Technique for Retroflex View During Upper GI Endoscopy

Proper Retroflex Technique

The fundus should be inspected by a J-maneuver in all patients during upper GI endoscopy, as this is essential for a complete examination 1
When a hiatus hernia is present, the diaphragmatic pinch should be specifically inspected while in retroflexion 1
Retroflexion in the stomach is considered a standard part of high-quality upper endoscopy to improve detection and characterization of abnormalities 3, 4

Advance the endoscope through the esophagus into the stomach 1
Continue to the gastric body with moderate insufflation to create adequate space 2
Once in the mid-gastric body, maximally deflect the tip upward 1
Apply clockwise rotation while maintaining upward deflection 3
Withdraw the scope slightly to bring the gastroesophageal junction and fundus into view 2
Rotate the endoscope to examine the entire circumference of the cardia and fundus 1
Ensure adequate insufflation for proper mucosal visualization 1, 5

Photo-documentation of the gastroesophageal junction/fundus in retroflexed view is considered a minimum requirement for a high-quality EGD 2
The British Society of Gastroenterology recommends documenting the quality of mucosal visualization achieved during the examination 5
Images should be captured of any abnormalities noted during retroflexion 2

Adequate air insufflation is necessary to create enough space for the J-maneuver 1, 5
Use mucosal cleansing techniques to improve visualization 5
In patients with altered anatomy or prior surgery, gentle manipulation and patient repositioning may be required 3
Avoid excessive force during the maneuver to prevent equipment damage 3

Retroflexion is essential for examining areas not visible in the forward view, particularly the gastric cardia and proximal fundus 1, 2
This technique improves detection of lesions in the proximal stomach and at the gastroesophageal junction 3
High-quality examination of the esophago-gastric junction is critical as this area may contain pathology that could be missed without proper retroflexion 1