Two Experts Give Advice on Best Basic Colonoscopy Techniques

Among the key and newer points from a recent review on the best performance of basic colonoscopy, including the resection of lesions <20 mm in size: 

• Always use split or same-day bowel preparations; low-volume preparations are preferred for routine use to enhance tolerability.
• Measurement of adenoma detection rates is mandatory.
• Consider adding measurement of sessile serrated lesion detection rates, with a goal of at least 6%.
• With difficult colonic anatomy, choose adult endoscopes for redundant colons and narrow endoscopes for angulated sigmoids.
• To avoid the rare risk of barotrauma, always switch to water filling when inserting through a difficult angulated sigmoid.
• Always remember the risk of splenic injury, particularly in thin women. Avoid maneuvers that stress the splenocolic attachments when the instrument tip is proximal to the splenic flexure.
• The basics of high-level detection continue to be probing the proximal aspects of all folds, achieving adequate distention, and cleaning up. Consider using one adjunct device to improve mucosal exposure and one device or technique to highlight flat lesions.
• Examine both the right side of the colon and rectum twice.
• Except in the rare instance of suspected cancer, all lesions <10 mm, including pedunculated lesions, can be removed without electrocautery.
• When performing cold piecemeal resection of 10- to 20-mm lesions, the keys to success are to overlap the snare with the lesion margin, use the water jet to expand the submucosal space, and overlap the lesion margin and the mucosal defect with subsequent snare placements. Accurate and precise snare placement is key to success.
• Electrocautery should be used to remove any lesion suspected of being cancerous because it cuts deeper than cold resection. Bulky sessile and larger (10-20 mm) lesions also often warrant using electrocautery.