Endoscopy 2019; 51(04): S102
DOI: 10.1055/s-0039-1681471
ESGE Days 2019 oral presentations
Saturday, April 6, 2019 11:00 – 13:00: Colonic polyps: detection Club D
Georg Thieme Verlag KG Stuttgart · New York

RETROFLEXION IN THE ASCENDING COLON IS A COSTLESS ENDOSCOPIC MANEUVER INCREASING ADENOMA DETECTION RATE

S Michopoulos
1   GI, Alexandra Hospital, Athens, Greece
,
G Axiaris
1   GI, Alexandra Hospital, Athens, Greece
,
P Baxevanis
1   GI, Alexandra Hospital, Athens, Greece
,
M Stoupaki
1   GI, Alexandra Hospital, Athens, Greece
,
V Gagari
1   GI, Alexandra Hospital, Athens, Greece
,
G Leonidakis
1   GI, Alexandra Hospital, Athens, Greece
,
A Karlaftis
1   GI, Alexandra Hospital, Athens, Greece
,
E Zampeli
1   GI, Alexandra Hospital, Athens, Greece
,
M Sotiropoulou
2   Pathology, Alexandra Hospital, Athens, Greece
,
K Petraki
3   Pathology, Metropolitan Hospital, Athens, Greece
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

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Aims:

Missing polyps during colonoscopy is an important factor for the appearance of interval cancers especially in the ascending colon (AscCol). Study aim: Evaluate the contribution of retroflexion to polyp/adenoma detection.

Methods:

Consecutive patients with complete colonoscopy were prospectively evaluated for polyp detection in the AscCol. Protocol of AscCol examination for polyp detection: 1st Phase (Forward view – FrwV)= Insertion from the right flexure (RFx) to the caecum followed by withdrawal till the Rfx and reinsertion to the caecum. 2nd Phase (Retroflexion): U-turn of the colonoscope in the caecum till the RFx, redressing to the FrwV and reinsertion to the caecum.

Statistics:

McNemar's test, logistic regression model to identify factors associated with per-patient adenoma miss rate.

Results:

628 out of 655 patients with successful Rfx (95.9%) were analyzed, mean age 62.5 years, 49.52% males, indication for colonoscopy: screening 33.6%, follow-up 35.67%, diagnostic assessment 30.73%, with poor preparation < 1%. Adenoma detection rate (ADR) for the entire colon was 54.14% [Screening (42.2%), Follow-up (62.0%) Diagnostic (58.0%), p < 0.01]. In total 269 polyps and 205 adenomas were detected in the AscCol. FrwV identified 148 polyps and 119 adenomas yielding a polyp and ADR in the AscCol of 16.72% (95% C.I:13.8 – 19.64) and 13.38% (95% C.I:10.7 – 16.0) respectively. Retroflexion identified 121 more polyps and 86 adenomas improving the polyp detection and ADR in the AscCol to 28.66% (95% C.I:25.13 – 32.2) and 22.29% (95% C.I:19.04 – 25.5) respectively, (p < 0.01). Adenoma miss rate was 42% (86/205) and per patient adenoma miss rate was 11.62%. Retroflexion improves ADR mainly in the upper third of the AscCol (p < 0.01). Multivariate analysis showed that age > 60 years, adenoma detection in FrwV, indication ''Follow-up'' and previous surgery influenced ADR with retroflexion.

Conclusions:

Retroflexion in the ascending colon is a simple and safe maneuver that substantially increases the ADR in the ascending colon, especially towards the right flexure.