threshold is important to promote the discovery of all polyps, particu-
larly flat lesions in the right colon that are more likely to be cancer-
ous. Based on that threshold, roughly three-fourths of colonoscopies
are considered adequate, according to Dr. Johnson. "But that's not
good enough," he says. "We should set the goal at 85%, and hopefully
that goal is surpassed."
There's been a recent push to enhance the detection of adenomas
and define colonoscopy quality based on a minimum detection thresh-
old, says Dr. Johnson. He says about one-third of missed incident
lesions of colon cancer should have been recognized during a
colonoscopy screening.
"Although there have been advancements in imaging and colono-
scope maneuvering, none have surpassed what skilled endoscopists
can achieve with conventional high-resolution magnification and
white light imaging," says Dr. Johnson. "We don't have to wait for
future technological advancements to achieve the improvements
we're striving for."
Enhanced views of the colon with retrograde imaging or wide views
offering an expanded range of visualization have not definitively
shown to provide major advantages in terms of outcomes, says Dr.
Johnson. "The technology may increase the detection rate of polyps,"
he explains, "but whether that leads to significant decreases in colon
cancer rates is unknown. We have a sizeable potential to make
colonoscopy better by making minor improvements made to present-
day technology."
Dr. Gross says 360-degree high-def colonoscopes, a reusable clip-on
device and flexible endoscope system that provide panoramic views
of the colon, and overtubes that improve views of the mucosa and
enhance control of the colonoscope's tip all have the potential to
improve colonoscopy screenings. But are they worth the added cost?
9 2 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • N O V E M B E R 2 0 1 6
