Trial reportThe American journal of gastroenterology2015
Impact of retroflexion vs. second forward view examination of the right colon on adenoma detection: a comparison study.
Trial report in The American journal of gastroenterology, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to 2 registered trials, which are not on this map. Cited by 44 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Efficacy of Segmental Re-examination and Retroflexion of Proximal Colon for Adenoma Miss Rate During Colonoscopy
Retroflexion in the Entire Colon for the Detection of Colon-related Diseases
Who cites it
44 citing papers in PubMed, 2 syntheses or guidelines pooled it, 111 citations in OpenAlex.
- [Efficacy of Second Forward-View Colonoscopy to Improve Adenoma Detection of Right-Side Colon: Systematic Review and Meta-Analysis].The Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi · 2024Pooled it
- The Effect of Right Colon Retroflexion on Adenoma Detection: A Systematic Review and Meta-analysis.Journal of clinical gastroenterology · 2017Pooled it
- Optimized computer-assisted technique for increasing adenoma detection during colonoscopy: a randomized controlled trial.Surgical endoscopy · 2025Trial
- Impact of second forward-view examination on adenoma detection rate during unsedated colonoscopy: a randomized controlled trial.BMC gastroenterology · 2021Trial
- Proximal retroflexion versus second forward view of the right colon during screening colonoscopy: A multicentre randomized controlled trial.United European gastroenterology journal · 2020Trial
- Retrograde inspectionWorld journal of gastroenterology · 2020Trial
- Change in Colonoscopy Quality Performance Indicators in Symptomatic Patients Following Introduction of the Bowel Screening Programme in Te Tai Tokerau.ANZ journal of surgery · 2025Article
- Imaging colonic polyps in 2024.Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology · 2024Review
- Excellent Bowel Preparation Quality Is Not Superior to Good Bowel Preparation Quality for Improving Adenoma/Polyp Detection Rate.Clinical Medicine Insights. Oncology · 2024Article
- Multicenter propensity score-matched analysis comparing shortJGH open : an open access journal of gastroenterology and hepatology · 2023Article
- Improving polyp detection at colonoscopy: Non-technological techniques.World journal of gastrointestinal endoscopy · 2023Review
- Unlocking quality in endoscopic mucosal resection.World journal of gastrointestinal endoscopy · 2023Review
- Risk Factors Related to Polyp Miss Rate of Short-Term Repeated Colonoscopy.Digestive diseases and sciences · 2023Article
- Key quality indicators in colonoscopy.Gastroenterology report · 2023Review
- Second exam of right colon improves adenoma detection rate: Systematic review and meta-analysis of randomized controlled trials.Endoscopy international open · 2022Review
- Detection of colorectal lesions during colonoscopy.DEN open · 2022Review
- Almost One-Third of Large Sessile Serrated Polyps Are Missed on CT Colonography.The Turkish journal of gastroenterology : the official journal of Turkish Society of Gastroenterology · 2021Article
- Patient, Physician, and Procedure Characteristics Are Independently Predictive of Polyp Detection Rates in Clinical Practice.Digestive diseases and sciences · 2021Article
- Cecal retroflexion is infrequently performed in routine practice and the retroflexed view is of poor quality.BMC gastroenterology · 2021Observational
- Success, safety, and usefulness of right colon retroflexion for the detection of additional colonic lesions not visualized with standard frontal view.Surgical endoscopy · 2021Article
Corrections and comments
- Erratum issued
Authors and funding
15 authors at 2 institutions in 1 country.
Funding
Abstract
objectivesAlthough screening colonoscopy is effective in preventing distal colon cancers, effectiveness in preventing right-sided colon cancers is less clear. Previous studies have reported that retroflexion in the right colon improves adenoma detection. We aimed to determine whether a second withdrawal from the right colon in retroflexion vs. forward view alone leads to the detection of additional adenomas.
methodsPatients undergoing screening or surveillance colonoscopy were invited to participate in a parallel, randomized, controlled trial at two centers. After cecal intubation, the colonoscope was withdrawn to the hepatic flexure, all visualized polyps removed, and endoscopist confidence recorded on a 5-point Likert scale. Patients were randomized to a second exam of the proximal colon in forward (FV) or retroflexion view (RV), and adenoma detection rates (ADRs) compared. Logistic regression analysis was used to evaluate predictors of identifying adenomas on the second withdrawal from the proximal colon.
resultsA total of 850 patients (mean age 59.1±8.3 years, 59% female) were randomly assigned to FV (N=400) or RV (N=450). Retroflexion was successful in 93.5%. The ADR (46% FV and 47% RV) and numbers of adenomas per patient (0.9±1.4 FV and 1.1±2.1 RV) were similar (P=0.75 for both). At least one additional adenoma was detected on second withdrawal in similar proportions (10.5% FV and 7.5% RV, P=0.13). Predictors of identifying adenomas on the second withdrawal included older age (odds ratio (OR)=1.04, 95% confidence interval (CI)=1.01-1.08), adenomas seen on initial withdrawal (OR=2.8, 95% CI=1.7-4.7), and low endoscopist confidence in quality of first examination of the right colon (OR=4.8, 95% CI=1.9-12.1). There were no adverse events.
conclusionsRetroflexion in the right colon can be safely achieved in the majority of patients undergoing colonoscopy for colorectal cancer screening. Reexamination of the right colon in either retroflexed or forward view yielded similar, incremental ADRs. A second exam of the right colon should be strongly considered in patients who have adenomas discovered in the right colon, particularly when endoscopist confidence in the quality of initial examination is low.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.