This ASG video tip is sponsored by Braintree, maker of the newly approved Souffleve and Soutab. We can talk in this session about many different techniques and technologies and people who can try to, factors who can try to change detection, but it really is us as endoscopists who have the most power in terms of detection. And this has been encouraging that when we've looked at when individuals are trained and have higher awareness of detection and then increase our detection rates, then reductions interval cancer follow. So we can change and we can improve and protect our patients more. So how can we do high quality inspection, high quality detection? We really do need to approach this with that mindset about what are we looking for? We're not looking for, you know, cancers. I always say that our, our privilege in colonoscopy is we can find stage zero, right? Like we can find it before it's cancer. We want to look for the subtle things, the flat and the depressed and remove them. And if that's our mind, when we start the detection, and then we have the tools of that which we'll go through some of how to recognize, then that's really huge in the, in the starting game for detection and then the technique part. So Amit talked a lot about insertion and having a straight scope when we get to the cecum, that's so important. If we aren't stable while we're withdrawing, that makes it so challenging for us to look behind folds, to be stable, to be efficient. And so that's, that's key. Having a clean mucosa, looking behind those folds, being dynamic in expansion and collapsing. It's really important. I find that with the world of water insertion, a lot of the trainees are hesitant to expand the colon then on withdrawal. And I think that's just something that's really important that we do need to have, you know, different tensions in the colon wall to identify lesions. And we definitely want to take time, but we want to be efficient with our time. And I think a longer, longer withdrawal is not necessarily a better withdrawal. There's a sweet spot. I'm sure that we'll all find too short's not good, but too long is also very inefficient. So we want to take time and the time we take, we want to take most of it in that right colon, examining it twice, either in retroflection or examining it twice in forward view. And then the different tools, optimizing things that are already available to us that aren't necessarily advanced, like the lighting on the processor, the monitor itself, using a cap. Those are all things that we have available that can, tools that can help us with detection. And then certainly engaging in a quality insurance program is a great tool because when we're accountable, then we perform better when we have a community that's accountable, then we could discuss and improve together better. So I won't go a lot into bell prep, but certainly it's the cornerstone of detection because we have to have a clean colon. We luckily have the ability with the water jet to wash, but that leads again to our time being spent washing and sectioning, taking our cognitive time away from looking. And that's just, again, anything the patient and the unit can do to get the patient clean before the procedure is certainly going to be a much better system. You can see here, yes, this colon, we can wash and get it clean, but that's time taken away from looking. And certainly these subtle lesions like this could be under a stool. So getting to here is definitely feasible, this excellent quality, and you can just see the difference already. I can see very clearly the vessels, the folds, the lines of the colon, all of the things I'm looking at to find polyps, I can see much more clearly with an excellent prep. The split bowel dose preparation has been around for 10 years now, that should be standard for our units. A low residue diet has also been recommended. And I think that the results show superiority in incorporating that into our units. There's better patient adherence then. So I think that making sure our units follow the systems of bowel prep protocols are really, really important in the detection realm. And then, again, I'm not going to go in as much with the insertion, but just highlighting and emphasizing having a straight endoscope is so important in our detection. So we need to have awareness of loops, awareness of the equipment that we are using, how we're handling it, and then, of course, the patient. Because a straight scope is responsive, we have that control, we're more efficient, the patient's more comfortable, and then we can focus on that inspection. So let's get to that part with detection here again. When the colon looks like this, we can look at the vessels, we can suction through clear liquid quickly, we can look at the folds and do this sort of circumferential spiral withdrawal where our eyes are surveying in order to detect polyps. So this is the goal of colonoscopy, that we can see these parts of the colon lining. Because when we are doing inspection, we're looking for certain patterns. We need the clean mucosa, we need that their lighting is good. I have the chromoendoscopy here mainly to show you that that small lesion that we found with white light is certainly very subtle and can be highlighted with that chromoendoscopy there. www.microsoft.com

endoscopists

polyp detection

colonoscopy techniques

quality assurance

early-stage cancer detection