Original article
Clinical endoscopy
Right-sided adenoma detection with retroflexion versus forward-view colonoscopy

https://doi.org/10.1016/j.gie.2014.08.039Get rights and content

Background

Colonoscopy and polypectomy can prevent up to 80% of colon cancer; however, a significant adenoma miss rate still exists, particularly in the right side of the colon.

Objective

To assess whether retroflexion in the right side of the colon significantly improves the adenoma detection rate (ADR) over forward-view assessment.

Design

Multicenter prospective cohort study.

Setting

Three tertiary care public and 2 private hospitals.

Patients

A total of 1351 consecutive adult patients undergoing elective colonoscopy.

Intervention

Withdrawal from the cecum was performed in the forward view initially and identified polyps removed. Once the hepatic flexure was reached, the cecum was reintubated and the right side of the colon was assessed in the retroflexed view to the hepatic flexure.

Main Outcome Measurements

ADR in the retroflexed view when compared with forward-view examination of the right side of the colon.

Results

Retroflexion was successful in 95.9% of patients, with looping the predominant (69.6%) reason for failure. Forward-view assessment of the right side of the colon identified 642 polyps, of which 531 were adenomas yielding a polyp and ADR of 28.57% and 24.64%, respectively. Retroflexion identified a further 84 polyps of which 75 were adenomas, improving the polyp and ADR to 30.57% and 26.4%, respectively.

Limitations

Observational study.

Conclusion

Right-sided retroflexion was successful in most of our cohort with a statistically significant but small increase in ADR. Right-sided retroflexion is safe when performed by experienced endoscopists with no adverse events observed in this cohort. (Clinical trial registration: Australian New Zealand Clinical Trials Registry, ACTRN12613000424707.)

Section snippets

Methods

A prospective multicenter cohort study was performed across 3 tertiary care and 2 private hospitals from January 2013 to January 2014. Five study endoscopists who routinely perform right-sided colonic retroflexion were involved with baseline endoscopic performance listed in Table 1. A standardized data sheet capturing patient demographics, procedure indication, whether retroflexion was successful, reasons behind failure to perform the maneuver, adverse events, and polyp characteristics was

Results

A total of 1351 patients was recruited over the study period. Patient demographics were a male-to-female ratio of 1:1.03, mean age of 59.97 years (range, 18-91 years), and the predominant indication was colon cancer screening (39.4% [532/1351]). The adult colonoscope was predominantly used across our cohort (94.4% [1276/1351]). Complete patient details are shown in Table 2.

Discussion

We undertook a multicenter prospective cohort study to evaluate whether right-sided retroflexion significantly improved the ADR. The emerging medical literature indicates that although colonoscopy has had a positive impact on preventing colon cancer, this effect is substantially reduced in the right side of the colon.18, 19, 20, 21 In Australia, colon cancer is the second-most commonly diagnosed malignancy, despite having 1 of the highest rates of colonoscopy.22 Retroflexion in the right side

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    DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.

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