Performance improvements of imaging-based screening tests

Endoscopic and radiologic tests appear to be more accurate than stool-tests in detecting advanced neoplasia because of direct visualisation of colorectal mucosa. Further technological advances are expected to improve the performance and acceptability of these tests. Several attempts at increasing the adenoma detection rate of colonoscopy have been tested, and in vivo histologic differentiation between neoplastic and hyperplastic polyps may lead to substantial saving in economic and medical resources. Low-volume and non-cathartic bowel preparations may improve CT colonography acceptability, whilst computer-aided detection and low-dose protocols may result in a higher accuracy and safety of this procedure. Despite the lack of ionising radiation, significant drawbacks will likely to limit the role of MR colonography in screening programs. Colon capsule endoscopy appears to be a safe and technically feasible procedure. The suboptimal accuracy of the first generation seems to be substantially improved by the second generation of this device.