Initial Experience with a New Double Balloon Colonoscope in Patients with Prior Incomplete Colonoscopy

Abstract

Background: The success rate of cecal intubation with a standard colonoscope is reported to be 80-95%. Despite using thinner & more flexible endoscopes, incomplete colonoscopy remains a significant problem. Double-balloon colonoscopy (DBC), using a push-and-pull technique with balloons on both the overtube and endoscope, may facilitate completion of the colonic exam after prior incomplete colonoscopy. Recent studies show that retrograde double balloon enteroscopy can be used for completion of colon examination but the technique is limited by the length of the scope (200 cm) and looping. A new double-balloon colonoscope (Fujinon FC450-B15C) is now available with a shorter length of 152 cm. Aim: To evaluate the procedural characteristics and success rate of DBC in patients with a prior incomplete exam. Methods: A retrospective chart review from January 1, 2008 through November 10, 2008 was performed to identify all patients who had undergone DBC after a prior incomplete colonoscopy using a conventional colonoscope. IRB approval was obtained. Baseline demographic information, procedural information from the initial colonoscopy and repeat DBC, and endoscopic findings during DBC were collected. Successful DBC was defined as cecal intubation. Data are presented as mean ± SD. Results: Twenty patients with incomplete colonoscopies (70% females, 68.5 ± 13.1 years, BMI 27.9 ± 4.3 kg/m2) were referred for DBC. The extent of initial exam was beyond the splenic flexure in 40% of cases. In 70% looping prevented cecal intubation. With DBC, 95% of procedures were completed beyond the splenic flexure and the cecal intubation rate was 80%. DBC allowed removal of polyps in an additional 9 patients. DBC failed to reach the cecum in 4 cases, 3 due to looping and 1 due to angulation. There was no difference in the quality of colonic preparations between the exams. Average procedure times and medication doses for DBC procedures are presented in Table 1. Conclusions: The new double balloon colonoscope is an effective technique for intubation of the cecum after incomplete colonoscopy with a standard colonoscope. However, incomplete colonoscopy, especially due to looping of the colon is not entirely eliminated with this new technology.