Screening colonoscopy: should we focus more on technique and less on technology?

Several large studies have confirmed that high quality colonoscopic surveillance can improve outcomes with substantial reduction in colorectal cancer rates. In order to improve outcomes from screening colonoscopy and help detect adenomas, the emphasis has been mainly on improvements in technology like high-resolution scopes, computerized as well as dye-based chromoendoscopy and wide-angle endoscopes. In addition to the equipment and technological innovation in the equipment used, a number of other factors like experience of the endoscopist, optimal withdrawal techniques, position changes during colonoscopy and bowel preparation can all influence adenoma detection and thereby the quality of colonoscopic surveillance. In this review we will focus on recent studies investigating these aspects of colonoscopy and their impact on adenoma or polyp detection.