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Colonoscopic polypectomy in retroflexion

  • Douglas K. Rex
    Correspondence
    Reprint requests: Douglas K. Rex, MD, Indiana University Medical Center, Indiana University Hospital, #4100, 550 N. University Blvd, Indianapolis, IN 46202.
    Affiliations
    Current affiliations: Department of Medicine, Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
    Search for articles by this author
  • Mouen Khashab
    Affiliations
    Current affiliations: Department of Medicine, Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
    Search for articles by this author

      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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      Linked Article

      • Retroflexion-assisted EMR in the colon with immediate closure of a procedure-related perforation
        Gastrointestinal EndoscopyVol. 72Issue 6
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          We 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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