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DOI: 10.1055/a-1896-4499
Second exam of right colon improves adenoma detection rate: Systematic review and meta-analysis of randomized controlled trials
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Abstract
Background and study aims A second examination of the right colon, either as a second forward view (SFV) or as retroflexion (RF) in the cecum, can increase adenoma detection rate (ADR) in the right colon. In this meta-analysis, we have evaluated the role of a second examination of the right colon in improving ADR.
Methods We reviewed several databases to identify randomized controlled trials that compared right colon SFV with no SFV, and RCTs that compared SFV with RF in the right colon, and reported data on ADR. Our outcomes of interest were ADR and polyp detection rate (PDR) with SFV vs no SFV, right colon and total withdrawal times, and additional ADR and PDR with SFV vs RF. For categorical variables, we calculated pooled risk ratios (RRs) with 95 % confidence intervals (CIs); for continuous variables, we calculated standardized mean difference (SMD) with 95 % CI. Data were analyzed using random effects model.
Results We included six studies with 3901 patients. Comparing SFV with no SFV, right colon ADR and PDR were significantly higher in the SFV group: ADR (RR [95 % CI] 1.39 [1.22,1.58]) and PDR (RR [95 % CI] 1.47 [1.30, 1.65]). We found no significant difference in right colon withdrawal time (SMD [95 % CI] 1.54 [–0.20,3.28]) or total withdrawal time (SMD (95 % CI) 0.37 [–0.39,1.13]) with and without SFV. We found no significant difference in additional ADR between SFV and RF.
Conclusions SFV of the right colon significantly increases right-sided and overall ADR.
Publikationsverlauf
Eingereicht: 27. Dezember 2021
Angenommen nach Revision: 08. Juli 2022
Accepted Manuscript online:
11. Juli 2022
Artikel online veröffentlicht:
17. Oktober 2022
© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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References
- 1 Winawer SJ, Zauber AG, Ho MN. et al. Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med 1993; 329: 1977-1981
- 2 Guo F, Chen C, Holleczek B. et al. Strong reduction of colorectal cancer incidence and mortality after screening colonoscopy: prospective cohort study from Germany. Am J Gastroenterol 2021; 116: 967-975
- 3 Heresbach D, Barrioz T, Lapalus MG. et al. Miss rate for colorectal neoplastic polyps: a prospective multicenter study of back-to-back video colonoscopies. Endoscopy 2008; 40: 284-290
- 4 Pohl H, Robertson DJ. Colorectal cancers detected after colonoscopy frequently result from missed lesions. Clin Gastroenterol Hepatol 2010; 8: 858-864
- 5 Zhao S, Wang S, Pan P. et al. Magnitude, risk factors, and factors associated with adenoma miss rate of tandem colonoscopy: a systematic review and meta-analysis. Gastroenterology 2019; 156: 1661-74 e11
- 6 Singh H, Nugent Z, Demers AA. et al. The reduction in colorectal cancer mortality after colonoscopy varies by site of the cancer. Gastroenterology 2010; 139: 1128-1137
- 7 Brenner H, Chang-Claude J, Seiler CM. et al. Protection from colorectal cancer after colonoscopy: a population-based, case-control study. Ann Intern Med 2011; 154: 22-30
- 8 Soetikno RM, Kaltenbach T, Rouse RV. et al. Prevalence of nonpolypoid (flat and depressed) colorectal neoplasms in asymptomatic and symptomatic adults. JAMA 2008; 299: 1027-1035
- 9 Benedix F, Kube R, Meyer F. et al. Comparison of 17,641 patients with right- and left-sided colon cancer: differences in epidemiology, perioperative course, histology, and survival. Dis Colon Rectum 2010; 53: 57-64
- 10 Nawa T, Kato J, Kawamoto H. et al. Differences between right- and left-sided colon cancer in patient characteristics, cancer morphology and histology. J Gastroenterol Hepatol 2008; 23: 418-423
- 11 Corley DA, Jensen CD, Marks AR. et al. Adenoma detection rate and risk of colorectal cancer and death. N Engl J Med 2014; 370: 1298-1306
- 12 Clark BT, Parikh ND, Laine L. Yield of repeat forward-view examination of the right side of the colon in screening and surveillance colonoscopy. Gastrointest Endosc 2016; 84: 126-132
- 13 Chandran S, Parker F, Vaughan R. et al. Right-sided adenoma detection with retroflexion versus forward-view colonoscopy. Gastrointest Endosc 2015; 81: 608-613
- 14 Kushnir VM, Oh YS, Hollander T. et al. Impact of retroflexion vs. second forward view examination of the right colon on adenoma detection: a comparison study. Am J Gastroenterol 2015; 110: 415-422
- 15 Desai M, Bilal M, Hamade N. et al. Increasing adenoma detection rates in the right side of the colon comparing retroflexion with a second forward view: a systematic review. Gastrointest Endosc 2019; 89: 453-9 e3
- 16 Kim SY, Lee SJ, Chung JW. et al. Efficacy of repeat forward-view examination of the right-sided colon during colonoscopy: A prospective randomized controlled trial. J Gastroenterol Hepatol 2020; 35: 1746-1752
- 17 Tang RSY, Lee JWJ, Chang LC. et al. Two vs one forward view examination of right colon on adenoma detection: an international multicenter randomized trial. Clin Gastroenterol Hepatol 2022; 20: 372-380.e2
- 18 Shan K, Lu H, Zhang Z. et al. Impact of second forward-view examination on adenoma detection rate during unsedated colonoscopy: a randomized controlled trial. BMC Gastroenterol 2021; 21: 213
- 19 Nunez Rodriguez MH, Diez Redondo P. et al. Proximal retroflexion versus second forward view of the right colon during screening colonoscopy: A multicentre randomized controlled trial. United European Gastroenterol J 2020; 8: 725-735
- 20 Guo CG, Zhang F, Ji R. et al. Efficacy of segmental re-examination of proximal colon for adenoma detection during colonoscopy: a randomized controlled trial. Endoscopy 2017; 49: 243-250
- 21 Nogales O, de la Maza J, Martos E. et al. Success, safety, and usefulness of right colon retroflexion for the detection of additional colonic lesions not visualized with standard frontal view. Surg Endosc 2021; 35: 620-625
- 22 Triantafyllou K, Tziatzios G, Sioulas AD. et al. Diagnostic yield of scope retroflexion in the right colon: A prospective cohort study. Digestive and Liver Disease 2016; 48: 176-181
- 23 Harrison M, Singh N, Rex DK. Impact of proximal colon retroflexion on adenoma miss rates. Am J Gastroenterol 2004; 99: 519-522
- 24 Papanikolaou IS, Apostolopoulos P, Tziatzios G. et al. Lower adenoma miss rate with FUSE vs. conventional colonoscopy with proximal retroflexion: a randomized back-to-back trial. Endoscopy 2017; 49: 468-475
- 25 Desai M, Sanchez-Yague A, Choudhary A. et al. Impact of cap-assisted colonoscopy on detection of proximal colon adenomas: systematic review and meta-analysis. Gastrointest Endosc 2017; 86: 274-81e3
- 26 Patel HK, Chandrasekar VT, Srinivasan S. et al. Second-generation distal attachment cuff improves adenoma detection rate: meta-analysis of randomized controlled trials. Gastrointest Endosc 2021; 93: 544-53 e7
- 27 Siersema PD, Rastogi A, Leufkens AM. et al. Retrograde-viewing device improves adenoma detection rate in colonoscopies for surveillance and diagnostic workup. World J Gastroenterol 2012; 18: 3400-3408
- 28 Cohen J, Grunwald D, Grossberg LB. et al. The effect of right colon retroflexion on adenoma detection: a systematic review and meta-analysis. J Clin Gastroenterol 2017; 51: 818-824
- 29 Geng Z, Agrawal D, Singal AG. et al. Contained colonic perforation due to cecal retroflexion. World J Gastroenterol 2016; 22: 3285-3288
- 30 Lv XH, Lu Q, Sun YN. et al. Retroflexed view for reexamination of the right colon after forward view examination: Systematic review and meta-analysis. Dig Endosc 2021; 34: 33-42
- 31 Rath T, Pfeifer L, Neufert C. et al. Retrograde inspection vs standard forward view for the detection of colorectal adenomas during colonoscopy: A back-to-back randomized clinical trial. World J Gastroenterol 2020; 26: 1962-1970
- 32 Anderson JC, Hisey W, Mackenzie TA. et al. Clinically significant serrated polyp detection rates and risk for post colonoscopy colorectal cancer: data from the New Hampshire Colonoscopy Registry. Gastrointest Endosc 2022; DOI: 10.1016/j.gie.2022.03.001.