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World J Gastrointest Endosc. Aug 10, 2015; 7(10): 969-980
Published online Aug 10, 2015. doi: 10.4253/wjge.v7.i10.969
New technologies and techniques to improve adenoma detection in colonoscopy
Ashley Bond, Sanchoy Sarkar
Ashley Bond, Sanchoy Sarkar, Department of Gastroenterology and Hepatology, Royal Liverpool and Broadgreen University Hospital Trust, Liverpool L7 8XP, United Kingdom
Author contributions: Both authors contributed equally to the literature search and writing of the review article; there was a collective decision upon the format of the final manuscript for submission.
Conflict-of-interest statement: Dr. Sanchoy Sarkar and Dr. Ashley Bond have no conflicts of interest to declare. They are both employed by Royal Liverpool and Broadgreen University Hospital Trust.
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: Dr. Sanchoy Sarkar, PhD, FRCP, BSc, Department of Gastroenterology and Hepatology, Royal Liverpool and Broadgreen University Hospital Trust, 5Z link, Prescot Street, Liverpool L7 8XP, United Kingdom. sanchoy@aol.com
Telephone: +44-151-7063554 Fax: +44-151-7065832
Received: May 13, 2015
Peer-review started: May 14, 2015
First decision: June 3, 2015
Revised: July 1, 2015
Accepted: July 7, 2015
Article in press: July 8, 2015
Published online: August 10, 2015
Processing time: 96 Days and 0.6 Hours
Abstract

Adenoma detection rate (ADR) is a key component of colonoscopy quality assessment, with a direct link between itself and future mortality from colorectal cancer. There are a number of potential factors, both modifiable and non-modifiable that can impact upon ADR. As methods, understanding and technologies advance, so should our ability to improve ADRs, and thus, reduce colorectal cancer mortality. This article will review new technologies and techniques that improve ADR, both in terms of the endoscopes themselves and adjuncts to current systems. In particular it focuses on effective techniques and behaviours, developments in image enhancement, advancement in endoscope design and developments in accessories that may improve ADR. It also highlights the key role that continued medical education plays in improving the quality of colonoscopy and thus ADR. The review aims to present a balanced summary of the evidence currently available and does not propose to serve as a guideline.

Keywords: Colorectal cancer, Adenoma detection, New technology, Techniques, Colonoscopy

Core tip: The most important quality indicator in colonoscopy is Adenoma detection rate. It is associated with outcomes from colorectal cancer, with low detection rates being associated with increased mortality and poor outcomes. Whilst a number of technologies are emerging to improve adenoma detection rate (ADR), at present, it seems that education, team work and optimising current practice will provide the biggest gains in ADR whilst maintaining financial acceptability.