Increase your adenoma detection rate without using fancy adjunct tools.

The correlation between a low adenoma detection rate (ADR) and interval cancers (ICs) has made ADR one of the most important quality indicators for colonoscopy. Data from nation-wide colorectal cancer (CRC) screening programs showed that there is room for improvement in ADR in order to reduce ICs in Taiwan. Measures with and without adjunct tools have been shown to have the potential to increase ADR, with the latter being more convenient to apply without additional cost. Optimal withdrawal techniques coupled with sufficient withdrawal time, training endoscopists with emphasis on recognition of subtle characteristics of flat lesions, dynamic position changes during the withdrawal phase, removing small polyps found during insertion, and retroflexion in the right colon have all been associated with increased ADR. In particular, water exchange (WE), which is characterized using water in lieu of air and suction removal of infused water during insertion, appears to meet the needs of colonoscopy patients in Taiwan. Analyses of both primary and secondary outcome variables of recently published studies have consistently shown that WE yields higher ADR than traditional air insufflation, even in propofol-sedated patients. Colonoscopists participating in the nationwide CRC screening program in Taiwan should consider applying one or more of the above measures to improve ADR and hopefully reduce ICs.