Polyp detection at colonoscopy: Endoscopist and technical factors.

Area of Science:

• Gastroenterology
• Endoscopy
• Cancer Prevention

Background:

• Adenoma detection rate (ADR) is the primary quality metric in colonoscopy, predicting post-procedure interval cancer risk.
• Improving ADR is a key focus of current colonoscopy quality initiatives.
• High ADR requires understanding lesion appearances, optimal bowel prep, and meticulous technique with high-definition scopes.

Purpose of the Study:

• To review adjunctive tools and techniques for improving adenoma detection rates (ADR) in colonoscopy.
• To categorize methods that assist endoscopists in achieving higher ADR.
• To provide options for both underperforming and high-performing endoscopists to enhance lesion detection.

Main Methods:

• Categorization of adjunctive tools into non-device methods, mucosal exposure devices, and lesion highlighting techniques.
• Review of techniques such as double right colon examination, patient position change, water exchange, wide-angle colonoscopy, fold flattening devices, and chromoendoscopy (including electronic variants).

Main Results:

• While skilled endoscopists can achieve high ADR without aids, many fall below desired thresholds.
• A variety of adjunctive tools and techniques are available to improve ADR.
• These methods range from simple maneuvers to advanced optical and device-based solutions.

Conclusions:

• Endoscopists can improve their adenoma detection rate (ADR) through various adjunctive methods.
• These tools offer valuable support for enhancing colonoscopic surveillance and reducing interval cancers.
• Both novice and experienced practitioners can benefit from exploring these techniques to optimize ADR.