Copyright ©The Author(s) 2022.
World J Gastrointest Endosc. May 16, 2022; 14(5): 302-310
Published online May 16, 2022. doi: 10.4253/wjge.v14.i5.302
Table 1 Commonly missed lesions requiring second-look colonoscopy[10,14-16] or upper endoscopy[10,20,24]
Bowel segment
Lesions missed
Intervention to improve lesion detection
AnorectumAnal/rectal cancersCareful anorectal exam before and on scope insertion with retroflexion
Anal fissures
Recto-cutaneous fistulas
Anal warts
ColonLesions in colonic folds (particularly sigmoid)Careful exam between the folds of the colon, especially in sigmoid segment, consider using a cap
Excellent, good, or adequate bowel preparation, supported by photography
Right colonSecond look
Retroflex in right colon
Cecum (especially behind IC valve)Document examination
Examine behind the ileocecal valve
Cecal intubation rate
Terminal ileumLesions in ileumIntubate in the terminal ileum
EsophagusBelow UES lesions, i.e., squamous cell carcinomaCareful examination of upper esophagus, slow scope withdrawal
Distal esophagus, collapsed varices in volume depleted patientCareful examination of distal esophagus and awareness of patient’s volume status
Subtle lesions of Barrett segmentAdequate time for examination of the segment
StomachCameron lesions, gastro-esophageal junction (especially challenging to detect/examine with large hiatal hernias)Careful examination of gastro-esophageal junction and diaphragmatic hiatus with retroflexion of the scope
Arteriovenous malformation, Dieulafoy’s lesionsCareful inspection between the gastric folds using a cap
Small bowelDuodenal bulbExamine all 4 walls of the duodenal bulb and
Duodenal sweepMay need to use of a side view scope
3rd and 4th part of the duodenum Advance scope by reducing the loop into 3rd and 4th parts of duodenum
Table 2 Quality metrics for endoscopic procedures[11,20,21,23,24]
High quality bowel preparation (excellent, good, or adequate), documented with photosAt least 1 min of inspection per centimeter of circumferential segment of Barrett’s esophagus
Digital rectal examination prior to colonoscopy with results documentedNDR record should be considered
When evaluating for gastric intestinal metaplasia, 5 or more biopsies need to be taken
Cecal intubation performed, landmarks noted in documentation and photos recordedOverall, EGD evaluation for gastric intestinal metaplasia has to last 7 min or more
Withdrawal time is 6 min or more
Retroflexion, if performed, is thoroughly documented (with photographs)
Endoscopists ADR exceeds recommended thresholds. Physician participates in quality-improvement and continues to measure individual ADR