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Lower adenoma detection rate (ADR) is associated with higher postcolonoscopy colorectal cancer (CRC) risk. Approaches to improving ADR include the use of distal colonoscope attachments to increase mucosal exposure, colonoscopes with wider viewing angles, imaging techniques such as dye-based and electronic chromoendoscopy to enhance mucosal visualization, and nondevice methods. Numerous comparative studies have been performed, but the relative efficacy of these approaches is unclear.
In this network meta-analysis, investigators identified 74 randomized, controlled trials (comprising 45,000 patients) comparing distal attachments (cap, Endocuff, Endorings, G-EYE), enhanced imaging (chromoendoscopy, narrow-band imaging, flexible spectral imaging…