Conventional forward-viewing colonoscopy may overlook lesions in the distal rectum, increasing the risk of missed colorectal neoplasia. Rectal retroflexion can improve visualization, but its diagnostic value remains debated. This study evaluated the diagnostic yield and safety of rectal retroflexion for detecting rectal polyps. A total of 1,330 colonoscopy cases were retrospectively analyzed. Demographic characteristics, procedural success rate, and findings from both forward and retroflexed views were reviewed. The primary endpoints were the success rate of retroflexion, the per-patient polyp detection rate (PDR), and the per-patient polyp miss rate (PMR). Logistic regression was used to identify factors associated with retroflexion failure and additional polyp detection. Rectal retroflexion was successfully completed in 98.7% of cases, with no procedure-related adverse events. Rectal edema was the only independent predictor of retroflexion failure (OR = 54.8, P = 0.008). Retroflexion identified additional polyps in 76 patients (PMR = 5.7%), resulting in an overall PDR of 37.3% compared with 31.6% by forward view alone. Male sex (OR = 1.64), initial colonoscopy (vs. follow-up; OR = 2.62), and the presence of forward-view polyps (OR = 1.87) independently predicted additional polyp detection. Forward-view polyps > 5 mm were strongly associated with the detection of missed adenomas or sessile serrated adenomas (OR = 4.40). Our findings suggest that rectal retroflexion is a safe and effective maneuver that can improve rectal polyp detection, particularly among male patients, those undergoing their first colonoscopy, and individuals with forward-view polyps, especially those > 5 mm. Routine inclusion of rectal retroflexion may enhance the quality and completeness of colonoscopic examinations.
He et al. (2026) studied this question.