Increasing adenoma detection rates in the right side of the colon comparing retroflexion or a second forward view: a systematic review. Journal Article

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Authors: Desai, M; Bilal, M; Hamade, N; Gorrepati, VS; Thogulva Chandrasekar, V; Jegadeesan, R; Gupta, N; Bhandari, P; Repici, A; Hassan, C; Sharma, P
Article Title: Increasing adenoma detection rates in the right side of the colon comparing retroflexion or a second forward view: a systematic review.
Abstract: BACKGROUND AND AIMS: Right-sided lesions are often missed during standard colonoscopy (SC). A second forward view examination or retroflexion in the right side of the colon, have both been proposed as techniques to improve ADR in the right side of the colon. Comparative data of examining the right side of the colon with a second forward view or retroflexion is not known in a pooled analysis. We performed a systematic review of the literature to assess the yield of a second forward view compared with retroflexion examination for the detection of right-sided adenomas. METHODS: A systematic literature search was performed using the following databases: Pubmed, Embase, Web of science, and Cochrane. Only full-length published articles that provided information on adenoma detection and miss rate during either a second forward view or retroflexed view of the right side of the colon after the initial standard forward withdrawal (SC) were included. The following outcomes were assessed: adenoma miss rate (AMR) comparison of second forward view versus retroflexion after SC, AMR of SC compared with second forward view, AMR of SC compared with retroflexion and right-sided adenoma detection of the second forward view and retroflexion. Pooled rates were reported as risk difference or odds ratio (OR) with 95% confidence intervals (CI) with a p-value 0.05 for statistical significance. Statistical analysis was performed with Review Manager v5.3. RESULTS: A total of 4 studies with 1882 patients were found eligible who underwent a second forward view of the right side of the colon after the initial SC. The average age of patients was 58.3 years. Data on right-side ADR were available from all 4 studies for the second forward view; however, only 2 incorporated studies provided information on right-sided ADR with retroflexion. Pooled estimate of AMR of a single SC was 13.3% (95% CI, 6.6%-20%) when compared with a second forward view examination (n=4), whereas it was 8.1% (3.7-12.5%) when compared with a retroflexion examination (n=3). However, when the second forward view was compared with retroflexion in terms of AMR from an analysis of 3 eligible studies, there was no statistically significant difference found (7.3% vs 6.3%; pooled OR, 1.2; 95% CI, 0.9-1.61; p=0.21). The second forward view of the right side of the colon increased the right-side ADR by 10% (n=4; second forward view vs SC: 33.6% vs 26.7%) with a pooled risk difference: 0.09 (95% CI, 0.03-0.15; p0.01). Retroflexion increased the right-side ADR by 6% (n=3, RF vs SC: 28.4% vs 22.7%) with a pooled risk difference: 0.06 (95% CI, 0.03-0.09; p0.01). CONCLUSION: After standard colonoscopy withdrawal, both a second forward view and retroflexed view of the right side of the colon are associated with improvement in ADR. Either one of these techniques should be considered during standard colonoscopy to increase ADR and to improve the quality of colonoscopy.
Journal Title: Gastrointestinal endoscopy
ISSN: 1097-6779; 0016-5107
Publisher: Mosby, Inc  
Date Published: 2018