Polyp detection at colonoscopy: Endoscopist and technical factors

Douglas K. Rex

Research output: Contribution to journalReview article

17 Scopus citations

Abstract

The adenoma detection rate (ADR) has emerged as the most important quality measure in colonoscopy, as it predicts the risk of interval cancer after colonoscopy. Measuring and improving ADR is the central focus of the current quality movement in colonoscopy. High ADRs can be achieved by a colonoscopist with a thorough understanding of the wide range of endoscopic appearances of precancerous lesions in the colorectum, effective bowel preparation, and meticulous technique using high definition colonoscopes. The knowledgeable and effective examiner needs no adjunctive devices or techniques to achieve master level ADRs. However, measurement reveals that many colonoscopists have ADRs that are below recommended minimum thresholds or below master levels. These colonoscopists, and even master level performers, can choose from a variety of adjunctive tools to improve ADR. This review describes these tools according to whether they are non-device methods (e.g. double right colon examination, patient position change, water exchange), mucosal exposure devices (wide angle colonoscopy, fold flattening devices), and lesion highlighting techniques (e.g. chromoendoscopy, electronic chromoendoscopy).

Original languageEnglish (US)
Pages (from-to)425-433
Number of pages9
JournalBest Practice and Research: Clinical Gastroenterology
Volume31
Issue number4
DOIs
StatePublished - Aug 2017

Keywords

  • Adenoma detection rate
  • Colon polyps
  • Colonoscopy
  • Colorectal cancer
  • Quality

ASJC Scopus subject areas

  • Gastroenterology

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