The Utility of Single-Balloon Colonoscopy for Completion of Colon Examination after Incomplete Colonoscopy with Conventional Colonoscope

Abstract

Purpose: To evaluate the completion rate of single-balloon assisted colonoscopy (SBC) for colon evaluation and therapeutic intervention after a prior incomplete colonoscopy using a conventional colonoscope. Methods: A retrospective chart review was performed in all patients undergoing SBC between May 2010 and May 2011 who had a previous incomplete conventional colonoscopy. Four expert gastroenterologists with or without a fellow, performed the procedures. Medical records of 22 patients were reviewed for details of initial colonoscopy, if available, and SBC. SBC was performed by using the Olympus SIF-Q180 enteroscope (Olympus Optical Co., Tokyo, Japan). Results: 22 SBC procedures were performed in 22 patients: median age 69 (range 45-82) years; 20 females. Indications for conventional colonoscopy included: personal history of colonic polyps (7/22; 31.9%), routine screening (6/22; 27.3%), iron deficiency anemia, family history of colorectal cancer, changes in bowel habit (2/22; 9.1% - each), guiac positive stool and bloating (1/22; 4.5%each). Extent of conventional colonoscopy was: sigmoid colon (18.2%), splenic flexure (27.3%), hepatic flexure (36.4%), ascending colon (4.5%), cecum (9.1%) and unknown (4.5%). The primary indications for SBC were looping +/- patients discomfort (7/22; 31.9% and 5/22; 22.7% respectively). Other indications included: looping with incomplete therapy, diverticulosis, redundant colon, patient discomfort alone (2/22; 9.1%-each), stricture and acute angulation (1/22; 4.5%-each). Median total procedure time for incomplete conventional colonoscopy was available for 14/22 patients (40.8 min; range 9-112). SBC allowed cecal intubation in all procedures (22/22; 100%). Median cecal intubation time was 18.4 min (range 9-43) and the median total procedure time was 42.5 min (range 21-68). 14/22 (63.6%) procedures were completed with anesthesia assistance. Gastroenterology trainees were involved in 6/22 (26.1%) procedures. Findings included: 40 polyps (14-tubular adenoma, 5-sessile serrated adenoma, 21-hyperplastic polyps) in 13/22 (59.1%), diverticulosis in 8/22 (36.4) and nonspecific colitis in 1/22 (4.5%) patients. Therapeutics were performed in 16/22 (72.7%) procedures (63.6%-polypectomies, 9.1%-random biopsies). No complications were encountered. Incomplete conventional colonoscopy and SBC were not different in total procedure times (Mean difference 5.7 min; 95% CI -11.3 to 22.9; P=0.48). Conclusion: SBC appears to be a safe and effective method for completing colonoscopy in patients who have previously failed conventional colonoscopy. It allows for both diagnostic and therapeutic interventions and is performed within similar time to conventional colonoscopy.