devices' flexible arms and rings fall flat against the scope during intu-
bation and expand during withdrawal to flatten folds, stabilize the
scope and prevent the scope from slipping while the physician exam-
ines the colon's mucosa.
• Balloon-assisted. Reusable balloon attachments can be connected
to standard scopes and inflated with a foot pedal once the scope has
reached the cecum. When the scope is withdrawn, the balloons steady
the scope and flatten folds in the colon.
These attachments are intended to improve ADR, and studies have
found they do to varying degrees. However, your facility's results
might vary. For example, Ned Snyder, MD, MACP, AGAF, chief of gas-
troenterology at the Kelsey-Seybold Clinic in Houston, Texas, says,
"We have intermittently used the [cuff] on the end of the scope, [but]
it has been difficult to demonstrate benefit."
3. Image enhancements
Beyond physical attachments, you can also improve your views of
the colon with high-tech approaches that highlight adenomas.
• Virtual/electronic chromoendoscopy. Chromoendoscopy, which
uses dye stains to highlight abnormalities in mucosa, has never really
caught on outside of inflammatory bowel disease because of the has-
sle associated with preparing it, notes Dr. Rex. But the concept obvi-
ously has merit as a highlighting technology for colonoscopy.
Virtual chromoendoscopy, also known as electronic chromoen-
doscopy, is not new to colonoscopy. It was largely ineffective in its
original form due to lighting issues, but newer versions, which have
brighter illumination, make the technique more effective, says Dr. Rex.
There are competing technologies available — narrow-band imaging
and blue light imaging being the most prominent.
The idea here, again, is to provide better contrast than traditional
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