Advanced Colonoscopy, Polypectomy, and Colonoscopic Imaging

Douglas K. Rex

Research output: Chapter in Book/Report/Conference proceedingChapter


Technically difficult colonoscope insertions can generally be categorized as either a very difficult sigmoid or a redundant colon. These categories guide instrument selection and the technical approach to achieving cecal intubation. Endoscopic mucosal dissection is the newest approach to endoscopic resection of colorectal polyps, but is rarely used in the United States, where piecemeal polypectomy is still preferred. The Third-Eye Retroscope produced a 12% gain in adenoma detection in an initial uncontrolled study. Wide-angle colonoscopy and cap-fitted colonoscopy have been studied more, and have generally not been useful increasing adenoma detection. Likewise, although chromoendoscopy produces small gains in small adenoma detection, the more practical electronic forms of highlighting polyps (e.g. narrow band imaging) have not successfully increased adenoma detection. A variety of imaging methods, including confocal laser microscopy, endocytoscopy, narrow band imaging, Fujinon Intelligent Chromo Endoscopy and the Pentax I-Scan, allow real time differentiation of polyp histology, at least adenomatous vs. hyperplastic histology.

Original languageEnglish (US)
Title of host publicationPractical Gastroenterology and Hepatology
Subtitle of host publicationSmall and Large Intestine and Pancreas
Number of pages5
ISBN (Print)9781405182744
StatePublished - Aug 31 2010


  • Colonoscopy
  • Colorectal polyp
  • Confocal laser microscopy
  • Endocystoscopy
  • Endoscopic submucosal dissection
  • Narrow-band imaging
  • Polypectomy
  • Water immersion

ASJC Scopus subject areas

  • Medicine(all)

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  • Cite this

    Rex, D. K. (2010). Advanced Colonoscopy, Polypectomy, and Colonoscopic Imaging. In Practical Gastroenterology and Hepatology: Small and Large Intestine and Pancreas (pp. 53-57). Wiley-Blackwell.