A BETTER LOOK Let your GI docs increase their visualization and improve their maneuverability during colonoscopy screenings.

The quality of your colonoscopy screenings is tied directly to your GI doctors' ability to easily move through the colon to the end and to visualize everything — including hidden polyps behind the colonic folds — along the way. You can keep your ADR (adenoma detection rate) and cecal intubation rates high by investing in the latest flexible endoscopes and innovative scope attachments to help with maneuverability and visibility so that your GI doctors can move more easily through the colon and see more clearly. Here's a review.

Maneuverability
Moving the scope successfully and safely can be a tricky thing. That's where certain types of scope tools, like 3D imaging technology, can be an enormous help. Some scopes have the imaging technology built into the body of the scope. The technology lets your doctors see a 3D image of the scope on a nearby screen, including every little motion and loop the device makes, says Seth Gross, MD, chief of gastroenterology at Tisch Hospital in New York, N.Y.

This can help doctors identify which type of loop is giving them trouble, whether it's an 'N' loop, which is seen in 80% of colonoscopies; a deep transverse loop, which is seen in about 30% of cases; an alpha loop, which is seen in 10% of cases; or one of the less common loops, says gastroenterologist Doug Weine, MD, of Red Bank (N.J.) Gastroenterology. Being able to visualize the specific loops helps doctors know when to torque the scope and which moves to use to pull the loop out of its position.

While many more experienced GI docs are trained to notice an error in the scope's movements without the use of 3D imaging, it can be a boon to newer physicians and physicians in training, says Dr. Weine. That's especially true when, during a colonoscopy, doctors reach the splenic flexure, where they can find some resistance as the scope works its way into the transverse colon, he says. In that case, some less-experienced doctors will just try to push the scope forward without the appropriate amount of delicacy. "You can actually rupture the spleen," says Dr. Weine.

3D imaging can give those newer doctors an indication of why they're being met with resistance, prompting them to be more careful as they move the scope onward.

Scope caps are another type of beneficial tool when it comes to maneuverability. There are different variations on the caps, but they're all attachments that are placed on the end of the scope and help guide the device through the colon.

One variation has rows of finger-like projections that reach out from the side of the scope, says Dr. Gross. Another has flexible discs that circle the side of the scope. Scope caps help to provide traction as your doctors move through the colon, says Dr. Gross, who explains, "It engages the colon and reduces loops." The rings or fingers of the scope cap also help to keep the device in the middle of the colon so it has less of a chance of straying to one side.

"Because you're stabilized and reaching the end of the colon with a straighter scope, it makes removing polyps easier," says Dr. Gross.

Both 3D imaging and CAC (cap-assisted colonoscopy) can make it easier for your doctors to reach the cecum more frequently. Giving your doctors that ease can help boost your center's cecal intubation rates, which guidelines stipulate should be at 95%, says Dr. Weine.

If you're interested in investing in 3D imaging technology, an example is the ScopeGuide by Olympus. If you're looking into scope caps, the Endocuff by Olympus or the EndoRing by EndoAid are 2 examples.

Visualization
In addition to helping with maneuverability, scope caps can also increase visualization during a procedure. When the cap is attached and the scope is inserted, the cap's projections or rings flatten and smooth out folds in the mucosa, making it easier for doctors to see the proximal side of colonic folds.

"All doctors here use them. It did flare out the colon and push out the walls to smooth them out," says Solomon Reed, senior GI technician for the Advanced Surgery Center in Rockville, Md. The "flat wall" — as Mr. Reed calls it — of mucosa makes it easier for doctors to see any polyps that might otherwise be hidden behind a fold.

Researchers have tested the benefits of the different kinds of caps with regards to adenoma detection. Some researchers have said the introduction of the scope caps with the finger-like projections has increased ADRs by 28% to 36% in the United States, says Dr. Weine.

In a study completed on 116 patients in 2015, researchers found that the AMR (adenoma miss rate) was 10.4% when doctors used the cap with the flexible rings, versus 48.3% when they completed a standard colonoscopy.

For some doctors, the most useful visualization devices are not add-ons but rather high-definition features already built into the more recent versions of some colonoscopes. The features, which are produced by different scope companies, have subtle differences but generally work in the same manner, by filtering white light in a way so that it penetrates just the surface of the tissue for a sharper image.

The HD technology gives your doctors a more detailed picture of the mucosa and inner wall of the colon, says Dr. Weine. That includes microvessels and patterns under the mucosa.

"There are subtle differences in different colors," says Dr. Weine. "You can see where the normal mucosa ends and a subtle flat polyp begins."

The technology is an asset for some doctors, especially when you consider how easy it can be for doctors to miss those subtle flat polyps during a standard procedure. According to a study published on the benefits of HD scope technology, missing those smaller, more hidden polyps results in up to 6% of new or missed cancer 3 years after the procedure.

If you're considering bringing HD scopes to your center, some examples include Evis Exera III scopes by Olympus, i-Scan by Pentax and Eluxeo scopes by Fujifilm Medical. OSM