Advanced endoscopic imaging for detection and differentiation of colorectal neoplasia

In the Netherlands, colorectal cancer (CRC) is one of the major causes of death and accounted for approximately 5000 deaths in 2015. To reduce mortality, a nationwide CRC screening program is gradually implemented in the Netherlands since January 2014. The implementation of this nationwide CRC screening program has already resulted in an annual increase in the number of colonoscopies from 190.000 to 250.000.6 The burden on colonoscopy programs will gradually expand further, also due to surveillance programs for those screenees with relevant lesions at colonoscopy, already resulting in waiting lists and increasing costs for the society. Improving cost-efficacy of this preventive program is therefore warranted. Advanced endoscopic imaging techniques have become readily available in routine practice and could aid endoscopists with decision-making on optimal treatment as precise detection and lesion characterization is crucial. Studies in this thesis underline that resecting and discarding small polyps without histopathological analysis can be regarded as safe, if endoscopists are properly trained and audited. Moreover, implementation of this strategy seems to improve cost-effectiveness of the Dutch screening program. Furthermore, endoscopic recognition of early stage CRC can be improved and this may result in better treatment outcomes of these lesion. This can presumably be achieved by providing training to endoscopists in structured lesion characterization with advanced endoscopic imaging techniques. Effective training modules based on validated criteria, combined with periodic auditing and monitoring, are needed to disseminate the use of advanced imaging techniques in clinical practice. Linking effective training modules of advanced imaging techniques to improved patient outcomes will be a key area for future research.