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CC BY-NC-ND 4.0 · Endosc Int Open 2022; 10(10): E1391-E1398
DOI: 10.1055/a-1896-4499
Review

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

Faisal Kamal
 1   Division of Gastroenterology, University of California-San Francisco, California, United States
,
Muhammad Ali Khan
 2   Division of Gastroenterology, Hepatology and Nutrition, University of Texas MD
,
Wade Lee-Smith
 3   Mulford Health Sciences Library, University of Toledo, Toledo, Ohio, United States
,
Sachit Sharma
 4   Department of Medicine, University of Toledo, Toledo, Ohio, United States
 5   Division of Gastroenterology, Virginia Commonwealth University, Richmond, Virginia, United States
,
Ashu Acharya
 4   Department of Medicine, University of Toledo, Toledo, Ohio, United States
,
Zaid Imam
 6   Division of Gastroenterology, William Beaumont Hospital, Royal Oak, Michigan, United States
,
Umer Farooq
 7   Department of Medicine, Loyola Medicine/MacNeal Hospital, Berwyn, Illinois, United States
,
John Hanson
 8   Department of Medicine, University of Tennessee Health Sciences Center, Memphis, Tennessee, United States
,
Vian Pulous
 8   Department of Medicine, University of Tennessee Health Sciences Center, Memphis, Tennessee, United States
,
Muhammad Aziz
 9   Division of Gastroenterology, University of Toledo, Toledo, Ohio, United States
,
Saurabh Chandan
10   Division of Gastroenterology, Creighton University Medical Center, Omaha, Nebraska, United States
,
Abdul Kouanda
 1   Division of Gastroenterology, University of California-San Francisco, California, United States
,
Sun-Chuan Dai
 1   Division of Gastroenterology, University of California-San Francisco, California, United States
,
Craig A. Munroe
 1   Division of Gastroenterology, University of California-San Francisco, California, United States
,
Colin W. Howden
11   Division of Gastroenterology, University of Tennessee Health Sciences Center, Memphis, Tennessee, United States
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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.

Supplementary material



Publication History

Received: 27 December 2021

Accepted after revision: 08 July 2022

Accepted Manuscript online:
11 July 2022

Article published online:
17 October 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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