@article{3124605,
    title = "Diagnostic yield of scope retroflexion in the right colon: A prospective cohort study",
    author = "Triantafyllou, K. and Tziatzios, G. and Sioulas, A.D. and Beintaris, I. and Gouloumi, A.-R. and Panayiotides, I.G. and Dimitriadis, G.D.",
    journal = "Digestive and Liver Disease",
    year = "2016",
    volume = "48",
    number = "2",
    pages = "176-181",
    publisher = "Elsevier B.V.",
    issn = "1590-8658",
    doi = "10.1016/j.dld.2015.11.024",
    keywords = "adult;  aged;  Article;  cecum;  colon adenoma;  colon polyp;  colonoscope retroflexion;  colonoscopy;  controlled study;  diagnostic test accuracy study;  diagnostic value;  digestive system examination;  disease surveillance;  female;  flexible colonoscope;  human;  major clinical study;  male;  predictive value;  priority journal;  adenoma;  adolescent;  ascending colon;  cohort analysis;  Colonic Neoplasms;  Colonic Polyps;  colonoscopy;  cross-sectional study;  early cancer diagnosis;  feasibility study;  middle aged;  pathology;  procedures;  prospective study;  very elderly;  young adult, Adenoma;  Adolescent;  Adult;  Aged;  Aged, 80 and over;  Cohort Studies;  Colon, Ascending;  Colonic Neoplasms;  Colonic Polyps;  Colonoscopy;  Cross-Sectional Studies;  Early Detection of Cancer;  Feasibility Studies;  Female;  Humans;  Male;  Middle Aged;  Prospective Studies;  Young Adult",
    abstract = "Background: Techniques have been implemented to improve colonoscopy adenoma detection rate (ADR) in the right colon. Aims & methods: We prospectively examined the additional diagnostic yield of right colon examination with colonoscope retroflexion in consecutive, symptomatic and screening-surveillance patients. Right colon was examined in forward-view first and thereafter, retroflexion was performed to re-inspect it. Results: Right colon examination in retroflexion was achieved in 620 (92%) patients. Increased inserted scope length to the cecum (OR: 0.48 [95%CI: 0.27-0.84]) and elderly status (OR: 0.53 [95%CI: 0.430-0.94]) predicted retrofexion failure. Forward-view colonoscopy detected 134 polyps and 112 adenomas in 105 and 85 patients, respectively. Scope retroflexion revealed 7 missed (6 adenomas - 2 advanced) polyps in 7 patients; indicating 4.96 (95%CI: 1.37-8.55)% and 5.1 (95%CI: 1.12-9.05)% per-polyp and per-adenoma miss rates, respectively. In ITT analysis, per-patient polyp and adenoma miss rates were 1.041% and 0.89%, respectively. Among screening-surveillance patients, retroflexion detected 3 missed adenomas (2 advanced) in 3 patients, resulting in changed surveillance schedule in 2 of them (5.12 per 1000 screening-surveillance patients). Early study termination was favored by low right colon ADR improvement and lacking substantial surveillance interval change. Conclusion: The additional diagnostic yield of scope retroflexion in the right colon is questionable. © 2015 Editrice Gastroenterologica Italiana S.r.l."
}