Colonoscopic Polypectomy in Retroflexion

Abstract

Background: Large sessile colon polyps present difficulty for endoscopists, because they are associated with the greatest risk from endoscopic resection, and because resection is time consuming, costly and technically difficult. One factor that creates technical difficulty is when all or a portion of the polyp is hard-to-access endoscopically. Little has been written about the value of retroflexion in the removal of hard-to-access large sessile colon polyps proximal to the rectum. Methods: We recorded the frequency with which retroflexion was needed in the removal of 59 consecutive sessile colon polyps 2 cm or larger located proximal to the rectum. All 59 polyps were removed using prototype colonoscopes with short bending sections that facilitate retroflexion. Results: Fourteen polyps were removed entirely (n = 4) or partially (n = 10) in retroflexion. Polyps that were removed in retroflexion were more likely to have been referred by another colonoscopist (14/49) compared to those initially discovered by the author during screening or diagnostic colonoscopy (0/10; p = 0.05). There were no perforations and no complications related to retroflexion. Conclusions: Retroflexion is a useful adjunctive procedure for removal of some large sessile colon polyps proximal to the rectum that are difficult to access endoscopically. This may be particularly true in a colonoscopic practice that accepts referrals of polyps from other endoscopists. Background: Large sessile colon polyps present difficulty for endoscopists, because they are associated with the greatest risk from endoscopic resection, and because resection is time consuming, costly and technically difficult. One factor that creates technical difficulty is when all or a portion of the polyp is hard-to-access endoscopically. Little has been written about the value of retroflexion in the removal of hard-to-access large sessile colon polyps proximal to the rectum. Methods: We recorded the frequency with which retroflexion was needed in the removal of 59 consecutive sessile colon polyps 2 cm or larger located proximal to the rectum. All 59 polyps were removed using prototype colonoscopes with short bending sections that facilitate retroflexion. Results: Fourteen polyps were removed entirely (n = 4) or partially (n = 10) in retroflexion. Polyps that were removed in retroflexion were more likely to have been referred by another colonoscopist (14/49) compared to those initially discovered by the author during screening or diagnostic colonoscopy (0/10; p = 0.05). There were no perforations and no complications related to retroflexion. Conclusions: Retroflexion is a useful adjunctive procedure for removal of some large sessile colon polyps proximal to the rectum that are difficult to access endoscopically. This may be particularly true in a colonoscopic practice that accepts referrals of polyps from other endoscopists.