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

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

Abstract

Objectives: Colorectal 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).

Methods: This 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.

Results: A 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.

Conclusions: This 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.

Keywords: Adenoma detection rate; Colonic polyps; Colonoscopy; Colorectal cancer; Polyp detection rate; Second forward-view examination.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart for patient inclusions. A total of 400 patients were enrolled and assigned randomly to the TC/SFE group
Fig. 2
Fig. 2
Comparison of ADR and PDR between two groups. PDR, polyp detection rate; ADR, adenoma detection rate. Asterisks indicate P value < 0.05 (0.021/0.042 by the χ2 test for PDR/ADR of the right colon). P value = 0.245/0.604/0.403 by the χ 2 test in overall PDR/ADR and advanced ADR, respectively

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