Impact of second forward-view examination on adenoma detection rate during unsedated colonoscopy: a randomized controlled trial

Keshu Shan,Chunjiu Hu,Jiarong Xie,Hongpeng Lu,Zhixin Zhang,Weihong Wang,Lei Xu,Lu Xu

doi:10.1186/s12876-021-01783-9

Keshu Shan, Chunjiu Hu + Show 6 more

Open Access

https://doi.org/10.1186/s12876-021-01783-9

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Journal: BMC gastroenterology	Publication Date: May 10, 2021
Citations: 2	License type: open-access

Affiliation: Ningbo First Hospital, Ningbo University

Abstract

ObjectivesColorectal cancer on the right side of the colon has been suggested to be harder to detect by colonoscopy. The aim of this study was to evaluate whether a second forward-view examination of the right side of the colon could increase the adenoma detection rate (ADR) and/or polyp detection rate (PDR).MethodsThis was a single-centre randomized controlled trial. Patients undergoing colonoscopy were recruited and randomly assigned to the second forward-view examination (SFE) group, in which the right side of the colon was examined twice or the traditional colonoscopy (TC) group in which the colonoscopy was performed in a standard manner. The primary outcome was the ADR of right colon. The overall PDR and ADR, PDR of the right colon, per-adenoma miss rate of the right colon, and advanced lesion detection rate were also recorded and compared.ResultsA total of 392 patients were included in the study (SFE group 197 vs. TC group 195). The ADR and PDR of the right colon in the SFE group were significantly higher than those in the TC group (ADR 10.7% vs. 5.1%; P = 0.042); PDR 17.8% vs. 9.7%, P = 0.021). No significant difference was found in overall PDR/ADR, or advanced lesion detection rate between the two groups.ConclusionsThis prospective controlled study revealed that a second forward-view examination could modestly increase the ADR and PDR of the right colon during unsedated colonoscopies. This simple, safe and time-effective technique might be recommended for routine unsedated colonoscopy.Trial registration: Clinical Trials.gov, NCT03619122. Registered on 7/8/2018.

Highlights

Colorectal cancer (CRC) is one of the most commonly diagnosed malignant neoplasms worldwide [1], the incidence of which has increased in recent decades [2]
This prospective controlled study revealed that a second forward-view examination could modestly increase the adenoma detection rate (ADR) and polyp detection rate (PDR) of the right colon during unsedated colonoscopies
392 patients were included in the analysis, of which 195 patients were allocated to the traditional colonoscopy (TC) group, while 197 patients were allocated to the second forward-view examination (SFE) group (Fig. 1)

Summary

Introduction

Colorectal cancer (CRC) is one of the most commonly diagnosed malignant neoplasms worldwide [1], the incidence of which has increased in recent decades [2]. A number of techniques have been implemented to achieve a potential improvement in the detection of adenomas in the proximal colon, such as repeated examination, cap-assisted colonoscopy [10], and use of a thirdeye retroscope [11]. Among these methods, a second forward-view examination of the proximal colon may be the easiest and most convenient method for endoscopists to perform, as no additional equipment, staff or expenses are required. A prospective cohort study of 280 patients revealed additional adenomas in 15.4% of patients with an increase in the ADR in the right side of the colon by 6.7% [12]. We aimed to evaluate the effect of forward-view examinations of the right colon on ADR performed by one endoscopist

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