New technologies and techniques to improve adenoma detection in colonoscopy

Abstract

Adenoma detection rate (ADR) is a key component of colonoscopy quality assessment, with a direct link between itself and future mortality from colorectal cancer. There are a number of potential factors, both modifiable and non-modifiable that can impact upon ADR. As methods, understanding and technologies advance, so should our ability to improve ADRs, and thus, reduce colorectal cancer mortality. This article will review new technologies and techniques that improve ADR, both in terms of the endoscopes themselves and adjuncts to current systems. In particular it focuses on effective techniques and behaviours, developments in image enhancement, advancement in endoscope design and developments in accessories that may improve ADR. It also highlights the key role that continued medical education plays in improving the quality of colonoscopy and thus ADR. The review aims to present a balanced summary of the evidence currently available and does not propose to serve as a guideline.

Keywords: Colorectal cancer; Adenoma detection; New technology; Techniques; Colonoscopy

Core tip: The most important quality indicator in colonoscopy is Adenoma detection rate. It is associated with outcomes from colorectal cancer, with low detection rates being associated with increased mortality and poor outcomes. Whilst a number of technologies are emerging to improve adenoma detection rate (ADR), at present, it seems that education, team work and optimising current practice will provide the biggest gains in ADR whilst maintaining financial acceptability.