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. Met...
Main Authors: | , , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
BMC
2021-07-01
|
Series: | BMC Gastroenterology |
Subjects: | |
Online Access: | https://doi.org/10.1186/s12876-021-01877-4 |
id |
doaj-a579825c5b6e44d59678677ead235660 |
---|---|
record_format |
Article |
spelling |
doaj-a579825c5b6e44d59678677ead2356602021-08-01T11:16:24ZengBMCBMC Gastroenterology1471-230X2021-07-012111510.1186/s12876-021-01877-4Cecal retroflexion is infrequently performed in routine practice and the retroflexed view is of poor qualityRajesh N. Keswani0Charles J. Kahi1Mark Benson2Andrew J. Gawron3Tonya R. Kaltenbach4Rena H. Yadlapati5Dyanna L. Gregory6Anna Duloy7Department of Gastroenterology and Hepatology, Northwestern UniversityDepartment of Gastroenterology, Indiana University Medical CenterDepartment of Gastroenterology and Hepatology, School of Medicine and Public Health, University of WisconsinDepartment of Gastroenterology, University of UtahDepartment of Gastroenterology, University of CaliforniaDivision of Gastroenterology, University of California, San Diego School of MedicineDepartment of Gastroenterology and Hepatology, Northwestern UniversityDepartment of Gastroenterology, University of ColoradoAbstract 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.https://doi.org/10.1186/s12876-021-01877-4RetroflexionQualityRight colon |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Rajesh N. Keswani Charles J. Kahi Mark Benson Andrew J. Gawron Tonya R. Kaltenbach Rena H. Yadlapati Dyanna L. Gregory Anna Duloy |
spellingShingle |
Rajesh N. Keswani Charles J. Kahi Mark Benson Andrew J. Gawron Tonya R. Kaltenbach Rena H. Yadlapati Dyanna L. Gregory Anna Duloy Cecal retroflexion is infrequently performed in routine practice and the retroflexed view is of poor quality BMC Gastroenterology Retroflexion Quality Right colon |
author_facet |
Rajesh N. Keswani Charles J. Kahi Mark Benson Andrew J. Gawron Tonya R. Kaltenbach Rena H. Yadlapati Dyanna L. Gregory Anna Duloy |
author_sort |
Rajesh N. Keswani |
title |
Cecal retroflexion is infrequently performed in routine practice and the retroflexed view is of poor quality |
title_short |
Cecal retroflexion is infrequently performed in routine practice and the retroflexed view is of poor quality |
title_full |
Cecal retroflexion is infrequently performed in routine practice and the retroflexed view is of poor quality |
title_fullStr |
Cecal retroflexion is infrequently performed in routine practice and the retroflexed view is of poor quality |
title_full_unstemmed |
Cecal retroflexion is infrequently performed in routine practice and the retroflexed view is of poor quality |
title_sort |
cecal retroflexion is infrequently performed in routine practice and the retroflexed view is of poor quality |
publisher |
BMC |
series |
BMC Gastroenterology |
issn |
1471-230X |
publishDate |
2021-07-01 |
description |
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. |
topic |
Retroflexion Quality Right colon |
url |
https://doi.org/10.1186/s12876-021-01877-4 |
work_keys_str_mv |
AT rajeshnkeswani cecalretroflexionisinfrequentlyperformedinroutinepracticeandtheretroflexedviewisofpoorquality AT charlesjkahi cecalretroflexionisinfrequentlyperformedinroutinepracticeandtheretroflexedviewisofpoorquality AT markbenson cecalretroflexionisinfrequentlyperformedinroutinepracticeandtheretroflexedviewisofpoorquality AT andrewjgawron cecalretroflexionisinfrequentlyperformedinroutinepracticeandtheretroflexedviewisofpoorquality AT tonyarkaltenbach cecalretroflexionisinfrequentlyperformedinroutinepracticeandtheretroflexedviewisofpoorquality AT renahyadlapati cecalretroflexionisinfrequentlyperformedinroutinepracticeandtheretroflexedviewisofpoorquality AT dyannalgregory cecalretroflexionisinfrequentlyperformedinroutinepracticeandtheretroflexedviewisofpoorquality AT annaduloy cecalretroflexionisinfrequentlyperformedinroutinepracticeandtheretroflexedviewisofpoorquality |
_version_ |
1721246129994072064 |