Diagnostic Yield and Therapeutic Impact of Rectal Retroflexion: A Prospective, Single-Blind Study Conducted in Three Centers

Abstract

Background/AimsNo clear data have been established and validated regarding whether rectal retroflexion has an important and therapeutic impact. The aim of the present study was to evaluate the diagnostic yield and therapeutic impact of rectal retroflexion compared with straight view examination.MethodsA prospective single-blind study was conducted. Consecutive patients evaluated between October 2011 and April 2012 were included.ResultsA total of 934 patients (542 women, 58%) were included. The mean age was 57.4±14.8 years. Retroflexion was successful in 917 patients (98.2%). Distinct lesions in the anorectal area were detected in 32 patients (3.4%), of which 10 (1%) were identified only on retroflex view and 22 (2.4%) on both straight and retroflex views. Of the 32 identified lesions, 16 (50%) were polyps, nine (28.1%) were angiodysplasias, six (18.8%) were ulcers, and one (3.1%) was a flat lesion. All 10 patients (1%) in whom lesions were detected only by rectal retroflexion showed a therapeutic impact.ConclusionsRectal retroflexion has minimal diagnostic yield and therapeutic impact. However, its low rate of major complications and the possibility of detecting lesions undetectable by straight viewing justify its use.

Colonoscopy screening and surveillance guidelines

“…According to a report, important lesions are visible in the rectum by forward-view observations, 190 but there are some lesions that can be detected by retroflexion only. 191 There is a high possibility that retroflexion increases visibility of lesions in the anus and lower rectum. However, although rare, retroflexion carries a risk of intestinal perforation, 192,193 so it is desirable to avoid unreasonable procedure.…”

Rectal Retroflexion during Colonoscopy: A Bridge over Troubled Water

“…In this issue of Clinical Endoscopy , Téllez-Ávila et al 11 conducted a prospective single-blind study in three centers to evaluate the diagnostic yield and therapeutic impact of RR compared with those of either digital rectal exploration or the straight view. They evaluated the therapeutic impact and diagnostic yield of RR during colonoscopy to elucidate whether RR can serve as a bridge over troubled water.…”

Video anoscopy: results of routine anal examination during colonoscopies

“…For visualization of anal fissures, it is also essential to use the anoscope, which sometimes becomes impossible without sedation. A prospective, multicenter, blinded study by Tellez-Ávilla et al showed that RR during colonoscopy has limited effect and little impact on diagnosis and therapy 13 . Two prospective studies have shown that anoscopy was superior to RR in detection of hemorrhoids 1 2 14 .…”

“…Rectal retroflexion (RR) is often used to evaluate hemorrhoids, but this technique has little sensitivity 1 5 . One study demonstrated that the gain related to the finding of lesions identified with RR was from 2 % to 8 % 13 . VA can determine the cause of bleeding if it is of anal origin.…”