Cecal retroflexion is infrequently performed in routine practice and the retroflexed view is of poor quality

Abstract

Background As right colon polyps are challenging to detect, a retroflexed view of right colon (RV) may be useful. However, cecal retroflexion (CR) without a RV to the hepatic flexure (HF) is inadequate. We aimed to determine the frequency of CR and quality of the RV in routine practice. Methods This prospective observational study performed at an academic medical center assessed colonoscopy inspection technique of endoscopists who had performed ≥ 100 annual screening colonoscopies. We video recorded ≥ 28 screening/surveillance colonoscopies per endoscopist and randomly evaluated 7 videos per endoscopist. Six gastroenterologists blindly reviewed the videos to determine if CR was performed and HF withdrawal time (cecum to HF time, excluding ileal/polypectomy time). Results Reviewers assessed 119 colonoscopies performed by 17 endoscopists. The median HF withdrawal time was 3 min and 46 s. CR was performed in 31% of colonoscopies. CR frequency varied between endoscopists with 9 never performing CR and 2 performing CR in all colonoscopies. When performed, nearly half (43%) of RVs did not extend to the HF with median RV duration of 16 s (IQR 9–30 s). Three polyps were identified in the RV (polyp detection rate of 8.1%), all identified prior to a forward view. Conclusions CR is performed infrequently in routine practice. When CR is performed, the RV is of low quality with a very short inspection duration and insufficient ascending colon examination. Further education is required to educate endoscopists in optimal technique to improve overall colonoscopy quality.

Performing High-Quality, Safe, Cost-Effective, and Efficient Basic Colonoscopy in 2023: Advice From Two Experts

“…For the right colon, the second examination can be performed in retroflexion or the forward view (51)(52)(53). After a meticulous initial inspection from the appendiceal orifice to the hepatic flexure, the instrument is reinserted and the cecum inspected a second time in the forward view.…”

Medical malpractice and gastrointestinal endoscopy

“…Missed lesions are a significant risk, especially in the anus and the cecum [20 ▪▪ ]. Performing cecal retroflexion or second forward view offers an opportunity to improve the quality of colonoscopy and better detect right colon polyps [22,23]. Those claims involving perforation (44%) often favored the defendant because of the established inherent risk of the procedure [24].…”