title: Technical interventions to increase adenoma detection rate in colonoscopy.
abstract: Adenoma detection rate (ADR) is the most robust colonoscopy quality metric and clinical studies have adopted it as the ideal method to assess the impact of technical interventions. Areas covered: We reviewed papers focusing on the impact of colonoscopy technical issues on ADR, including withdrawal time and technique, second evaluation of the right colon, patient positional changes, gastrointestinal assistant participation during colonoscopy, water-aided technique, optimization of bowel preparation and antispasmodic administration. Expert commentary: Overall, technical interventions are inexpensive, available worldwide and easy to implement. Some of them, such as the adoption of split dose regimen and slow scope withdrawal to allow a careful inspection, have been demonstrated to significantly improve ADR. Emerging data support the use of water-exchange colonoscopy. According to published studies, other technical interventions seem to provide only marginal benefit to ADR. Unfortunately, the available evidence has methodological limitations, such as small sample sizes, the inclusion of expert endoscopists only and the evaluation of single technical interventions. Additionally, larger studies are needed to clarify whether these interventions might have a higher benefit on low adenoma detectors and whether the implementation of a bundle of them, instead of a single technical maneuver, might have a greater impact on ADR.
authors.affiliation: a Gastroenterology Unit , Ospedale Valduce , Como , Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Rondonotti
authors.affiliation: a Gastroenterology Unit , Ospedale Valduce , Como , Italy.
authors.forename: Alida
authors.initials: A
authors.lastname: Andrealli
authors.affiliation: a Gastroenterology Unit , Ospedale Valduce , Como , Italy.
authors.forename: Arnaldo
authors.initials: A
authors.lastname: Amato
authors.affiliation: a Gastroenterology Unit , Ospedale Valduce , Como , Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Paggi
authors.affiliation: b Università degli Studi , Milan , Italy.
authors.forename: Clara Benedetta
authors.initials: CB
authors.lastname: Conti
authors.affiliation: a Gastroenterology Unit , Ospedale Valduce , Como , Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Spinzi
authors.affiliation: a Gastroenterology Unit , Ospedale Valduce , Como , Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Radaelli
mesh_terms: D000236:Adenoma / Q000473:pathology*; D002400:Cathartics / Q000008:administration & dosage; D003110:Colonic Neoplasms / Q000473:pathology*; D003113:Colonoscopy / Q000379:methods*; D006801:Humans; D010276:Parasympatholytics / Q000008:administration & dosage; D056888:Patient Positioning; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D007507:Therapeutic Irrigation; D013997:Time Factors
chemical_list: D002400:Cathartics; D010276:Parasympatholytics
keywords: Adenoma detection rate; bowel preparation; colonoscopy quality; colonoscopy withdrawal time; dynamic positional changes; split-dose regimen; water-exchange colonoscopy