Of all colorectal cancer screening methods, colonoscopy used as a primary screening tool is both the most promising and the most discussed in the current literature. Several countries have introduced colonoscopic screening on a national scale, but many issues still require further research. The practicality of using colonoscopic screening can be questionable given the huge target population, which requires a great increase in endoscopic resources. Limiting the target population by shifting the use of colonoscopy from low-risk to high-risk groups is a valid option. The quality of colonoscopy related to the individual colonoscopist’s skill has become a surprisingly considerable problem, and it is obvious that continuous quality improvement programs need to be established. The accuracy of detecting important colorectal lesions is also still influenced by the old problem of cleansing the large bowel, and further research would be welcome. Technological improvements in current endoscopic equipment will hopefully increase the diagnostic yield of colonoscopy and eventually strengthen its use in the setting of colorectal cancer screening.
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