Konstantinos Triantafyllou1, Georgios Tziatzios2, Athanasios D Sioulas2, Iosif Beintaris2, Alina-Roxani Gouloumi3, Ioannis G Panayiotides3, George D Dimitriadis2. 1. Hepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, Medical School, University of Athens, "Attikon" University General Hospital, Athens, Greece. Electronic address: ktriant@med.uoa.gr. 2. Hepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, Medical School, University of Athens, "Attikon" University General Hospital, Athens, Greece. 3. Second Department of Pathology, Medical School, University of Athens, "Attikon" University General Hospital, Athens, Greece.
Abstract
BACKGROUND: Techniques have been implemented to improve colonoscopy adenoma detection rate (ADR) in the right colon. AIMS & METHODS: We prospectively examined the additional diagnostic yield of right colon examination with colonoscope retroflexion in consecutive, symptomatic and screening-surveillance patients. Right colon was examined in forward-view first and thereafter, retroflexion was performed to re-inspect it. RESULTS: Right colon examination in retroflexion was achieved in 620 (92%) patients. Increased inserted scope length to the cecum (OR: 0.48 [95% CI: 0.27-0.84]) and elderly status (OR: 0.53 [95% CI: 0.430-0.94]) predicted retrofexion failure. Forward-view colonoscopy detected 134 polyps and 112 adenomas in 105 and 85 patients, respectively. Scope retroflexion revealed 7 missed (6 adenomas--2 advanced) polyps in 7 patients; indicating 4.96 (95% CI: 1.37-8.55) % and 5.1 (95% CI: 1.12-9.05) % per-polyp and per-adenoma miss rates, respectively. In ITT analysis, per-patient polyp and adenoma miss rates were 1.041% and 0.89%, respectively. Among screening-surveillance patients, retroflexion detected 3 missed adenomas (2 advanced) in 3 patients, resulting in changed surveillance schedule in 2 of them (5.12 per 1000 screening-surveillance patients). Early study termination was favored by low right colon ADR improvement and lacking substantial surveillance interval change. CONCLUSION: The additional diagnostic yield of scope retroflexion in the right colon is questionable.
BACKGROUND: Techniques have been implemented to improve colonoscopy adenoma detection rate (ADR) in the right colon. AIMS & METHODS: We prospectively examined the additional diagnostic yield of right colon examination with colonoscope retroflexion in consecutive, symptomatic and screening-surveillance patients. Right colon was examined in forward-view first and thereafter, retroflexion was performed to re-inspect it. RESULTS: Right colon examination in retroflexion was achieved in 620 (92%) patients. Increased inserted scope length to the cecum (OR: 0.48 [95% CI: 0.27-0.84]) and elderly status (OR: 0.53 [95% CI: 0.430-0.94]) predicted retrofexion failure. Forward-view colonoscopy detected 134 polyps and 112 adenomas in 105 and 85 patients, respectively. Scope retroflexion revealed 7 missed (6 adenomas--2 advanced) polyps in 7 patients; indicating 4.96 (95% CI: 1.37-8.55) % and 5.1 (95% CI: 1.12-9.05) % per-polyp and per-adenoma miss rates, respectively. In ITT analysis, per-patient polyp and adenoma miss rates were 1.041% and 0.89%, respectively. Among screening-surveillance patients, retroflexion detected 3 missed adenomas (2 advanced) in 3 patients, resulting in changed surveillance schedule in 2 of them (5.12 per 1000 screening-surveillance patients). Early study termination was favored by low right colon ADR improvement and lacking substantial surveillance interval change. CONCLUSION: The additional diagnostic yield of scope retroflexion in the right colon is questionable.
Authors: Faisal Kamal; Muhammad Ali Khan; Wade Lee-Smith; Sachit Sharma; Ashu Acharya; Zaid Imam; Umer Farooq; John Hanson; Vian Pulous; Muhammad Aziz; Saurabh Chandan; Abdul Kouanda; Sun-Chuan Dai; Craig A Munroe; Colin W Howden Journal: Endosc Int Open Date: 2022-10-17
Authors: Ma Henar Núñez Rodríguez; Pilar Díez Redondo; Fausto Riu Pons; Marta Cimavilla; Luis Hernández; Andrea Loza; Manuel Pérez-Miranda Journal: United European Gastroenterol J Date: 2020-05-07 Impact factor: 4.623