Improved adenoma detection rates
There's been a renewed focus on increasing and benchmarking the
detection of cancerous growths in the colon. The CDC says endo-
scopists performing colonoscopy on average risk individuals should
identify, at a minimum, 20% of polyps in women and 30% of polyps in
men. Physicians who do a thorough colonoscopy know polyps have dif-
ferent presentations and most can identify obvious growths, but it's their
ability to identify subtle growths that can be a life-and-death distinction
for patients.
To increase adenoma detection rates, physicians should meet the
recommended 6-minute withdraw time and capture photo documenta-
tion that they've reached the cecum. They should also track per-
screening performances to ensure they're meeting best practice detec-
tion rate standards. They should prescribe split-dose bowel preps
(now considered the standard of care) and use endoscopes, high-defi-
nition imaging and accessories that let them examine more areas of
the colon. For example, mechanical caps with finger projections
placed on the distal tips of colonoscopes stabilize the scope during
withdraw and flatten folds along the colon wall to expose more
mucosal surface area. Recent studies have shown that mechanical
enhancement improves adenoma detection rates, even for top-per-
forming endoscopists.
Preventing cross-contamination
Maintaining good infection control practices continues to be an
important issue to ensure scopes are properly cleaned and disinfected
between uses. Facilities are using ATP testing to validate and monitor
the quality of endoscope reprocessing and investing in borescopes to
examine the working channels of reprocessed endoscopes to ensure
biofilm has been removed from internal lumens and groves.
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On Point
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