Yield of repeat forward-view examination of the right side of the colon in screening and surveillance colonoscopy

Abstract

Background and Aims Colonoscopy is less protective for right-sided colon cancers than distal colon cancers. Repeat right-sided examination has been suggested to increase adenoma detection and right-sided protective effect. Our prospective study assessed the yield of a second forward-view examination of the right colon done immediately after the initial examination. Methods All men, age 50 to 75 years, undergoing screening or surveillance colonoscopy at the West Haven Veterans Affairs Medical Center were invited to participate. A second forward-view examination was performed if the Boston Bowel Preparation Scale score was 8 to 9 (scale = 0 – 9) with right-colon-segment score 2 to 3 (scale = 0 – 3). The primary outcome was per-patient detection rate of adenomas (including sessile serrated polyps) on repeat right-colon examination, defined as number of patients with ≥1 adenoma on the second right-sided colon examination divided by total number of patients. An increase in the adenoma detection rate (ADR) was a secondary outcome. Results Repeat right-sided colon examination, performed in 280 patients, revealed additional adenomas in 43 patients (15.4%; 95% CI of difference, 11.3%–21.0%). Overall ADR increased by 3.2% (95% CI, 1.1%–5.3%) after the second right-sided colon examination; right-sided colon ADR increased by 6.7% (95% CI, 3.8%–9.7%). Ten (3.6%) patients had a change in their screening/surveillance interval with the addition of findings on the repeat right-sided colon examination. Conclusions A substantial 15.4% of patients had additional adenomas detected on repeat forward-view examination of the right side of the colon, whereas overall ADR increased significantly by 3.2%. Given the lack of additional training or equipment required, repeat forward-view examination of the right side of the colon is a simple, readily available method to achieve a modest improvement in ADR.

Caution with iceberg model for colonoscopy in mind! A large easily missed sessile serrated polyp surrounding seemingly diminutive protruded polyp: A case report

“…8 In addition, a second observation with retroflexion or the same forward-view examination resulted in a higher detection rate of proximal adenomas. 9,10 However, in this case, these techniques could not help detect this large sessile polyp hiding beneath the obvious, misleading protruded polyp. Therefore, we raised the iceberg model of colonoscopy to alert endoscopists to pay attention to this type of SSA/P, a sessile polyp surrounding a seemingly misleading protruded polyp.…”

“…Longer withdrawal time was associated with higher proximal serrated polyp detection rates . In addition, a second observation with retroflexion or the same forward‐view examination resulted in a higher detection rate of proximal adenomas . However, in this case, these techniques could not help detect this large sessile polyp hiding beneath the obvious, misleading protruded polyp.…”

Colonoscopic withdrawal time and adenoma detection in the right colon

“…RC was defined as cecum to hepatic flexure, as mentioned in the literature. [9,11,15–19] CWT was calculated by PACS, in which the endoscopists captured the colonoscopic image with the present time simultaneously. We calculated the CWT by subtracting the time between cecum to hepatic flexure for the RC CWT and cecum to anus for total colon (TC) CWT.…”

“…There are many methods to increase ADR in the RC, such as retroflexion [9] , retroscope, [10] repeating forward view examinations, [11] changing positions of the patient, [12] and cap-assisted colonoscopy (CAC). [13] We hypothesized that all of the above methods may be associated with increasing the CWT of the RC, and thus eventually increasing the ADR of the RC.…”

My approach to water-assisted colonoscopy

“…Once the retroverted view is seen, pull back towards the hepatic flexure. With the patient in the right lateral position, re-advance the scope to the caecal pole for a second look in a different position 19…”