Colonoscopy: The Current King of the Hill in the USA

Abstract

Colonoscopy is the dominant colorectal cancer screening strategy in the United States.There are no randomized controlled trials completed of screening colonoscopy, but multiple lines of evidence establish that colonoscopy reduces colorectal cancer incidence in both the proximal and distal colon. Colonoscopy is highly operator dependent, but systematic efforts to measure and improve quality are impacting performance.Colonoscopy holds a substantial advantage over other strategies for detection of serrated lesions, and a recent case-control study suggests that once-only colonoscopy or colonoscopy at 20 year intervals, by a high level detector, could ensure lifetime protection from colorectal cancer for many patients. 3Introduction and historical perspective on screening colonoscopy

Endoscopic Improvement of the Adenoma Detection Rate during Colonoscopy - Where Do We Stand in 2015?

“…Although colon cancer screening programs were initiated in the industrialized world, the risk of colon cancer development after a negative colonoscopy - defined as interval carcinomas - remains a problem yet to be addressed [2]. Therefore, improving the adenoma detection rate (ADR) during colonoscopy is the future key tool in preventing colorectal cancer mortality and morbidity [3].…”

Optical diagnosis of colorectal neoplasia: A Western perspective

“…Furthermore, NBI expertise was not strictly defined in the meta‐analysis conducted by the AGSE technology committee, and may have comprised substantial experience in academic centers, or more formal methods of assessment. Colonoscopy has a long history of operator dependence for clinical effectiveness, with multiple studies demonstrating wide variation in adenoma detection rates, a key quality metric of mucosal inspection . As with other aspects of colonoscopy practice, limiting the operator dependency of optical diagnosis will be important for widespread adoption in clinical practice.…”

“…Colonoscopy has a long history of operator dependence for clinical effectiveness, 69 with multiple studies demonstrating wide variation in adenoma detection rates, a key quality metric of mucosal inspection. 1,2,[70][71][72] As with other aspects of colonoscopy practice, limiting the operator dependency of optical diagnosis will be important for widespread adoption in clinical practice. Methods of achieving this need evaluation, as Digestive Endoscopy 2016; 28: 281-288…”

“…Despite the unrivalled capability of colonoscopy at reducing both colorectal cancer incidence (from the detection of precancerous polyps followed by endoscopic resection) and patient mortality (from the detection of early cancers followed by curative endoscopic resection or surgery), the clinical effectiveness of colonoscopy has been limited by its operator dependence and variation in performance . Optical diagnosis is an emerging paradigm for the management of diminutive polyps that promises to transform current colonoscopic practice with resulting benefits to health‐care systems.…”

“…D ESPITE THE UNRIVALLED capability of colonoscopy at reducing both colorectal cancer incidence (from the detection of precancerous polyps followed by endoscopic resection) and patient mortality (from the detection of early cancers followed by curative endoscopic resection or surgery), the clinical effectiveness of colonoscopy has been limited by its operator dependence and variation in performance. [1][2][3][4][5] Optical diagnosis is an emerging paradigm for the management of diminutive polyps that promises to transform current colonoscopic practice with resulting benefits to health-care systems. In the present review, we highlight the potential for optical diagnosis of colorectal neoplasia during colonoscopy to alleviate the rising costs of health care in the West, and describe the challenges of operator dependence that must be overcome before this paradigm is considered for widespread adoption in Western clinical practice.…”