Skip to main content

Advertisement

SpringerLink
Log in

Can Technology Improve the Quality of Colonoscopy?

  • GI Oncology (R Bresalier, Section Editor)
  • Published:
Current Gastroenterology Reports Aims and scope Submit manuscript

Abstract

In order for screening colonoscopy to be an effective tool in reducing colon cancer incidence, exams must be performed in a high-quality manner. Quality metrics have been presented by gastroenterology societies and now include higher adenoma detection rate targets than in the past. In many cases, the quality of colonoscopy can often be improved with simple low-cost interventions such as improved procedure technique, implementing split-dose bowel prep, and monitoring individuals’ performances. Emerging technology has expanded our field of view and image quality during colonoscopy. We will critically review several technological advances in the context of quality metrics and discuss if technology can really improve the quality of colonoscopy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Corley DA, Jensen CD, Marks AR, et al. Adenoma detection rate and risk of colorectal cancer and death. N Engl J Med. 2014;370:1298–306. This work helped strengthen the correlation between ADR and risk of colon cancer.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Kaminski MF, Regula J, Kraszewska E, et al. Quality indicators for colonoscopy and the risk of interval cancer. N Engl J Med. 2010;362:1795–803.

    Article  CAS  PubMed  Google Scholar 

  3. Barclay RL, Vicari JJ, Greenlaw RL. Effect of a time-dependent colonoscopic withdrawal protocol on adenoma detection during screening colonoscopy. Clin Gastroenterol Hepatol. 2008;6:1091–8.

    Article  PubMed  Google Scholar 

  4. Bretagne JF, Hamonic S, Piette C, et al. Variations between endoscopists in rates of detection of colorectal neoplasia and their impact on a regional screening program based on colonoscopy after fecal occult blood testing. Gastrointest Endosc. 2010;71:335–41.

    Article  PubMed  Google Scholar 

  5. Chen SC, Rex DK. Endoscopist can be more powerful than age and male gender in predicting adenoma detection at colonoscopy. Am J Gastroenterol. 2007;102:856–61.

    Article  PubMed  Google Scholar 

  6. Millan MS, Gross P, Manilich E, et al. Adenoma detection rate: the real indicator of quality in colonoscopy. Dis Colon Rectum. 2008;51:1217–20.

    Article  PubMed  Google Scholar 

  7. Ross WA, Thirumurthi S, Lynch PM, et al. Detection rates of premalignant polyps during screening colonoscopy: time to revise quality standards? Gastrointest Endosc. 2015;81:567–74.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Rex DK, Schoenfeld PS, Cohen J, et al. Quality indicators for colonoscopy. Gastrointest Endosc. 2015;81:31–53. ASGE task force publication outlining the quality metrics for screening colonoscopy.

    Article  PubMed  Google Scholar 

  9. Powell N, Hayee BH, Yeoh DP, et al. Terminal ileal photography or biopsy to verify total colonoscopy: does the endoscope agree with the microscope? Gastrointest Endosc. 2007;66:320–5.

    Article  PubMed  Google Scholar 

  10. Benson ME, Reichelderfer M, Said A, et al. Variation in colonoscopic technique and adenoma detection rates at an academic gastroenterology unit. Dig Dis Sci. 2010;55:166–71.

    Article  PubMed  Google Scholar 

  11. Lee TJ, Blanks RG, Rees CJ, et al. Longer mean colonoscopy withdrawal time is associated with increased adenoma detection: evidence from the Bowel Cancer Screening Programme in England. Endoscopy. 2013;45:20–6.

    Article  CAS  PubMed  Google Scholar 

  12. East JE, Stavrindis M, Thomas-Gibson S, et al. A comparative study of standard vs. high definition colonoscopy for adenoma and hyperplastic polyp detection with optimized withdrawal technique. Aliment Pharmacol Ther. 2008;28:768–76.

    Article  CAS  PubMed  Google Scholar 

  13. Rastogi A, Early DS, Gupta N, et al. Randomized, controlled trial of standard-definition white-light, high-definition white-light, and narrow-band imaging colonoscopy for the detection of colon polyps and prediction of polyp histology. Gastrointest Endosc. 2011;74:593–602.

    Article  PubMed  Google Scholar 

  14. Pellise M, Fernandez-Esparrach G, Cardenas A, et al. Impact of wide-angle, high-definition endoscopy in the diagnosis of colorectal neoplasia: a randomized controlled trial. Gastroenterology. 2008;135:1062–8.

    Article  PubMed  Google Scholar 

  15. Tribonias G, Theodoropoulou A, Konstantinidis K, et al. Comparison of standard vs high-definition, wide-angle colonoscopy for polyp detection: a randomized controlled trial. Colorectal Dis. 2010;12:e260–6.

    Article  CAS  PubMed  Google Scholar 

  16. Adler A, Aminalai A, Aschenbeck J, et al. Latest generation, wide-angle, high-definition colonoscopes increase adenoma detection rate. Clin Gastroenterol Hepatol. 2012;10:155–9.

    Article  PubMed  Google Scholar 

  17. Fatima H, Rex DK, Rothstein R, et al. Cecal insertion and withdrawal times with wide-angle versus standard colonoscopes: a randomized controlled trial. Clin Gastroenterol Hepatol. 2008;6:109–14.

    Article  PubMed  Google Scholar 

  18. Gralnek IM, Siersema PD, Halpern Z, et al. Standard forward-viewing colonoscopy versus full-spectrum endoscopy: an international, multicentre, randomised, tandem colonoscopy trial. Lancet Oncol. 2014;15:353–60.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Hassan C, Gralnek IM. Cost-effectiveness of “full spectrum endoscopy” colonoscopy for colorectal cancer screening. Dig Liver Dis. 2015;47:390–4.

    Article  PubMed  Google Scholar 

  20. Waye JD, Heigh RI, Fleischer DE, et al. A retrograde-viewing device improves detection of adenomas in the colon: a prospective efficacy evaluation (with videos). Gastrointest Endosc. 2010;71:551–6.

    Article  PubMed  Google Scholar 

  21. Leufkens AM, DeMarco DC, Rastogi A, et al. Effect of a retrograde-viewing device on adenoma detection rate during colonoscopy: the TERRACE study. Gastrointest Endosc. 2011;73:480–9.

    Article  PubMed  Google Scholar 

  22. DeMarco DC, Odstrcil E, Lara LF, et al. Impact of experience with a retrograde-viewing device on adenoma detection rates and withdrawal times during colonoscopy: the Third Eye Retroscope study group. Gastrointest Endosc. 2010;71:542–50.

    Article  PubMed  Google Scholar 

  23. Rubin M, Lurie L, Bose K, et al. Expanding the view of a standard colonoscope with the Third Eye Panoramic cap. World J Gastroenterol. 2015;21:10683–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. de Wijkerslooth TR, Stoop EM, Bossuyt PM, et al. Adenoma detection with cap-assisted colonoscopy versus regular colonoscopy: a randomised controlled trial. Gut. 2012;61:1426–34.

    Article  PubMed  Google Scholar 

  25. Pohl H, Bensen SP, Toor A, et al. Cap-assisted colonoscopy and detection of Adenomatous Polyps (CAP) study: a randomized trial. Endoscopy. 2015;47:891–7. Reference supporting the use of the distal cap attachment in improving ADR.

    Article  PubMed  Google Scholar 

  26. Rastogi A, Bansal A, Rao DS, et al. Higher adenoma detection rates with cap-assisted colonoscopy: a randomised controlled trial. Gut. 2012;61:402–8.

    Article  PubMed  Google Scholar 

  27. Rzouq F, Gupta N, Wani S, et al. Cap assisted colonoscopy for the detection of serrated polyps: a post-hoc analysis. BMC Gastroenterol. 2015;15:11.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Floer M, Biecker E, Fitzlaff R, et al. Higher adenoma detection rates with endocuff-assisted colonoscopy—a randomized controlled multicenter trial. PLoS One. 2014;9:e114267.

    Article  PubMed  PubMed Central  Google Scholar 

  29. van Doorn SC, van der Vlugt M, Depla A, et al. Adenoma detection with Endocuff colonoscopy versus conventional colonoscopy: a multicentre randomised controlled trial. Gut 2015.

  30. Biecker E, Floer M, Heinecke A, et al. Novel endocuff-assisted colonoscopy significantly increases the polyp detection rate: a randomized controlled trial. J Clin Gastroenterol. 2015;49:413–8.

    Article  PubMed  Google Scholar 

  31. Khiani VS, Soulos P, Gancayco J, et al. Anesthesiologist involvement in screening colonoscopy: temporal trends and cost implications in the medicare population. Clin Gastroenterol Hepatol. 2012;10:58–64. e1.

    Article  PubMed  Google Scholar 

  32. Wernli KJ, Brenner AT, Rutter CM, et al. Risks associated with anesthesia services during colonoscopy. Gastroenterology 2015.

  33. Hayashi N, Tanaka S, Hewett DG, et al. Endoscopic prediction of deep submucosal invasive carcinoma: validation of the Narrow-Band Imaging International Colorectal Endoscopic (NICE) classification. Gastrointest Endosc. 2013;78:625–32. Endoscopists performing colonoscopy & polypectomy should be familiar with the NICE classification system.

    Article  PubMed  Google Scholar 

  34. Kahi CJ, Anderson JC, Waxman I, et al. High-definition chromocolonoscopy vs. high-definition white light colonoscopy for average-risk colorectal cancer screening. Am J Gastroenterol. 2010;105:1301–7.

    Article  PubMed  Google Scholar 

  35. Brown SR, Baraza W. Chromoscopy versus conventional endoscopy for the detection of polyps in the colon and rectum. Cochrane Database Syst Rev 2010:CD006439. Chromoendoscopy can improve ADR

  36. Leung JW, Ransibrahmanakul K, Toomsen L, et al. The water method combined with chromoendoscopy enhances adenoma detection. J Interv Gastroenterol. 2011;1:53–8.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Dinesen L, Chua TJ, Kaffes AJ. Meta-analysis of narrow-band imaging versus conventional colonoscopy for adenoma detection. Gastrointest Endosc. 2012;75:604–11.

    Article  PubMed  Google Scholar 

  38. Nagorni A, Bjelakovic G, Petrovic B. Narrow band imaging versus conventional white light colonoscopy for the detection of colorectal polyps. Cochrane Database Syst Rev 2012;1:CD008361.

  39. Pasha SF, Leighton JA, Das A, et al. Comparison of the yield and miss rate of narrow band imaging and white light endoscopy in patients undergoing screening or surveillance colonoscopy: a meta-analysis. Am J Gastroenterol. 2012;107:363–70. quiz 371.

    Article  PubMed  Google Scholar 

  40. Cadoni S, Gallittu P, Sanna S, et al. A two-center randomized controlled trial of water-aided colonoscopy versus air insufflation colonoscopy. Endoscopy. 2014;46:212–8.

    Article  PubMed  Google Scholar 

  41. Hafner S, Zolk K, Radaelli F, et al. Water infusion versus air insufflation for colonoscopy. Cochrane Database Syst Rev. 2015;5:CD009863.

    PubMed  Google Scholar 

  42. Yen AW, Leung JW, Leung FW. A novel method with significant impact on adenoma detection: combined water-exchange and cap-assisted colonoscopy. Gastrointest Endosc. 2013;77:944–8.

    Article  PubMed  Google Scholar 

  43. Triantafyllou K, Tziatzios G, Sioulas AD, et al. Diagnostic yield of scope retroflexion in the right colon: a prospective cohort study. Dig Liver Dis. 2016;48:176–81.

    Article  PubMed  Google Scholar 

  44. Chandran S, Parker F, Vaughan R, et al. Right-sided adenoma detection with retroflexion versus forward-view colonoscopy. Gastrointest Endosc. 2015;81:608–13.

    Article  PubMed  Google Scholar 

  45. Kushnir VM, Oh YS, Hollander T, et al. Impact of retroflexion vs. second forward view examination of the right colon on adenoma detection: a comparison study. Am J Gastroenterol. 2015;110:415–22.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Clark BT, Parikh ND, Laine L. Yield of repeat forward-view examination of the right side of the colon in screening and surveillance colonoscopy. Gastrointest Endosc 2016. Jan 6 Epub ahead of print. PMID:26769408. A repeat second forward look can improve ADR

  47. Brenner H, Chang-Claude J, Jansen L, et al. Role of colonoscopy and polyp characteristics in colorectal cancer after colonoscopic polyp detection: a population-based case-control study. Ann Intern Med. 2012;157:225–32.

    Article  PubMed  Google Scholar 

  48. Robertson DJ, Lieberman DA, Winawer SJ, et al. Colorectal cancers soon after colonoscopy: a pooled multicohort analysis. Gut. 2014;63:949–56.

    Article  PubMed  Google Scholar 

  49. Lee SW, Chang JH, Ji JS, et al. Effect of dynamic position changes on adenoma detection during colonoscope withdrawal: a randomized controlled multicenter trial. Am J Gastroenterol. 2016;111:63–9.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The John Stroehlein Distinguished Professorship supported part of this work.

Author information

Authors and Affiliations

  1. Department of Gastroenterology, Hepatology & Nutrition, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA

    Selvi Thirumurthi, William A. Ross & Gottumukkala S. Raju

Authors
  1. Selvi Thirumurthi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. William A. Ross
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gottumukkala S. Raju
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Selvi Thirumurthi.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on GI Oncology

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Thirumurthi, S., Ross, W.A. & Raju, G.S. Can Technology Improve the Quality of Colonoscopy?. Curr Gastroenterol Rep 18, 38 (2016). https://doi.org/10.1007/s11894-016-0505-1

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11894-016-0505-1

Keywords

Search

Navigation