Advanced endoscopic technologies for colorectal cancer screening

Abstract

Colorectal cancer is the third most common cancer in men and the second most common cancer in women worldwide. Diagnosing colorectal has been increasingly successful due to advances in technology. Flexible endoscopy is considered to be an effective method for early diagnosis and treatment of gastrointestinal cancer, making it a popular choice for screening programs. However, millions of people who may benefit from endoscopic colorectal cancer screening fail to have the procedure performed. Main reasons include psychological barriers due to the indignity of the procedure, fear of procedure related pain, bowel preparation discomfort, and potential need for sedation. Therefore, an urgent need for new technologies addressing these issues clearly exists. In this review, we discuss a set of advanced endoscopic technologies for colorectal cancer screening that are either already available or close to clinical trial. In particular, we focus on visual-inspection-only advanced flexible colonoscopes, interventional colonoscopes with alternative propulsion mechanisms, wireless capsule colonoscopy, and technologies for intraprocedural bowel cleansing. Many of these devices have the potential to reduce exam related patient discomfort, obviate the need for sedation, increase diagnostic yield, reduce learning curves, improve access to screening, and possibly avert the need for a bowel preparation.

Keywords: Capsule colonoscopy; Colorectal cancer; Endoscopy; Screening; Technology.

Figure 1

Figures of the devices. A: The CathCam system, reprinted from[15], with permission from Elsevier; B: The Aer-O-Scope™ system, reprinted from[18], with permission from Elsevier; C: The Endotics™ system, image courtesy of Era Endoscopy; D: The NeoGuide™ system, reprinted by permission from Macmillan Publisher Ltd.: The American Journal of Gastroenterology[11], copyright 2007; E: The Invendoscope™ system, reprinted from[24] with permission from Elsevier; F: The ColonoSight™ system, reprinted from[26] with permission from Elsevier; G: Magnetic endoscopic device described in[27]; H: The Endo-Ease™ overtube over a pediatric colonoscope, reprinted from[28], with permission from Elsevier.