How can Olympus technology help to decrease sedation without compromising patient comfort?

Olympus technologies have been evaluated in clinical studies on their ability to significantly reduce patient pain during colonoscopy.ScopeGuide and Variable Stiffness were proven to be able to reduce sedation levels and patient pain scores.(31,36) Using the ultra-thin pediatric colonoscope with Passive Bending and High Force Transmission, sedation levels were shown to be significantly lower compared to standard colonoscopes.(37)

Combined use of colonoscopes with Responsive Insertion Technology and ScopeGuide may help to decrease the use of sedative drugs while improving patient comfort

Why are patients sedated during colonoscopy?

Many patients request sedation because of anxiety and concerns about the procedure. Pain during insertion may occur if the anatomy is difficult and loops become likely to occur.(28)
Sedation is used routinely in various countries, especially if guidelines allow the application by nurses. Studies show that sedation may increase patient satisfaction.(33)

What issues exist with sedation?
Sedation in colonoscopy is, in general, safe. Usual side effects reported are nausea, headache, and hypoxemia.(33)
However, sedation also represents significant cost and prohibits a direct communication with the patient, making it difficult to perform patient position changes to optimize cecal intubation and adenoma detection rate.(35)

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Clinical Studies

  1. 1.Update on Endoscopic Tissue Sampling Devices. Gastrointest Endosc. 2006 May;63(6):741-5. Technology Assessment Committe, Barkun A, Liu J, Carpenter S, Chotiprasidhi P, Chuttani R, Ginsberg G, Hussain N, Silverman W, Taitelbaum G, Petersen BT.
  2. 2.The Role of Endoscopy in Barrett‘s Esophagus and Other Premalignant Conditions of the Esophagus. Gastrointest Endosc. 2012 Dec;76(6):1087-94. doi: 10.1016/j.gie.2012.08.004. ASGE Standards of Practice Committee, Evans JA, Early DS, Fukami N, Ben-Menachem T, Chandrasekhara V, Chathadi KV, Decker GA, Fanelli RD, Fisher DA, Foley KQ, Hwang JH, Jain R, Jue TL, Khan KM, Lightdale J, Malpas PM, Maple JT, Pasha SF, Saltzman JR, Sharaf RN, Shergill A, Dominitz JA, Cash BD; Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy.
  3. 3.American Gastroenterological Association Institute Guideline on the Role of Upper Gastrointestinal Biopsy to Evaluate Dyspepsia in the Adult Patient in the Absence of Visible Mucosal Lesions Gastroenterology. 2015 Oct;149(4):1082-7. doi: 10.1053/j.gastro.2015.07.039. Epub 2015 Aug 14. Yang YX, Brill J, Krishnan P, Leontiadis G; American Gastroenterological Association Clinical Practice Guidelines Committee.
  4. 4.The Role of Endoscopy in Inflammatory Bowel Disease Gastrointest Endosc. 2015 May;81(5):1101-21.e1-13. doi: 10.1016/j. ie.2014.10.030. Epub 2015 Mar 20. American Society for Gastrointestinal Endoscopy Standards of Practice Committee, Shergill AK, Lightdale JR, Bruining DH, Acosta RD, Chandrasekhara V, Chathadi KV, Decker GA, Early DS, Evans JA, Fanelli RD, Fisher DA, Fonkalsrud L, Foley K, Hwang JH, Jue TL, Khashab MA, Muthusamy VR, Pasha SF, Saltzman JR, Sharaf R, Cash BD, DeWitt JM.
  1. 5.The Seattle Protocol Does Not More Reliably Predict the Detection of Cancer at the Time of Esophagectomy Than a Less Intensive Surveillance Protocol Clin Gastroenterol Hepatol. 2009 Jun;7(6):653-8; quiz 606. doi: 10.1016/j. cgh.2008.11.024. Epub 2008 Dec 13. Kariv R, Plesec TP, Goldblum JR, Bronner M, Oldenburgh M, Rice TW, Falk GW.
  2. 6.Random Biopsies Taken During Colonoscopic Surveillance of Patients with Longstanding Ulcerative Colitis: Low Yield and Absence of Clinical Consequences Am J Gastroenterol. 2014 May;109(5):715-22. doi: 10.1038/ajg.2011.93. Epub 2011 Mar 22. van den Broek FJ, Stokkers PC, Reitsma JB, Boltjes RP, Ponsioen CY, Fockens P, Dekker E.
  3. 7.Validation of a Simple Classification System for Endoscopic Diagnosis of Small Colorectal Polyps Using Narrow-Band Imaging Gastroenterology. 2012 Sep;143(3):599-607.e1. doi: 10.1053/j.gastro.2012.05.006. Epub 2012 May 15. Hewett DG, Kaltenbach T, Sano Y, Tanaka S, Saunders BP, Ponchon T, Soetikno R, Rex DK.
  4. 8.Endoscopic Prediction of Deep Submucosal Invasive Carcinoma: Validation of the Narrow-Band Imaging International Colorectal Endoscopic (NICE) Classification Gastrointest Endosc. 2013 Oct;78(4):625-32. doi: 10.1016/j.gie.2013.04.185. Epub 2013 Jul 30. Hayashi N, Tanaka S, Hewett DG, Kaltenbach TR, Sano Y, Ponchon T, Saunders BP, Rex DK, Soetikno RM.
  1. 9.Narrow-Band Imaging with Dual Focus Magnification in Differentiating Colorectal Neoplasia Dig Endosc. 2013 May;25 Suppl 2:16-20. doi: 10.1111/den.12075. Singh R, Jayanna M, Navadgi S, Ruszkiewicz A, Saito Y, Uedo N.
  2. 10.Standard Endoscopy with Random Biopsies Versus Narrow Band Imaging Targeted Biopsies in Barrett‘s Oesophagus: A Prospective, International, Randomised Controlled Trial Gut. 2013 Jan;62(1):15-21. doi: 10.1136/gutjnl-2011-300962. Epub 2012 Feb 7. Sharma P, Hawes RH, Bansal A, Gupta N, Curvers W, Rastogi A, Singh M, Hall M, Mathur SC, Wani SB, Hoffman B, Gaddam S, Fockens P, Bergman JJ.
  3. 11.Advanced Imaging Technologies Increase Detection of Dysplasia and Neoplasia in Patients with Barrett‘s Esophagus: A Meta-Analysis and Systematic Review Clin Gastroenterol Hepatol. 2013 Dec;11(12):1562-70.e1-2. doi: 10.1016/j. cgh.2013.06.017. Epub 2013 Jul 12. Qumseya BJ, Wang H, Badie N, Uzomba RN, Parasa S, White DL, Wolfsen H, Sharma P, Wallace MB.
  4. 12.White-Light or Narrow-Band Imaging Colonoscopy in Surveillance of Ulcerative Colitis: A Prospective Multicenter Study Clin Gastroenterol Hepatol. 2015 Oct;13(10):1776-1781.e1. doi: 10.1016/j. cgh.2015.04.172. Epub 2015 May 5. Leifeld L, Rogler G, Stallmach A, Schmidt C, Zuber-Jerger I, Hartmann F, Plauth M, Drabik A, Hofstädter F, Dienes HP, Kruis W; Detect Dysplasia Study Group.
  1. 13.Narrow Band Imaging with Magnification Endoscopy for Celiac Disease: Results from a Prospective, Single-Center Study Diagn Ther Endosc. 2013;2013:580526. doi: 10.1155/2013/580526. Epub 2013 Aug 6. De Luca L, Ricciardiello L, Rocchi MB, Fabi MT, Bianchi ML, de Leone A, Fiori S, Baroncini D.
  2. 14.Adenoma Detection Rate and Risk of Colorectal Cancer and Death N Engl J Med. 2014 Apr 3;370(14):1298-306 van den Broek E, Richard W, van Tinteren H, et al.
  3. 15.Improving Measurement of the Adenoma Detection Rate and Adenoma Per Colonoscopy Quality Metric: The Indiana University Experience Gastrointest Endosc. 2014 Mar;79(3):448-54. Kahi CJ, Vemulapalli KC, Johnson CS, Rex DK.
  4. 16.Impact of Bowel Preparation with Low-Volume (2-Liter) and Intermediate-Volume (3-Liter) Polyethylene Glycol on Colonoscopy Quality: A Prospective Observational Study Digestion. 2015;92(3):156-64. Cheng CL, Kuo YL, Liu NJ, Lin CH, Tang JH, Tsui YN, Lee BP, Su MY, Chiu CT.
  1. 17.Adenoma Detection Rate Is not Influenced by the Timing of Colonoscopy When Performed in Half-Day Blocks Am J Gastroenterol. 2011 Aug;106(8):1466-71. doi: 10.1038/ajg.2011.125. Epub 2011 Apr 19. Gurudu SR, Ratuapli SK, Leighton JA, Heigh RI, Crowell MD.
  2. 18.A Patient-Blinded Randomized, Controlled Trial Comparing Air Insufflation, Water Immersion, and Water Exchange During Minimally Sedated Colonoscopy Am J Gastroenterol. 2014 Sep;109(9):1390-400. doi: 10.1038/ajg.2014.126. Epub 2014 Jun 3. Hsieh YH, Koo M, Leung FW.
  3. 19.High Definition Colonoscopy vs. Standard Video Endoscopy for the Detection of Colonic Polyps: A Meta-Analysis Endoscopy. 2011 Jun;43(6):499-505. doi: 10.1055/s-0030-1256207. Epub 2011 Feb 28. Subramanian V, Mannath J, Hawkey CJ, Ragunath K.
  4. 20.Detection of Colorectal Adenoma by Narrow Band Imaging (HQ190) vs. High-Definition White Light Colonoscopy: A Randomized Controlled Trial Am J Gastroenterol. 2014 Jun;109(6):855-63. doi: 10.1038/ajg.2014.83. Epub 2014 Apr 22. Leung WK, Lo OS, Liu KS, Tong T, But DY, Lam FY, Hsu AS, Wong SY, Seto WK, Hung IF, Law WL.
  1. 21.Next-Generation Narrow Band Imaging System for Colonic Polyp Detection: A Prospective Multicenter Randomized Trial Int J Colorectal Dis. 2015 Jul;30(7):947-54. doi: 10.1007/s00384-015-2230-x. Epub 2015 Apr 30. Horimatsu T, Sano Y, Tanaka S, Kawamura T, Saito S, Iwatate M, Oka S, Uno K, Yoshimura K, Ishikawa H, Muto M, Tajiri H.
  2. 22.Narrow Band Imaging to Differentiate Neoplastic and Non-Neoplastic Colorectal Polyps in Real Time: A Meta-Analysis of Diagnostic Operating Characteristics Gut. 2013 Dec;62(12):1704-13. doi: 10.1136/gutjnl-2012-303965. Epub 2013 Jan 7. McGill SK, Evangelou E, Ioannidis JP, Soetikno RM, Kaltenbach T.
  3. 23.Diagnostic Performance of Narrowed Spectrum Endoscopy, Autofluorescence Imaging, and Confocal Laser Endomicroscopy for Optical Diagnosis of Colonic Polyps: A Meta-Analysis Lancet Oncol. 2013 Dec;14(13):1337-47. doi: 10.1016/S1470-2045(13)70509-6. Epub 2013 Nov 13. Wanders LK, East JE, Uitentuis SE, Leeflang MM, Dekker E.
  4. 24.ASGE Technology Committee Systematic Review and Meta-Analysis Assessing the ASGE PIVI Thresholds for Adopting Real-Time Endoscopic Assessment of the Histology of Diminutive Colorectal Polyps Gastrointest Endosc. 2015 Mar;81(3):502.e1-502.e16. doi: 10.1016/j.gie.2014.12.022. Epub 2015 Jan 16. ASGE Technology Committee, Abu Dayyeh BK, Thosani N, Konda V, Wallace MB, Rex DK, Chauhan SS, Hwang JH, Komanduri S, Manfredi M, Maple JT, Murad FM, Siddiqui UD, Banerjee S.
  1. 25.Real-Time Optical Diagnosis for Diminutive Colorectal Polyps Using Narrow-Band Imaging: The VALID Randomised Clinical Trial Gut. 2015 Oct;64(10):1569-77. doi: 10.1136/gutjnl-2014-307742. Epub 2014 Nov 11. Kaltenbach T, Rastogi A, Rouse RV, McQuaid KR, Sato T, Bansal A, Kosek JC, Soetikno R.
  2. 26.Advanced Imaging for Detection and Differentiation of Colorectal Neoplasia: European Society of Gastrointestinal Endoscopy (ESGE) Guideline Endoscopy. 2014 May;46(5):435-49. doi: 10.1055/s-0034-1365348. Epub 2014 Mar 17. Kamiński MF, Hassan C, Bisschops R, Pohl J, Pellisé M, Dekker E, Ignjatovic-Wilson A, Hoffman A, Longcroft-Wheaton G, Heresbach D, Dumonceau JM, East JE.
  3. 27.An Analysis of the Learning Curve to Achieve Competency at Colonoscopy Using the JETS Database Gut. 2014 Nov;63(11):1746-54. doi: 10.1136/gutjnl-2013-305973. Epub 2014 Jan 27. Ward ST, Mohammed MA, Walt R, Valori R, Ismail T, Dunckley P.
  4. 28.Patient Pain During Colonoscopy: An Analysis Using Real-Time Magnetic Endoscope Imaging Endoscopy. 2002 Jun;34(6):435-40. Shah SG, Brooker JC, Thapar C, Williams CB, Saunders BP.
  1. 29.Magnetic Endoscopic Imaging Versus Standard Colonoscopy in a Routine Colonoscopy Setting: A Randomized, Controlled Trial. Gastrointest Endosc. 2011 Jun;73(6):1215-22. doi: 10.1016/j.gie.2011.01.054. Epub 2011 Apr 8. Holme Ö, Höie O, Matre J, Stallemo A, Garborg K, Hasund A, Wiig H, Hoff G, Bretthauer M.
  2. 30.Magnetic Endoscopic Imaging Versus Standard Colonoscopy: Meta-Analysis of Randomized Controlled Trials World J Gastroenterol. 2013 Nov 7;19(41):7197-204. doi: 10.3748/wjg.v19.i41.7197. Chen Y, Duan YT, Xie Q, Qin XP, Chen B, Xia L, Zhou Y, Li NN, Wu XT.
  3. 31.Magnetic Endoscopic Imaging as an Adjuvant to Elective Colonoscopy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials Endoscopy. 2015 Mar;47(3):251-61. doi: 10.1055/s-0034-1390767. Epub 2014 Dec 18. Mark-Christensen A, Brandsborg S, Iversen LH.
  4. 32.Does “Responsive Insertion Technology” Improve Practice of Colonoscopy? Results of a Randomized Study Scand J Gastroenterol. 2014 Mar;49(3):355-61. doi: 10.3109/00365521.2013.871576. Epub 2014 Jan 13. Cuesta R, Sola-Vera J, Uceda F, García Sepulcre MF, Morillo E, Vázquez N.
  1. 33.Conscious Sedation and Analgesia in Colonoscopy [...] Anesth Pain Med. 2013 Summer;3(1):208-13. doi: 10.5812/aapm.9653. Epub 2013 Jul 1. Khajavi M, Emami A, Etezadi F, Safari S, Sharifi A, Shariat Moharari R.
  2. 34.Safety Analysis of Endoscopist-Directed [...] J Gastroenterol Hepatol. 2014 Mar;29(3):517-23. Sieg A; bng-Study-Group, Beck S, Scholl SG, Heil FJ, Gotthardt DN, Stremmel W, Rex DK, Friedrich K.
  3. 35.Position Change During Colonoscope Withdrawal Increases Polyp and Adenoma Detection in the Right but not in the Left Side of the Colon: Results of a Randomized Controlled Trial Gastrointest Endosc. 2015 Sep;82(3):488-94. doi: 10.1016/j.gie.2015.01.035. Epub 2015 Apr 22. Ball AJ, Johal SS, Riley SA.
  4. 36.Variable Stiffness Colonoscope Versus Regular Adult Colonoscope: Meta-Analysis of Randomized Controlled Trials Endoscopy. 2009 Jan;41(1):17-24. doi: 10.1055/s-0028-1103488. Epub 2009 Jan 21. Othman MO, Bradley AG, Choudhary A, Hoffman RM, Roy PK.
  1. 37.[...] Sedation for Colonoscopy with a New Ultrathin or a Standard Endoscope: A Prospective Randomized Controlled Study Endoscopy. 2013 Jun;45(6):439-44. doi: 10.1055/s-0032-1326270. Epub 2013 Mar 6. Töx U, Schumacher B, Toermer T, Terheggen G, Mertens J, Holzapfel B, Lehmacher W, Goeser T, Neuhaus H.
  2. 38.Long-Term Colorectal-Cancer Incidence and Mortality after Lower Endoscopy N Engl J Med. 2013 Sep 19;369(12):1095-105. doi: 10.1056/NEJMoa1301969 Nishihara R, Wu K, Lochhead P, Morikawa T, Liao X, Qian ZR, Inamura K, Kim SA, Kuchiba A, Yamauchi M, Imamura Y, Willett WC, Rosner BA, Fuchs CS, Giovannucci E, Ogino S, Chan AT.
  3. 39.The Comparative Cost-Effectiveness of Colorectal Cancer Screening Using Faecal Immunochemical Test Versus Colonoscopy Sci Rep. 2015 Sep 4;5:13568. doi: 10.1038/srep13568. Wong MC, Ching JY, Chan VC, Sung JJ.
  4. 40.Trends in Adenoma Detection Rates During the First 10 Years of the German Screening Colonoscopy Program Gastroenterology. 2015 Aug;149(2):356-66.e1. doi: 10.1053/j.gastro.2015.04.012. Epub 2015 Apr 22. Brenner H, Altenhofen L, Kretschmann J, Rösch T, Pox C, Stock C, Hoffmeister M
  1. 41.Global Epidemiology of Barrett‘s Esophagus Expert Rev Gastroenterol Hepatol. 2011 Feb;5(1):123-30. doi: 10.1586/egh.10.82. Fock KM, Ang TL.
  2. 42.Cost Considerations in Implementing a Screening and Surveillance Strategy for Barrett‘s Oesophagus Best Pract Res Clin Gastroenterol. 2015 Feb;29(1):51-63. doi: 10.1016/j. bpg.2014.12.002. Epub 2014 Dec 18. Inadomi JM.
  3. 43.Preliminary Feasibility Study Using a Novel Narrow-Band Imaging System with Dual Focus Magnification Capability in Barrett‘s Esophagus: Is the Time Ripe to Abandon Random Biopsies? Dig Endosc. 2013 May;25 Suppl 2:151-6. doi: 10.1111/den.12106. Singh R, Shahzad MA, Tam W, Goda K, Yu LH, Fujishiro M, Uedo N, Ruszkiewicz A.
  4. 44.Carbon Dioxide Insufflation Versus Conventional Air Insufflation for Colonoscopy: A Systematic Review and Meta-Analysis of Published Randomized Controlled Trials Colorectal Dis. 2015 Feb;17(2):111-23. doi: 10.1111/codi.12837. Sajid MS, Caswell J, Bhatti MI, Sains P, Baig MK, Miles WF.
  1. 45.Reduced Pain During Screening Colonoscopy with an Ultrathin Colonoscope: A Randomized Controlled Trial Endoscopy. 2012 Aug;44(8):740-6. doi: 10.1055/s-0032-1309755. Epub 2012 May 23. Garborg KK, Løberg M, Matre J, Holme O, Kalager M, Hoff G, Bretthauer M.
  2. 46.ASGE Technology Committee systematic review and meta-analysis assessing the ASGE Preservation and Incorporation of Valuable Endoscopic Innovations thresholds for adopting real-time imaging-assisted endoscopic targeted biopsy during endoscopic surveillance of Barrett's esophagus. Gastrointest Endosc. 2016 Apr;83(4):684-698.e7. ASGE Technology Committee, Thosani N, Abu Dayyeh BK, Sharma P, Aslanian HR, Enestvedt BK, Komanduri S, Manfredi M, Navaneethan U, Maple JT, Pannala R, Parsi MA, Smith ZL, Sullivan SA, Banerjee S.
  3. 47.Longer Withdrawal Time Is Associated With a Reduced Incidence of Interval Cancer After Screening Colonoscopy. Gastroenterology 2015 Jul 9 (ahead of print) Shaukat A, Rector TS, Church TR, Lederle FA, Kim AS, Rank JM, Allen JI.
  4. 48.Virtual chromoendoscopy to assess colorectal polyps during colonoscopy NICE National Institute for Health and Care Excellence, United Kingdom Newland A, Kroese M, Akehurst R, Bagshaw J, Crawford S, Edwards S, Fleming S, Gray J, Halligan S, Hitchman J, Hyde C, McGinley P, Messenger M, Moseley A, Naylor P, Neely D, Richards S, Sculpher M, Stevenson M, Wierzbicki A, East J, McConnell S, Moorghen M, Subramanian V, Maloney J, Nixon F, Albrow R, Fernley R
  1. 1.Update on Endoscopic Tissue Sampling Devices. Gastrointest Endosc. 2006 May;63(6):741-5.

    Technology Assessment Committe, Barkun A, Liu J, Carpenter S, Chotiprasidhi P, Chuttani R, Ginsberg G, Hussain N, Silverman W, Taitelbaum G, Petersen BT.
  2. 2.The Role of Endoscopy in Barrett‘s Esophagus and Other Premalignant Conditions of the Esophagus. Gastrointest Endosc. 2012 Dec;76(6):1087-94. doi: 10.1016/j.gie.2012.08.004.

    ASGE Standards of Practice Committee, Evans JA, Early DS, Fukami N, Ben-Menachem T, Chandrasekhara V, Chathadi KV, Decker GA, Fanelli RD, Fisher DA, Foley KQ, Hwang JH, Jain R, Jue TL, Khan KM, Lightdale J, Malpas PM, Maple JT, Pasha SF, Saltzman JR, Sharaf RN, Shergill A, Dominitz JA, Cash BD; Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy.
  3. 3.American Gastroenterological Association Institute Guideline on the Role of Upper Gastrointestinal Biopsy to Evaluate Dyspepsia in the Adult Patient in the Absence of Visible Mucosal Lesions Gastroenterology. 2015 Oct;149(4):1082-7. doi: 10.1053/j.gastro.2015.07.039. Epub 2015 Aug 14.

    Yang YX, Brill J, Krishnan P, Leontiadis G; American Gastroenterological Association Clinical Practice Guidelines Committee.
  1. 4.The Role of Endoscopy in Inflammatory Bowel Disease Gastrointest Endosc. 2015 May;81(5):1101-21.e1-13. doi: 10.1016/j. ie.2014.10.030. Epub 2015 Mar 20.

    American Society for Gastrointestinal Endoscopy Standards of Practice Committee, Shergill AK, Lightdale JR, Bruining DH, Acosta RD, Chandrasekhara V, Chathadi KV, Decker GA, Early DS, Evans JA, Fanelli RD, Fisher DA, Fonkalsrud L, Foley K, Hwang JH, Jue TL, Khashab MA, Muthusamy VR, Pasha SF, Saltzman JR, Sharaf R, Cash BD, DeWitt JM.
  2. 5.The Seattle Protocol Does Not More Reliably Predict the Detection of Cancer at the Time of Esophagectomy Than a Less Intensive Surveillance Protocol Clin Gastroenterol Hepatol. 2009 Jun;7(6):653-8; quiz 606. doi: 10.1016/j. cgh.2008.11.024. Epub 2008 Dec 13.

    Kariv R, Plesec TP, Goldblum JR, Bronner M, Oldenburgh M, Rice TW, Falk GW.
  3. 6.Random Biopsies Taken During Colonoscopic Surveillance of Patients with Longstanding Ulcerative Colitis: Low Yield and Absence of Clinical Consequences Am J Gastroenterol. 2014 May;109(5):715-22. doi: 10.1038/ajg.2011.93. Epub 2011 Mar 22.

    van den Broek FJ, Stokkers PC, Reitsma JB, Boltjes RP, Ponsioen CY, Fockens P, Dekker E.
  1. 7.Validation of a Simple Classification System for Endoscopic Diagnosis of Small Colorectal Polyps Using Narrow-Band Imaging Gastroenterology. 2012 Sep;143(3):599-607.e1. doi: 10.1053/j.gastro.2012.05.006. Epub 2012 May 15.

    Hewett DG, Kaltenbach T, Sano Y, Tanaka S, Saunders BP, Ponchon T, Soetikno R, Rex DK.
  2. 8.Endoscopic Prediction of Deep Submucosal Invasive Carcinoma: Validation of the Narrow-Band Imaging International Colorectal Endoscopic (NICE) Classification Gastrointest Endosc. 2013 Oct;78(4):625-32. doi: 10.1016/j.gie.2013.04.185. Epub 2013 Jul 30.

    Hayashi N, Tanaka S, Hewett DG, Kaltenbach TR, Sano Y, Ponchon T, Saunders BP, Rex DK, Soetikno RM.
  3. 9.Narrow-Band Imaging with Dual Focus Magnification in Differentiating Colorectal Neoplasia Dig Endosc. 2013 May;25 Suppl 2:16-20. doi: 10.1111/den.12075.

    Singh R, Jayanna M, Navadgi S, Ruszkiewicz A, Saito Y, Uedo N.
  1. 10.Standard Endoscopy with Random Biopsies Versus Narrow Band Imaging Targeted Biopsies in Barrett‘s Oesophagus: A Prospective, International, Randomised Controlled Trial Gut. 2013 Jan;62(1):15-21. doi: 10.1136/gutjnl-2011-300962. Epub 2012 Feb 7.

    Sharma P, Hawes RH, Bansal A, Gupta N, Curvers W, Rastogi A, Singh M, Hall M, Mathur SC, Wani SB, Hoffman B, Gaddam S, Fockens P, Bergman JJ.
  2. 11.Advanced Imaging Technologies Increase Detection of Dysplasia and Neoplasia in Patients with Barrett‘s Esophagus: A Meta-Analysis and Systematic Review Clin Gastroenterol Hepatol. 2013 Dec;11(12):1562-70.e1-2. doi: 10.1016/j. cgh.2013.06.017. Epub 2013 Jul 12.

    Qumseya BJ, Wang H, Badie N, Uzomba RN, Parasa S, White DL, Wolfsen H, Sharma P, Wallace MB.
  3. 12.White-Light or Narrow-Band Imaging Colonoscopy in Surveillance of Ulcerative Colitis: A Prospective Multicenter Study Clin Gastroenterol Hepatol. 2015 Oct;13(10):1776-1781.e1. doi: 10.1016/j. cgh.2015.04.172. Epub 2015 May 5.

    Leifeld L, Rogler G, Stallmach A, Schmidt C, Zuber-Jerger I, Hartmann F, Plauth M, Drabik A, Hofstädter F, Dienes HP, Kruis W; Detect Dysplasia Study Group.
  1. 13.Narrow Band Imaging with Magnification Endoscopy for Celiac Disease: Results from a Prospective, Single-Center Study Diagn Ther Endosc. 2013;2013:580526. doi: 10.1155/2013/580526. Epub 2013 Aug 6.

    De Luca L, Ricciardiello L, Rocchi MB, Fabi MT, Bianchi ML, de Leone A, Fiori S, Baroncini D.
  2. 14.Adenoma Detection Rate and Risk of Colorectal Cancer and Death N Engl J Med. 2014 Apr 3;370(14):1298-306

    van den Broek E, Richard W, van Tinteren H, et al.
  3. 15.Improving Measurement of the Adenoma Detection Rate and Adenoma Per Colonoscopy Quality Metric: The Indiana University Experience Gastrointest Endosc. 2014 Mar;79(3):448-54.

    Kahi CJ, Vemulapalli KC, Johnson CS, Rex DK.
  1. 16.Impact of Bowel Preparation with Low-Volume (2-Liter) and Intermediate-Volume (3-Liter) Polyethylene Glycol on Colonoscopy Quality: A Prospective Observational Study Digestion. 2015;92(3):156-64.

    Cheng CL, Kuo YL, Liu NJ, Lin CH, Tang JH, Tsui YN, Lee BP, Su MY, Chiu CT.
  2. 17.Adenoma Detection Rate Is not Influenced by the Timing of Colonoscopy When Performed in Half-Day Blocks Am J Gastroenterol. 2011 Aug;106(8):1466-71. doi: 10.1038/ajg.2011.125. Epub 2011 Apr 19.

    Gurudu SR, Ratuapli SK, Leighton JA, Heigh RI, Crowell MD.
  3. 18.A Patient-Blinded Randomized, Controlled Trial Comparing Air Insufflation, Water Immersion, and Water Exchange During Minimally Sedated Colonoscopy Am J Gastroenterol. 2014 Sep;109(9):1390-400. doi: 10.1038/ajg.2014.126. Epub 2014 Jun 3.

    Hsieh YH, Koo M, Leung FW.
  1. 19.High Definition Colonoscopy vs. Standard Video Endoscopy for the Detection of Colonic Polyps: A Meta-Analysis Endoscopy. 2011 Jun;43(6):499-505. doi: 10.1055/s-0030-1256207. Epub 2011 Feb 28.

    Subramanian V, Mannath J, Hawkey CJ, Ragunath K.
  2. 20.Detection of Colorectal Adenoma by Narrow Band Imaging (HQ190) vs. High-Definition White Light Colonoscopy: A Randomized Controlled Trial Am J Gastroenterol. 2014 Jun;109(6):855-63. doi: 10.1038/ajg.2014.83. Epub 2014 Apr 22.

    Leung WK, Lo OS, Liu KS, Tong T, But DY, Lam FY, Hsu AS, Wong SY, Seto WK, Hung IF, Law WL.
  3. 21.Next-Generation Narrow Band Imaging System for Colonic Polyp Detection: A Prospective Multicenter Randomized Trial Int J Colorectal Dis. 2015 Jul;30(7):947-54. doi: 10.1007/s00384-015-2230-x. Epub 2015 Apr 30.

    Horimatsu T, Sano Y, Tanaka S, Kawamura T, Saito S, Iwatate M, Oka S, Uno K, Yoshimura K, Ishikawa H, Muto M, Tajiri H.
  1. 22.Narrow Band Imaging to Differentiate Neoplastic and Non-Neoplastic Colorectal Polyps in Real Time: A Meta-Analysis of Diagnostic Operating Characteristics Gut. 2013 Dec;62(12):1704-13. doi: 10.1136/gutjnl-2012-303965. Epub 2013 Jan 7.

    McGill SK, Evangelou E, Ioannidis JP, Soetikno RM, Kaltenbach T.
  2. 23.Diagnostic Performance of Narrowed Spectrum Endoscopy, Autofluorescence Imaging, and Confocal Laser Endomicroscopy for Optical Diagnosis of Colonic Polyps: A Meta-Analysis Lancet Oncol. 2013 Dec;14(13):1337-47. doi: 10.1016/S1470-2045(13)70509-6. Epub 2013 Nov 13.

    Wanders LK, East JE, Uitentuis SE, Leeflang MM, Dekker E.
  3. 24.ASGE Technology Committee Systematic Review and Meta-Analysis Assessing the ASGE PIVI Thresholds for Adopting Real-Time Endoscopic Assessment of the Histology of Diminutive Colorectal Polyps Gastrointest Endosc. 2015 Mar;81(3):502.e1-502.e16. doi: 10.1016/j.gie.2014.12.022. Epub 2015 Jan 16.

    ASGE Technology Committee, Abu Dayyeh BK, Thosani N, Konda V, Wallace MB, Rex DK, Chauhan SS, Hwang JH, Komanduri S, Manfredi M, Maple JT, Murad FM, Siddiqui UD, Banerjee S.
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