New endoscopes and add-on devices to improve colonoscopy performance

Abstract

Colonoscopy is the gold standard for colorectal cancer prevention; however, it is still an imperfect modality. Precancerous lesions can be lost during screening examinations, thus increasing the risk of interval cancer. A variety of factors either patient-, or endoscopist dependent or even the procedure itself may contribute to loss of lesions. Sophisticated modalities including advanced technology endoscopes and add-on devices have been developed in an effort to eliminate colonoscopy’s drawbacks and maximize its ability to detect potentially culprit polyps. Novel colonoscopes aim to widen the field of view. They incorporate more than one cameras enabling simultaneous image transmission. In that way the field of view can expand up to 330°. On the other hand a plethora of add-on devices attachable on the standard colonoscope promise to detect lesions in the proximal aspect of colonic folds either by offering a retrograde view of the lumen or by straightening the haustral folds during withdrawal. In this minireview we discuss how these recent advances affect colonoscopy performance by improving its quality indicators (cecal intubation rate, adenoma detection rate) and other metrics (polyp detection rate, adenomas per colonoscopy, polyp/adenoma miss rate) associated with examination’s outcomes.

Is there a difference in adenoma detection rates between gastroenterologists and surgeons?

“…Utilising technological adjuncts to augment ADRs have been explored[ 29 , 30 ]. High definition imaging and selective application of dyes are not useful in increasing ADRs[ 29 , 31 ].…”

Influence of Simethicone Added to the Rinse Water during Colonoscopies on Polyp Detection Rates: Results of an Unintended Cohort Study

“…Many technical modifications have been trialled with regard to the polyp and adenoma detection rates [6]. While withdrawal time appears to be an important factor influencing polyp and adenoma detection rates [7], innovations of technology may have a small but significant effect on polyp and subsequent adenoma detection rates [6].…”

“…While withdrawal time appears to be an important factor influencing polyp and adenoma detection rates [7], innovations of technology may have a small but significant effect on polyp and subsequent adenoma detection rates [6]. Technological improvements include widened fields of view, incorporation of more than one camera that allows simultaneous image transmission or add-on attachable devices on standard colonoscopes that facilitate the detection of lesions in the proximal aspect of colonic folds [6]. As an example, a recent systematic review assessing the effects of Endocuff ® concluded that the use of this device significantly improved pre-cancerous polyp detection from 43.3 to 50.4% [8].…”

“…Many technical modifications have been trialled with regard to the polyp and adenoma detection rates [6]. While withdrawal time appears to be an important factor influencing polyp and adenoma detection rates [7], innovations of technology may have a small but significant effect on polyp and subsequent adenoma detection rates [6]. Technological improvements include widened fields of view, incorporation of more than one camera that allows simultaneous image transmission or add-on attachable devices on standard colonoscopes that facilitate the detection of lesions in the proximal aspect of colonic folds [6].…”

Colonoscopy attachments for the detection of precancerous lesions during colonoscopy: A review of the literature

“…Inadequate bowel preparation, lack of physician’s expertise, inability to accurately visualize the colonic mucosa located proximal to the haustral folds or in proximity to anatomic flexures have been listed among the main reasons such lesions can be missed during a colonoscopy[ 12 ]. Lately, several devices-ranging from complex endoscopic systems to simple plastic attachments- have been developed, in an attempt to address this problem[ 13 ]. They promise to flatten the mucosa during scope withdrawal and facilitate maneuverability around anatomic flexures offering meticulous mucosal visualization and detection of “hidden” lesions.…”