retroscopic views, accessories for flattening the folds that hide polyps
and solutions for clearing incompletely prepped bowels. There's a lot
of innovation out there, but how do your physicians decide which
advances are worth the investment? Three endoscopic specialists told
us the factors that matter most to them.
1. Does the technology
deliver improved results?
High-definition views in multiple directions without obstructions
are impressive, but detection rates are always the goal, and physi-
cians want to see that data.
"How much data, how many studies are there backing this up?" asks
Imran Fayyaz, MD, president and medical director at the Hamilton
(N.J.) Endoscopy & Surgery Center. "I need more hard data that says
it's going to be safer and more efficient."
He and his colleagues rejected an endoscope add-on that mechani-
cally smooths out the colon while the scope is in motion due to a
scarcity of clinical literature. "We need to have larger trials," he says.
"Most new devices on the market have been tested on a small number
of patients, numbers that are too small to be meaningful."
"A lot of the new technologies available deal with one thing, trying
to see behind folds, especially in the right colon, where there tends to
be a higher miss rate," says Steven Davidoff, MD, of the Endo Center
at Voorhees in New Jersey. "None have radically increased the adeno-
ma detection rate that I've seen." While he admits that no endoscopist
can boast a 100% detection rate, each is seeking demonstrable gains
from the new technologies he adopts.
Also, are these gains going to be clinically valuable? "Every time
there's a next-generation scope, there are incremental improvements
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