Abstract
Clinical demand for colonoscopy has increased with the introduction of colorectal cancer screening worldwide. The goal is a complete, comfortable, and high-quality procedure. Up to one third of colonoscopies are challenging, and incomplete colonoscopy occurs in 10% of cases. High cecal intubation rates can be achieved by minimizing air insufflation and looping, and by using ancillary maneuvers such as position change and abdominal pressure. In difficult cases, changing to a non-standard endoscope, the use of magnetic endoscopic imaging, and endoscopic accessories including a transparent cap or an overtube can be an effective measure. The use of carbon dioxide instead of air insufflation reduces post-procedure discomfort. A new technique involving water immersion in lieu of air insufflation may reduce discomfort and facilitate insertion to the cecum. Data from alternative novel colonoscopy platforms including capsule colonoscopy, Neoguide, Invendoscope, and the Aer-O-scope appear promising, and prospective clinical studies are warranted.
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