Application of Double-Balloon Endoscopy for Technically Difficult Cases with Conventional Colonoscopy

Abstract

Backgrounds: Even experienced endoscopists fail to achieve insertion of the endoscope to the cecum of the colon in a small portion of patients mainly because of the firm adhesion of the gastrointestinal tract due to surgical procedures. Double-balloon endoscopy (Fujinon EN-450P5/20, Fuji Photo Optical Co., Ltd., Omiya, Japan) is a new system of endoscopy which can prevent intestine from forming redundant loops. We have applied this new system of endoscopy for colonoscopy of technically difficult patients. Methods: The double-balloon method of endoscopy uses 2 balloons, one attached to the tip of the endoscope and another at the distal end of an overtube. By using these balloons to grip the intestinal wall, the endoscope can be inserted further without forming redundant loops of intestine. Although this endoscope was originally designed for enteroscopy, we used the same endoscope as a colonoscope in the technically difficult patients. 18 consecutive patients were chosen as the technically difficult patients because of the inability of insertion to the cecum with a conventional colonoscope by experienced colonoscopists in our endoscopy unit. The average success rate of total colonic insertion with conventional colonoscopy by the colonoscopists is over 98% in our unit. We evaluated the outcomes of the double-balloon method as colonoscopy in these technically difficult cases. Results: Endoscopic insertion up to the cecum was achieved in all 18 cases studied. No complications were encountered during and after the procedures in any patient. The double-balloon colonoscopy was much more tolerable to the patients than conventional colonoscopy. Conclusions: Double-balloon colonoscopy is useful for technically difficult patients by conventional colonoscopy.