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01-02-2021 | Abdominal Surgery

Success, safety, and usefulness of right colon retroflexion for the detection of additional colonic lesions not visualized with standard frontal view

Authors: Oscar Nogales, Jon de la Maza, Esperanza Martos, Laura Carrión, Rodrigo Borobia, Luis Lucendo, María López-Ibáñez, Javier García-Lledó, Leticia Pérez-Carazo, Beatriz Merino

Published in: Surgical Endoscopy | Issue 2/2021

Abstract

Background

Missed adenomas are the main concern for endoscopists. Right colon retroflexion (RCR) seems to increase the adenoma detection rate (ADR), but important variation in success and usefulness of this maneuver has been reported in the literature

Aims

Primary objective: to assess additional adenoma detection rate (AADR) detected during the RCR attempt. Secondary objectives: to assess success rates of RCR, variables associated with it, and safety of RCR.

Methods

This is a prospective, unicentric, non-randomized study. Consecutive colonoscopies done by six endoscopists (3 of them with < 3 years of experience and 3 with > 3 years) from March to May 2017 were included. Olympus colonoscopes were used (CF-H190, CF-H180) Demographic, clinical, and endoscopic variables were collected.

Results

463 colonoscopies were included. RCR success rate was 93.1% (431/463 colonoscopies). Forty additional lesions were visualized during RCR in 34/463 colonoscopies (7.3%). Additional adenomas were detected in 31/463 colonoscopies (6.7%; OR 0.07). Histology: low-grade dysplasia adenomas in 29/40 (72.5%) lesions; 3/40 (7.5%), adenomas with high-grade dysplasia; and 7/40 (17.5%) sessile serrated lesions. Additional adenoma detection contributed to modify the colonoscopy surveillance interval in 25 patients (5.4% of the cohort). Variables associated with RCR success in multivariate analysis were no 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 was a safe maneuver, with no adverse events in our study.

Conclusions

RCR is a feasible and safe maneuver that can increase ADR, so its routine inclusion in colonoscopy practice should be considered.

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Title: Success, safety, and usefulness of right colon retroflexion for the detection of additional colonic lesions not visualized with standard frontal view
Authors: Oscar Nogales
Jon de la Maza
Esperanza Martos
Laura Carrión
Rodrigo Borobia
Luis Lucendo
María López-Ibáñez
Javier García-Lledó
Leticia Pérez-Carazo
Beatriz Merino
Publication date: 01-02-2021
Publisher: Springer US
Keywords: Abdominal Surgery
Colonoscopy
Colorectal Cancer
Colorectal Cancer
Published in: Surgical Endoscopy / Issue 2/2021
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-020-07424-8

At a glance: The STEP trials

Springer Medicine

Success, safety, and usefulness of right colon retroflexion for the detection of additional colonic lesions not visualized with standard frontal view

Abstract

Background

Aims

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Aims

Methods

Results

Conclusions

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