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Right-sided adenoma detection with retroflexion versus forward-view colonoscopy.

Sujievvan Chandran1, Frank Parker2, Rhys Vaughan1

  • 1Department of Gastroenterology, Austin Health, Melbourne, Victoria, Australia; Department of Medicine, Austin Health, University of Melbourne, Melbourne, Victoria, Australia.

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Summary

Retroflexion during colonoscopy improved adenoma detection rates (ADR) in the right colon. This technique is safe and effective for experienced endoscopists, enhancing colon cancer prevention.

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Area of Science:

  • Gastroenterology and Endoscopy
  • Cancer Prevention
  • Colorectal Cancer Screening

Background:

  • Colonoscopy and polypectomy are crucial for preventing colorectal cancer, yet adenoma miss rates persist, especially in the right colon.
  • Improving adenoma detection rates (ADR) is essential for maximizing the efficacy of colon cancer screening.
  • Current forward-view colonoscopy may have limitations in visualizing the entire right colon.

Purpose of the Study:

  • To evaluate the impact of retroflexion in the right colon on adenoma detection rates (ADR) compared to standard forward-view assessment.
  • To determine the safety and feasibility of right-sided colon retroflexion in a large patient cohort.

Main Methods:

  • A multicenter prospective cohort study involving 1351 adult patients undergoing elective colonoscopy.
  • Initial withdrawal was performed using forward view, followed by re-intubation and assessment of the right colon in retroflexed view.
  • Adenoma detection rate (ADR) was compared between forward-view and retroflexed-view examinations of the right colon.

Main Results:

  • Right-sided retroflexion was successful in 95.9% of patients.
  • Retroflexion identified an additional 75 adenomas, increasing the overall ADR from 24.64% to 26.4%.
  • The technique demonstrated a statistically significant, albeit small, increase in ADR.

Conclusions:

  • Right-sided colon retroflexion is a safe and effective adjunct to standard colonoscopy for improving adenoma detection.
  • The technique offers a valuable tool for experienced endoscopists to enhance the sensitivity of colorectal cancer screening.
  • Further research may explore optimizing retroflexion techniques to further minimize missed adenomas.