Colorectal Cancer Awareness Issue

Beginning as a national initiative launched by US President Clinton in 2000, recognition of March as the “Colorectal Cancer Awareness Month” is now a global event. Accordingly we are dedicating the March issue of Endoscopy to endoscopic research into colonoscopy methods, optical diagnosis of polyps, and adenoma detection rate.

As colorectal cancer continues to be a leading cause of cancer death, endoscopists can make a difference in the prevention, early detection, and optimal treatment of colorectal malignancy.

The important research articles in this issue include a Norwegian study comparing the use of water exchange with carbon dioxide insufflation in colonoscopy. The authors conclude that although water exchange colonoscopy reduces procedural pain, there is no effect on overall pain or on use of on-demand sedation. An interesting study from Israel evaluates a new colonoscope that is equipped with an inflatable balloon to flatten folds during withdrawal; the results indicate that this new colonoscope reduces adenoma miss rate.

Several screening programs for early detection of colorectal cancer have been initiated in Europe in recent years. This issue features some interesting results from these programs. An Austrian study, in contrast to previous studies from other programs, found a high quality of colonoscopy regardless of endoscopist specialty in settings where standard quality requirements were applied. A pragmatic pilot study for a national flexible sigmoidoscopy program in England concludes that uptake is higher when participants receive a simple invitation with a set appointment time rather than with a more interactive invitation method.

Adenoma detection rates have a demonstrated link to post-colonoscopy colorectal cancer rates; thus methods to improve adenoma detection rates remain important. Implementation of a “bundle” of quality interventions in colonoscopy, including, for example, supine positioning for examination of the transverse colon and a minimum withdrawal time, increases adenoma detection rates, particularly in colonoscopists with poorer performance. A US study shows that delay in starting times of colonoscopy (“running late”) does not affect the quality of the examination. Another study from the US shows that the quality of real-time optical diagnosis of colorectal polyps is maintained in a standardized and continued training program. Along the same lines, research from the US found that the adenoma detection rate of an experienced colonoscopist and one reviewer, based only on photography, was nearly the same as that using the pathology-based gold standard.

Also in this issue, the effects of using magnetic imaging as an adjuvant to elective colonoscopy are reviewed, and an innovative study from Japan evaluates a new technique for endoscopic submucosal dissection, the “clip-flap” method, that allows countertraction during the procedure.

We hope that you enjoy this issue of Endoscopy, and that the research presented this month will contribute to success in the fight against colorectal cancer.

On behalf of the Editors,
Peter D. Siersema, Editor-in-Chief