Archive Hot Technology 2018

Colon Cancer Doesn't Stand a Chance

Endoscope advances and new diagnostic tools are helping physicians find difficult-to-spot polyps.

Daniel Cook

Daniel Cook, Executive Editor


William Karnes, MD
WORTH A LOOK Gastroenterologist William Karnes, MD, believes artificial intelligence will significantly improve adenoma detection rates.

Only the best GI docs achieve a 50% adenoma detection rate (ADR), most falling well short of that threshold, some finding polyps in less than 10% of colonoscopies. As you know, the more polyps you find, the less likely colorectcal carcinoma will appear after a negative screening test or examination.

"For every 1% increase in ADR, there's a 3 to 6% chance of spotting a cancer between scheduled colonoscopies," says William Karnes, MD, a gastroenterologist at UC Irvine Health in Orange, Calif. "That's why we're trying to get better at finding polyps."

Let's take a look at the latest advances in scope design and computer-aided diagnosis designed to improve your gastroenterologists' ability to see more polyps — and decrease the incidence of interval colon cancer.

Scope design

Endoscope manufacturers are doing their part with improving imaging technology that provides wider-angle views of the colon and a variety of different light sources, such as narrow-band imaging and light filtering, to enhance the pattern recognition of polyps. Slimmer scopes with tighter bending angles and smaller distal ends make scopes easier for physicians to maneuver and make screenings more comfortable for patients. Side- and backward-viewing scopes provide 360-degree views of the colon and mucosal folds.

Cap devices placed on the distal end of endoscopes flatten folds in the mucosa and stabilize the scope in the colon to give surgeons better views of the wall. The tools are a struggle to use in patients with a lot of diverticulitis and narrow, angulated sigmoid colons, because they impede the forward progress of the scope and make maneuvering around sharp turns difficult, says Dr. Karnes. He says cost is also a concern: The devices run about $20 per case.

Cap devices are most effective along the left side of the transverse colon, but less effective along the right side, which is wider, adds David Margolin, MD, FACS, FASCRS, director of colon and rectal surgical research at the Ochsner Clinic Foundation in New Orleans, La.

Dr. Margolin believes some of the newer endoscopes with rear-viewing capabilities are cumbersome and aren't yet ready for prime time. "Does the technology give you a great image? Absolutely," he says. "But does it fit into routine workflows? Can it be used regularly to improve adenoma detection rates? I think the technology needs to get better and become more user-friendly."

Robotics continues to push the boundaries of what's possible in such specialties as general surgery and orthopedics. Some see remote controlled, self-propelled colonoscopes as the basis for the robotic future of diagnostic and therapeutic platforms.

New to Outpatient Surgery Magazine?
Sign-up to continue reading this article.
Register Now
Have an account? Please log in:
Email Address:
  Remember my login on this computer

advertiser banner

Other Articles That May Interest You

How to Outfit for GI

5 design and equipment tips for efficient endo suites.

Get Up to Speed On GERD

An update on minimally invasive treatments designed to turn down the burn of acid reflux.