Increasing adenoma detection rates in the right side of the colon comparing retroflexion with a second forward view: a systematic review

Desai, Madhav; Bilal, Mohammad; Hamade, Nour; Gorrepati, Venkata Subhash; Chandrasekar, Viveksandeep Thoguluva; Jegadeesan, Ramprasad; Gupta, Neil; Bhandari, Pradeep; Repici, Alessandro; Hassan, Cesare; Sharma, Prateek

doi:10.1016/j.gie.2018.09.006

Cited by 53 publications

(46 citation statements)

References 26 publications

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“…Numerous interventions have been introduced to improve the ADR of colonoscopy. These include the use of add‐on devices (endocap, endoring, endocuff, G‐EYE, and amplifEYE), electronic chromoendoscopy (narrow band imaging, linked color imaging, blue laser imaging, and flexible spectral imaging color enhancement), water‐aided techniques (water immersion and water exchange), use of second observer, antispasmodic administration, retroflexion in the right colon or second forward view, quality control initiatives, and improved bowel preparation . However, there are still a number of adenomas that are missed during colonoscopy, and current efforts are being directed to prevent this.…”

Section: Introductionmentioning

confidence: 99%

The impact of deep convolutional neural network‐based artificial intelligence on colonoscopy outcomes: A systematic review with meta‐analysis

Aziz

Fatima

Dong

et al. 2020

J of Gastro and Hepatol

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The authors declare no conflict of interest. No human subjects/animals were involved in this systematic review and meta-analysis. Author contribution: Muhammad Aziz planned and conducted the study, collected and interpreted the data, conducted the statistical analysis, and drafted the manuscript. Rawish Fatima collected the data, interpreted the data, and drafted the manuscript. Dong Charles interpreted the data and drafted the manuscript. Wade Lee-Smith created the search strategy and collected the data, and drafted the manuscript. Ali Nawras was involved in study design/conception and critical revision of the manuscript. All authors have approved the submission of this manuscript to the journal and are accountable for all aspects of the work as relevant. Financial support: No funding was received for the preparation of this manuscript.

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Section: Introductionmentioning

confidence: 99%

The impact of deep convolutional neural network‐based artificial intelligence on colonoscopy outcomes: A systematic review with meta‐analysis

Aziz

Fatima

Dong

et al. 2020

J of Gastro and Hepatol

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“…Polyp detection during first withdrawal and age ≥ 55 years were significantly predictors of adenoma detection using retroflexion of the right‐sided colon 24 . Retroflexion is particularly useful for finding polyps located on the proximal sides of haustral folds; these are difficult to access in the forward view 10,13 . However, the endoscopic maneuver required during retroflexion is more challenging than that of the forward view.…”

Section: Discussionmentioning

confidence: 99%

“…A variety of colonoscopic methods have been used in an attempt to improve the ADR and PDR 11,12 . Recently, studies have been conducted to increase the ADR and PDR in the right‐sided colon using only repeat examination, without mechanical or optical enhancement technologies 11,13 . The retroflexion technique was expected to improve visualization of the proximal aspects of folds and increases adenoma/polyp detection of the right‐sided colon.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of repeat forward‐view examination of the right‐sided colon during colonoscopy: A prospective randomized controlled trial

Kim

Lee

Chung

et al. 2020

J of Gastro and Hepatol

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Background and Aim: Generally, colonoscopy is less effective for detecting colorectal adenomas in the right-sided colon compared with the distal colon. Repeat forward-view (RF) examination of the right-sided colon has been suggested to increase the adenoma detection rate (ADR). However, studies investigating the efficacy of RF examination are lacking. Thus, the aim of this study was to determine whether RF examination in the right-sided colon enhances right-sided ADR. Methods: We performed a prospective, randomized controlled trial, including asymptomatic subjects who underwent screening colonoscopy. Subjects were randomized to the RF group, in which the right-sided colon was examined twice in the forward view, or to the standard forward-view (SF) group, in which the right-sided colon was examined once in the forward view. The primary outcome was the right-sided ADR on RF examination of the right-sided colon. Results: A total of 640 subjects completed the study protocol (RF group, n = 320; SF group, n = 320). The right-sided ADR in the RF group was significantly higher than that in the SF group (17.5% vs 11.9%, respectively; P = 0.044). In the RF group, an additional 31 adenomas were found, resulting in an increased detection rate of adenomas of 38.3% compared with the first forward view. The ADR of the whole colon was similar between the groups. Conclusions: In our prospective randomized controlled trial, RF examination of the right-sided colon, which can be easily performed in clinical practice, was associated with an increased rate of detection of right-sided ADR.

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“…3 Reports show disparate results for proximal retroflexion, but uniformly show an increased ADR after a second right colon examination. [17][18][19] The population analysed in all studies is heterogeneous, so we wanted to focus only on patients from a CRC screening programme with a positive faecal immunochemical test (FIT). The main objective of this study was to determine whether proximal retroflexion improved the ADR in the right colon compared with a forward view in a CRC screening programme with a positive FIT.…”

Section: Introductionmentioning

confidence: 99%

Proximal retroflexion versus second forward view of the right colon during screening colonoscopy: A multicentre randomized controlled trial

Rodríguez

Redondo

Pons³

et al. 2020

UEG Journal

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Background Colonoscopy is the gold standard investigation for the detection of colorectal cancer, but the right colon is more difficult to examine than the left colon. A second examination of the proximal colon has the potential to reduce rates of missed pathology. Objective To determine whether proximal retroflexion improves the adenoma detection rate or other outcomes in the right colon compared with the forward view. Methods We performed a multicentre randomized controlled trial of patients from the colorectal cancer screening programme with a positive faecal immunochemical test. Patients were randomized to a second right colon examination using proximal retroflexion or forward view. Results A total of 692 patients were included. A second examination of the right colon, with an average additional procedure time of 1.62 min, increased the adenoma detection rate by 11%, regardless of the method used (9% proximal retroflexion vs. 12% second forward view, p = 0.21). The adenoma miss rate was 19% (17% proximal retroflexion vs. 20% forward view, p = 0.28) The success rate of retroflexion was 83%, without secondary complications. In the 15.6% of patients in whom lesions were detected during the second pass, endoscopic follow-up was modified by reducing the time of the next colonoscopy. Conclusions A second examination of the right colon, either from retroflexion or second forward view, can increase adenoma detection rate and shorten surveillance intervals in patients undergoing screening colonoscopy. This should be emphasized during colonoscopy training and integrated into diagnostic colonoscopy practice.

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Increasing adenoma detection rates in the right side of the colon comparing retroflexion with a second forward view: a systematic review

Cited by 53 publications

References 26 publications

The impact of deep convolutional neural network‐based artificial intelligence on colonoscopy outcomes: A systematic review with meta‐analysis

The impact of deep convolutional neural network‐based artificial intelligence on colonoscopy outcomes: A systematic review with meta‐analysis

Efficacy of repeat forward‐view examination of the right‐sided colon during colonoscopy: A prospective randomized controlled trial

Proximal retroflexion versus second forward view of the right colon during screening colonoscopy: A multicentre randomized controlled trial

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