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

Abstract

<jats:sec><jats:title>Background</jats:title><jats:p> 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. </jats:p></jats:sec><jats:sec><jats:title>Objective</jats:title><jats:p> To determine whether proximal retroflexion improves the adenoma detection rate or other outcomes in the right colon compared with the forward view. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> 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. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> 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. </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> 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. </jats:p></jats:sec>

Retroflexed view for reexamination of the right colon after forward view examination: Systematic review and meta‐analysis

“…Among the included studies, four studies were RCTs, [13][14][15][16] and six studies were PCSs. [17][18][19][20][21][22] All RCTs compared the impact of the second withdrawal from the right colon in RV vs. FV after a standard withdrawal during colonoscopy.…”

Second exam of right colon improves adenoma detection rate: Systematic review and meta-analysis of randomized controlled trials

“…A previous meta-analysis 15 that included both observational studies and randomized controlled trials (RCTs) found that SFV and RF of the right colon independently increased ADR. Since then, additional RCTs have compared SFV with no SFV, and SFV with RF, in the right colon and have reported data on right colon ADR 16 17 18 19 . In order to examine this further, we have conducted an updated systematic review and meta-analysis confined only to RCTs to evaluate the role of a second examination of the right colon in improving ADR.…”

Interventions to improve adenoma detection rates for colonoscopy

“…46 Similarly, in a recent multicenter randomized controlled trial, although a second look in the right-sided colon increased the ADR by 11% compared with standard colonoscopy in fecal immunochemical test-positive patients, a significant difference was not found between the second forward view and retroflexion groups (12% vs 9%, P Z .28). 53 Both techniques resulted in an average additional procedure time of 1.6 minutes for second visualization.…”

“…Likewise, a right-sided sessile serrated lesion rate of 11.1% at the second examination has been demonstrated. 53 Summary: Second look, either retroflexion in the cecum or a second forward look in the proximal colon, increases ADR by up to 10 percentage points and rightsided adenoma detection by 5 percentage points.…”