{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T10:28:40Z","timestamp":1760956120970},"reference-count":11,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,7,31]],"date-time":"2021-07-31T00:00:00Z","timestamp":1627689600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,7,31]],"date-time":"2021-07-31T00:00:00Z","timestamp":1627689600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Gastroenterol"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>As right colon polyps are challenging to detect, a retroflexed view of right colon (RV) may be useful. However, cecal retroflexion (CR) without a RV to the hepatic flexure (HF) is inadequate. We aimed to determine the frequency of CR and quality of the RV in routine practice.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>This prospective observational study performed at an academic medical center assessed colonoscopy inspection technique of endoscopists who had performed\u2009\u2265\u2009100 annual screening colonoscopies. We video recorded\u2009\u2265\u200928 screening\/surveillance colonoscopies per endoscopist and randomly evaluated 7 videos per endoscopist. Six gastroenterologists blindly reviewed the videos to determine if CR was performed and HF withdrawal time (cecum to HF time, excluding ileal\/polypectomy time).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Reviewers assessed 119 colonoscopies performed by 17 endoscopists. The median HF withdrawal time was 3\u00a0min and 46\u00a0s. CR was performed in 31% of colonoscopies. CR frequency varied between endoscopists with 9 never performing CR and 2 performing CR in all colonoscopies. When performed, nearly half (43%) of RVs did not extend to the HF with median RV duration of 16\u00a0s (IQR 9\u201330\u00a0s). Three polyps were identified in the RV (polyp detection rate of 8.1%), all identified prior to a forward view.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>CR is performed infrequently in routine practice. When CR is performed, the RV is of low quality with a very short inspection duration and insufficient ascending colon examination. Further education is required to educate endoscopists in optimal technique to improve overall colonoscopy quality.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12876-021-01877-4","type":"journal-article","created":{"date-parts":[[2021,7,31]],"date-time":"2021-07-31T21:02:27Z","timestamp":1627765347000},"update-policy":"http:\/\/dx.doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Cecal retroflexion is infrequently performed in routine practice and the retroflexed view is of poor quality"],"prefix":"10.1186","volume":"21","author":[{"given":"Rajesh N.","family":"Keswani","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charles J.","family":"Kahi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Benson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew J.","family":"Gawron","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tonya R.","family":"Kaltenbach","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rena H.","family":"Yadlapati","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dyanna L.","family":"Gregory","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"Duloy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,7,31]]},"reference":[{"key":"1877_CR1","doi-asserted-by":"publisher","first-page":"952","DOI":"10.1053\/j.gastro.2015.06.044","volume":"149","author":"A Shaukat","year":"2015","unstructured":"Shaukat A, Rector TS, Church TR, et al. Longer withdrawal time is associated with a reduced incidence of interval cancer after screening colonoscopy. Gastroenterology. 2015;149:952\u20137.","journal-title":"Gastroenterology"},{"key":"1877_CR2","doi-asserted-by":"publisher","first-page":"1298","DOI":"10.1056\/NEJMoa1309086","volume":"370","author":"DA Corley","year":"2014","unstructured":"Corley DA, Jensen CD, Marks AR, et al. Adenoma detection rate and risk of colorectal cancer and death. N Engl J Med. 2014;370:1298\u2013306.","journal-title":"N Engl J Med"},{"key":"1877_CR3","doi-asserted-by":"publisher","first-page":"1375","DOI":"10.1038\/ajg.2014.171","volume":"109","author":"S Singh","year":"2014","unstructured":"Singh S, Singh PP, Murad MH, Singh H, Samadder NJ. Prevalence, risk factors, and outcomes of interval colorectal cancers: a systematic review and meta-analysis. 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Clin Gastroenterol Hepatol. 2018;17:691\u2013700.","journal-title":"Clin Gastroenterol Hepatol"},{"key":"1877_CR8","doi-asserted-by":"publisher","first-page":"1128","DOI":"10.1053\/j.gastro.2010.06.052","volume":"139","author":"H Singh","year":"2010","unstructured":"Singh H, Nugent Z, Demers AA, Kliewer EV, Mahmud SM, Bernstein CN. The reduction in colorectal cancer mortality after colonoscopy varies by site of the cancer. Gastroenterology. 2010;139:1128\u201337.","journal-title":"Gastroenterology"},{"key":"1877_CR9","doi-asserted-by":"publisher","first-page":"1504","DOI":"10.1111\/j.1572-0241.2003.07470.x","volume":"98","author":"DK Rex","year":"2003","unstructured":"Rex DK. Accessing proximal aspects of folds and flexures during colonoscopy: impact of a pediatric colonoscope with a short bending section. 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JAMA Intern Med. 2013;173:1262\u20133.","journal-title":"JAMA Intern Med"}],"container-title":["BMC Gastroenterology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12876-021-01877-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12876-021-01877-4\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12876-021-01877-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,7,31]],"date-time":"2021-07-31T21:04:36Z","timestamp":1627765476000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcgastroenterol.biomedcentral.com\/articles\/10.1186\/s12876-021-01877-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7,31]]},"references-count":11,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["1877"],"URL":"https:\/\/doi.org\/10.1186\/s12876-021-01877-4","relation":{},"ISSN":["1471-230X"],"issn-type":[{"value":"1471-230X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,7,31]]},"assertion":[{"value":"19 May 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 July 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"31 July 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The Northwestern University Institutional Review Board approved the study (Institutional Review Board No. STU00203769, approval date September 8, 2016). Colonoscopists included in the study provided written informed consent.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"307"}}