Colonoscopy quality, innovation, and the assessment of new technology

Colonoscopy serves a vital role in screening and surveillance for colorectal cancer and has seen incredible innovations in the past several decades. Amidst a growing landscape of emerging technologies, it has become increasingly critical to develop a process for the evaluation and adoption of new technology into the endoscopy suite. In this paper, we propose a framework for assessing a new colonoscopy technology utilizing quality improvement principles applied in procedural and integration assessments. After defining key quality indicators in colonoscopy, we follow the arc of innovation across pre-procedural, intra-procedural, and post-procedural advancements in colonoscopy to highlight the process and outcome measures that comprise the procedural assessment. This discussion is followed by case studies in key structure and balance measures that serve to assess the feasibility of integrating novel technology into the endoscopy suite. At both assessment levels, we explore the advent of artificial intelligence in colonoscopy, citing relevant examples in computer-aided detection and computer-aided diagnosis. We highlight innovations that have been successfully adopted into clinical practice alongside technologies that had limited uptake or were otherwise retired from standard of care. In doing so, we illustrate the iterative nature of this process of innovation and technological development.