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Colonoscopy: new approaches to better outcomes

Coe, Susan G.; Wallace, Michael B.

Current Opinion in Gastroenterology: January 2012 - Volume 28 - Issue 1 - p 70–75
doi: 10.1097/MOG.0b013e32834ddab9
LARGE INTESTINE: Edited by Ciarán Kelly

Purpose of review Prevention of colorectal cancer relies on the detection and removal of colorectal neoplasia. Recent advances in mucosal imaging and inspection techniques have increased the detection of small and diminutive colorectal polyps with unknown clinical impact. The ability to accurately predict whether a polyp is neoplastic may allow for an optical triage approach to polyp management, improving efficiency while reducing the cost and risk of polypectomy.

Recent findings High-definition white light colonoscopy, cap-fitted colonoscopy, and dye-based pan-chromoendoscopy have each shown to increase polyp detection. Virtual chromoendoscopy, although not beneficial for polyp detection, allows for accurate in-vivo prediction of polyp pathology. Endoscopists’ behaviors, independent of patient factors, strongly influence adenoma detection. Training methods focused on the techniques of high adenoma detectors also increase adenoma and polyp detection.

Summary Advances in mucosal imaging and improvements in inspection technique have allowed us to detect more polyps and to predict their pathology with greater accuracy. An optical triage approach to either ‘diagnose and discard’ or ‘diagnose and leave behind’ has the potential to reduce the risk and cost of polypectomy.

Department of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA

Correspondence to Michael B. Wallace, MD, MPH, Professor of Gastroenterology, Chair, Department of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL 32224, USA. Tel: +1 904 953 7382; e-mail:

© 2012 Lippincott Williams & Wilkins, Inc.