As stool- and blood-based colorectal cancer screening gains traction, gastroenterology is entering a new phase—one where completion colonoscopies are becoming more frequent and more complex.
Traditionally, screening colonoscopies have been evenly distributed across endoscopists, largely because the likelihood of encountering advanced neoplasms in average-risk patients has been low. For example, large adenomas (≥20 mm) appear in less than 1% of screening and surveillance procedures, allowing most endoscopists to manage cases within their comfort zone.
That model is now being challenged.
Positive noninvasive tests are more likely to funnel patients into colonoscopy with a higher pre-test probability of advanced lesions. As a result, endoscopists are increasingly encountering larger or more complex polyps that require advanced resection techniques such as EMR or ESD.
This creates a structural shift in workflow. When endoscopists are not trained or experienced in complex polypectomy, patients are referred for repeat procedures with advanced specialists—introducing delays, inefficiencies, and added burden on both patients and the system.