Indications and techniques for lower intestinal endoscopy

The search for inflammatory and neoplastic lesions are the main indications for colonoscopy. A high rate of detection of polyps has become a quality criterion that depends on skilled handling of the colonoscope, on expertise and concentration during the examination, on excellent bowel preparation, and on a high standard of technical equipment. The diagnostic benefits outweigh the risk of bleeding, perforation and infection in almost all situations. Contraindications are signs of perforated intestine or imminent perforation due to deep ulcerations, necroses, or fulminant colitis. The patient's comorbidity must be considered to assess the physical stress of bowel preparation, colonoscopy and sedation. Informed consent is necessary and must be documented in all cases. It is advisable to explain planned therapeutic manoeuvres before the examination, since all non-invasive polyps must be removed completely. Total colonoscopy is possible in 95–99% of cases, but technical efforts are under way to solve the problem of looping and fixed colon angulations. Optimising optical imaging is another main focus of industrial development. The combination of narrow-band imaging, zoom magnification, and high-definition processor technology is currently the most promising tool for identifying small and flat lesions in the colon.