[Screening: management after incomplete colonoscopy could be improved]

Abstract

In 2014 in the Netherlands a national screening programme for bowel cancer was started in which a colonoscopy is performed after a positive immunochemical faecal occult blood test. If colonoscopy is incomplete a CT colonography (CTC) is offered in order to visualize the remaining colon. Balloon endoscopy (BE), double- or single-balloon, is an effective and safe endoscopic alternative which has advantages over CTC, including the option of endoscopic polypectomy and histological examination. However, its cost and the need for an additional procedure on a different day are disadvantageous. BE deserves a place in the national screening programme for bowel cancer after an incomplete colonoscopy, as a possible alternative for CTC and certainly after finding polyps on CTC. Because expertise in BE and its availability are limited, in each screening region some centres should be appointed as designated referral centres to perform BE.