Colonoscopy is the preferred procedure for the detection, biopsy and removal of neoplastic lesions of the colon. It is estimated that about 14 million colonoscopies will have been performed in the US in 2014. The number of patients undergoing colonoscopy worldwide is also increasing, however, the procedure is far from perfect and recent studies have questioned its impact on colon cancer prevention, particularly in the proximal colon. Whereas standard endoscopes are designed to provide a view of a cylindrical lumen, the colon is not a simple hollow tube, but a tortuous organ with many folds that can prevent polyps from being seen. Poor color contrast of some flat lesions also make detection more difficult. A number of techniques have been developed to increase the surface area of the colon viewed, from accessories that can be used with existing colonoscopes to new endoscopy systems. Methods to improve lesion contrast are also being developed. The ideal device should not only maximize the surface of the colon viewed and improve lesion contrast to aid detection, but should do so inexpensively and without increasing the complexity and duration of the procedure. Healthcare reform will soon require endoscopists to report the quality of their procedures, as measured by individual rates of adenoma detection. Therefor the need to develop new devices that improve lesion detection is profound, but for any product to be clinically assimilated, it needs to be easy to use and affordable.