Randomized Controlled Trial
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Nov 15, 2020; 12(11): 1336-1345
Published online Nov 15, 2020. doi: 10.4251/wjgo.v12.i11.1336
Diagnostic value of novel retroflexion colonoscopy in the right colon: A randomized controlled trial
Wen-Kun Li, Yun Wang, Ya-Dan Wang, Kui-Liang Liu, Chun-Mei Guo, Hui Su, Hong Liu, Jing Wu
Wen-Kun Li, Ya-Dan Wang, Kui-Liang Liu, Chun-Mei Guo, Hui Su, Hong Liu, Jing Wu, Department of Gastroenterology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
Wen-Kun Li, National Clinical Research Center for Digestive Diseases, Beijing 100050, China
Yun Wang, Ya-Dan Wang, Kui-Liang Liu, Chun-Mei Guo, Hui Su, Hong Liu, Department of Gastroenterology, Peking University Ninth School of Clinical Medicine, Beijing 100038, China
Jing Wu, Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing 100050, China
Author contributions: Wu J, Liu H, Liu KL, and Li WK completed the study concept and design; Li WK and Wang Y recruited the patients; Li WK and Wang Y acquired the data; Li WK performed statistical analysis and drafted the manuscript; Liu KL, Wang YD, Guo CM, and Su H performed colonoscopy; Wu J and Liu KL provided critical review of the manuscript; all authors read and approved the final manuscript.
Supported by Digestive Medical Coordinated Development Center of Beijing Hospitals Authority, No. XXZ015; Capital Citizens Health Cultivation Project of Beijing Municipal Science & Technology Commission, No. Z161100000116084; Medical and Health Public Foundation of Beijing, No. YWJKJJHKYJJ-B17262-067; and Science and Technology Development Project of China State Railway Group, No. N2019Z004.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Beijing Shijitan Hospital, Capital Medical University (Approval No. 2018-59).
Clinical trial registration statement: This study is registered at http://www.chictr.org.cn/. The registration identification number is ChiCTR2000031186.
Informed consent statement: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that there is no conflict of interests in this study.
Data sharing statement: Dataset available from the corresponding author at bjsjtyywj@ccmu.edu.cn.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jing Wu, PhD, Director, Professor, Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, No. 95 Yongan Road, Xicheng District, Beijing 100050, China. bjsjtyywj@ccmu.edu.cn
Received: July 13, 2020
Peer-review started: July 13, 2020
First decision: September 17, 2020
Revised: September 27, 2020
Accepted: October 15, 2020
Article in press: October 15, 2020
Published online: November 15, 2020
Processing time: 122 Days and 3.1 Hours
ARTICLE HIGHLIGHTS
Research background

Colonoscopy is the most effective method in the screening and prevention of colorectal cancer (CRC), and it could reduce the mortality from CRC. However, colonoscopy is less effective in preventing CRC in the right-side compared with the left-side colon.

Research motivation

Failure to detect more preneoplastic lesions is regarded as one of the mechanisms in the development of interval CRC. Retroflexion in the proximal colon allows for better visualization of the folds and the hepatic flexure, which may increase adenoma detection rate (ADR).

Research objectives

The current study aimed to investigate the effectiveness and safety of the EC-3490Ti colonoscope in detecting adenomas in the proximal colon.

Research methods

We enrolled patients who underwent colonoscopy for screening or surveillance for CRC. When the endoscopists could not grasp the whole observation of the colon mucosa in the forward view, retroflexion was performed in the retroflexion view group with the EC-3490Ti colonoscope, while insertion and withdrawal were repeatedly conducted with the EC38-i10F colonoscope. ADR, total number of adenomas per positive participant (APP), success rate of retroflexion, and withdrawal time were compared.

Research results

The success rate of proximal retroflexion was 91.7%. There were no complications with the maneuver. Polyp detection rate, ADR for the right colon, and APP were significantly increased with retroflexion during withdrawal in the proximal colon, compared with the forward view group.

Research conclusions

Proximal retroflexion with the EC-3490Ti colonoscope in the right colon could be accomplished safely and effectively. Retroflexion in the proximal colon significantly increases the detection of adenomas compared with conventional colonoscopy.

Research perspectives

Retroflexion should be adopted as a complementary procedure in the future for the improvement of CRC prevention.