Advances in colonoscope technique and technology.

To date, no alternative platform for colonoscopy seems prepared to substantially supplant the traditional colonoscopy platform. The Invendoscope and capsule colonoscopy are the most promising of the alternative platforms. With regard to colonoscope insertion, water immersion is quite noteworthy but requires additional study in broader populations. The benefits of cap-fitted colonoscopy for insertion are small. With regard to imaging, wide-angle colonoscopy may produce an operator-dependent improvement in efficiency, but there is no consistent evidence that it improves adenoma detection. Similarly, cap-fitted colonoscopy is not convincing as a method to improve adenoma detection. There is no method for seeing flat lesions that is both effective and practical for high-level white light adenoma detectors. Narrow-band imaging may have a learning effect on low-level adenoma detectors, and autofluorescence seems promising and deserves additional study. Several methods for determination of real-time histology are promising and seem to be methods by which the cost-effectiveness of colonoscopy could be improved through reduction in pathology charges for diminutive polyps.