Post written by Manol Jovani, MD, MPH, from the Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.

The focus of this study was to ascertain whether larger monitors could improve the quality of colonoscopies, and whether this could be quantified objectively by an improvement of adenoma detection rates.

Many endoscopists and managers of endoscopic centers who consider the types of devices to acquire for their practice have posed this question. Most assume that a larger monitor will help to see the mucosa better and therefore naturally improve the quality of colonoscopies. Thus, they direct economic resources toward this end. We decided to explore whether this assumption is objectively true.

In our study, we found that there was no substantial difference in the overall adenoma detection rate between colonoscopies performed with 2 types of monitors: a standard 19-inch monitor and a larger 32-inch monitor (27.4% vs 27.9%; P = .80). The same results were observed if we took into account the polyp detection rate (32.8% vs 34.4%; P = .50). In addition, the larger monitor size did not result in finding a significantly larger absolute number of polyps compared to the standard, smaller monitor. These findings were not significantly altered when we studied different subgroups defined by indication for colonoscopy, bowel preparation, operator experience, and time of endoscopy. Finally, the results of each individual endoscopist also did not appear to be influenced by monitor size. There were some indications that perhaps operators with less experience could benefit from larger monitors. However, the study was not powered for that conclusion; this may be explored in further studies. In summary, the objective quantitative approach to answering the question of whether monitor size influences the quality of colonoscopy showed no effect. However, when the endoscopists were queried about their subjective experience, most reported that the larger monitor size offered a more positive experience. Future studies might explore whether these other benefits might justify the expenses of getting larger monitors, or whether endoscopy directors and managers should focus their economic resources on improving other aspects of their practice.

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