title: Evolving techniques in colonoscopy.
abstract: OBJECTIVE
  This review summarizes recent clinical studies of colonoscopy technique and new technologies.
  
  
  RESULTS
  Water immersion reduces pain and sedation doses in unsedated and lightly sedated colonoscopy. Cap-fitted colonoscopy makes insertion faster and improves detection of lesions behind folds, but the latter effect is operator-dependent. A single controlled trial showed improved detection with the Third Eye Retroscope, but the two arms of the study were not controlled for withdrawal time. Chromoendoscopy increases detection of diminutive adenomas, but adds time to the colonoscopy procedure. Electronic chromoendoscopy methods (narrow band imaging, Fujinon Intelligent ChromoEndoscopy, i-scan, and autofluorescence) have been either unsuccessful in improving detection or require more study. However, these methods and several other methods (chromoendoscopy with magnification, confocal laser microscopy, and endocytoscopy) allow accurate real time determination of polyp histology.
  
  
  CONCLUSIONS
  Water immersion is a clear advance in unsedated colonoscopy. Cap-fitted colonoscopy is a promising method for both practical and effective visualization of the proximal sides of haustral folds. Electronic chromoendoscopy has been largely ineffective at improving polyp detection, but is effective (as are confocal laser microscopy and endocytoscopy) for diagnosis of polyp histology.
authors.affiliation: Division of Gastroenterology/Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA.
authors.forename: Krishna C
authors.initials: KC
authors.lastname: Vemulapalli
authors.forename: Douglas K
authors.initials: DK
authors.lastname: Rex
mesh_terms: D003111:Colonic Polyps / Q000175:diagnosis* / Q000601:surgery; D003113:Colonoscopy / Q000295:instrumentation / Q000379:methods*; D054810:Deep Sedation; D006801:Humans; D007089:Image Enhancement; D014867:Water / Q000008:administration & dosage
chemical_list: D014867:Water