ArticleAnnals of gastroenterology2021
Retroflexion, a costless endoscopic maneuver, increases adenoma detection rate in the ascending colon.
Article in Annals of gastroenterology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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4 citing papers in PubMed, 5 citations in OpenAlex.
- Adherence of Greek gastroenterologists to established quality indicators in gastrointestinal endoscopy.Annals of gastroenterology · 2026Article
- Unlocking quality in endoscopic mucosal resection.World journal of gastrointestinal endoscopy · 2023Review
- Improving polyp detection at colonoscopy: Non-technological techniques.World journal of gastrointestinal endoscopy · 2023Review
- Low Colon Capsule Endoscopy (CCE) False Negative Rate for Polyps Excluding Reader Error.Diagnostics (Basel, Switzerland) · 2022Article
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Authors and funding
9 authors at 1 institution in 1 country.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundMissed polyps during colonoscopy are considered an important factor for interval cancer appearance, especially in the ascending colon (AC). We evaluated the contribution of retroflexion to polyp and adenoma detection in the AC.
methodsThis prospective observational study included consecutive patients who underwent a complete colonoscopy between 06/2017 and 06/2018. The AC was examined in 2 phases: the first included 2 forward views from the hepatic flexure to the cecum; the second involved a retroflexion in the cecum, inspection up to the hepatic flexure and reinsertion to the cecum.
resultsThe study included 655 patients, 628 (95.88%) with successful retroflexion (mean age: 62.5±10.8 years, 332 male). Indications for colonoscopy were screening in 33.28%, follow up in 36.03%, and diagnostic assessment in 30.69%. In total, 286 polyps and 220 adenomas were detected in the AC. Phase 1 identified 119 adenomas, yielding an adenoma detection rate (ADR) in the AC of 14.2% (95% confidence interval [CI] 11.52-16.84%) while phase 2 identified 86 additional adenomas, improving the ADR in the AC to 22.75% (95%CI 19.54-25.96%; P<0.01). Adenoma miss rate was 39.1% (86/225) and per-patient adenoma miss rate was 11.15% (73/655). Retroflexion proved beneficial mainly in the upper third of the AC (odds ratio [OR] 4.29, 95%CI 1.84-11.56; P<0.01) and for small (<5 mm) adenomas (OR 1.61, 95%CI 1.02-2.56; P=0.04). Multivariate analysis showed that age >60 years, detection of adenomas in forward views and the indication "follow up" influenced ADR during retroflexion.
conclusionRetroflexion is a simple and safe maneuver that increases the ADR in the AC and should complete a second forward view.
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