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In adult patients undergoing colonoscopy, does retroflexion of the colonoscope in the right colon compared to standard forward viewing endoscopy increase the detection of adenomatous colonic polyps.

ABSTRACT: Interventions: Retroflexion of the colonoscope in the right colon which is standard practice for many endoscopists despite the paucity of data anaecdotally is thought to improve the detection of polyps behind folds that may not been seen on standard forward view withdrawal. The procedure duration for colonoscopy is approximately 20 minutes with retroflexion only adding an extra 1-2mins to the total procedure time and is standard practice for the endoscopists involved. The process is undertaken in each patient once. Primary outcome(s): Adenoma detection rate[At the time of endoscopy] Study Design: Purpose: Diagnosis; Allocation: Non-randomised trial; Masking: Open (masking not used);Assignment: Single group;Type of endpoint: Safety/efficacy

DISEASE(S): Oral And Gastrointestinal-other Diseases Of The Mouth, Teeth, Oesophagus, Digestive System Including Liver And Colon,Right Sided Colonic Adenomatous Polyps,Cancer-bowel-back Passage (rectum) Or Large Bowel (colon)

PROVIDER: 2459423 | ecrin-mdr-crc |

REPOSITORIES: ECRIN MDR

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Project description:It is estimated that there are about 1.4 million patients with colorectal cancer (CRC) worldwide, with a rising trend in CRC incidence in many Asian Pacific countries. In Hong Kong, colorectal cancer ranks first in cancer incidence and second in cancer mortality based on data from 2013. CRC is one of the most preventable cancers because its development in general follows an adenoma-carcinoma sequence. Adenomas are considered precursor lesions for CRC. While early detection and removal of colorectal adenoma by screening colonoscopy with polypectomy reduce CRC incidence and mortality, interval cancers (cancers that develop after a colonoscopy and before the next scheduled colonoscopy) may still occur and were reported to account for up to 10.5% of CRC. The protective effect of colonoscopy against cancer in the right colon has not been consistently demonstrated. Interval CRC has been associated with proximal colon location, small lesion, flat lesion, missed lesion, inadequate examination, incomplete resection of lesion, tumor biology, and low adenoma detection rate (ADR). High ADR (eg, ≥ 20%) has been associated with a reduced risk of interval CRC. Methods that can improve polyp detection in the right colon such as retroflexed examination of the right colon, second forward view examination of the right colon, use of colonic fold flattening device, colonoscope with an increased field of view may potentially reduce the risk of interval CRC, but data is still limited. Performance of a second forward view (SFV) examination of the right colon may be the easiest and safest from a practical standpoint when compared to other options (eg, additional training is often needed for retroflexed examination of the right colon since there may be a potentially higher risk of perforation in endoscopists not familiar with the technique, additional equipment is needed when using a colonic fold flattening device, or a colonoscope with an increased field of view). Our current study aims to determine whether a routine SFV examination in the right colon can lead to an increase in adenoma / polyp detection when compared to conventional withdrawal examination in the right colon in both male and female patients undergoing screening and surveillance colonoscopies.

Dataset Information

In adult patients undergoing colonoscopy, does retroflexion of the colonoscope in the right colon compared to standard forward viewing endoscopy increase the detection of adenomatous colonic polyps.

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