Efficacy of Double-Balloon Colonoscopy in Technically Difficult Cases: Growing Evidence Favoring its Frontline Use

Abstract

We read with great interest the results of the meta-analysis by Tan et al1Tan M. et al.Clin Gastroenterol Hepatol. 2017; 15: 1628-1630Abstract Full Text Full Text PDF Scopus (15) Google Scholar that highlight the usefulness of balloon overtube-assisted colonoscopy for technically difficult (TD) cases. Interestingly, among the 18 studies included in this meta-analysis,1Tan M. et al.Clin Gastroenterol Hepatol. 2017; 15: 1628-1630Abstract Full Text Full Text PDF Scopus (15) Google Scholar only 3 were prospective randomized studies; this underlines the scarcity of higher-quality data regarding this important subject. In support of the findings of the meta-analysis,1Tan M. et al.Clin Gastroenterol Hepatol. 2017; 15: 1628-1630Abstract Full Text Full Text PDF Scopus (15) Google Scholar we draw attention to our recently published prospective, randomized, controlled study that also addressed this issue.2Despott E.J. et al.Dig Liver Dis. 2017; 49: 507-513Google Scholar For this, we designed and validated an evidence-based original cumulative scoring system to predefine TD cases. Patients (n = 44) then were randomized to conventional colonoscopy (n = 22) or double-balloon colonoscopy (DBC) (n = 22). The cecal intubation rate was 100% in the DBC group, compared with 59% in the unassisted conventional colonoscopy group (this increased to 86% with ancillary assistance including use of a magnetic endoscopic imager and/or a pediatric colonoscope). Our study showed the clinical efficacy and safety of DBC in TD cases and emphasized its other additional benefits: patient comfort and satisfaction scores were significantly better with DBC; sedation requirements also were lower, allowing for quicker patient recovery. We therefore fully agree with the recommendations of Tan et al1Tan M. et al.Clin Gastroenterol Hepatol. 2017; 15: 1628-1630Abstract Full Text Full Text PDF Scopus (15) Google Scholar and also propose that DBC (or other balloon overtube-assisted colonoscopy) should be considered as the first-line endoscopic option for TD colonoscopy. Furthermore, the use of an evidence-based cumulative scoring system2Despott E.J. et al.Dig Liver Dis. 2017; 49: 507-513Google Scholar to predefine TD cases lends itself well to clinical practice, allowing for preplanning according to the TD score of patients. The authors wish to acknowledge the contribution of Dr Chris Fraser, who was the senior author of our study. Efficacy of Balloon Overtube-Assisted Colonoscopy in Patients With Incomplete or Previous Difficult Colonoscopies: A Meta-analysisClinical Gastroenterology and HepatologyVol. 15Issue 10PreviewColonoscopy is an effective tool to diagnose and treat colorectal conditions. Cecal intubation rates (CIRs) of 95% or greater for screening and of 90% or greater for all colonoscopies have been advocated as measures for a good quality colonoscopy.1 Factors associated with failed colonoscopy include older age, female sex, and previous abdominopelvic surgeries.2 Options for previously failed colonoscopy include using a smaller-caliber endoscope, water-assisted, cap-assisted, magnetic endoscope imaging (MEI), and balloon overtube-assisted colonoscopy (BOAC). Full-Text PDF Fitting Balloon Overtube-Assisted Colonoscopy (BOAC) Into the Difficult or Failed Colonoscopy AlgorithmClinical Gastroenterology and HepatologyVol. 16Issue 4PreviewWe thank Koukias et al for highlighting the recent article from their group that supports our view that balloon overtube-assisted colonoscopy (BOAC) should be available in major endoscopy units as an option for technically challenging colonoscopies.1 Full-Text PDF