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Many different techniques for colon cancer screening are available. The fecal immunochemical test is best for fecal-based screening, although the DNA investigation may be more specific when further developed. Computed tomographic colonography is as good as colonoscopy for detecting colon cancer and is almost as good as colonoscopy for detecting advanced adenomas, but has limitations. The flexible sigmoidoscopic examination markedly decreases the incidence of cancer in the visualized segments, but colonoscopy is currently the best procedure for evaluating the large bowel. Techniques for retroflexion or backward view of the colon have been investigated, with all showing increased polyp detection.

Colon screening examinations have been shown to discover neoplastic lesions at an early stage. Even the most careful studies by colonoscopy and by computed tomographic colonography (CTC) can overlook tumors with a diameter greater than 5 mm. Advances in technology have continually improved the ability to find polyps, which will lead to a real decrease in colorectal cancer incidence.

Advanced polypectomy includes the approach to large polyps, polyps that are difficult to access, and polyps that require special maneuvers for removal. Sessile polyps are considered difficult to remove, the larger diameters falling into the "very difficult" category, requiring advanced polypectomy techniques. Some pedunculated polyps may require advanced techniques. Most polyps in the colon are sessile, and many of these are located in the right colon, from the hepatic flexure to the cecal caput. Pedunculated polyps, with a pedicle of pulled-out mucosa and submucosa caused by the constant action of peristalsis in the colon's attempt to evacuate the polyp, usually are located in the sigmoid colon.

The term submucosal injection polypectomy (SIP) more accurately describes the technique used for removal of flat colonic polyps and is preferred, in the colon, to endoscopic mucosal resection (a procedure that usually uses a special suction-activated device). Using SIP, most polyps can be removed safely from any part of the colon. The methodology is described in detail and is within the capability of most colonoscopists.

The three most prominent advances in colonoscopic polypectomy are the submucosal injection of saline to ensure safety of polypectomy, the use of the small, or mini, snare for removal of most colon polyps, and the introduction of the argon plasma coagulator for the treatment of vascular abnormalities of the colon and the fulguration of residual adenoma at the base of sessile polyps with a noncontact technique. The role of Endoloop, endoscopic clips, and rubber band ligation for polypectomy is discussed.

Complications can occur during both diagnostic and therapeutic endoscopy. Most statistics concerning complications are based on reports generated when colonoscopy was in its infancy. This article examines the diagnosis and treatment of complications that arise during the course of both colonoscopy and polypectomy. Surgery may not be required in all cases. The criteria for operative or nonoperative treatment are presented.

This article discusses the important role endoscopy plays in the diagnosis and management of inflammatory bowel disease and how the procedure adds crucial information to the constellation of history, physical examination, radiographic findings, and laboratory values. Differentiation between Crohn's disease and ulcerative colitis has important ramifications for medical therapy, surgical options, and prognosis. This distinction can be accurately made in at least 85% of patients.