Response.

Abstract

Yung et al emphasize the value of double-balloon enteroscopy (DBE) in completing cecal intubation in patients with prior incomplete colonoscopy. In 57 patients they achieved a cecal intubation rate of 96.5%. In a systematic review of 16 studies they found that DBE achieved a cecal intubation rate of 95% in 621 patients with prior incomplete colonoscopy. In our center, DBE is available and performed by several of my partners, but I use standard instruments (colonoscopes and occasionally push enteroscopes) in all patients referred with prior incomplete examinations. With standard instruments, I achieved a cecal intubation rate of 97.3% in 520 patients with no perforations and an adenoma detection rate of 53%.1Bick B.L. Vemulapalli K.C. Rex D.K. Regional center for complex colonoscopy: yield of neoplasia in patients with prior incomplete colonoscopy.Gastrointest Endosc. 2016; 83: 1239-1244Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar The advantages of using colonoscopes and other standard instruments include first a success rate in cecal intubation at least as high as that of DBE; once cecal intubation is achieved any necessary therapy can be applied with instruments that are shorter, generally have larger working channels, and handle considerably easier than double-balloon enteroscopes. For these reasons I recommend standard instruments as first line in patients with prior incomplete colonoscopies. However, although my preference is for standard instruments in patients referred for incomplete colonoscopy, I acknowledge that DBE may be the preferred alternative in some centers, depending on available instruments and expertise with standard instruments. The author disclosed no financial relationships relevant to this publication. Double-balloon colonoscopy for failed conventional colonoscopy: the Edinburgh experience and systematic review of existing dataGastrointestinal EndoscopyVol. 84Issue 5PreviewWe read with interest the article by Bick et al1 on the importance of techniques such as double-balloon colonoscopy (DBC) for completion colonoscopy after prior incomplete examination. In 520 patients, a single expert colonoscopist achieved completion in 97.3% of cases. DBC is useful in these patients2-16; we have had a similar experience. Over a 7-year period (December 2008 to November 2015), DBC was performed in 57 patients (31 women, 26 men; median age, 62.9 years; range, 20-89 years). Nineteen (33.3%) patients had previously undergone 2 or more failed colonoscopies. Full-Text PDF