Right-sided adenoma detection with retroflexion versus forward-view colonoscopy

Chandran, Sujievvan; Parker, Frank; Vaughan, Rhys; Mitchell, B.; Fanning, Scott B.; Brown, Gregor J.; Yu, Jenny Y.; Efthymiou, Marios

doi:10.1016/j.gie.2014.08.039

Cited by 73 publications

(61 citation statements)

References 24 publications

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“…Proximal colon retroflexion showed a modest increase in proximal serrated lesion detection, although this gain might have been achieved with a repeated examination in the forward view 75. In a tandem study, the Third Eye Retroscope detected 77 versus 58 non-adenomatous polyps, but in the right colon this was only 19 versus 22 non-adenomatous polyps, so better detection of clinically relevant serrated lesions was not shown 76.…”

Section: Technologies and Techniques To Improve Serrated Polyp Detectionmentioning

confidence: 93%

Serrated lesions in colorectal cancer screening: detection, resection, pathology and surveillance

East

Vieth

Rex

2015

Gut

114

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Section: Technologies and Techniques To Improve Serrated Polyp Detectionmentioning

confidence: 93%

Serrated lesions in colorectal cancer screening: detection, resection, pathology and surveillance

East

Vieth

Rex

2015

Gut

114

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“…10 While some evidence suggests that the biology of right-sided polyps to cancer sequence may be different than proximal lesions 12 , others believe that there is a higher miss rate of right sided lesions because of the folds in the cecum and ascending colon that are difficult to see behind without a retroflexed view. 20 While some theorize that right colon retroflexion is merely a surrogate for increased withdrawal time and that it isn't the retroflexion maneuver per se which detects more polyps, there is evidence which supports that withdrawal time beyond a minimum accepted threshold of 7 minutes does not in fact improve polyp detection. 33 …”

Section: Discussionmentioning

confidence: 99%

The Effect of Right Colon Retroflexion on Adenoma Detection

Cohen

Grunwald

Grossberg

et al. 2017

Journal of Clinical Gastroenterology

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Background While colonoscopy with polypectomy can prevent up to 80% of colorectal cancers, a significant adenoma miss rate still exists, particularly in the right colon. Previous studies addressing right colon retroflexion have revealed discordant evidence regarding the benefit of this maneuver on adenoma detection with concomitant concerns about safety and rates of maneuver success. In this meta-analysis, we sought to determine the effect of right colon retroflexion on improving adenoma detection compared with conventional colonoscopy without retroflexion, as well as determine the rates of retroflexion maneuver success and adverse events. Methods Multiple databases including MEDLINE, Embase, and Web of Science were searched for studies on right colon retroflexion and its impact on adenoma detection compared with conventional colonoscopy. Pooled analyses of adenoma detection and retroflexion success were based on mixed-effects and random-effects models with heterogeneity analyses. Results Eight studies met the inclusion criteria (N = 3660). The primary analysis comparing colonoscopy with right-sided retroflexion vs. conventional colonoscopy to determine the per-adenoma miss rate in the right colon was 16.9% [95% CI, 12.5-22.5%]. The overall rate of successful retroflexion was 91.9% [95% CI, 86-95%] and rate of adverse events was 0.03%. Conclusions Colonoscopy with right-sided retroflexion significantly increases the detection of adenomas in the right colon compared with conventional colonoscopy with a high rate of maneuver success and small risk of adverse events. Thus, reexamination of the right colon in retroflexed view should be strongly considered in future standard of care colonoscopy guidelines for quality improvement in colon cancer prevention.

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“…Some of these include: high-resolution endoscopic imaging, narrowband endoscopic imaging, wide-angle colonoscopes, high definition colonoscopes, third eye retroscopes, Full Spectrum Endoscopy, balloon assisted colonoscopy (G-Eye), second forward view of the right colon and cecal retroflexion (19,(21)(22)(23)(24). The latest accessory devices in this field are the transparent cap colonoscopy (Endocap) and EC.…”

Section: Discussionmentioning

confidence: 99%

Endocuff assisted colonoscopy significantly increases sessile serrated adenoma detection in veterans

Baek

Jackson

Lunn

et al. 2017

J. Gastrointest. Oncol.

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Background: Colorectal cancer (CRC) is the second most common cause of cancer related deaths in the United States. Colonoscopy is the gold standard for the detection of CRC. There are many colonoscopy quality measures and among these the adenoma detection rate (ADR) has demonstrated a significant impact in reducing mortality from CRC. The primary aim of our study was to compare ADR and distribution of polyp type in patients undergoing Endocuff-assisted colonoscopy (EAC) versus standard colonoscopy (SC) in a VA system. Methods: Retrospective data was collected from 496 patients who underwent routine screening, surveillance and diagnostic colonoscopies either via SC from January 6, 2014 through March 12, 2014 or EAC from September 24, 2014 through February 19, 2015. A total of 54 patients were excluded based on a personal history of CRC and prior resection, incomplete colonoscopy due to poor bowel preparation, and removal or loss of Endocuff (EC). Primary outcomes measured and compared were ADR and types of polyps found. Results: The overall ADR in the EAC group was higher at 59.91% versus 50.66% for SC, accounting for a 9% increase (P=0.0508). EAC was able to detect a total of 59 sessile serrated adenoma/polyps (SSA/Ps) compared to SC only detecting 8 (P≤0.0001). There was a significant increase in the SSA/P detection rate with EAC at 15% versus 3% in the SC group (P≤0.0001). Conclusions: EAC significantly increases the detection of SSA/P and has shown a trend in improving ADR in our veteran population.

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Right-sided adenoma detection with retroflexion versus forward-view colonoscopy

Cited by 73 publications

References 24 publications

Serrated lesions in colorectal cancer screening: detection, resection, pathology and surveillance

Serrated lesions in colorectal cancer screening: detection, resection, pathology and surveillance

The Effect of Right Colon Retroflexion on Adenoma Detection

Endocuff assisted colonoscopy significantly increases sessile serrated adenoma detection in veterans

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