Advanced colorectal polyp detection techniques.

A long-term follow-up of the landmark National Polyp Study recently showed that colonoscopy was associated with critical clinical benefit, including reduced overall death rate, colorectal cancer (CRC) death rate, and CRC incidence Zauber et al. (N Engl J Med 366(8):687-96, 2012). This and other recent studies emphasize the need for high-quality colonoscopy to realize maximal benefit. Adenoma detection has emerged as an important predictor of quality colonoscopy. Studies from Europe have shown that individuals whose colonoscopy was performed by a physician with high adenoma detection have a much lower likelihood of interval CRC. Studies now suggest that it is possible to train endoscopists to improve their adenoma detection rate. The specific methods associated with higher quality colonoscopy include careful inspection behind folds, washing the colon surface, adequate insufflation, and recognition of subtle flat polyps. Use of high-definition white light colonoscopy, chromoendoscopy, and cap-fitted colonoscopy has also been studied as potential methods for increasing adenoma detection. We will review these methods and techniques in this article.