For high-level detectors at colonoscopy, forward-viewing HD instruments dominate the FUSE system, indicating that for these examiners image resolution trumps angle of view. Further, Endocuff is a dominant strategy over EndoRings and no mucosal exposure device on a forward-viewing HD colonoscope. (Clinical trial registration number: NCT02345889.).

The prevalence of cancer in small and diminutive polyps is relevant to "resect and discard" and CT colonography reporting recommendations.We evaluated a prospectively collected colonoscopy polyp database to identify polyps < 10 mm and those with cancer or advanced histology (high-grade dysplasia or villous elements)Of 32,790 colonoscopies, 15,558 colonoscopies detected 42,630 polyps < 10 mm in size. A total of 4,790 lesions were excluded as they were not conventional adenomas or serrated class lesions.There were 23,524 conventional adenomas < 10 mm of which 22,952 were tubular adenomas.There were 14,316 serrated class lesions of which 13,589 were hyperplastic polyps and the remainder were sessile serrated polyps. Of all conventional adenomas, 96 had high-grade dysplasia including 0.3% of adenomas ≤ 5 mm in size and 0.8% of adenomas 6-9 mm in size. Of all conventional adenomas, 2.1% of those ≤ 5 mm in size and 5.6% of those 6-9 mm in size were advanced. Among 36,107 polyps ≤ 5 mm in size and 6,523 polyps 6-9 mm in size, there were no cancers.These results support the safety of resect and discard as well as current CT colonography reporting recommendations for small and diminutive polyps.

Current recommendations are to calculate the adenoma detection rate (ADR) in screening colonoscopies only. The need to confine the measure to screening has not been established. We retrospectively assessed our quality database for whether calculating ADR from screening, surveillance, and diagnostic colonoscopies (overall ADR) would alter conclusions about the performance of colonoscopists, compared to using an ADR based only on screening colonoscopies. We also prospectively tested the extent to which one physician could corrupt the screening-only ADR by changing the procedure indication after reviewing the examination findings. For 15 physicians, screening ADRs differed from the overall ADR by a mean of 2.6 percentage points (range 0 - 6.9 percentage points). Using the overall ADR rather than screening ADR changed the ADR from just below to just above the recommended screening threshold for one physician. In the prospective assessment, a single expert colonoscopist utilized indication gaming in patients with both screening and diagnostic indications and was able to increase his apparent screening-only ADR from 48.4 % to 55.1 %. Use of an overall ADR rather than screening-only ADR could simplify ADR measurement, increase the number of examinations available to measure ADR, seldom affect whether a doctor meets recommended ADR thresholds, and eliminate the potential for gaming the ADR by changing the colonoscopy indication.

No abstract

Background and Aims

Please cite this article as: Ponugoti P, Lin J, Odze R, Snover D, Kahi C, Rex DK, Prevalence of sessile serrated adenoma/polyp in hyperplastic appearing diminutive rectosigmoid polyps, Gastrointestinal Endoscopy (2016),

Despite being 10 years older, persons with a screening colonoscopy with negative results 10 years earlier had lower rates of adenoma and advanced neoplasm at the second screening examination compared with patients in the same practice undergoing a first screening colonoscopy, and they had no cancers. The fraction of advanced neoplasms that were proximal to the sigmoid colon was high in both first and second screenings. These results support the safety of the recommended 10-year interval between colonoscopies in average-risk persons with an initial examination with negative results.

Underwater EMR is effective and safe and does not require submucosal injection. Here, we describe the first perforation during underwater EMR.A 62-year-old man had a 30-mm flat lesion in the proximal ascending colon visible only in retroflexion. It appeared that submucosal injection would move it too close to the colonoscope tip to permit easy therapy. During underwater EMR, transection of the first piece resulted in perforation ( The patient remained asymptomatic (he was afebrile and his white blood cell count was normal).Because the EMR was not completed, right hemicolectomy was performed 30 hours later. The perforation was adjacent to pericolonic fat, without peritoneal contamination. After primary anastomosis, the patient's recovery was uneventful. D.K.R. performed >30 underwater EMRs of lesions >2 cm before and >20 after this perforation, all without adverse events. We believe this perforation was caused by the retroflexed instrument stretching the colon wall, preventing the lesion from floating. Fortunately, water did not enter the peritoneal cavity. Caution is appropriate when performing underwater EMR in retroflexion. Colonoscopists performing underwater EMR should look for the lesion floating as a safety predictor.