Gastroenterology in MotionRetroflexion in Colonoscopy: Why? Where? When? How? What Value?
Section snippets
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 Once in retroflexion, the instrument is withdrawn until the lesion is seen.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
References (9)
Am J Gastroenterol
(1999)Gastrointest Endosc
(2009)Gastrointest Endosc
(2011)Gastrointest Endosc
(2006)
Cited by (0)
Conflicts of interest The authors disclose no conflicts.