Aim: Colonoscopy can be difficult in some women who have undergone hysterectomies–which can be associated with a fixed, angulated sigmoid colon from post-op pelvic adhesions.We sought to determine if colonoscopy was easier and more comfortable for women with prior hysterectomies when performed with a pediatric colonoscope, which is narrower in diameter and more flexible than a standard adult colonoscope. Methods: Ninety women with a history of a prior hysterectomy undergoing outpatient colonoscopy were randomized to colonoscopy with a standard colonoscope (Olympus CF-100L or CF-Q140L; 164-cm working length & 13.3-mm outside diameter) or with a pediatric colonoscope (Olympus PCF-100; 133-cm working length & 11.3-mm outside diameter). All procedures were performed by a faculty endoscopist and timed. Following examinations, the endoscopist graded procedure difficulty, and patients were given a questionnaire assessing their experience. Results: The cecum was reached more frequently with the pediatric scope (96%, 44/46) than with the adult scope (72%, 32/44)(p=0.003). In 11 of the cases in which the adult scope was unsuccessful in traversing the sigmoid colon, the endoscopist switched to the pediatric scope, which was then successful in reaching the cecum in 8 cases (73%, 8/11). This increased the cecal intubation rate for cases in which the procedure was started with the adult scope to 91% (40/44). Overall, the cecum was ultimately reached in 84 of 90 cases (93%). There was no significant difference in the two scope groups (pediatric versus adult) in terms of mean time to reach the cecum (11.4 min versus 12.9 min), mean total procedure time (21.2 min versus 22.5 min), mean doses of midazolam given (1.49 mg versus 1.65 mg), scales of procedure difficulty as graded by endoscopists, or comfort scales as graded by patients. Conclusions: The pediatric colonoscope is a reasonable choice to use in women who have had a prior hysterectomy. However, if the endoscopist elects to start the procedure with a standard adult colonoscope, it is helpful to have access to a pediatric colonoscope to switch to if he/she encounters a fixed, angulated sigmoid colon that cannot be easily or safely traversed with the adult scope. Aim: Colonoscopy can be difficult in some women who have undergone hysterectomies–which can be associated with a fixed, angulated sigmoid colon from post-op pelvic adhesions.We sought to determine if colonoscopy was easier and more comfortable for women with prior hysterectomies when performed with a pediatric colonoscope, which is narrower in diameter and more flexible than a standard adult colonoscope. Methods: Ninety women with a history of a prior hysterectomy undergoing outpatient colonoscopy were randomized to colonoscopy with a standard colonoscope (Olympus CF-100L or CF-Q140L; 164-cm working length & 13.3-mm outside diameter) or with a pediatric colonoscope (Olympus PCF-100; 133-cm working length & 11.3-mm outside diameter). All procedures were performed by a faculty endoscopist and timed. Following examinations, the endoscopist graded procedure difficulty, and patients were given a questionnaire assessing their experience. Results: The cecum was reached more frequently with the pediatric scope (96%, 44/46) than with the adult scope (72%, 32/44)(p=0.003). In 11 of the cases in which the adult scope was unsuccessful in traversing the sigmoid colon, the endoscopist switched to the pediatric scope, which was then successful in reaching the cecum in 8 cases (73%, 8/11). This increased the cecal intubation rate for cases in which the procedure was started with the adult scope to 91% (40/44). Overall, the cecum was ultimately reached in 84 of 90 cases (93%). There was no significant difference in the two scope groups (pediatric versus adult) in terms of mean time to reach the cecum (11.4 min versus 12.9 min), mean total procedure time (21.2 min versus 22.5 min), mean doses of midazolam given (1.49 mg versus 1.65 mg), scales of procedure difficulty as graded by endoscopists, or comfort scales as graded by patients. Conclusions: The pediatric colonoscope is a reasonable choice to use in women who have had a prior hysterectomy. However, if the endoscopist elects to start the procedure with a standard adult colonoscope, it is helpful to have access to a pediatric colonoscope to switch to if he/she encounters a fixed, angulated sigmoid colon that cannot be easily or safely traversed with the adult scope.