Gastroenterology

Gastroenterology

Volume 144, Issue 5, May 2013, Pages 882-883
Gastroenterology

Gastroenterology in Motion
Retroflexion in Colonoscopy: Why? Where? When? How? What Value?

https://doi.org/10.1053/j.gastro.2013.01.077Get rights and content

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Retroflexion in the Rectum

Early studies reported a substantial gain in polyp detection with retroflexion, including detection of large lesions.1, 2 Recent prospective studies in which the rectum is first systematically examined in the forward view, have reported much lower polyp yields from retroflexion.3, 4 In 1 series, retroflexion resulted in 4 perforations in 40,000 patients, accounting for 10% of all colonoscopy perforations.5 Retroflexion can provide valuable information and photodocumentation regarding benign

Retroflexion in the Right Colon

Colonoscopy is less effective in preventing right-sided compared with left-sided colon cancer. This finding has led to discussion of potential methods to improve detection during right colon examination. Split-dose bowel preparation is increasingly accepted as essential for the right colon. Technical steps under consideration include a separate withdrawal time target for the right colon, examination of the right colon twice, and performance of right colon retroflexion after a careful forward

Polypectomy in Retroflexion

Some polyps are difficult to access during colonoscopy because of location on the proximal sides of folds or flexures. The forward view demonstrates only a portion of the polyp. Retroflexion typically exposes the entire polyp surface that could not be seen in the forward view.8, 9 The endoscopist advances proximal to the polyp to find an open section of colon in which to form the U-turn. Once in retroflexion, the instrument is withdrawn until the lesion is seen. Retroflexion may be needed only

Video Description

The video demonstrates retroflexion in the proximal colon, in the rectum, and for performance of polypectomy in the ascending colon. Audio accompaniment explains the video.

Take Home Message

Retroflexion in the proximal colon is a recently described adjunct to proximal colon examination as well as to endoscopic resection of difficult-to-access polyps proximal to the rectum. The technique can be safely applied using colonoscopes in the right and transverse colons and upper endoscopes in the descending and sigmoid colon. A second examination of the proximal colon should be considered when the first examination in the forward view reveals lesions. A second examination in the forward

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There are more references available in the full text version of this article.

Cited by (0)

Conflicts of interest The authors disclose no conflicts.

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