Retroflexion in the Right Colon in Screening Colonoscopy: A Retrospective Analysis

Abstract

Introduction: Objectives: Retroflexion in the rectum at the end of a colonoscopy is a requirement for a complete colonoscopy. Retroflexion detects polyps which could be missed otherwise. Studies have shown a significant miss rate for right-sided colon cancer. Retroflexion in the right colon is not a standard of care currently. Could retroflexion in the right colon improve polyp detection, a final verdict is still not out. Aim: Our study aims to compare the rate of polyp detection in the right colon, with and without retroflexion in the right colon during screening colonoscopy. Methods: This is a single center, retrospective study. A total of two hundred randomized patients undergoing screening colonoscopy, 100 without retroflexion in the right colon followed by 100 patients with retroflexion in the right colon were involved. A single center IRB waiver was obtained. Patients were divided into two groups based on the presence /absence of retroflexion in the right colon during their colonoscopy. The data was obtained from 2017 records. Group A (n = 100) had colonoscopy without retroflexion in the right colon. Group B (n = 100) had colonoscopy with retroflexion in the right colon. Inclusion criteria: Patients undergoing screening colonoscopy between the age of 40 and 85. Results: Table 1 Image 1 Group B with right colon retroflexion had more sessile serrated polyp detection, in spite of having fewer patients with polyps. No significant difference was seen in polyp detection in male versus female. Side Events: Two mass lesions were noted in both group A and B. Cecal intubation was not achieved in 1 patient in each group. No complications were reported from retroflexion in the right colon from either group. Conclusion: This retrospective analysis revealed an increase in detection of sessile serrated polyps with retroflexion in the right colon. These polyps are more likely to be missed and have more malignant potential than tubular adenomas. However, a large multicenter analysis will be required to validate the above observation.242_A Figure 1 No Caption available.242_B Figure 2 No Caption available.