Utility of retroflexion in lower gastrointestinal endoscopy

Although recommended, retroflexion to evaluate the rectal vault is not alwa ys practiced in endoscopy. A prospective study of 600 consecutive patients undergoing flexible sigmoidoscopy or colonoscopy was done to evaluate wheth er retroflexion increased the diagnostic yield compared with straight view examination of the distal rectum and whether the findings altered subsequen t patient management. In this Study, 30 patients were found to have distinc t lesions in the anorectum. More than 50% of lesions in the rectal vault we re identified only by retroflexion. Adenomatous polyps were seen in nine pa tients, of which six were identified only by retroflex view. Fifty percent of patients with adenomatous polyps in the rectal vault identified only by retroflexion during screening sigmoidoscopy were found to have right sided adenomas on colonoscopy. The retroflex view produced significant additional information, compared with standard forward view of the rectum, and altere d the patient management plan. The procedure was easily performed without c omplications and was tolerated well by patients. Unless contraindicated, oc tal retroflexion should be universally practiced and emphasized in training as more nonphysicians become involved in performing sigmoidoscopy.