Stasinos I, Voulgaris TA, Alexopoulos T, Karamanolis GP. Combining techniques and technologies increases adenoma detection rates in colonoscopy: More is more. World J Gastrointest Endosc 2025; 17(8): 107734 [DOI: 10.4253/wjge.v17.i8.107734]
Corresponding Author of This Article
Theodoros A Voulgaris, MD, PhD, Department of Endoscopy, 2nd Academic Surgical Unit, National and Kapodistrian University of Athens, Aretaieion Hospital, Vas Sofias 76, Athens 11528, Greece. thvoulgaris87@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Endosc. Aug 16, 2025; 17(8): 107734 Published online Aug 16, 2025. doi: 10.4253/wjge.v17.i8.107734
Combining techniques and technologies increases adenoma detection rates in colonoscopy: More is more
Ioannis Stasinos, Theodoros A Voulgaris, Theodoros Alexopoulos, Georgios P Karamanolis
Ioannis Stasinos, Department of Gastroenterology, 417 Army Equity Fund Hospital (NIMTS), Athens 11528, Greece
Theodoros A Voulgaris, Georgios P Karamanolis, Department of Endoscopy, 2nd Academic Surgical Unit, National and Kapodistrian University of Athens, Aretaieion Hospital, Athens 11528, Greece
Theodoros Alexopoulos, Department of Endoscopy, East Kent Hospital University, NHS Foundation Trust, East Kent CT91UJ, United Kingdom
Author contributions: Stasinos I, Voulgaris TA and Alexopoulos T wrote the initial draft; Karamanolis GP reviewed and finalized the manuscript; all of the authors read and approved the final version of the manuscript to be published.
Conflict-of-interest statement: There are no conflicts of interest.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Theodoros A Voulgaris, MD, PhD, Department of Endoscopy, 2nd Academic Surgical Unit, National and Kapodistrian University of Athens, Aretaieion Hospital, Vas Sofias 76, Athens 11528, Greece. thvoulgaris87@gmail.com
Received: March 28, 2025 Revised: April 29, 2025 Accepted: June 19, 2025 Published online: August 16, 2025 Processing time: 140 Days and 6.2 Hours
Abstract
Screening colonoscopy with adenoma removal is the gold standard strategy to reduce colorectal cancer (CRC) incidence. Nevertheless, it remains an imperfect tool as nearly Twenty-five percent of adenomas can be missed during inspection by experienced endoscopists. Missed lesions are one of the primary reasons for post colonoscopy CRC and are associated with a significant variability in adenoma detection rate (ADR), which is the most important quality indicator for colonoscopy. Increasing ADR unquestionably decreases carcinoma miss rate. Simple measures to improve ADR include among others slower withdrawal time and position change. The introduction of optical imaging innovations has improved mucosal visualization. Moreover, auxiliary devices attached to the colonoscope tip have been introduced, aiming to improve lumen visualization by flattening the folds and revealing lesions hidden in blind spots, thereby increasing ADR. Digital image analysis using artificial intelligence is the latest approach to polyp detection. All of the above approaches have been separately evaluated concerning their effect in ADR; however, it has not been thoroughly investigated whether any benefit exists from their combined use. We aim to review the available data on the efficacy of each technique/technology and whether their combination offers any additional benefit while remaining cost-effective.
Core Tip: Nowadays, no single measure has uniformly proven its efficacy in increasing the adenoma detection rate (ADR). Optical imaging innovations, auxiliary devices and computer-aided diagnosis systems may be of value when used by trainees and low detectors. Unfortunately, none of these have been able to increase the advanced ADR (AADR). Recent data from studies combining devices and technologies have shown increased ADRs, though failed to provide solid evidence that they increase AADR, especially among expert endoscopists. Data evaluating the combined efficacy of simple measures, such as a second look of the right colon, together with more advanced methods, are needed.
