Does retroflexion improve adenoma miss rates on the right side of the colon when using a pediatric variable-stiffness colonoscope during routine colonoscopy?

Abstract

Optical colonoscopy is widely accepted as the gold standard for detecting colorectal pathology, especially adenomas and cancer. However, even in the most experienced hands, miss rates of adenomas and small cancers of up to 30 % have been reported in the literature [1] [2]. The visibility of the colorectal surface by colonoscopy is only 86.6 % compared with colonography simulation [3]. There are of course several reasons for this, one of which is the difficulty of locating adenomas that are hidden behind proximal sides of folds and the inner aspect of flexures [4] [5] [6], especially in the hepatic flexure, where the colonoscope can slip during removal [7]. Once the cecum is reached, retroflexion is often possible, and this is helpful in examining behind haustra as far as the hepatic flexure. However, retroflexion in the cecum of adult patients has proven to be significantly more successful when pediatric colonoscopes are used compared with when standard instruments are used [8] [9]. Furthermore, retroflexion in the colon facilitates resection of polyps during colonoscopy [10] [11]. So far, the impact of proximal colon retroflexion on adenoma miss rates has been negative when using normal endoscopes [12]. However, the prospective pilot study described below suggests significant advancement in colonoscopy when using pediatric variable-stiffness colonoscopes.