September 19th, 2011
Is it time to make a U-turn in the right colon during colonoscopy?
The right side of the colon seems to be the Achilles heel of colonoscopy because polyps there tend to be flat and harder to find, and we confer the least protection from later colon cancer in that zone.
A recent article summary in Journal Watch Gastroenterology concludes that when we see a right-sided colon polyp, we may have missed another, so we should go back and look again.
This provocative recommendation represents a major change in the way we normally perform colonoscopy. But the issue is, and always has been, how to identify and remove all polyps from the colon.
So the questions I have for you are:
1) Should we routinely reexamine the right colon in everyone, only those with a polyp, or no one?
2) Have you already changed the way you inspect the right colon, or will you now?
3) If you do inspect the right colon differently, do you use retroflexion, repeat examination, narrow-band imaging?
I look forward to your response.
One Response to “Is it time to make a U-turn in the right colon during colonoscopy?”
M. Brian Fennerty, MD
Editor-in-Chief
NEJM Journal Watch Gastroenterology
Biography | Disclosures | Summaries
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I have now been performing a retroflexed exam in the cecum on any patient with a R sided polyp found, assuming I do not think the colon wall itself is inflamed or the procedure itself was difficult/long. The find rate is high, though I am no longer sure if I am finding polyps I would not have found in standard view.