INSPECTION OF THE COLON IN RETROFLECTION USING A RETROGRADE VIEWING ENDOSCOPE INCREASES ADENOMA DETECTION RATE

Aims:

Adenoma detection rate (ADR) is inversely related to the incidence of interval colorectal cancers and therefore serves as a benchmark criterion for quality assessment during screening or surveillance colonoscopies Within this study, we evaluated whether additional retrograde inspection of the colon can increase ADR and the number of adenomas per patient.

Methods:

Patients undergoing screening or surveillance colonoscopies were prospectively enrolled. During colonoscopy, each segment of the colon (Cecum and ascending colon, transverse colon, descending and sigmoid colon) were inspected first with HD standard forward view (SFV) followed by inspection of the same segment in retroflected view (RFV) using a dedicated endoscope with a 210 ° retroflex angulation (Pentax RetroView). Number of adenomas in each segment detected with SFV and RFV as well as withdrawal times with SFV and RFV were recorded.

Results:

At the time of abstract submission, 44 patients (mean age 58 years, 28 male) were prospectively included. Inspection of the whole colon in retroflexion was possible in all patients. Polyp detection rate (PDR) with SFV was 34% and increased to 45% when additional RFV was performed in each segment. Likewise, ADR increased by 9% when RFV was performed (ADR SFV: 30%, ADR RFV: 39%). Adenoma per patient rate was 1.6 with SFV and increased to 2.3 with additional RFV. Size of the additional adenomas found with RFV ranged from 3 to 10 mm. Withdrawal times were not significantly different between SFV and RFV.

Conclusions:

Additional retroflection of the colon using a dedicated endoscope can significantly increase ADR and the number of adenomas found per patient. This approach should be considered during standard colonoscopy to increase ADR and to improve the quality of colonoscopy.