Background
Little has been written about the value of retroflexion in the removal of large sessile
colon polyps.
Objective
The objective of the study was to evaluate the utility of retroflexion for removal
of large sessile colon polyps.
Design
This was a retrospective evaluation of consecutive cases.
Setting
This study was conducted at an academic-hospital-based tertiary-referral colonoscopy
practice.
Patients
The study comprised consecutive patients with sessile polyps ≥2 cm who were undergoing
endoscopic resection.
Interventions
The intervention was endoscopic resection of 59 consecutive sessile colon polyps 2
cm or larger in size and located proximal to the rectum by using prototype colonoscopes
with short bending sections.
Main Outcome Measures
The main outcome measurement was successful endoscopic resection.
Results
Fourteen of the polyps were removed either entirely (n = 4) or partially (n = 10)
in retroflexion. Patients with polyps that were removed in retroflexion were more
likely to have been referred by another colonoscopist than those patients with polyps
removed entirely in the forward view (p = 0.05). There were no perforations and no complications related to retroflexion.
Limitations
The study is retrospective, and the practice is a tertiary referral colonoscopy practice.
The colonoscopes used are not widely available at this time.
Conclusions
Retroflexion is a useful adjunctive procedure for the removal of some colon polyps
proximal to the rectum that are difficult to access endoscopically. The use of retroflexion
can increase the fraction of proximal sessile colon polyps amenable to endoscopic
resection.
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Article info
Publication history
Accepted:
September 1,
2005
Received:
December 10,
2004
Indianapolis, Indiana, USAIdentification
Copyright
© 2006 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Retroflexion-assisted EMR in the colon with immediate closure of a procedure-related perforationGastrointestinal EndoscopyVol. 72Issue 6
- PreviewWe have read with interest the articles by Quallick and Brown1 as well as Tribonias et al2 on perforation caused by diagnostic colonoscopy in retroflexion. It is a rare complication, and the clinical experience on its nonsurgical treatment is quite poor.2-4 A retroflexed colonoscope may also facilitate the endoscopic removal of early neoplastic lesions in difficult colonic positions with retrograde fold involvement.5,6 However, there is no experience on perforation during retroflexion-assisted endotherapy.
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