Quality of colonoscopy and advances in detection of colorectal lesions: a current overview

Abstract

Colonoscopy is the gold standard for the detection of colorectal cancer and its precursors. Nevertheless multiple studies have demonstrated a significant miss-rate for polyps and, more importantly, demonstrated the occurrence of interval cancers in the years after colonoscopy. This imperfect protection against colorectal cancer can be explained by multiple factors related to both the endoscopist and the equipment. To ensure the quality of colonoscopy, several quality indicators have been described. These include bowel preparation, cecal intubation rate, withdrawal time, adenoma detection rate and complication rate. Measurement of these quality indicators, followed by awareness, benchmarking and additional training will hopefully optimize daily practice. If these basic quality parameters are well taken care of, advanced colonoscopic techniques will aim at further increasing the detection and differentiation of colonic lesions. In this review, the authors discuss the literature on quality indicators for colonoscopy and give a comprehensive overview of the advanced colonoscopic techniques currently available.

Keywords:

• advanced imaging
• colonic polyps
• colonoscopy
• colorectal cancer
• detection
• quality

Financial & competing interests disclosure

E Dekker and P Fockens have received research funding and have equipment on loan from Olympus. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• High-quality colonoscopy and optimal polyp detection depends on the endoscopist, the patient and the technique.

• Colonoscopy should be evaluated according to a predefined set of quality indicators.

• Currently, of all advanced imaging techniques, only chromoendoscopy increases ADR significantly compared to conventional white light endoscopy.

• Wide-view colonoscopy appears promising in improving ADR, but more research is needed.