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Advances in diagnostic and therapeutic colonoscopy

Gómez, Victoria; Wallace, Michael B.

Current Opinion in Gastroenterology: January 2014 - Volume 30 - Issue 1 - p 63–68
doi: 10.1097/MOG.0000000000000026
LARGE INTESTINE: Edited by Ciarán P. Kelly

Purpose of review We review current studies on endoscopic and technologic advances for the detection and treatment of colorectal neoplasia.

Recent findings Improvements in adenoma detection have been shown to be possible with the use of high definition white light as well as water-related methods such as water exchange. Use of cap assist colonoscopy, when combined with water-related methods, has recently been shown to also improve the detection of adenomas. Narrow band imaging and confocal laser endomicroscopy may have an advantage of offering endoscopists the ability to make an ‘optical diagnosis’ with the possibility of discarding nonadenomatous tissue. Furthermore, educational interventions aimed at improving adenoma detection may have lasting effects on endoscopists’ adenoma detection rates. Lastly, endoscopic mucosal resection and endoscopic submucosal dissection are being applied for the treatment of large colorectal polyps, obviating the need for surgery in most instances. However, further studies are needed to establish the optimal methods for polyp resection.

Summary Advances in endoscopic technology are being shown to enhance the detection of early cancers and precancerous lesions. However, these tools may be supplementary to a high-quality colonoscopy using excellent techniques, factors that are now being implemented in training programs.

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

Correspondence to Michael B. Wallace, MD, MPH, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL 32224, USA. Tel: +1 904 953 7382; fax: +1 904 953 7260; e-mail:

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins