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Education in practice
Photodocumentation in colonoscopy: the need to do better?
  1. Ahmir Ahmad,
  2. Brian P Saunders
  1. Wolfson Unit for Endoscopy, St Mark's Hospital, Harrow, UK
  1. Correspondence to Dr Ahmir Ahmad, Wolfson Unit for Endoscopy, St Mark's Hospital, Harrow HA1 3UJ, London, UK; ahmir.ahmad{at}

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There is wide variation in the recommendations for photodocumentation at colonoscopy. The British Society of Gastroenterology (BSG) quality assurance standard suggests ‘photographic proof of ileocaecal valve, terminal ileum, anastomosis or appendix orifice [is] required in all cases’.1 Like the American Society for Gastrointestinal Endoscopy (ASGE)/American College of Gastroenterology (ACG) guidelines,2 documentation of any other part of the colon is not currently mandated. Although caecal photographs serve to confirm that the colonoscope has been passed the full length of the colon, they do not document whether the colonic mucosa has been adequately visualised. Photodocumentation is a relatively simple ‘push button’ process, and most endoscopists now have access to reporting systems that can automatically integrate multiple images in real time. A pertinent question therefore is, should we perform more comprehensive photodocumentation and will this lead to improvements in the quality and reliability of the examination?


One approach to overcoming the limitations of static photodocumentation would be to video record the entire procedure, and with improvements in data storage, this is now technically possible. Video-recording has been found to increase mean inspection time by 49% and quality of mucosal inspection technique (measured by blinded assessment) by up to 30%.3 However, there are still significant data storage costs and issues arise around sharing of information with colleagues and manipulation of large data files. Given that endoscopists are familiar with photodocumentation and files are smaller and easy to embed in current software records, enhancing current practice with specific emphasis on quality and training in photodocumentation may be a more acceptable and realistic way of enhancing quality.

An example of where enhanced photodocumentation has been recommended is the BSG standards for upper gastrointestinal (GI) endoscopy.4 Eight photos of anatomical landmarks are now advised. The impetus for this approach was a recognition that …

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  • Twitter @DrAhmirAhmad

  • Contributors AA conceived the idea and developed it with BPS. AA wrote the first draft. AA and BPS were involved in manuscript planning, editing, review, and are responsible for overall content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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