It is a truism that no two people are the same. Even their colons are different. Some people have a loopy, or narrow bowel. In others it is straighter and wide. For some it is floppy, and in others the walls are surrounded by firm muscles. Furthermore, some people will have cleared all the stool from the bowel whereas others, who still follow the bowel preparation routine correctly, can have significant residual stool. This can make a very big difference to the ease of the procedure.
Over the years, we have learned that inflating the bowel with carbon dioxide rather than air makes the procedure less painful and leaves the patient feeling better immediately afterwards with less cramps, bloating and discharging of wind. More recently, we are realising that flushing the bowel with large amounts of water make the procedure faster, more comfortable and cleaner with a higher chance of detecting subtle abnormalities. All of these issues should be considered by a careful colonoscopist.
One of the key issues is to ensure that the colonoscopist has reached the far end of the large bowel (the caecum). But this comes with its own risks. If the doctor is too focused on achieving this key performance indicator, once they have done so, they may switch off and not focus properly on the more important part of the exam which is a slow, careful withdrawal making sure that enough time is spent assessing the entire colon for subtle (and not-so-subtle) abnormalities. We have been working on artificial intelligence systems as a ‘second pair of eyes’ to help endoscopists spot abnormalities. We have shown that this dramatically improves the likelihood of spotting polyps as well as working towards ever safer colonoscopy.
