Endoscopy 2018; 50(04): S118
DOI: 10.1055/s-0038-1637380
ESGE Days 2018 ePoster Podium presentations
21.04.2018 – Colorectal polyps: diagnosis
Georg Thieme Verlag KG Stuttgart · New York

META-ANALYSIS SHOWS THAT THE SECOND INSPECTION OF THE PROXIMAL COLON INCREASES ADENOMA DETECTION RATE

K Triantafyllou
1   Attikon University General Hospital, Hepatogastroenterology Unit, Athens, Greece
,
P Gkolfakis
1   Attikon University General Hospital, Hepatogastroenterology Unit, Athens, Greece
,
G Tziatzios
1   Attikon University General Hospital, Hepatogastroenterology Unit, Athens, Greece
,
L Fuccio
2   S. Orsola-Malpighi University Hospital, Department of Medical and Surgical Sciences, Bologna, Italy
,
C Hassan
3   Nuovo Regina Margherita Hospital, Endoscopy Unit, Rome, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

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Aims:

There is evidence that a second examination of the proximal colon (PC) increases the diagnostic yield of colonoscopy. The aim of this meta-analysis was to examine the incremental benefit of a second, back-to-back mucosa inspection of the PC.

Methods:

We performed literature searches to identify studies evaluating the effect of a second endoscopic examination on adenoma detection rate (ADR) and advanced ADR in the PC. We also measured the incremental benefit of the second exam on the number of detected PC adenomas (and advanced adenomas) per patient. Outcomes effect sizes are presented as RR[95% CI].

Results:

We identified 8 studies (5 cohort – 3 RCT with 9 sets of data and 5461, CRC screening/surveillance and symptomatic patients). Three sets of data examined the yield of the second direct view as compared to that of a single inspection and six sets evaluated the yield of the second examination with scope retroflexion compared to that of the single direct view. The second PC examination significantly increased ADR (1.18 [1.11 – 1.25], I 2= 31%) overall, in the direct view arm (1.38 [1.22 – 1.55], I 2= 0%) and in the retroflexion arm (1.13 [1.05 – 1.21], I 2= 0%). Analysis did not show significant increase in PC advanced ADR (1.14 [0.85 – 1.53], I 2= 0%) after the second exam. Per patient PC mean number of adenomas (0.50 ± 0.03 vs. 0.39 ± 0.01, p = 0.09) and mean number of advanced adenomas (0.040 ± 2.2 × 10-4 vs. 0.038 ± 2.3 × 10-4, p = 0.85) were numerically higher after the second exam.

Conclusions:

In comparison to a single pass, the second inspection of the proximal colon either in direct view or with scope retroflextion increases ADR in this colon segment.