using an accessory device equipped with a panoramic view.
"Almost without a doubt, we will have side-viewing scopes here with-
in the next 3 to 5 years," says Reed B. Hogan II, MD, senior partner in
GI Associates & Endoscopy Center of Flowood, Miss. "When they're at
the right price, I think the majority of us will go for it because it will
improve care and it's a way to increase ADR."
• A closer look. While the retroflexion technique can improve detec-
tion of polyps, particularly in the distal rectum, a number of dispos-
able accessory devices let endoscopists enjoy better visualization of
the mucosa throughout the colon. Example: The endoscopic cuff,
which slides over the distal tip of the colonoscope, features flexible
finger-like projections designed to flatten the walls of the colon.
According to a May 2015 study published in the Journal of Clinical
Gastroenterology, ADR increased 14% when performing a
colonoscopy with an endoscopic cuff, while the number of polyps
detected per patient climbed by 63%.
The issue of cost may be prohibiting broad acceptance of such
devices, especially as reimbursements slide and profit margins get
sliced thinner and thinner. Regardless of its effectiveness in visualiz-
ing the tissue in the mucosal folds, Dr. Hogan considers the device —
at a little more than $20 each, by his estimate — to be cost-prohibi-
tive. "For a company like ours, doing 20,000 colonoscopies per year,
that would have cost us about $460,000 a year," he says. "We can buy
a set of scopes for that much."
• Ergonomically speaking. Musculoskeletal complaints are com-
J A N U A R Y 2 0 1 7 • O U T PA T I E N TS U R G E R Y. N E T • 1 0 7
within the next 3 to 5 years, but the other 90% — 900 patients —
would not be invited back for 10 years. Translation: A higher ADR
not only measures how well you're screening patients, it also
feeds your bottom line. —Bill Donahue
