Right-sided Retroflexion With Standard Adult Versus Pediatric Colonoscopes

Screening colonoscopy has been shown to be less effective in preventing colorectal cancer in
the proximal colon compared to the distal colon. Possible reasons for this include bowel
preparation often being worse in the proximal colon as well as flat depressed lesions being
more common in the proximal colon.

Retroflexion is commonly regarded as standard practice in the rectum, but retroflexion in
the proximal colon is not currently routinely performed due to concerns of perforation and
possibly because of the increased time required.

Proximal colon retroflexion has been shown to be safe and effective without any
complications, but data regarding ability to retroflex with certain types of colonoscopes is
limited. Endoscopists interchangeably use standard adult colonoscopes or pediatric
colonoscopes. Studies have not been performed to comparatively evaluate the success rates of
standard adult and pediatric colonoscopes and whether either type of instrument confers a
greater polyp detection rate.