Comparing the miss rate of detecting adenoma using 2 imaging techniques during colonoscopy

Interventional Procedure (Arm 1): Initial inspection with linked colour imaging (LCI) then white light (WL) The procedure will be performed by qualified gastroenterologists (who also underwent additional advanced therapeutic colonoscopy training). They are A/Prof David Hewett (FRACP), Dr Nicholas Tutticci (FRACP) and Dr Ammar Kheir (FRACP). The duration of the total procedure time will be approximately 30 - 40 minutes. Keeping in mind that insertion time to the caecum will average 5 minutes with minimum 6 minutes withdrawal time (as per national standard) for each insertion. The device used is the new is the 7000 'Trademark' endoscopic system powered by Fujifilm’s unique 4-LED Multi Light 'Trademark' technology sets a new standard in light intensity and endoscopic imaging (this is equivalent to the European model ELUXEO 'Trademark'). The white light (WL) is essentially a high definition normal white light without manipulation of the normal light wavelengths. The Linked-colour imaging (LCI) creates clear and bright endoscopic images using short wavelength witha narrow-band light that enhances the vessels in on the mucosal surface and patterns of the mucosa (410-nm and 450-nm wavelengths with a bandwidth that is <2nm), A research assistant will measure insertion and withdrawal times by using a stopwatch. On insertion, the stopwatch will be started at the moment the rectal mucosa is visualised, and timing will be continued until the colonoscope tip has entered the caecal caput. On withdrawal, mucosal inspection will be performed firstly using linked colour imaging until withdrawn to the rectum. Polyps will be removed as they are identified (via standard polypectomy techniques) and each polyp submitted separately for pathological examination. Reinsertion will then be performed to the caecum and further mucosal inspection performed using white light until withdrawn to the rectum. Further detected polyps will be removed as they are identified (via standard polypectomy techniques) and each polyp submitted separately for pathological examination.