Evolving Techniques in Colonoscopy

Vemulapalli, Krishna C.; Rex, Douglas K.

Disclosures

Curr Opin Gastroenterol. 2011;27(5):430-438. 

In This Article

Abstract and Introduction

Abstract

Purpose of review: This review summarizes recent clinical studies of colonoscopy technique and new technologies.
Recent findings: Water immersion reduces pain and sedation doses in unsedated and lightly sedated colonoscopy. Cap-fitted colonoscopy makes insertion faster and improves detection of lesions behind folds, but the latter effect is operator-dependent. A single controlled trial showed improved detection with the Third Eye Retroscope, but the two arms of the study were not controlled for withdrawal time. Chromoendoscopy increases detection of diminutive adenomas, but adds time to the colonoscopy procedure. Electronic chromoendoscopy methods (narrow band imaging, Fujinon Intelligent ChromoEndoscopy, i-scan, and autofluorescence) have been either unsuccessful in improving detection or require more study. However, these methods and several other methods (chromoendoscopy with magnification, confocal laser microscopy, and endocytoscopy) allow accurate real time determination of polyp histology.
Summary: Water immersion is a clear advance in unsedated colonoscopy. Cap-fitted colonoscopy is a promising method for both practical and effective visualization of the proximal sides of haustral folds. Electronic chromoendoscopy has been largely ineffective at improving polyp detection, but is effective (as are confocal laser microscopy and endocytoscopy) for diagnosis of polyp histology.

Introduction

Colonoscopy is the gold standard for colorectal imaging.[1,2] It is used around the world for evaluation of symptomatic patients, post cancer resection surveillance, post polypectomy surveillance, evaluation of positive screening tests[3,4,5••] and in the US, Germany, and Poland, for average-risk colorectal cancer (CRC) screening.[6] However, there is increased recognition of high level variation in detection of polyps and cancers[7,8] and successful cecal intubation.[9] The procedure is invasive, associated with complications, and with costs and risks of resecting insignificant distal colon hyperplastic polyps. Relatively poor protection against cancer in the right side of the colon has also been recently recognized.[10•,11,12]

Thus improvements in colonoscopy technique and technology are needed. The current article will review recent studies in colonoscope techniques and technologies. Recent studies are summarized in tables, and older studies can be identified in the reference list.[13–30] In order for a new technology to enter practice, it must be both effective and practical to use. Practical to use may be the most important criterion, as some technologies (e.g., wide angle colonoscopy, high definition optics) have become standard equipment on colonoscopes without clear evidence of efficacy.

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