Colonoscopy with removal and pathologic assessment of all polyps is frequently performed in patients at risk for colorectal cancer. Surveillance intervals are then determined based on quantity and size of adenomatous polyps. While colonoscopy serves as the current gold standard for colon cancer prevention and diagnosis, there is an inherent miss rate with the procedure. For example, 5% of patients diagnosed with colorectal cancer had a recent colonoscopy that failed to detect the malignancy [1 ]. Additionally, tandem colonoscopy studies have shown an adenoma miss rate of 2.1% for adenomas >10mm, 13% for adenomas 5-10mm, and 26% for adenomas of 1-5 mm [2]. Several factors have been shown to contribute to miss rates including poor bowel preparation, failure to reach the lesion, flat or depressed polyps, exam performance by a non-gastroenterologists [2], overly rapid withdrawal times [3], incomplete polypectomies, or polyps hidden behind folds. Whether and to what extent technological advances in imaging can improve the detection of colonic neoplasia remains an open question.
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