Right colon retroflexion improves adenoma detection
Researchers performed a meta-analysis of studies on right colon retroflexion and its impact on adenoma detection compared with conventional colonoscopy by searching multiple databases including Embase, Medline and Web of Science. Pooled analyses of adenoma detection and retroflexion success were based on mixed-effects and random-effects models with heterogeneity analyses.
A total of eight studies, involving 3,660 participants, were included in the meta-analysis. The primary analysis comparing the two procedures to determine the per-adenoma miss rate in the right colon was 16.9 percent (95 percent CI, 12.5 to 22.5 percent).
Colonoscopy with right-sided retroflexion had a 91.9-percent (86 to 95 percent) overall rate of successful retroflexion and 0.03-percent rate of adverse events.
“Thus, re-examination of the right colon in retroflexed view should be strongly considered in future standard of care colonoscopy guidelines for quality improvement in colon cancer prevention,” according to researchers.
“Although colonoscopy with polypectomy can prevent up to 80 percent of colorectal cancers, a significant adenoma miss rate still exists, particularly in the right colon. Previous studies addressing right colon retroflexion have revealed discordant evidence regarding the benefit of this manoeuvre on adenoma detection with concomitant concerns about safety and rates of manoeuvre success,” they added.