Prospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Sep 25, 2015; 7(13): 1103-1106
Published online Sep 25, 2015. doi: 10.4253/wjge.v7.i13.1103
Triradiate caecal fold: Is it a useful landmark for caecal intubation in colonoscopy?
Andrew Finlayson, Raaj Chandra, Ian A Hastie, Ian T Jones, Susan Shedda, Michael K-Y Hong, Aileen Yen, Ian P Hayes
Andrew Finlayson, Raaj Chandra, Ian A Hastie, Ian T Jones, Susan Shedda, Michael K-Y Hong, Aileen Yen, Ian P Hayes, Colorectal Surgery Unit, Department of General Surgical Specialties, Royal Melbourne Hospital, Parkville, Victoria 3050, Australia
Michael K-Y Hong, Ian P Hayes, Department of Surgery, University of Melbourne, Parkville, Victoria 3050, Australia
Author contributions: Finlayson A, Chandra R, Hastie IA, Jones IT, Shedda S, Hong MK-Y, Yen A and Hayes IP contributed to study design, data collection, analysis, revising and approval of the manuscript; in addition, Finlayson A wrote the initial manuscript; Finlayson A and Hayes IP were responsible for the study conception.
Supported by The Melbourne Health Human Research Ethics Committee, No. QA2013050.
Conflict-of-interest statement: The authors of this manuscript have no conflicts of interest to disclose.
Data sharing statement: There is no additional data available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ian P Hayes, MBBS, MS, FRCS (Gen Surg), FRACS, Associate Professor, Head of Colorectal Surgery Unit, Department of General Surgical Specialties, Royal Melbourne Hospital, Grattan Street, Parkville, Victoria 3050, Australia. ian.hayes@mh.org.au
Telephone: +61-3-93427000
Received: June 3, 2015
Peer-review started: June 5, 2015
First decision: August 10, 2015
Revised: August 21, 2015
Accepted: September 1, 2015
Article in press: September 2, 2015
Published online: September 25, 2015
Processing time: 114 Days and 19.3 Hours
Abstract

AIM: To determine the frequency of identification of the triradiate fold during colonoscopy and evaluate its reliability as a marker of caecal intubation.

METHODS: One hundred consecutive patients undergoing colonoscopy in a tertiary hospital colorectal unit from May to September 2013 were studied. Video documentation of the caecum was recorded and shown to consultant colorectal surgeons on the unit. Each reviewer was asked through a series of questions to independently identify the triradiate fold. The main outcome was the frequency of visualisation of the triradiate fold in the caecum.

RESULTS: The triradiate fold was seen on average in 18% of cases, but inter-observer agreement was poor. There were only four patients (4%) in which all reviewers agreed on the presence of a triradiate fold. In patients who had undergone previous appendicectomy, the appendiceal orifice was less frequently seen compared with patients who had not undergone appendicectomy.

CONCLUSION: The triradiate fold is infrequently seen during colonoscopy and is therefore an unreliable landmark of caecal intubation.

Keywords: Colonoscopy; Triradiate fold; Appendiceal orifice; Caecal intubation; Prospective study

Core tip: The triradiate fold is often described as a major landmark of caecal intubation in colonoscopy, but its frequency of visualisation has not been previously documented. This study shows that identification of the triradiate fold is infrequent and its presence is subjective. Inclusion in guidelines or colonoscopy software programs as a sole marker of complete colonoscopy is questionable.