title: Right-sided adenoma detection with retroflexion versus forward-view colonoscopy.
abstract: BACKGROUND
  Colonoscopy and polypectomy can prevent up to 80% of colon cancer; however, a significant adenoma miss rate still exists, particularly in the right side of the colon.
  
  
  OBJECTIVE
  To assess whether retroflexion in the right side of the colon significantly improves the adenoma detection rate (ADR) over forward-view assessment.
  
  
  METHODS
  Multicenter prospective cohort study.
  
  
  METHODS
  Three tertiary care public and 2 private hospitals.
  
  
  METHODS
  A total of 1351 consecutive adult patients undergoing elective colonoscopy.
  
  
  METHODS
  Withdrawal from the cecum was performed in the forward view initially and identified polyps removed. Once the hepatic flexure was reached, the cecum was reintubated and the right side of the colon was assessed in the retroflexed view to the hepatic flexure.
  
  
  METHODS
  ADR in the retroflexed view when compared with forward-view examination of the right side of the colon.
  
  
  RESULTS
  Retroflexion was successful in 95.9% of patients, with looping the predominant (69.6%) reason for failure. Forward-view assessment of the right side of the colon identified 642 polyps, of which 531 were adenomas yielding a polyp and ADR of 28.57% and 24.64%, respectively. Retroflexion identified a further 84 polyps of which 75 were adenomas, improving the polyp and ADR to 30.57% and 26.4%, respectively.
  
  
  CONCLUSIONS
  Observational study.
  
  
  CONCLUSIONS
  Right-sided retroflexion was successful in most of our cohort with a statistically significant but small increase in ADR. Right-sided retroflexion is safe when performed by experienced endoscopists with no adverse events observed in this cohort. (
  
  
  BACKGROUND
  Australian New Zealand Clinical Trials Registry, ACTRN12613000424707.).
authors.affiliation: Department of Gastroenterology, Austin Health, Melbourne, Victoria, Australia; Department of Medicine, Austin Health, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Sujievvan
authors.initials: S
authors.lastname: Chandran
authors.affiliation: Department of Anaesthetics, Austin Health, Melbourne, Victoria, Australia.
authors.forename: Frank
authors.initials: F
authors.lastname: Parker
authors.affiliation: Department of Gastroenterology, Austin Health, Melbourne, Victoria, Australia; Department of Medicine, Austin Health, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Rhys
authors.initials: R
authors.lastname: Vaughan
authors.affiliation: Department of Gastroenterology, Launceston General Hospital, Tasmania, Australia; Calvary Health Care, St. Vincent's Campus, Tasmania, Australia.
authors.forename: Brent
authors.initials: B
authors.lastname: Mitchell
authors.affiliation: Department of Gastroenterology, Launceston General Hospital, Tasmania, Australia; Calvary Health Care, St. Vincent's Campus, Tasmania, Australia.
authors.forename: Scott
authors.initials: S
authors.lastname: Fanning
authors.affiliation: Department of Gastroenterology, Alfred Health, Victoria, Australia; Epworth HealthCare, Richmond, Victoria, Australia.
authors.forename: Gregor
authors.initials: G
authors.lastname: Brown
authors.affiliation: Department of Gastroenterology, Austin Health, Melbourne, Victoria, Australia.
authors.forename: Jenny
authors.initials: J
authors.lastname: Yu
authors.affiliation: Department of Gastroenterology, Austin Health, Melbourne, Victoria, Australia.
authors.forename: Marios
authors.initials: M
authors.lastname: Efthymiou
mesh_terms: D000236:Adenoma / Q000175:diagnosis*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003110:Colonic Neoplasms / Q000175:diagnosis*; D003111:Colonic Polyps / Q000175:diagnosis*; D003113:Colonoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D055815:Young Adult