New Developments in Colonoscopy

Abstract

Colonoscopy has revolutionised our understanding and management of colorectal disease by providing direct, in vivo, colour images of the mucosal surface. In expert hands the procedure can be performed with little or no sedation and can inspect the entire colorectal mucosa with up to 50 cm of the terminal ileum in 95%–99% of patients. Most importantly it also provides biopsy diagnosis and access for direct therapy, which often precludes the need for surgery. The all-round capability of the procedure makes it the optimal investigation for suspected colonic neoplasia, colonic bleeding, suspected inflammatory mucosal disease and for surveillance of those at increased risk for colorectal cancer. Radiologists should be aware that conventional colonoscopy is constantly developing as a technique. Recent developments have seen better instruments that are easier to pass to the caecum and better visualisation and identification of mucosal abnormalities thus increasing diagnostic accuracy. Colonoscopy provides internal access for therapy and is enabling a new form of minimally invasive surgery with endoscopic resection of very large polyps, early cancers, treatment of colonic stenoses with dilatation and stenting and mucosal ablation to treat bleeding lesions.