Advances in colonoscopy.

There is intense interest in optimizing currently available colonoscopy techniques and developing new methods to improve early detection and prevention of colorectal cancer. These improvements apply to many aspects of colonoscopy, including screening effectiveness, reduced pain and complications, in vivo lesion classification, and easier insertion methods. Inherent characteristics of colonoscopy such as blind spots, residual stool, colonic contractions, and the subtle nature of some polyps present challenges to colonoscopic effectiveness. With the advent of several promising techniques, these issues are being addressed. Wide-angle colonoscopes, retroflexion, and water immersion technique are methods that have been developed. Concurrently, there is a need to reduce complications and improve patient acceptance and comfort. The education of endoscopists has appropriately focused on awareness of potential complications, with recent advances in the ability to manage complications such as bleeding and perforation. Despite its effectiveness, there are key opportunities to further improve colonoscopy including reducing the cost, improving the quality and tolerance of bowel preparation, and upgrading variance in detection and removal of polyps.