The secret to a "good" adenoma detection rate? Most gastroenterologists will say it comes down to 2 key variables: the clinician's level of care and the withdrawal time ("At least 6 minutes," is the common refrain). Even so, high-tech tools designed to improve visualization high-resolution imaging, accessories for peering into the tough-to-see spaces behind mucosal folds, and full-spectrum cameras offering far superior wall-to-wall views can change the game in a GI doc's favor.
"Our future in endoscopy is in technology," says gastroenterologist Vincent Jabour, MD, of the Wooster (Ohio) Ambulatory Surgery Center. "It will lead us to better detection rates. Just look at how much scopes have improved in the last 10 years. We've had a dramatic improvement in terms of flexibility and visualization. Right now, most of us are looking at a 180- to 240-degree view, and in time it will be an even better view."
Although there are no adequate substitutes for training and conscientious technique, physicians now have more tools than ever to reach, and even exceed, the ADR gold standard, which currently stands at 30% for male patients and 20% for females. ADR is defined as the percentage of first-time patients in which at least 1 adenoma has been detected during a screening. Here are 4 trends that can help GI centers improve their ADR rate.
- Improved visualization. Just as it has in other areas of medicine, high-definition imaging has turned endoscopists' world on its ear: superior image quality for discovering and treating adenomas that might otherwise have gone undetected; faster cecal intubation times; and increased contrast for examining mucosal tissue. For example, visualization systems that employ narrow band imaging (NBI) can drive up ADR because NBI enhances the visibility of vessels and other tissue on the mucosal surface.
Wide-angle and full-spectrum colonoscopes, as well as ancillary devices with side-viewing cameras and powerful light sources, have significantly expanded the effective view of the colon as much as 330 degrees, compared to the standard 170-degree view of traditional forward-viewing colonoscopes, which might not easily show adenomas in mucosal folds. A 2015 study in the World Journal of Gastroenterology showed that endoscopists achieved an ADR of 44% using an accessory device equipped with a panoramic view.