Balloon-Assisted Colonoscopy after Incomplete Conventional Colonoscopy-Experience from Two European Centres with A Comprehensive Review of the Literature.

Trimble Kenneth,Robertson Alexander R,Yung Diana E,Wurm Johansson Gabriele,Plevris John N,Fraser Christopher,Toth Ervin,Koulaouzidis Anastasios,Nemeth Artur

doi:10.3390/jcm9092981

Abstract

Background: Conventional colonoscopy (CC) allows access for colonic investigation and intervention; in the small group in whom CC is unsuccessful alternative imaging is often sufficient. There remains a subset, however, requiring full colonic visualisation or intervention. Balloon-assisted colonoscopy (BAC) gives a further option when access is difficult. Aims: This study aims to present the experience with BAC of two European tertiary referral centres. Methods: Procedures were carried out under local protocol over 15-years (2006–2020). Markers of procedural quality such as caecal intubation, complications and comfort were retrospectively compiled and analysed. Published evidence was summarised for comparison. Results: 122 procedures were undertaken, with polyps the most frequent indication and 90.2% having at least one previously incomplete CC. Features associated with difficult colonoscopy were common, including intraabdominal surgery (32.0%). 92.6% reached the caecum; completion was higher (96.3%) in those failing CC due to discomfort and lower in those failing due to anatomical difficulties (90.7%) or previous surgery (84.6%). Mean time to the caecum was 20.9 minutes and mean midazolam and fentanyl doses were 2.6 mg and 49.9 µg with low discomfort scores. Conclusion(s): Balloon-assisted colonoscopy is successful in >90% of patients, is well-tolerated, and is safe.

Highlights

The flexible endoscope has been in evolution since the 1950s and today is established as the principal mode for investigation and intervention of the colonic and terminal ileal mucosa [1,2]
Despite ongoing development in colonoscope design and improvements in endoscopic technique(s), there remains a subset of patients in whom complete colonoscopy proves challenging
We present the experience of using Balloon-assisted colonoscopy (BAC), in two European tertiary referral centres, to address this issue, which represents the largest single study published so far

Summary

Introduction

The flexible endoscope has been in evolution since the 1950s and today is established as the principal mode for investigation and intervention of the colonic and terminal ileal mucosa [1,2]. Despite ongoing development in colonoscope design and improvements in endoscopic technique(s), there remains a subset of patients in whom complete colonoscopy proves challenging. The expectation would be that the number of incomplete procedures is reduced to a very small subset of difficult cases [5]. Conventional colonoscopy (CC) allows access for colonic investigation and intervention; in the small group in whom CC is unsuccessful alternative imaging is often sufficient. Balloon-assisted colonoscopy (BAC) gives a further option when access is difficult. 92.6% reached the caecum; completion was higher (96.3%) in those failing CC due to discomfort and lower in those failing due to anatomical difficulties (90.7%) or previous surgery (84.6%). Conclusion(s): Balloon-assisted colonoscopy is successful in >90% of patients, is well-tolerated, and is safe

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Conclusion