Single Balloon Enteroscope Without Overtube for Cecal Intubation after an Incomplete Colonoscopy

Abstract

Purpose: Cecal intubation rate is one of the major quality indicators of a complete colonoscopy. Unfortunately, studies demonstrate that 5-10% of colonoscopies fail to reach the cecum. Reasons for failed cecal intubation include redundant or tortuous colon loops, previous abdominal or pelvic surgery, angulation of the colon, severe diverticular disease, female gender, and patient discomfort. Previously, repeat colonoscopy attempts or use of radiologic imaging was the only modality for further evaluation of the unseen colon. With the advent in small bowel imaging, longer endoscopes such as a single balloon endoscope have been put to use to fill this void. The goal of this study is to determine whether the single balloon enteroscope without overtube is efficacious in achieving cecal intubations in incomplete colonoscopies despite using a pediatric colonoscope. Methods: Between August 2010 to June 2013, patients with incomplete colonoscopy (using pediatric colonoscope) had a follow-up exam using a single balloon enteroscope without overtube-balloon equipment. Procedures were performed by 11 different endoscopists with varying experience, some with fellow-in-training participation during either the same or a follow-up session. Results: Single balloon enteroscope was used in 53 patients with a failed colonoscopy, 44 Females: 9 Males with a mean age of 67 years (range 47-88 years). Cecal intubation was obtained in 47/53 (89%) of the cases. Single balloon enteroscope assisted colonoscopy provided a new diagnosis in 10/53 (19%) cases with additional findings of 14 adenomatous polyps and 2 colon cancers. No complications were reported. Conclusion: The use of a single balloon enteroscope without overtube-balloon equipment may be a safe and effective method to increase the cecal intubation rate after a failed colonscopy. If used during the same failed colonoscopic session, it provides a complete exam with the option for therapeutic intervention without the need for a repeat bowel preparation or additional sedation exposure.