The Effect of Right Colon Retroflexion on Adenoma Detection: A Systematic Review and Meta-analysis

Abstract

Background: Although colonoscopy with polypectomy can prevent up to 80% 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 maneuver on adenoma detection with concomitant concerns about safety and rates of maneuver success. In this meta-analysis, we sought to determine the effect of right colon retroflexion on improving adenoma detection compared with conventional colonoscopy without retroflexion, as well as determine the rates of retroflexion maneuver success and adverse events.

Methods: Multiple databases including MEDLINE, Embase, and Web of Science were searched for studies on right colon retroflexion and its impact on adenoma detection compared with conventional colonoscopy. Pooled analyses of adenoma detection and retroflexion success were based on mixed-effects and random-effects models with heterogeneity analyses.

Results: Eight studies met the inclusion criteria (N=3660). The primary analysis comparing colonoscopy with right-sided retroflexion versus conventional colonoscopy to determine the per-adenoma miss rate in the right colon was 16.9% (95% confidence interval, 12.5%-22.5%). The overall rate of successful retroflexion was 91.9% (95% confidence interval, 86%-95%) and rate of adverse events was 0.03%.

Conclusions: Colonoscopy with right-sided retroflexion significantly increases the detection of adenomas in the right colon compared with conventional colonoscopy with a high rate of maneuver success and small risk of adverse events. Thus, reexamination 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.

Conflict of interest statement

Conflicts of Interest: Drs. Cohen, Grunwald, Grossberg and Sawhney have no conflicts of interest to declare relevant to this research.

Figures

Figure 1. Flow diagram of study selection for systematic review and meta-analysis

Figure 2. Funnel plot of studies included in the meta-analysis demonstrating no publication bias

Figure 3. Comparison of right colon per-adenoma miss rates for studies evaluating right colon retroflexion compared with conventional colonoscopy

CI, confidence interval.

Figure 4. Comparison of right colon per-colonoscopy miss rates for studies evaluating right colon retroflexion compared with conventional colonoscopy

CI, confidence interval.

Figure 5. Meta-regression for the per-colonoscopy adenoma miss rate in the right colon with the prevalence of adenomas detected per colonoscopy