COMBINED FORWARD AND RETROFLEXION WITHDRAWAL DURING COLONOSCOPY USING A SECOND-GENERATION SHORT-TURN RADIUS COLONOSCOPE

Aims Polyps and adenomas are missed indivertibly in colonoscopy due to factors such as the location of lesions on difficult areas (i.e., proximal side of ileocecal valve). We aimed to evaluate the impact of combined forward and retroflexion withdrawal using a second-generation short-turn radius colonoscope during colonoscopy.

Methods A non-randomized, prospective trial. Patients were submitted first to a standard high-definition colonoscopy, followed by a second procedure combining forward and retroflexion performed by a different operator. Lesions detected on the second procedures were considered as originally missed during standard colonoscopy. We calculated the polyp detection rate (PDR) and the adenoma detection rate (ADR) of both standard and combined colonoscopy techniques. Statistical analysis was performed on R.4.0.3. NCT03901651.

Results A total of 319 complete colonoscopies in 319 cases were performed combining forward and retroflexion withdrawal. Colonoscopy reason: diagnostic on 266 (83.4%), screening on 41 (12.9%) and 12 (3.8%) for polypectomy/CCR surveillance. Regarding size of the lesions, 140/163 (85.9%) detected on forward viewing were<5 mm. Whereas, during second procedure (forward and retroflexion), 65/71 (91.5%) sized<5mm and 6/71 (8.5%) between 5-10 mm. For forward viewing, the PDR and ADR was 45.1 and 16.3, respectively. For second procedure (combined forward and retroflex), the PDR and ADR increased to 21.9 and 7.8, correspondingly (Table 1).

Fig. 1

Conclusions We found that combined forward and retroflexion withdrawal technique during colonoscopy increases the PDR and ADR in comparison to standard colonoscopy. Larger, multi-center trials are necessary to validate these data.

Publication History

Article published online:
14 April 2022