Seeing better - Evidence based recommendations onoptimizing colonoscopy adenoma detection rate

Colorectal cancer is one of the three most frequentcauses of cancer deaths in men and women in Europe and North America. Diagnosis and resectionof adenomas has convincingly demonstrated its utilityin diminishing colorectal cancer incidence. Therefore,colonoscopy is now the gold standard for colorectalcancer screening. But it is also known that colonoscopyeffectiveness varies among endoscopists. Amongdifferent quality indicators, the most used is theadenoma detection rate （ADR） which is the percentageof average-risk patients for colorectal cancer who arefound to have at least one adenoma or adenocarcinomaduring a screening colonoscopy. There is compellingevidence supporting an inverse correlation betweenADR and interval colorectal cancer （cancer found aftera screening colonoscopy）. Many factors such as qualityof precolonoscopy preparation, additional observers,manoeuvres with the endoscope （second view, retroflexion,water inflation rather than air）, time spentduring withdrawal, changes in patient position, foldflattenerdevices, new imaging or endoscopic modalitiesand use of intravenous or through the scope sprayeddrugs, have been studied and developed with the aimof increasing the ADR. This reviews discusses thesefactors, and the current evidence, to ＂see better＂ in thecolon and optimize ADR.