaradnam, Ramesh P.

Citation:

BMC Gastroenterology. 25(1):363, 2025 May 13.

Abstract:

BACKGROUND: Colon capsule endoscopy (CCE) has become an alternative to traditional colonoscopy for low-risk patients. However, CCE's low completion rate and inability to take biopsies or remove polyps often result in a CCE-to-conventional colonoscopy conversion (CCC).

OBJECTIVE(S): The aim is to identify the factors that predict issues with bowel cleansing, capsule excretion rates, pathology detection, and the need for CCC.

METHODS: This prospective study analysed data from patients who underwent CCE as part of the CESCAIL study from Nov 2021 till June 2024. Predictive factors were examined for their association with CCC, including patient demographics, comorbidities, medications, and laboratory results from symptomatic and surveillance groups. Statistical methods such as LASSO, linear, and logistic regression were applied.

RESULTS: Six hundred and three participants were analysed. Elevated f-Hb levels (OR = 1.48, 95% CI:1.18-1.86, p = 0.0002) and smoking (OR = 1.44, 95% CI: 1.01-2.11, p = 0.047) were significantly associated with CCC. The area under the curve (AUC) of elevated f-Hb for predicting CCC was 0.62 after adjusting for confounders. Diabetes was linked to poor bowel preparation (OR = 0.40, 95%CI:0.18-0.87, p = 0.022). Alcohol (p = 0.004), smoking (p = 0.003), psychological conditions (p = 0.001), and haemoglobin levels (p = 0.046) were significantly associated with the number of polyps, whilst antidepressants (p = 0.003) and beta-blockers (p = 0.001) were linked to the size of polyps.

CONCLUSION: Non-smokers with lower f-Hb levels are less likely to need conventional colonoscopy (CCC). Patient selection criteria are key to minimising the colonoscopy conversion rate. Our findings would benefit from validation in different populations to develop a robust CCE Conversion Scoring System (CECS) and ultimately improve the cost-effectiveness.

DOI: 10.1186/s12876-025-03828-9

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Robotic Versus Laparoscopic Approaches to Distal Pancreatectomy: Quality Assessment of the Current Evidence (2025)

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Type of publication:

Journal article

Author(s):

*Khan, Attam Ullah; Khan, Adan; Danial, Arbab.

Citation:

JCPSP, Journal of the College of Physicians & Surgeons – Pakistan. 35(5):628-635, 2025 May.

Abstract:

Pancreatic surgery, associated with technical difficulties and high complication rates, remains a challenge for surgeons. The laparoscopic approach has been shown to have benefits over the open approach; however laparoscopic distal pancreatectomy (LDP) still has its challenges. Robotic distal pancreatectomy (RDP) offers a technical edge over the laparoscopic approach in terms of superior imaging and ergonomics. Whether the technical advantages translate into improved outcomes is to be established. The aim of this study was to produce an overview of systematic reviews, summarising the evidence to date comparing RDP and LDP in terms of intraoperative, postoperative, and oncological outcomes and assessing the quality of the included reviews. Three electronic databases, PubMed, Embase, and Scopus, were searched to identify systematic reviews with meta-analyses comparing RDP with LDP. The AMSTAR-2 format was used to assess the quality of the studies. Fourteen systematic reviews were identified for inclusion. RDP had a significantly higher rate of spleen preservation, significantly shorter hospital stay, and a significantly lower rate of conversion to open surgery, whilst having higher total costs compared to LDP. The overall quality of the reviews was variable. The evidence suggests that RDP has potential advantages over LDP in terms of higher spleen preservation rate, shorter hospital stays, and lower conversion rate to open surgery, whilst maintaining comparability with most other outcomes. Based on the variable quality evidence, RDP is a safe alternative to LDP.

DOI: 10.29271/jcpsp.2025.05.628

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