SUCCESS, SECURITY AND USEFULNESS OF RIGHT COLON RETROFLEXION FOR THE DETECTION OF ADDITIONAL COLONIC LESIONS NOT VISUALIZED WITH STANDARD FRONTAL VIEW

Aims:

Right colon retroflexion (RCR) seems to increase adenoma detection rate (ADR), but important variation in success and usefulness of this manoeuvre in the literature has been reported.

Aims:

1. to assess additional ADR detection with RCR;

2. to assess security and factors associated with successful RCR

Methods:

Colonoscopy method: after reaching the cecum, colonoscope was moved back to hepatic flexure and a second exploration of right colon with frontal view was performed and adenomas resected. After that, a RCR was performed searching for additional adenomas.

A prospective, unicentric, not randomized study was planned. Complete consecutive colonoscopies were included (from March to May 2017), all performed by 6 endoscopists (3 of them with < 3 years of experience and 3 with > 3 year experience). Olympus colonoscopes were used (CF-H190, CF-H180) Demographic and endoscopic variables were collected (success of RCR, grade of RCR -depending on the number of haustra coli visualized-, colonoscope model, length of colonoscope inserted in cecum, additional adenomas visualized or adverse events, etc.)

Results:

463 colonoscopies were included. Success in RCR was 93.1% (431/463 colonoscopies) Additional polyps were visualized in 34/463 colonoscopies (7.3%). Number of additional polyps per colonoscopy: 1 – 3 lesions; size range: 1 – 10 mm. Histology: adenoma with low grade dysplasia in 71.9% (23/34) of lesions; 6.3% (2/34) were adenomas with high grade dysplasia; no carcinomas were found. Variables associated with RCR success in multivariate analysis were: non previous abdominal surgery, length of colonoscope insertion in cecum < 80 cm and use of Olympus 190 series colonoscopes. No differences between endoscopists experience were found. RCR grade correlated with additional ADR (grade 1, 0%; grade 2, 13%; grade 3, 27%) RCR was a secure manoeuvre, with no significant adverse events in our study.

Conclusions:

RCR is a feasible and secure manoeuvre that could increase ADR, so its routinary inclusion in colonoscopy practice should be considered.

 

Scroll to top