L'augmentation du taux de détection des adénomes par la coloscopie optimisée : meilleur moyen contre le cancer colorectal d'intervalle. Quand la coloscopie optimisée supplante la coloscopie standard.

Optimization of the adenoma detection rate (ADR), inversely proportional to the risk of interval colorectal cancer, is a major objective in colorectal cancer (CRC) screening. Achieving optimal ADR involves not only adherence to best practice guidelines but also benefits from technological advancements and developments in endoscope technology. Best practices with demonstrated positive impact on ADR include ensuring strict adherence to a residue-free diet for at least 24 hours (by increasing patient awareness or even offering "pre-packaged diets"), promoting split-dose bowel preparation, scheduling dedicated and sufficiently long operating sessions, systematically using a washing pump, maintaining an adequate colon exploration time, and performing a double exploration of the right colon, preferably with cecal retrovision. Adhering to these best practices enables achieving high-quality patient preparation, completeness of colonoscopies, and ultimately a sufficiently high ADR. On the other hand, optimization devices developed in recent years, which have shown their effectiveness in numerous randomized studies, must now be implemented in routine practice. These three different types of optimization devices are caps (enabling exploration of a larger surface area of colonic mucosa), artificial intelligence (AI) that enhances endoscopist vigilance, and image contrast enhancement devices that make a barely visible flat polyp more visible. The combined use of these three highly complementary devices appears optimal. The gradual shift toward routine practice of optimized screening colonoscopy using these devices will undoubtedly lead to an increase in the minimum required ADR, well beyond the currently recommended rate of 25% in the target population for CRC screening. [ABSTRACT FROM AUTHOR]