Effectiveness, training and quality assurance of colonoscopy screening for colorectal cancer

Gut. 2015 Jun;64(6):982-90. doi: 10.1136/gutjnl-2014-308076. Epub 2015 Mar 24.


Screening for colorectal cancer has been proven to be effective in reducing colorectal cancer incidence and mortality. While the precise benefit of screening exclusively by colonoscopy is not yet known, unarguably, the exam is central to the success of any screening programme. The test affords the opportunity to detect and resect neoplasia across the entire large bowel and is the definitive examination when other screening tests are positive. However, colonoscopy is invasive and often requires sedation as well as extensive bowel preparation, all of which puts the patient at risk. Furthermore, the test can technically be demanding and, unarguably, there is variation in how it is performed. This variation in performance has now been definitively linked to important outcome measures. For example, interval cancers are more common in low adenoma detectors as compared with high adenoma detectors. This review outlines the most current thinking regarding the effectiveness of colonoscopy as a screening tool. It also outlines key concepts to optimise its performance through robust quality assurance programmes and high-quality training.


Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.
  • Review

MeSH terms

  • Colonoscopy / education*
  • Colonoscopy / standards*
  • Colorectal Neoplasms / diagnosis*
  • Colorectal Neoplasms / prevention & control*
  • Curriculum
  • Early Detection of Cancer
  • Education, Medical / methods
  • Europe
  • Humans
  • Mass Screening / standards*
  • Observational Studies as Topic
  • Patient Acceptance of Health Care
  • Program Evaluation
  • Quality Assurance, Health Care / organization & administration*
  • Randomized Controlled Trials as Topic