Colonoscopy: Advanced and Emerging Techniques—A Review of Colonoscopic Approaches to Colorectal Conditions

Abstract

A complete colonoscopy is key in the diagnostic and therapeutic approaches to a variety of colorectal diseases. Major challenges are incomplete polyp removal and missed polyps, particularly in the setting of a difficult colonoscopy. There are a variety of both well-established and newer techniques that have been developed to optimize polyp detection, perform complete polypectomy, and endoscopically treat various complications and conditions such as strictures and perforations. The objective of this article is to familiarize the colorectal surgeon with techniques utilized by advanced endoscopists.

Keywords

colonoscopy - endoscopic submucosal dissection - chromoendography - colonic stents

• References

• 1 Rex DK, Schoenfeld PS, Cohen J , et al. Quality indicators for colonoscopy. Am J Gastroenterol 2015; 110 (1) 72-90
• 2 Pohl H, Srivastava A, Bensen SP , et al. Incomplete polyp resection during colonoscopy-results of the complete adenoma resection (CARE) study. Gastroenterology 2013; 144 (1) 74-80.e1
• 3 Nass JP, Connolly SE. Current status of chromoendoscopy and narrow band imaging in colonoscopy. Clin Colon Rectal Surg 2010; 23 (1) 21-30
• 4 Robertson DJ, Lieberman DA, Winawer SJ , et al. Colorectal cancers soon after colonoscopy: a pooled multicohort analysis. Gut 2014; 63 (6) 949-956
• 5 Amato A, Radaelli F, Paggi S, Baccarin A, Spinzi G, Terruzzi V. Carbon dioxide insufflation or warm-water infusion versus standard air insufflation for unsedated colonoscopy: a randomized controlled trial. Dis Colon Rectum 2013; 56 (4) 511-518
• 6 Dik VK, Moons LM, Siersema PD. Endoscopic innovations to increase the adenoma detection rate during colonoscopy. World J Gastroenterol 2014; 20 (9) 2200-2211
• 7 Moreels TG, Macken EJ, Pelckmans PA. Renewed attention for overtube-assisted colonoscopy to prevent incomplete endoscopic examination of the colon. Dis Colon Rectum 2013; 56 (8) 1013-1018
• 8 Pasha SF, Harrison ME, Das A, Corrado CM, Arnell KN, Leighton JA. Utility of double-balloon colonoscopy for completion of colon examination after incomplete colonoscopy with conventional colonoscope. Gastrointest Endosc 2007; 65 (6) 848-853
• 9 Schembre DB, Ross AS, Gluck MN, Brandabur JJ, McCormick SE, Lin OS. Spiral overtube-assisted colonoscopy after incomplete colonoscopy in the redundant colon. Gastrointest Endosc 2011; 73 (3) 515-519
• 10 Lee YT, Lai LH, Hui AJ , et al. Efficacy of cap-assisted colonoscopy in comparison with regular colonoscopy: a randomized controlled trial. Am J Gastroenterol 2009; 104 (1) 41-46
• 11 Ng SC, Tsoi KK, Hirai HW , et al. The efficacy of cap-assisted colonoscopy in polyp detection and cecal intubation: a meta-analysis of randomized controlled trials. Am J Gastroenterol 2012; 107 (8) 1165-1173
• 12 Westwood DA, Alexakis N, Connor SJ. Transparent cap-assisted colonoscopy versus standard adult colonoscopy: a systematic review and meta-analysis. Dis Colon Rectum 2012; 55 (2) 218-225
• 13 Buchner AM, Shahid MW, Heckman MG , et al. High-definition colonoscopy detects colorectal polyps at a higher rate than standard white-light colonoscopy. Clin Gastroenterol Hepatol 2010; 8 (4) 364-370
• 14 Kudo S, Tamura S, Nakajima T, Yamano H, Kusaka H, Watanabe H. Diagnosis of colorectal tumorous lesions by magnifying endoscopy. Gastrointest Endosc 1996; 44 (1) 8-14
• 15 Rutter MD, Saunders BP, Schofield G, Forbes A, Price AB, Talbot IC. Pancolonic indigo carmine dye spraying for the detection of dysplasia in ulcerative colitis. Gut 2004; 53 (2) 256-260
• 16 Marion JF, Waye JD, Present DH , et al; Chromoendoscopy Study Group at Mount Sinai School of Medicine. Chromoendoscopy-targeted biopsies are superior to standard colonoscopic surveillance for detecting dysplasia in inflammatory bowel disease patients: a prospective endoscopic trial. Am J Gastroenterol 2008; 103 (9) 2342-2349
• 17 Matsumoto T, Esaki M, Fujisawa R, Nakamura S, Yao T, Iida M. Chromoendoscopy, narrow-band imaging colonoscopy, and autofluorescence colonoscopy for detection of diminutive colorectal neoplasia in familial adenomatous polyposis. Dis Colon Rectum 2009; 52 (6) 1160-1165
• 18 Hurlstone DP, Cross SS, Brown S, Sanders DS, Lobo AJ. A prospective evaluation of high-magnification chromoscopic colonoscopy in predicting completeness of EMR. Gastrointest Endosc 2004; 59 (6) 642-650
• 19 Dekker E, van den Broek FJ, Reitsma JB , et al. Narrow-band imaging compared with conventional colonoscopy for the detection of dysplasia in patients with longstanding ulcerative colitis. Endoscopy 2007; 39 (3) 216-221
• 20 Waye JD, Heigh RI, Fleischer DE , et al. A retrograde-viewing device improves detection of adenomas in the colon: a prospective efficacy evaluation (with videos). Gastrointest Endosc 2010; 71 (3) 551-556
• 21 Neumann H, Nägel A, Buda A. Advanced endoscopic imaging to improve adenoma detection. World J Gastrointest Endosc 2015; 7 (3) 224-229
• 22 Swan MP, Bourke MJ, Alexander S, Moss A, Williams SJ. Large refractory colonic polyps: is it time to change our practice? A prospective study of the clinical and economic impact of a tertiary referral colonic mucosal resection and polypectomy service (with videos). Gastrointest Endosc 2009; 70 (6) 1128-1136
• 23 Moss A, Bourke MJ, Williams SJ , et al. Endoscopic mucosal resection outcomes and prediction of submucosal cancer from advanced colonic mucosal neoplasia. Gastroenterology 2011; 140 (7) 1909-1918
• 24 McGill SK, Evangelou E, Ioannidis JPA, Soetikno RM, Kaltenbach T. Narrow band imaging to differentiate neoplastic and non-neoplastic colorectal polyps in real time: a meta-analysis of diagnostic operating characteristics. Gut 2013; 62 (12) 1704-1713
• 25 Sanchez-Yague A, Kaltenbach T, Raju G, Soetikno R. Advanced endoscopic resection of colorectal lesions. Gastroenterol Clin North Am 2013; 42 (3) 459-477
• 26 Gallegos-Orozco JF, Gurudu SR. Complex colon polypectomy. Gastroenterol Hepatol (N Y) 2010; 6 (6) 375-382
• 27 Repici A, Pellicano R, Strangio G, Danese S, Fagoonee S, Malesci A. Endoscopic mucosal resection for early colorectal neoplasia: pathologic basis, procedures, and outcomes. Dis Colon Rectum 2009; 52 (8) 1502-1515
• 28 Ferrara F, Luigiano C, Ghersi S , et al. Efficacy, safety and outcomes of ‘inject and cut’ endoscopic mucosal resection for large sessile and flat colorectal polyps. Digestion 2010; 82 (4) 213-220
• 29 Luigiano C, Consolo P, Scaffidi MG , et al. Endoscopic mucosal resection for large and giant sessile and flat colorectal polyps: a single-center experience with long-term follow-up. Endoscopy 2009; 41 (10) 829-835
• 30 Seitz U, Bohnacker S, Seewald S, Thonke F, Soehendra N. Long-term results of endoscopic removal of large colorectal adenomas. Endoscopy 2003; 35 (8) S41-S44
• 31 Park JJ, Cheon JH, Kwon JE , et al. Clinical outcomes and factors related to resectability and curability of EMR for early colorectal cancer. Gastrointest Endosc 2011; 74 (6) 1337-1346
• 32 Conio M, Blanchi S, Repici A, Ruggeri C, Fisher DA, Filiberti R. Cap-assisted endoscopic mucosal resection for colorectal polyps. Dis Colon Rectum 2010; 53 (6) 919-927
• 33 Anderloni A, Jovani M, Hassan C, Repici A. Advances, problems, and complications of polypectomy. Clin Exp Gastroenterol 2014; 7: 285-296
• 34 Repici A, Hassan C, De Paula Pessoa D , et al. Efficacy and safety of endoscopic submucosal dissection for colorectal neoplasia: a systematic review. Endoscopy 2012; 44 (2) 137-150
• 35 Nakajima T, Saito Y, Tanaka S , et al. Current status of endoscopic resection strategy for large, early colorectal neoplasia in Japan. Surg Endosc 2013; 27 (9) 3262-3270
• 36 Ko CW, Dominitz JA. Complications of colonoscopy: magnitude and management. Gastrointest Endosc Clin N Am 2010; 20 (4) 659-671
• 37 Rabeneck L, Paszat LF, Hilsden RJ , et al. Bleeding and perforation after outpatient colonoscopy and their risk factors in usual clinical practice. Gastroenterology 2008; 135 (6) 1899-1906 , 1906.e1
• 38 Shioji K, Suzuki Y, Kobayashi M , et al. Prophylactic clip application does not decrease delayed bleeding after colonoscopic polypectomy. Gastrointest Endosc 2003; 57 (6) 691-694
• 39 Metz AJ, Bourke MJ, Moss A, Williams SJ, Swan MP, Byth K. Factors that predict bleeding following endoscopic mucosal resection of large colonic lesions. Endoscopy 2011; 43 (6) 506-511
• 40 Liaquat H, Rohn E, Rex DK. Prophylactic clip closure reduced the risk of delayed postpolypectomy hemorrhage: experience in 277 clipped large sessile or flat colorectal lesions and 247 control lesions. Gastrointest Endosc 2013; 77 (3) 401-407
• 41 Kouklakis G, Mpoumponaris A, Gatopoulou A, Efraimidou E, Manolas K, Lirantzopoulos N. Endoscopic resection of large pedunculated colonic polyps and risk of postpolypectomy bleeding with adrenaline injection versus endoloop and hemoclip: a prospective, randomized study. Surg Endosc 2009; 23 (12) 2732-2737
• 42 Saito Y, Uraoka T, Yamaguchi Y , et al. A prospective, multicenter study of 1111 colorectal endoscopic submucosal dissections (with video). Gastrointest Endosc 2010; 72 (6) 1217-1225
• 43 Nishiyama N, Mori H, Kobara H , et al. Efficacy and safety of over-the-scope clip: including complications after endoscopic submucosal dissection. World J Gastroenterol 2013; 19 (18) 2752-2760
• 44 Kaltenbach T, Soetikno R. Endoscopic resection of large colon polyps. Gastrointest Endosc Clin N Am 2013; 23 (1) 137-152
• 45 Sebastian S, Johnston S, Geoghegan T, Torreggiani W, Buckley M. Pooled analysis of the efficacy and safety of self-expanding metal stenting in malignant colorectal obstruction. Am J Gastroenterol 2004; 99 (10) 2051-2057
• 46 Khot UP, Lang AW, Murali K, Parker MC. Systematic review of the efficacy and safety of colorectal stents. Br J Surg 2002; 89 (9) 1096-1102
• 47 Fisher DA, Maple JT, Ben-Menachem T , et al; ASGE Standards of Practice Committee. Complications of colonoscopy. Gastrointest Endosc 2011; 74 (4) 745-752
• 48 Kim JH, Ku YS, Jeon TJ , et al. The efficacy of self-expanding metal stents for malignant colorectal obstruction by noncolonic malignancy with peritoneal carcinomatosis. Dis Colon Rectum 2013; 56 (11) 1228-1232
• 49 Thomas-Gibson S, Brooker JC, Hayward CM, Shah SG, Williams CB, Saunders BP. Colonoscopic balloon dilation of Crohn's strictures: a review of long-term outcomes. Eur J Gastroenterol Hepatol 2003; 15 (5) 485-488
• 50 Ferlitsch A, Reinisch W, Püspök A , et al. Safety and efficacy of endoscopic balloon dilation for treatment of Crohn's disease strictures. Endoscopy 2006; 38 (5) 483-487
• 51 Greener T, Shapiro R, Klang E , et al. Clinical outcomes of surgery versus endoscopic balloon dilation for stricturing Crohn's disease. Dis Colon Rectum 2015; 58 (12) 1151-1157
• 52 Byeon JS. Colonic perforation: can we manage it endoscopically?. Clin Endosc 2013; 46 (5) 495-499
• 53 Saito Y, Uraoka T, Matsuda T , et al. Endoscopic treatment of large superficial colorectal tumors: a case series of 200 endoscopic submucosal dissections (with video). Gastrointest Endosc 2007; 66 (5) 966-973
• 54 Nishiyama H, Isomoto H, Yamaguchi N , et al. Endoscopic submucosal dissection for colorectal epithelial neoplasms. Dis Colon Rectum 2010; 53 (2) 161-168
• 55 Parodi A, Repici A, Pedroni A, Blanchi S, Conio M. Endoscopic management of GI perforations with a new over-the-scope clip device (with videos). Gastrointest Endosc 2010; 72 (4) 881-886
• 56 Gubler C, Bauerfeind P. Endoscopic closure of iatrogenic gastrointestinal tract perforations with the over-the-scope clip. Digestion 2012; 85 (4) 302-307