title: Efficacy and effectiveness of colonoscopy: how do we bridge the gap?
abstract: Colonoscopy is sometimes considered the preferred colorectal cancer screening modality, yet this modality may be subject to variation in operator performance more than any other screening test. Failures of colonoscopy to consistently detect precancerous lesions threaten the effectiveness of this technique for the prevention of colorectal cancer. Studies on high-level adenoma detectors under optimal conditions have begun to establish the true efficacy of colonoscopy and further widen the gap between efficacy and effectiveness. Research is required to establish the component skills, attitudes, and behaviors for high-level mucosal inspection competence necessary for training and assessment. Interventions to bridge the gap between efficacy and effectiveness are lacking, yet they should emphasize quality measurement and operate at various levels within the health system to motivate change in endoscopist behavior.
authors.affiliation: Division of Gastroenterology, Department of Medicine, Indiana University School of Medicine, University Hospital 4100, 550 North University Boulevard, Indianapolis, IN 46202, USA. d.hewett@uq.edu.au
authors.forename: David G
authors.initials: DG
authors.lastname: Hewett
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Kahi
authors.forename: Douglas K
authors.initials: DK
authors.lastname: Rex
mesh_terms: D002983:Clinical Competence; D003113:Colonoscopy / Q000592:standards*; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000517:prevention & control*; D055088:Early Detection of Cancer / Q000592:standards*; D006801:Humans; D015588:Observer Variation; D015397:Program Evaluation; D058996:Quality Improvement; D019984:Quality Indicators, Health Care / Q000592:standards*