What Influences the Quality of Prevention Colonoscopy?

Abstract

KeywordsColonoscopy · Colonoscopy methods · Water-aided colonoscopy · Cap-assisted colonoscopy · Carbon dioxide insufflation · Colorectal neoplasms · Mass screening Summary Background: Colorectal cancer still has a high incidence and mortality. Although colonoscopy is considered as gold standard of colorectal cancer screening, there still exists an unsatisfactory level of adenomas missed in screening and surveillance colonoscopy. Furthermore, patients bear the burden of potentially unpleasant and painful examination and preparation procedures. Method: A search of the literature using PubMed was carried out, supplemented by a review of the programs of the Digestive Disease Week (DDW) and the United European Gastroenterology Week (UEGW) 2011-2013. Results: Several new approaches to colonoscopy were described: water, CO 2 and cap colonoscopy, and application of spasmolytics such as hyoscine butylbromide and glucagon. The use of these methods does not necessitate the purchase of new endoscopes. They are feasible and safe, facilitate achieving the aim of more comfort and less pain, and perhaps allow lower doses of sedatives to be used. However, a clear effect on procedure time is lacking. Furthermore, the published data do not consistently answer the question of whether these techniques have a positive impact on the most important goal, the better detection of carcinoma precursors. Conclusion: More efforts to optimize bowel preparation have to be made to improve visualization of the mucosal surface. The most reliable criteria for the quality of screening and surveillance colonoscopy remain a minimum cecal intubation rate of >90%, a withdrawal time of at least 6 or better 9 min, and an adenoma detection rate of >20%. These results should be achieved with a complication rate lower than 1%, including polypectomy. Schlüsselwörter

The Role of Behind Folds Visualizing Techniques and Technologies in Improving Adenoma Detection Rate

“…There are also some limitations, related to both our review and the individual studies. First, we decided to exclude a significant number of studies because older versions of the Endocuff and EndoRings were used, full-text peer-reviewed papers were not available, or studies were published in the non-English literature, such as studies in the German [41][42][43][44], Italian [45], Japanese [46], Korean [47][48][49], and Spanish [50] languages. Having excluded these studies may have led to selection bias and a lower generalizability of our results.…”

Does the withdrawal time affect adenoma detection in non-screening colonoscopies?

“…A slower withdrawal may suggest that the clinician had time to adequately inspect the entire mucosa—any quicker may lead to some areas not adequately examined. Methods have been adopted to improve mucosal visualisation, such as repositioning of the patient, rectal retroflexion, adequate insufflation and suctioning were found to extend both the CWT and ADR simultaneously 11 15…”