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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 7, 2016; 22(5): 1767-1778
Published online Feb 7, 2016. doi: 10.3748/wjg.v22.i5.1767
Seeing better - Evidence based recommendations on optimizing colonoscopy adenoma detection rate
Javier Aranda-Hernández, Jason Hwang, Gabor Kandel
Javier Aranda-Hernández, Jason Hwang, Gabor Kandel, Division of Gastroenterology, University of Toronto, Therapeutic Endoscopy and Endoscopic Oncology, St. Michael’s Hospital, Toronto, Ontario M5B 1W8, Canada
Author contributions: Aranda-Hernández J, Hwang J, Kandel G performed the literature review, wrote the manuscript; and approved the final manuscript.
Conflict-of-interest statement: The authors have no conflict-of-interest to report.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Gabor Kandel, MD, Division of Gastroenterology, University of Toronto, Therapeutic Endoscopy and Endoscopic Oncology, St. Michael’s Hospital, 30 Bond St., Toronto, Ontario M5B 1W8, Canada. kandelg@smh.ca
Telephone: +1-416-8643093 Fax: +1-416-8645994
Received: June 22, 2015
Peer-review started: June 25, 2015
First decision: July 20, 2015
Revised: August 17, 2015
Accepted: December 1, 2015
Article in press: December 1, 2015
Published online: February 7, 2016
Processing time: 213 Days and 13.8 Hours
Abstract

Colorectal cancer is one of the three most frequent causes of cancer deaths in men and women in Europe and North America. Diagnosis and resection of adenomas has convincingly demonstrated its utility in diminishing colorectal cancer incidence. Therefore, colonoscopy is now the gold standard for colorectal cancer screening. But it is also known that colonoscopy effectiveness varies among endoscopists. Among different quality indicators, the most used is the adenoma detection rate (ADR) which is the percentage of average-risk patients for colorectal cancer who are found to have at least one adenoma or adenocarcinoma during a screening colonoscopy. There is compelling evidence supporting an inverse correlation between ADR and interval colorectal cancer (cancer found after a screening colonoscopy). Many factors such as quality of precolonoscopy preparation, additional observers, manoeuvres with the endoscope (second view, retroflexion, water inflation rather than air), time spent during withdrawal, changes in patient position, fold-flattener devices, new imaging or endoscopic modalities and use of intravenous or through the scope sprayed drugs, have been studied and developed with the aim of increasing the ADR. This reviews discusses these factors, and the current evidence, to “see better” in the colon and optimize ADR.

Keywords: Adenoma; Detection; Colonoscopy; Cancer; Screening

Core tip: Adenoma resection has demonstrated its utility in diminishing colorectal cancer incidence and colonoscopy has become the gold standard for screening. Nevertheless we also understand that colonoscopy does not predate cancer itself but “quality colonoscopy” does. Adenoma detection rate is the most important quality parameter that inversely correlates with colorectal cancer appearance after colonoscopy. Therefore we conducted an up to date review of the literature of different factors that may have an impact in the adenoma detection rate. We critically review the evidence and brought some crucial points for discussion.