EQUIPping ourselves for future quality improvements in colonoscopy.

Area of Science:

• Gastroenterology
• Oncology
• Cancer Prevention

Background:

• Colonoscopy is a key tool for colorectal cancer (CRC) screening, with an estimated 50% reduction in mortality.
• Current quality improvement initiatives primarily target the adenoma detection rate (ADR).
• While ADR improvements have been achieved, their sufficiency in reducing CRC is debated.

Discussion:

• The focus on ADR may overlook other significant pathways to CRC, such as the serrated pathway.
• Interval cancers, occurring after a negative colonoscopy, suggest limitations in current detection strategies.
• The serrated pathway is increasingly recognized as a critical contributor to post-colonoscopy CRC.

Key Insights:

• Improving ADR alone may not be sufficient to maximize the benefits of colonoscopy.
• Detecting and completely removing serrated lesions is crucial for reducing interval CRC.
• A balanced approach to quality improvement, encompassing both adenoma and serrated lesion detection, is warranted.

Outlook:

• Future research should evaluate the impact of serrated lesion detection and resection on CRC mortality.
• Developing standardized methods for identifying and managing serrated polyps during colonoscopy is essential.
• Enhanced training and quality metrics focusing on the serrated pathway could further optimize colonoscopy effectiveness.