BACKGROUND: Colonoscopy is the gold standard investigation for the detection of colorectal cancer, but the right colon is more difficult to examine than the left colon. A second examination of the proximal colon has the potential to reduce rates of missed pathology. OBJECTIVE: To determine whether proximal retroflexion improves the adenoma detection rate or other outcomes in the right colon compared with the forward view. METHODS: We performed a multicentre randomized controlled trial of patients from the colorectal cancer screening programme with a positive faecal immunochemical test. Patients were randomized to a second right colon examination using proximal retroflexion or forward view. RESULTS:A total of 692 patients were included. A second examination of the right colon, with an average additional procedure time of 1.62 min, increased the adenoma detection rate by 11%, regardless of the method used (9% proximal retroflexion vs. 12% second forward view, p = 0.21). The adenoma miss rate was 19% (17% proximal retroflexion vs. 20% forward view, p = 0.28) The success rate of retroflexion was 83%, without secondary complications. In the 15.6% of patients in whom lesions were detected during the second pass, endoscopic follow-up was modified by reducing the time of the next colonoscopy. CONCLUSIONS: A second examination of the right colon, either from retroflexion or second forward view, can increase adenoma detection rate and shorten surveillance intervals in patients undergoing screening colonoscopy. This should be emphasized during colonoscopy training and integrated into diagnostic colonoscopy practice.
RCT Entities:
BACKGROUND: Colonoscopy is the gold standard investigation for the detection of colorectal cancer, but the right colon is more difficult to examine than the left colon. A second examination of the proximal colon has the potential to reduce rates of missed pathology. OBJECTIVE: To determine whether proximal retroflexion improves the adenoma detection rate or other outcomes in the right colon compared with the forward view. METHODS: We performed a multicentre randomized controlled trial of patients from the colorectal cancer screening programme with a positive faecal immunochemical test. Patients were randomized to a second right colon examination using proximal retroflexion or forward view. RESULTS: A total of 692 patients were included. A second examination of the right colon, with an average additional procedure time of 1.62 min, increased the adenoma detection rate by 11%, regardless of the method used (9% proximal retroflexion vs. 12% second forward view, p = 0.21). The adenoma miss rate was 19% (17% proximal retroflexion vs. 20% forward view, p = 0.28) The success rate of retroflexion was 83%, without secondary complications. In the 15.6% of patients in whom lesions were detected during the second pass, endoscopic follow-up was modified by reducing the time of the next colonoscopy. CONCLUSIONS: A second examination of the right colon, either from retroflexion or second forward view, can increase adenoma detection rate and shorten surveillance intervals in patients undergoing screening colonoscopy. This should be emphasized during colonoscopy training and integrated into diagnostic colonoscopy practice.
Entities:
Keywords:
Proximal retroflexion; adenoma detection rate; colorectal cancer screening
Authors: Nancy N Baxter; Joan L Warren; Michael J Barrett; Therese A Stukel; V Paul Doria-Rose Journal: J Clin Oncol Date: 2012-06-11 Impact factor: 44.544
Authors: Henar Núñez-Rodríguez; Pilar Diez-Redondo; Manuel Pérez-Miranda; Manuel Gonzalez Sagrado; Rosa Conde; Carlos De la Serna Journal: J Clin Gastroenterol Date: 2019-03 Impact factor: 3.062
Authors: Vladimir M Kushnir; Young S Oh; Thomas Hollander; Chien-Huan Chen; Gregory S Sayuk; Nicholas Davidson; Daniel Mullady; Faris M Murad; Noura M Sharabash; Eric Ruettgers; Themistocles Dassopoulos; Jeffrey J Easler; C Prakash Gyawali; Steven A Edmundowicz; Dayna S Early Journal: Am J Gastroenterol Date: 2015-03-03 Impact factor: 10.864
Authors: Harminder Singh; Zoann Nugent; Alain A Demers; Erich V Kliewer; Salaheddin M Mahmud; Charles N Bernstein Journal: Gastroenterology Date: 2010-06-20 Impact factor: 22.682
Authors: Jeong-Yeop Song; Youn Hee Cho; Mi A Kim; Jeong-Ae Kim; Chun Tek Lee; Moon Sung Lee Journal: World J Gastroenterol Date: 2016-02-28 Impact factor: 5.742
Authors: J Ferlay; M Colombet; I Soerjomataram; T Dyba; G Randi; M Bettio; A Gavin; O Visser; F Bray Journal: Eur J Cancer Date: 2018-08-09 Impact factor: 9.162
Authors: Faisal Kamal; Muhammad Ali Khan; Wade Lee-Smith; Sachit Sharma; Ashu Acharya; Zaid Imam; Umer Farooq; John Hanson; Vian Pulous; Muhammad Aziz; Saurabh Chandan; Abdul Kouanda; Sun-Chuan Dai; Craig A Munroe; Colin W Howden Journal: Endosc Int Open Date: 2022-10-17