Improving quality measures in colonoscopy and its therapeutic intervention

Core Tip

Core tip: Achieving appropriate bowel preparation and proper luminal distention for endoscopic mucosal imaging remains the key step enabling the endoscopist to detect colorectal neoplasia and predict polyp pathology. Success improves with experience and feedback. In this review we discuss the impact of high-definition colonoscopy, hood-assisted colonoscopy, and dye-based and virtual chromoendoscopy on colorectal polyp detection and prediction. Colonoscopic polypectomy is a continuously evolving therapy and has the potential to further reduce the risk of colorectal cancer. We propose that optimal polypectomy techniques for nonpedunculated polyps should be primarily based on polyp size, and these include cold forceps polypectomy (1-3 mm), cold snare polypectomy (4-10 mm), conventional polypectomy (7-14 mm), and endoscopic mucosal resection (EMR) (15-20 mm). For polyps larger than 21 mm, piecemeal EMR or endoscopic submucosal dissection is preferred.