title: Seeing better--Evidence based recommendations on optimizing colonoscopy adenoma detection rate.
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.
authors: 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.
authors: Javier
authors: J
authors: Aranda-Hernández
authors: 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.
authors: Jason
authors: J
authors: Hwang
authors: 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.
authors: Gabor
authors: G
authors: Kandel
mesh_terms: D018256:Adenomatous Polyps / Q000000981:diagnostic imaging*; D002983:Clinical Competence / Q000592:standards; D003106:Colon / Q000000981:diagnostic imaging*; D003111:Colonic Polyps / Q000000981:diagnostic imaging*; D003113:Colonoscopy / Q000592:standards*; D015179:Colorectal Neoplasms / Q000000981:diagnostic imaging*; D055088:Early Detection of Cancer / Q000592:standards; D019317:Evidence-Based Medicine / Q000592:standards*; D006801:Humans; D015588:Observer Variation; D056888:Patient Positioning / Q000592:standards; D017410:Practice Guidelines as Topic / Q000592:standards; D011237:Predictive Value of Tests; D015203:Reproducibility of Results
keywords: Adenoma; Cancer; Colonoscopy; Detection; Screening