Retroflexion in the Stomach During Endoscopy: Importance of the Examination and Its Utility

Endoscopic retroflexion in the stomach is an important diagnostic and therapeutic maneuver that is often underappreciated and underperformed by general endoscopists. Beyond providing a comprehensive visualization of the gastric cardia and fundus, the retroflexed endoscope is key to assessing the esophagogastric junction, identifying diaphragmatic hernias, and assessing wrap integrity after fundoplication. Such evaluation is critical given the ever-rising incidence of gastroesophageal reflux disorder, prevalence of diaphragmatic hernias, and demand for antireflux and antiobesity surgeries. Careful retroflexed inspection of the gastric cardia is also important in Helicobacter pylori infection, junctional cancers, and neoplasia associated with Barrett's esophagus. Retroflexion provides therapeutic options in ablation of Barrett's esophagus and dilation of subtle strictures. We review here the diagnostic and potential therapeutic importance of the retroflexed endoscope.