Colonoscopic polypectomy in retroflexion

BackgroundLittle has been written about the value of retroflexion in the removal of large sessile colon polyps.ObjectiveThe objective of the study was to evaluate the utility of retroflexion for removal of large sessile colon polyps.DesignThis was a retrospective evaluation of consecutive cases.SettingThis study was conducted at an academic-hospital-based tertiary-referral colonoscopy practice.PatientsThe study comprised consecutive patients with sessile polyps ≥2 cm who were undergoing endoscopic resection.InterventionsThe 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 MeasuresThe main outcome measurement was successful endoscopic resection.ResultsFourteen 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.LimitationsThe study is retrospective, and the practice is a tertiary referral colonoscopy practice. The colonoscopes used are not widely available at this time.ConclusionsRetroflexion 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.