Right-sided adenoma detection with retroflexion versus forward-view colonoscopy

Area of Science:

• Gastroenterology and Endoscopy
• Cancer Prevention
• Colorectal Cancer Screening

Background:

• Colonoscopy and polypectomy are crucial for preventing colorectal cancer, yet adenoma miss rates persist, especially in the right colon.
• Improving adenoma detection rates (ADR) is essential for maximizing the efficacy of colon cancer screening.
• Current forward-view colonoscopy may have limitations in visualizing the entire right colon.

Purpose of the Study:

• To evaluate the impact of retroflexion in the right colon on adenoma detection rates (ADR) compared to standard forward-view assessment.
• To determine the safety and feasibility of right-sided colon retroflexion in a large patient cohort.

Main Methods:

• A multicenter prospective cohort study involving 1351 adult patients undergoing elective colonoscopy.
• Initial withdrawal was performed using forward view, followed by re-intubation and assessment of the right colon in retroflexed view.
• Adenoma detection rate (ADR) was compared between forward-view and retroflexed-view examinations of the right colon.

Main Results:

• Right-sided retroflexion was successful in 95.9% of patients.
• Retroflexion identified an additional 75 adenomas, increasing the overall ADR from 24.64% to 26.4%.
• The technique demonstrated a statistically significant, albeit small, increase in ADR.

Conclusions:

• Right-sided colon retroflexion is a safe and effective adjunct to standard colonoscopy for improving adenoma detection.
• The technique offers a valuable tool for experienced endoscopists to enhance the sensitivity of colorectal cancer screening.
• Further research may explore optimizing retroflexion techniques to further minimize missed adenomas.