Korean J Gastroenterol.  2024 Dec;84(6):265-273. 10.4166/kjg.2024.117.

Efficacy of Second Forward-View Colonoscopy to Improve Adenoma Detection of Right-Side Colon: Systematic Review and Meta-Analysis

• Kim HJ
• Yoon H
• Lee JW

• KMID: 2563343
• DOI: http://doi.org/10.4166/kjg.2024.117

Abstract

Background/Aims
The second forward view (SFV) has been considered an effective method to improve the adenoma detection rate (ADR) in the right-side colon. On the other hand, there is insufficient evidence on how much the ADR is improved compared to standard one forward view (OFV) colonoscopy. A systematic review and meta-analysis were performed to determine the efficacy of improvement in the ADR by SFV colonoscopy.
Methods
This study conducted a systematic literature search in Medline, Embase, and Cochrane Library until Sep 2024. Two independent investigators (HJK, JWL) conducted a database search, and studies regarding the SFV or retroflexion were selected. The primary outcomes were the ADR of the right-side colon, polyp detection rate, and withdrawal time. Statistical analyses were performed using STATA 18.0 Special edition.
Results
Ten studies with 5,886 patients were included in this review. The pooled ADR of SFV colonoscopy for the right colon was significantly higher than that of the OFV, with a risk ratio (RR) of 1.25 (95% CI, 1.13–1.38 I² =0.0%). This result was statistically significant in three non-randomized trials (RR 1.19, 95% CI 1.06–1.34, I² =0.0%) with low heterogeneity. The right-sided polyp detection rate (RR 1.19, 95% CI 1.06–1.34, I² =61.6%) and the ADR of the whole colon (RR 1.10, 95% CI 1.01–1.20, I² =0.0%) were also significantly higher than those of OFV colonoscopy.
Conclusions
SFV colonoscopy is an effective method to improve the ADR of the right colon.

Keyword

Colonoscopy; Adenoma; Polyp; Second forward view

Figure

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  Fig. 1 PRISMA flow diagram.

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  Fig. 2 (A) Adenoma detection rate of SFV for Rt side colon compared with OFV among six RCTs. (B) Polyp detection rate of SFV for Rt side colon compared with OFV among five RCTs. (C) Adenoma detection rate of SFV for the whole colon compared with OFV among five RCTs.

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  Fig. 3 (A) Withdrawal time of Right-side colon between SFV and OFV among 4 RCTs. (B) Withdrawal time of whole colon between SFV and OFV among 5 RCTs.

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