Standard screening high-definition colonoscopy without any optimization device is no longer relevant: Time to move to...

Area of Science:

• Gastroenterology and Endoscopy
• Cancer Screening Technologies
• Clinical Practice Improvement

Background:

• Adenoma Detection Rate (ADR) is a key metric for colorectal cancer (CRC) screening effectiveness, directly impacting post-colonoscopy CRC risk.
• High-definition white light imaging (HD-WLI) colonoscopy is the current standard, but its limitations in ADR optimization are well-documented.

Discussion:

• Numerous studies demonstrate that optimization devices (e.g., caps, CAD, contrast enhancement) significantly improve ADR.
• These technologies offer complementary benefits, suggesting a synergistic approach to enhance detection capabilities.
• Despite consistent evidence, clinical practice lags, with standard HD-WLI often used without any supplementary tools.

Key Insights:

• The inverse relationship between ADR and post-colonoscopy CRC risk underscores the need for improved detection methods.
• Optimization devices have consistently shown positive impacts on ADR across various studies.
• A significant gap exists between research findings and the routine adoption of advanced colonoscopy technologies.

Outlook:

• Investigating the barriers to widespread adoption of ADR-enhancing technologies is essential for clinical practice change.
• Re-evaluating the relevance of standard HD-WLI colonoscopy in 2024, considering the availability of superior, evidence-based alternatives.
• Future efforts should focus on integrating proven optimization devices into routine CRC screening protocols to maximize patient benefit.