Anchorage Associates in Radiation Medicine

Introduction: The primary goal of screening colonoscopy is to detect and resect premalignant colon lesions. However, the miss rate of these lesions remains significant in quality adjusted colonoscopies. A previous meta-analysis showed that right-sided retroflexion significantly increases the detection of adenomas in the right colon. However, evidence regarding the value of rectal retroflexion remains unclear. In this meta-analysis, we attempt to determine the effect of rectal retroflexion on the polyp detection rate compared to straight view examination and to determine the overall success rate of this maneuver. Methods: A systematic review of all the major databases was performed (MEDLINE, Embase, CINHAL, Google Scholar). Abstracts of all major gastrointestinal scientific meetings were also searched. Two reviewers extracted the data from selected studies. Data on patient demographics, study design, country of publication, polyp histology, detection rate of polyps with retroflexion were extracted. Pooled proportions were calculated using the arcsine square root transformed portion. Pooled estimates were obtained using a random effects model. Heterogeneity and publication bias were assessed. Results: Six studies were included in this analysis (N=5482). Studies were reported from the USA, United Kingdom and Mexico. All the studies were prospective studies. The mean age of the patients ranged from 53-60 years with 48.8% females. Retroflexion lead to higher polyp detection rates in the rectum (pooled event rate 1.2%; 95% CI: 0.6%-2.3%, p< 0.0001). A subgroup analysis for the detection rate of tubular adenoma or tubulovillous adenoma revealed a statistically significant higher detection in the retroflexion group compared to the forward view (pooled event rate 0.4%, 95% CI: 0.1%-0.9%, p=0.009). The overall rate of success of rectal retroflexion was 97.3%. Only 2 studies reported the rate of adverse events of this technique. The adverse events reported were pain and erosions with minor bleeding. Conclusion: Rectal retroflexion significantly increased the detection of adenomatous polyps compared to forward view with a high maneuver success rate. Further studies with a randomized design and with reporting of adverse events are needed to guide recommendations regarding the efficacy of rectal retroflexion for screening colonoscopy.

Predicting outcome following shunt placement in normal pressure hydrocephalus (NPH) remains problematic, especially for those individuals without a known cause for the hydrocephalus. A variety of tests have been devised to assess CSF absorption and intracranial dynamics and aid in patient selection. Some reports have also suggested improved results from monitoring intracranial pressure (ICP). We present our series of 45 patients evaluated prospectively for possible NPH, with specific reference to evaluation of CSF conductance and ICP monitoring in a group of patients with primarily idiopathic NPH.