Impact of water filling on terminal ileum intubation with a distal-tip mucosal exposure device

Abstract

Endocuff improves detection at colonoscopy but seems to impede terminal ileal (TI)intubation. We assessed the impact of Endocuff Vision (EV) on TI intubation using adult or pediatric colonoscopes and evaluated whether filling the cecum with gas versus water affected the impact of EV on TI intubation. Using a prospectively recorded quality control database, we explored the impact of EV on TI intubation in≤1 minute. We used adult and pediatric colonoscopes and tested the effect of filling the cecum with gas versus water. If the initial attempt failed, then the alternative (water vs gas) was tried as a rescue method. TI intubation in≤1 minute occurred in 91% of colonoscopies without EV versus 65% with EV, but the use of the pediatric colonoscope with EV had a higher success rate for TI intubation in≤1 minute compared with the adult colonoscope with EV (73% vs 57%, P= .043). TI intubation in≤1 minute was more successful with EV when the cecum was filled with water rather than gas (74% vs 56%, P= .019), but the benefit of water filling was limited to the adult colonoscope with EV. When EV was in place, water filling was more successful as a rescue method of TI intubation (58% vs 21%, P= .011). EV adversely affects TI intubation, particularly for adult colonoscopes. Water filling of the cecum mitigates the impact of EV on TI intubation with adult colonoscopes.