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Second forward, retroflexed views improve right-sided adenoma detection
Two colonoscopy techniques designed to provide a better view in the right side of the colon both improved adenoma detection over standard colonoscopy withdrawal, colonoscopy withdrawal, according to research published in Gastrointestinal Endoscopy.
Prateek Sharma, MD, from the division of gastroenterology and hepatology at the Veteran Affairs Medical Center and University of Kansas School of Medicine, and colleagues wanted to compare the second forward view and retroflexed view techniques, which both seek to address the high adenoma miss rate in the right side of the colon.
“It has previously been established that adenoma miss rates are higher in the right side of the colon as compared with the left side, and colonoscopy is less effective in preventing right-sided colon cancer as compared with the left side,” they wrote. “Therefore, it is important to establish techniques to improve the effectiveness of colonoscopy in detection of right-sided lesions.”
Investigators searched the literature for studies that provided information on adenoma detection and miss rate during either technique after the initial standard forward colonoscopy withdrawal was performed. They compared adenoma miss rate between second forward view vs. retroflexion, as well as the adenoma miss rate of both techniques compared with standard colonoscopy.
Sharma and colleagues identified four studies that met their inclusion criteria comprising 1,882 patients who underwent a second forward view of the right side of the colon after the initial standard colonoscopy. However, only two of the studies included data on right-sided adenoma detection rate with retroflexion.
Researchers found that the pooled estimate of adenoma miss rate in a single standard colonoscopy was 13.3% (95% CI, 6.6–20%) compared with a second forward facing exam. It was 8.1% (95% CI, 3.7–12.5%) compared with retroflexion.
When they compared both techniques head-to-head, Sharma and colleagues found no significant difference in adenoma miss rate (7.3% vs. 6.3%; pooled OR = 1.2; 95% CI, 0.9–1.61). Second forward view increased right-sided adenoma detection by 10%, while retroflexion increased right-sided adenoma detection by 6%.
Sharma and colleagues wrote that future research could determine if one technique is better at adenoma or sessile serrated lesion detection.
“After standard colonoscopy withdrawal, both a second forward view and retroflexed view of the right side of the colon are associated with improvement in right-side [adenoma detection rate],” they wrote. “This analysis demonstrates that either one of these techniques should be considered during standard colonoscopy to increase ADR and improving the quality of colonoscopy.” – by Alex Young
Disclosures: Healio Gastroenterology and Liver Disease could not confirm the authors’ relevant financial disclosures at the time of publication.