The significance of retroflexion technique in the right colon on adenoma detection rates during colonoscopy

Abstract Background Linked color imaging (LCI) is a newly developed image-enhancing endoscopy technology that provides bright endoscopic images and increases color contrast. We investigated whether LCI improves the detection of neoplastic lesions in the right colon when compared with high definition white-light imaging (WLI). Methods Consecutive patients undergoing colonoscopy were randomized (1:1) after cecal intubation into right colon inspection at first pass by LCI or by WLI. At the hepatic flexure, the scope was reintroduced to the cecum under LCI and a second right colon inspection was performed under WLI in previously LCI-scoped patients (LCI–WLI group) and vice versa (WLI–LCI group). Lesions detected on first- and second-pass examinations were used to calculate detection and miss rates, respectively. The primary outcome was the right colon adenoma miss rate. Results Of the 600 patients enrolled, 142 had at least one adenoma in the right colon, with similar right colon adenoma detection rates (r-ADR) in the two groups (22.7 % in LCI–WLI and 24.7 % in WLI–LCI). At per-polyp analysis, double inspection of the right colon in the LCI–WLI and WLI–LCI groups resulted in an 11.8 % and 30.6 % adenoma miss rate, respectively (P < 0.001). No significant difference in miss rate was found for advanced adenomas or sessile serrated lesions. At per-patient analysis, at least one adenoma was identified in the second pass only (incremental ADR) in 2 of 300 patients (0.7 %) in the LCI – WLI group and in 13 of 300 patients (4.3 %) in the WLI – LCI group (P = 0.01). Conclusions LCI could reduce the miss rate of neoplastic lesions in the right colon.

Download Full-text

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

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2018.09.006 ◽

2019 ◽

Vol 89 (3) ◽

pp. 453-459.e3 ◽

Cited By ~ 13

Author(s):

Madhav Desai ◽

Mohammad Bilal ◽

Nour Hamade ◽

Venkata Subhash Gorrepati ◽

Viveksandeep Thoguluva Chandrasekar ◽

...

Keyword(s):

Systematic Review ◽

Detection Rates ◽

Adenoma Detection ◽

Adenoma Detection Rates ◽

The Right

Download Full-text

Faculty Opinions recommendation of Compared Abilities of Endoscopic Techniques to Increase Colon Adenoma Detection Rates: A Network Meta-analysis.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.734614921.793562099 ◽

2019 ◽

Author(s):

Edward Seward

Keyword(s):

Meta Analysis ◽

Colon Adenoma ◽

Detection Rates ◽

Endoscopic Techniques ◽

Adenoma Detection ◽

Adenoma Detection Rates

Download Full-text

Impact of second forward-view examination on adenoma detection rate during unsedated colonoscopy: a randomized controlled trial

BMC Gastroenterology ◽

10.1186/s12876-021-01783-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Keshu Shan ◽

Hongpeng Lu ◽

Zhixin Zhang ◽

Jiarong Xie ◽

Lu Xu ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Detection Rate ◽

Controlled Trial ◽

Lesion Detection ◽

Adenoma Detection Rate ◽

Right Colon ◽

Randomized Controlled ◽

Adenoma Detection ◽

Advanced Lesion ◽

The Right

Abstract Objectives Colorectal cancer on the right side of the colon has been suggested to be harder to detect by colonoscopy. The aim of this study was to evaluate whether a second forward-view examination of the right side of the colon could increase the adenoma detection rate (ADR) and/or polyp detection rate (PDR). Methods This was a single-centre randomized controlled trial. Patients undergoing colonoscopy were recruited and randomly assigned to the second forward-view examination (SFE) group, in which the right side of the colon was examined twice or the traditional colonoscopy (TC) group in which the colonoscopy was performed in a standard manner. The primary outcome was the ADR of right colon. The overall PDR and ADR, PDR of the right colon, per-adenoma miss rate of the right colon, and advanced lesion detection rate were also recorded and compared. Results A total of 392 patients were included in the study (SFE group 197 vs. TC group 195). The ADR and PDR of the right colon in the SFE group were significantly higher than those in the TC group (ADR 10.7% vs. 5.1%; P = 0.042); PDR 17.8% vs. 9.7%, P = 0.021). No significant difference was found in overall PDR/ADR, or advanced lesion detection rate between the two groups. Conclusions This prospective controlled study revealed that a second forward-view examination could modestly increase the ADR and PDR of the right colon during unsedated colonoscopies. This simple, safe and time-effective technique might be recommended for routine unsedated colonoscopy. Trial registration: Clinical Trials.gov, NCT03619122. Registered on 7/8/2018.

Download Full-text