Improving polyp detection at colonoscopy: Non-technological techniques

Table 1 Summary of studies evaluating colonic withdrawal times

Ref.	Year	Design	n	Outcome
Barclay et al[17]	2006	Prospective	7882	WT > 6 min associated with increased ADR
Barclay et al[18]	2008	Prospective	2053	WT ≥ 8 min associated with increased ADR
Sawhney et al[19]	2008	Prospective	23,910	Minimum 7 min WT not associated with increased PDR
Gellad et al[27]	2010	Prospective	304	WT ≥ 12 min not associated with risk of interval neoplasia
Gromski et al[21]	2012	Prospective	1210	WT ≥ 10 min associated with increased ADR
Moritz et al[24]	2012	Prospective	4429	WT ≥ 6 min not associated with increased ADR
Lee et al[20]	2013	Prospective	31088	WT up to 10 min associated with increased ADR
Butterly et al[28]	2014	Prospective	7996	WT ≥ 9 min associated with increased ADR
Zhao et al[29]	2022	RCT	1027	Increased ADR associated with WT of 9 min vs WT of 6 min

WT: Withdrawal times; RCT: Randomized controlled trial; ADR: Adenoma detection rate; PDR: Polyp detection rate.

Table 2 Results of studies evaluating colonic withdrawal times

Ref.	Intervention limb, %	Control limb, %	P value
Barclay et al[17]	28.3%	11.8%	< 0.001
Barclay et al[18]	34.7%	23.5%	> 0.0001
Sawhney et al[19]	NA	NA	NA
Gellad et al[27]	NA	NA	NA
Gromski et al[21]	32.3%	9.5%	< 0.001
Moritz et al[24]	NA	NA	NA
Lee et al[20]	47.1%	42.5%	< 0.001
Butterly et al[28]	ADR: IRR = 1.50		0.001
Zhao et al[29]	36.6%	27.1%	0.001

ADR: Adenoma detection rate; IRR: Incidence rate ratio; NA: Not available.

Table 3 Summary of studies evaluating dynamic position change

Ref.	n	Design	Control limb	Dynamic position change limb
East et al[37]	130	RCT	Left lateral	RC = left lateral, TC = supine, LC = right
Koksal et al[41]	102	RCT	Left lateral	RC = left lateral, TC = supine, LC = right lateral + supine
Lee et al[36]	1072	RCT	Left lateral	RC = left lateral, TC = supine, LC = right lateral
Ball et al[42]	130	RCT	Supine	RC = left lateral, TC = supine, LC = right lateral
Ou et al[40]	776	RCT	Usual position	RC = left lateral, TC = supine, LC = right lateral

RCT: Randomized controlled trial; RC: Right colon; TC: Transverse colon; LC: Left colon.

Table 4 Results of studies evaluating dynamic position change

Ref.	Year	Outcome	Control limb position	Dynamic position change limb	P value
East et al[37]	2011	Increased ADR	23% ADR	34% ADR	0.01
Koksal et al[41]	2013	Increased ADR	23.5% ADR	33.3% ADR	0.002
Lee et al[36]	2016	Increased ADR	33.3% ADR	42.4% ADR	0.002
Ball et al[42]	2015	Increased PDR in RC only	17.7% ADR	26.2% ADR	0.01
Ou et al[40]	2014	No effect on ADR	37.9% ADR	40.7% ADR	0.44

ADR: Adenoma detection rate; PDR: Polyp detection rate; RC: Right colon.

Table 5 Summary of studies evaluating proximal colon retroflexion

Ref.	Year	n	Design
Harrison et al[44]	2004	100	RCT
Hewett et al[46]	2011	1000	Prospective
Chandran et al[45]	2015	1351	Prospective
Kushnir et al[49]	2015	850	RCT
Lee et al[50]	2017	1020	Prospective
Núñez Rodríguez et al[51]	2020	692	RCT
Rath et al[52]	2020	205	RCT
Michopoulos et al[53]	2021	655	Prospective

RCT: Randomized controlled trial.

Table 6 Results of studies evaluating proximal colon retroflexion

Ref.	Outcome	RV	SFV	P value
Harrison et al[44]	No difference in AMR in SFV vs RV	23.7%	33.3%	0.31
Hewett et al[46]	AMR in RV comparable to 2nd examination in SFV	NA	NA	NA
Chandran et al[45]	Increased ADR in RV vs SFV	26.40%	24.60%	< 0.001
Kushnir et al[49]	No difference in ADR in SFV vs RV	47%	46%	0.75
Lee et al[50]	Increased ADR in RV vs SFV	27.50%	25.50%	< 0.001
Núñez Rodríguez et al[51]	No difference in ADR in SFV vs RV	9%	12%	0.28
Rath et al[52]	No difference in ADR in SFV vs RV	42%	44.3%	0.88
Michopoulos et al[53]	Increased ADR in RV vs SFV	22.75%	14.20%	< 0.01

AMR: Adenoma miss rate; ADR: Adenoma detection rate; SFV: Standard forward view; RV: Retroflexed view; NA: Not available.