Previous Incomplete Colonoscopy Research Articles

Motorized spiral enteroscopy: effectiveness when used for new indications.

Motorized spiral enteroscopy is proven to be effective in antegrade and retrograde enteroscopy. Nevertheless, little is known about its use in less common indications. The aim of this study was to identify new indications for the motorized spiral enteroscope. Monocentric retrospective analysis of 115 patients who underwent enteroscopy using PSF-1 motorized spiral enteroscope between January 2020 and December 2022. A total of 115 patients underwent PSF-1 enteroscopy. 44 (38%) were antegrade procedures and 24 (21%) were retrograde procedures in patients with normal gastrointestinal anatomy with conventional enteroscopy indications. The remaining 47 (41%) patients underwent PSF-1 procedures for secondary less conventional indications: n=25 (22%) enteroscopy-assisted ERCP, n=8 (7%) endoscopy of the excluded stomach after Roux-en-Y gastric bypass, n=7 (6%) retrograde enteroscopy after previous incomplete conventional colonoscopy and n=7 (6%) antegrade panenteroscopy of the entire small bowel. In this group of secondary indications, technical success rate was significantly lower (72.5%) as compared to technical success rates in the conventional groups (98-100%, p<0.001 Chi-square). Minor adverse events occurred in 17/115 patients (15%), all treated conservatively (AGREE I and II). This study demonstrates the capabilities of PSF-1 motorized spiral enteroscope for secondary indications. PSF-1 is useful to complete colonoscopy in case of long redundant colon, to reach the excluded stomach after Roux-en-Y gastric bypass, to perform unidirectional pan-enteroscopy and to perform ERCP in patients with surgically altered anatomy. However, technical success rates are lower as compared to conventional antegrade and retrograde enteroscopy procedures, with only minor adverse events.

Prospective evaluation of the motorized spiral enteroscope for previous incomplete colonoscopy.

Background and study aims A significant percentage of colonoscopies remain incomplete because of failure to intubate the cecum. The motorized spiral enteroscope (MSE) technique, originally developed for deep small bowel enteroscopy, may be an effective alternative technique in cases of incomplete examination of abnormally long colons (dolichocolon). We prospectively evaluated the success rate of cecal intubation, safety and the therapeutic consequences of using MSE after incomplete conventional colonoscopy. Patients and methods A total of 36 consecutive patients with an indication for diagnostic and/or therapeutic colonoscopy were prospectively enrolled in this multicenter trial. All patients had undergone at least one incomplete colonoscopy attributed to abnormally long colons. Patients with incomplete colonoscopy due to stenosis were excluded. Results Twenty-two men and 14 women (median age 66 years, range 35–82) were enrolled. Median procedure time was 30 minutes (range 16–50). Cecal intubation rate was 100 % and median cecal intubation time was 10 minutes (range 4–30). Abnormalities, mostly neoplastic lesions, were detected in 23 of 36 patients, corresponding to a diagnostic yield of 64 %. All these findings were in the right side of the colon and had not been described by the antecedent incomplete coloscopy. No adverse events occurred. Conclusions In case of a difficult and long colon, MSE is safe and effective for diagnostic and therapeutic colonoscopy. It may provide an attractive solution to accomplish completeness of previous incomplete colonoscopies in these patients.

The Prediction of Inadequate Colon Capsule Cleansing: A Cohort Selection Guided by CC-CLEAR

Introduction: In order to optimize the rate of adequate cleansing in colon capsule, it may be important to identify risk factors that can predict a suboptimal colon preparation. Aim:To define predictive factors for inadequate bowel preparation in colon capsule, according to CC-CLEAR (Colon Capsule CLEansing Assessment and Report). Methods: Retrospective, single center, cohort study. Patients’ demographics, data, and quality of bowel preparation, according to CC-CLEAR, were collected retrospectively. A univariate analysis tested the association between covariables and the outcome, inadequate cleansing. The statistically significant variables were included in multivariable logistic binary regression, and a receiver operating characteristic curve (ROC) assessment was performed. Results: We included 167 consecutive colon capsules. Sixty-eight percent (n = 114) of patients were female, with a mean age of 64 years. The main indication for colon capsule was previous incomplete colonoscopy, in 158 patients (94.6%). The colon capsules cleansing was graded as good or excellent in 96 patients (57.5%) and as inadequate in 71 (42.5%), according to CC-CLEAR. The variables inadequate previous colon cleansing (OR adjusted 41.72 [95% CI 12.57–138.57], p value < 0.001); chronic laxative (OR adjusted 4.86 [95% CI 1.08–21.79], p value = 0.039); antidepressant (OR adjusted 5.00 [95% CI 1.65–15.16], p value = 0.004), and impaired mobility (OR adjusted 5.54 [95% CI 1.17–26.31], p value = 0.031) were independently associated with the outcome inadequate cleansing, after adjusting for confoundment. The model presented an excellent discriminative power towards the outcome variable (AUC ROC 0.937 [CI 95% 0.899–0.975], p value < 0.001). Conclusion: A previous inadequate colon cleansing, the use of chronic laxative and antidepressant, or impaired mobility are predictors of inadequate colon capsule cleansing, as assessed by the CC-CLEAR. These 4 predictors come together as a model enabling an accurate categorization of the patients at major risk of inadequate bowel preparation for capsule colonoscopy, with an excellent discriminative power and performance, which seems useful for the selection of patients for tailored optimization of the colon cleansing protocol.

Detection of Postcolonoscopy Colorectal Neoplasia by Multi-target Stool DNA.

INTRODUCTION:Significant variability between colonoscopy operators contributes to postcolonoscopy colorectal cancers (CRCs). We aimed to estimate postcolonoscopy colorectal neoplasia (CRN) detection by multi-target stool DNA (mt-sDNA), which has not previously been studied for this purpose.METHODS:In a retrospective cohort of patients with +mt-sDNA and completed follow-up colonoscopy, positive predictive value (PPV) for endpoints of any CRN, advanced adenoma, right-sided neoplasia, sessile serrated polyps (SSP), and CRC were stratified by the time since previous colonoscopy (0–9, 10, and ≥11 years). mt-sDNA PPV at ≤9 years from previous average-risk screening colonoscopy was used to estimate CRN missed at previous screening colonoscopy.RESULTS:Among the 850 studied patients with +mt-sDNA after a previous negative screening colonoscopy, any CRN was found in 535 (PPV 63%). Among 107 average-risk patients having +mt-sDNA ≤9 years after last negative colonoscopy, any CRN was found in 67 (PPV 63%), advanced neoplasia in 16 (PPV 15%), right-sided CRN in 48 (PPV 46%), and SSP in 20 (PPV 19%). These rates were similar to those in 47 additional average risk persons with previous incomplete colonoscopy and in an additional 68 persons at increased CRC risk. One CRC (stage I) was found in an average risk patient who was mt-sDNA positive 6 years after negative screening colonoscopy.DISCUSSION:The high PPV of mt-sDNA 0–9 years after a negative screening colonoscopy suggests that lesions were likely missed on previous examination or may have arisen de novo. mt-sDNA as an interval test after negative screening colonoscopy warrants further study.

Transparent cap‐assisted, water‐exchange colonoscopy in previous incomplete difficult colonoscopy patients: A retrospective study

AbstractThe reported rates of incomplete colonoscopy (IC) range from 4% to 25% for both screening and nonscreening colonoscopy. Colonic neoplasm can be found in up to 53% on successful repeat colonoscopy. Transparent cap‐assisted colonoscopy (TCAC) and water‐exchange colonoscopy (WEC) have been applied seperately for repeat colonoscopy in the setting of failed difficult colonoscopy, but combination of these two methods for previous incomplete difficult colonoscopy has not been reported. The aim of this study is to report the success rate, time‐to cecum duration, polyp detection rate, and any complications using the combined methods of TCAC and WEC for previous incomplete difficult colonoscopy. Eight cases of incomplete difficult colonoscopy were enrolled from November 2016 to October 2018. Water exchange method (air‐less colonoscopy) performed during insertion of Cap‐fitted colonoscope, and after reaching the cecum, CO2 was insufflated for examination during withdrawal. The mean age of all eight female patients was 59 years (39‐72 year). One patient had failed colonoscopy twice previously, four had previous abdominal surgery. Six cases were performed by gastroenterologists, and two by colorectal surgeons previously. The cecal intubation rate was 100% on repeat colonoscopy with the combined TCAC and WEC methods without complications. The mean duration time to reach the ceum was 12.5 minutes (6.8‐23.3 minutes). Out of the eight patients, four had colon polyps, all confined to proximal colon. Two patients have advanced colon adenoma. Combining cap‐assisted colonoscopy (TCAC), and water exchange colonoscopy (WEC) are useful in previous incomplete colonoscopy cases.

Use of enteroscope without the overtube in incomplete colonoscopies

Objectives: Colonoscopy is the gold standard diagnostic method for colorectal cancer (CRC) screening. Despite the progress in the endoscopy technology field, a small percentage of colonoscopies is still incomplete. The reasons for that are mostly associated with anatomic features, such as fixed, angulated, long and loopy colon, intra-abdominal adherences and female gender. To overcome such difficulties, the usefulness of scopes different from conventional adult colonoscope (CF), such as paediatric colonoscope (PCF), gastroscope (GIF), single and double balloon enteroscope (SBE and DBE, respectively), has been shown in literature. Our retrospective study aims to evaluate the caecal intubation rate using a SBE without the overtube in patients who previously underwent an incomplete procedure with a different scope.Methods: Patients with a previous incomplete colonoscopy with CF, PCF or GIF were retrospectively enrolled through the analysis of a dedicated database. The enteroscope used was the Olympus Enteropro Single Balloon SiF-Q180 with no overtube. Complete colonoscopy was defined as successful caecal intubation.Results: SBE was used to scope 47 adult patients, mostly female, and it led to a complete procedure in 91% of them. The most frequent reason for an incomplete procedure even with the use of SBE was a fixed and angulated colon.Conclusions: Colonoscopy performed with SBE was safe and no adverse events during and/or after the procedure occurred. Our results suggest that SBE with no overtube is a useful and valid alternative to other type of scopes in difficult cases, especially those related to fixed/angulated colon and in female gender.

Balloon-assisted endoscopy facilitates endoscopic submucosal dissection of difficult superficial proximal colon tumors.

Colorectal endoscopic submucosal dissection (ESD) can be technically difficult in some situations, such as paradoxical movement of the proximal colon. The double-balloon endoscope provides stable endoscopic maneuvering, even in the small intestine. The aim of this study was to assess the outcomes of balloon-assisted endoscopic submucosal dissection (BAESD) of colonoscopically difficult superficial proximal colon tumors. We retrospectively reviewed the records of patients who underwent BAESD of superficial proximal colon tumors where colonoscopic difficulties were encountered, from January 2011 to September 2016. Difficulties were defined as a previous incomplete colonoscopy using a conventional colonoscope or unstable endoscopic maneuverability around the tumor with a conventional colonoscope. A propensity score model was used as a secondary analysis to compare outcomes of the BAESD group with those of a non-BAESD group. RESULTS: BAESD was performed on 63 tumors in 63 patients. En bloc resection was achieved for 62 tumors (98 %) and an R0 resection was achieved for 55 tumors (87 %). Propensity score matching analysis created 59 matched pairs from the BAESD and non-BAESD groups. There were no statistically significant differences between the two groups in en bloc resection (100 % vs. 100 %; P > 0.99), R0 resection (90 % vs. 93 %; P = 0.74), perforation (0 % vs. 2 %; P > 0.99) or postoperative bleeding (3 % vs. 0 %; P = 0.50). Balloon-assisted endoscopy achieved safe and reliable ESD of colonoscopically difficult superficial proximal colon tumors.

The role of single-balloon colonoscopy for patients with previous incomplete standard colonoscopy: Is it worth doing it?

The rate of cecal intubation is a well-recognized quality measure of successful colonoscopy. Infrequently, the standard colonoscopy techniques fail to achieve complete examination. The role of single-balloon overtube-assisted colonoscopy (SBC) in these situations has only been sparsely studied. This prospective single-center study aimed to investigate the technical success (rate of cecal intubation) and the diagnostic gain of SBC. The study recruited consecutive patients with previous incomplete standard colonoscopy who were admitted for SBC at our tertiary center in Eastern Switzerland between February 2008 and October 2014. The primary outcome was defined as successful cecal intubation. Data on patient characteristics, indication, technical details of procedure, and outcome were collected prospectively. The Olympus enteroscope SIF-Q180 was used. The study included 100 consecutive patients (median age 70years; range 38-87years; 54% female) who were examined using a single-balloon overtube-assisted technique. The cecal intubation rate was 98% (98/100). The median time of total procedure was 54min (range 15-119min); the median time to reach the cecal pole was 27.5min (range 4-92min). Passage of the sigmoid colon was not possible in two cases with a fixed, angulated sigmoid colon. The diagnostic gain was 21% regarding adenomatous polyps in the right colon. The complication rate was 2% (2/100, minor) without need for surgery. This prospective patient cohort study shows that single-balloon colonoscopy is a safe and effective procedure to achieve a complete endoscopic examination in patients with a previous failed standard colonoscopy. A significant diagnostic and therapeutic gain in the right colon justifies additional procedure time.

Colon capsule versus CT colonography in patients with incomplete colonoscopy: a prospective, comparative trial

ObjectiveIn case of incomplete colonoscopy, several radiologic methods have traditionally been used, but more recently, capsule endoscopy was also shown to be accurate. Aim of this study was to compare...

High success rate of repeat colonoscopy with standard endoscopes in patients referred for prior incomplete colonoscopy

BackgroundIn patients with incomplete colonoscopy, cecal intubation is sometimes unsuccessful due to a redundant or tortuous colon. Repeat colonoscopy may be successful with the use of alternate endoscopes or careful attention to technique but limited outcomes data is available. The aim of this study was to describe the technique, success rate and outcomes of consecutive patients referred for previous incomplete colonoscopy.MethodsWe conducted a retrospective chart review of incomplete colonoscopy procedures in patients age 18-90 at an academic teaching hospital referred to an endoscopist specializing in difficult colonoscopy.ResultsCecal intubation was successful in 96 of 100 repeat colonoscopies and 83 procedures were completed with a standard endoscope (adult, pediatric, or gastroscope). The adenoma detection rate was 28% for successful repeat colonoscopies; a majority of these patients had no adenomas identified on incomplete exam. In 69.4% of cases, an endoscope was used to successfully complete colonoscopy that was not used in the incomplete colonoscopy. The median insertion time was significantly less for the complete colonoscopy (10.6 min) compared to the incomplete colonoscopy (18.8 min, P = 0.004).ConclusionsRepeat colonoscopy has a high success rate and identified a significant number of new adenomas. Use of all available endoscopes should be considered prior to procedure termination in patients with a tortuous colon. Repeat colonoscopy can often be accomplished using a standard endoscope and is not attributed to increased endoscope insertion time.

Double-balloon Enteroscopy in Patients With Previous Incomplete Colonoscopy

Double-balloon Enteroscopy in Patients With Previous Incomplete Colonoscopy

High Success Rate of Repeat Colonoscopy in Patients Referred for Prior Incomplete Colonoscopy

Purpose: In a minority of colonoscopies, cecal intubation is unsuccessful due to a redundant or tortuous colon. Repeat colonoscopy may be successful with the use of alternate endoscopes or careful attention to technique. We describe the technique, success rate and outcomes of consecutive patients referred for repeat colonoscopy due to previous incomplete colonoscopy. Methods: A retrospective chart review was performed over a 26-month time period (April 2010 to May 2012) of all patients referred for repeat colonoscopy due to prior incomplete colonoscopy. Patients with an incomplete colonoscopy due solely to inadequate preparation or sedation were excluded. All procedures were performed by a single endoscopist using monitored anesthesia. Results: Over the study period, 32,246 colonoscopies were performed at our institution. A total of 100 patients with prior incomplete colonoscopy were referred to a single endoscopist for repeat colonoscopy attempt. Patients were predominantly female (67%) with a median age of 63y (range 23-92y). Initial incomplete colonoscopy was due to tortuousity (51.8%) and redundancy (49.2%) in those patients with a documented cause (n=85). Median time from incomplete to repeat colonoscopy was 85d (range 2-3677d). The majority of patients (71%) underwent repeat exam within 1 year of incomplete colonoscopy. The overall cecal intubation rate was 96% for repeat colonoscopy. Cecal intubation was unsuccessful in 4 patients (4%) due to inguinal hernia (n=1), Crohn's disease stricture (n=1), looping (n=1), and tortuousity (n=1). Cecal intubation was achieved with an adult colonoscope (32%), pediatric colonoscope (32%), gastroscope (19%), or single balloon enteroscope (13%). In 75% of patients with an incomplete colonoscopy due to tortuous colon, successful colonoscopy was completed using a standard smaller caliber endoscope (pediatric colonoscope or gastroscope) not used in the initial procedure. There were no procedural complications. The overall adenoma detection rate was 28% (range 1-10 adenomas). In the subgroup of patients with repeat colonoscopy within 1 year of incomplete exam, the adenoma detection rate was 31.7%. Among these patients, 89.5% had no adenomas on initial incomplete colonoscopy. A single cecal adenocarcinoma was detected in a patient with a unremarkable barium study 2 days prior to the exam. Conclusion: In patients with a prior incomplete colonoscopy, repeat colonoscopy has a high success rate and is often accomplished using a standard endoscope. Repeat colonoscopy identified a significant number of new adenomas even in patients without adenomas seen on initial incomplete exam. Repeat colonoscopy should be strongly considered in patients with prior incomplete colonoscopy.

Single- Versus Double-Balloon-Assisted Colonoscopy After Previous Incomplete Standard Colonoscopy

Colonoscopy is the principle screening tool used for the detection of colorectal cancer and removal of colorectal adenomatous polyps [1, 2]. Recently, a large clinical study showed that colonoscopic removal of adenomatous polyps reduced mortality from colorectal cancer by 53 % [3]. While complete colonic evaluation is essential for screening colonoscopy, the rate of incomplete colonoscopy using a conventional standard colonoscope has been reported to be 5–10 % [4–6]. A study conducted in Ontario found that 43,483 (13.1 %) of 331,608 screening colonoscopies failed to evaluate the entire colon [7]. In this population-based cohort study, the factors associated with incomplete colonoscopy were increased patient age, female sex, a history of prior abdominal or pelvic surgery, and having the procedure done in a private office. Other predictors of incomplete colonoscopy include decreased functional status of the patient [8] and anatomic factors such as colonic elongation, tortuosity, and severe diverticulosis [9]. Malignant and pre-malignant lesions may go undetected in patients that are not completely evaluated by screening colonoscopy. In a population-based cohort study, 4.3 % of advanced colonic neoplasms were missed by incomplete colonoscopy [10]. Since 33–50 % of advanced neoplasms are found only in the proximal colon [11–13], additional efforts should be made to adequately visualize the remaining colon after an incomplete colonoscopy. An alternative diagnostic modality such as computed tomographic colonography has been utilized in these cases, however, its usefulness is limited by low sensitivity for small polyps, radiation exposure, and the inability to perform histologic biopsy and therapeutic procedures including polypectomy [14, 15]. As a result, endoscopic approaches are still favored after incomplete standard colonoscopy. Additional endoscopic techniques using gastroscope, variable stiffness colonoscope, pediatric or cap-pitted colonoscope have been tried, but failed to achieve an adequate cecal intubation rate. More recently, a balloon-assisted technique, which was originally introduced to investigate the small bowel, has been applied in patients with previous failed or incomplete colonoscopy. For a balloon-assisted colonoscopy, two types of balloon enteroscopes are available; the double-balloon enteroscope developed by Yamamoto et al. [16], and the single-balloon enteroscope developed by Tsujikawa et al. [17]. The reported success rates of single(SBC) or doubleballoon-assisted colonoscopy (DBC) in patients with previous incomplete conventional colonoscopy range from 88 to 100 % [18–23]. In the current issue of Digestive Diseases and Sciences, Dzeletovic et al. [24] compared the performance outcomes of SBC and DBC in patients with previous incomplete conventional colonoscopy. In this study, the authors retrospectively reviewed 26 cases of SBC and 27 cases of DBC in patients whom underwent failed conventional colonoscopy. The current study showed that cecal intubation was successful in 96 % of patients using either SBC or DBC (100 % with SBC vs. 93 % with DBC, p = 0.049). The median cecal intubation time and total procedure time using SBC and DBC were 17 min vs. 20 min (p = 0.37) and 43.5 min vs. 46.0 min (p = 0.32), respectively. While SBC required less time than DBC, the difference was not statistically significant. Balloon-assisted colonoscopy revealed additional colonic polyps in 35 % of patients in the SBC group and 30 % of patients in the DBC group. Despite the J. U. Lim J. M. Cha (&) Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, 149 Sangil-dong, Gangdong-gu, Seoul 134-727, Korea e-mail: drcha@khu.ac.kr

Comparison of Single- Versus Double-Balloon Assisted-Colonoscopy for Colon Examination After Previous Incomplete Standard Colonoscopy

Colonoscopy fails to achieve cecal intubation in 5-10 % of cases. Many of these cases can be completed using balloon-assisted colonoscopy, either with the single-balloon colonoscopy (SBC) or the double-balloon colonoscopy (DBC) techniques. To compare the completion rates of SBC and DBC in patients with previous incomplete conventional colonoscopy. Between August 2009 and July 2011 either SBC or DBC was performed in 53 patients in whom previous conventional colonoscopy did not achieve cecal intubation. The medical records of these 53 patients were reviewed retrospectively for details regarding (1) indication for the initial colonoscopy, (2) patient characteristics, (3) data from the initial colonoscopy, and (4) details on both SBC and DBC. SBC was successful in intubating the cecum in 100 % (26/26) of patients and DBC was successful in 93 % (25/27) of patients. The median (range) time to reach the cecum was 17 (9-43) min in the SBC group and 20 (7-58) min in the DBC group (P = 0.37). The presence of polyps was an entirely new finding in 35 % (9/26) of patients in the SBC group and 30 % (8/27) of patients in DBC group. Therapeutics were performed in 73 % (19/26) of patients in SBC group and 67 % (18/27) of patients in DBC group. For patients with incomplete conventional colonoscopy, SBC and DBC offer high cecal intubation rates as well as detection of additional polyps and therapeutic capability. Either SBC or DBC can be considered after incomplete conventional colonoscopy.

Su1440 Comparison of Single-Balloon Versus Double-Balloon Assisted Colonoscopy for Colon Examination After Previous Incomplete Colonoscopy Using a Standard Colonoscope

Colonoscopy fails to achieve cecal intubation in 5 to 10% of cases. Many of these cases can be completed using balloon assisted colonoscopy, either with the single-balloon colonoscopy (SBC) or the double-balloon colonoscopy (DBC) techniques. Aim: To compare the success rates of SBC and DBC in patients with previous incomplete conventional colonoscopy.

Mo1379 Double Balloon Enteroscopy in Patients With Previous Incomplete Colonoscopy: Should We Perform Them More Often?

Mo1379 Double Balloon Enteroscopy in Patients With Previous Incomplete Colonoscopy: Should We Perform Them More Often?

Continuing Medical Education Exam: April 2012

Instructions: The GIE: Gastroinintestinal Endoscopy CME Activity can now be completed entirely on-line. To complete do the following: 1. Read the CME article in this issue carefully and complete the activity: Isayama H, Sasaki T, Nakai Y, et al. Management of malignant gastric outlet obstruction with a modified triple-layer covered metal stent. Gastrointest Endosc 2012;75:757-63. Ogura T, Yamao K, Sawaki A, et al. Clinical impact of K-ras mutation analysis in EUS-guided FNA specimens from pancreatic masses. Gastrointest Endosc 2012;75:769-74. Hong SK, Loren DE, Rogart JN, et al. Targeted cyst wall puncture and aspiration during EUS-FNA increases the diagnostic yield of premalignant and malignant pancreatic cysts. Gastrointest Endosc 2012;75:775-82. Hotta K, Katsuki S, Ohata K, et al. A multicenter, prospective trial of total colonoscopy using a short double-balloon endoscope in patients with previous incomplete colonoscopy. Gastrointest Endosc 2012;75:813-8. 2. To date, ACC Sections and their Councils have been a valuable resource for the decision-making bodies of the College and have provided a welcome opportunity for the ACC to cultivate leadership and engage members. Visit the journals Web site at www.asge.org (members) or www.giejournal.org (nonmembers). 3. To date, ACC Sections and their Councils have been a valuable resource for the decision-making bodies of the College. Exams can be saved to be acessed at a later date. ou may create a free personal account to save and return to your work in progress, as well as save and track your completed activities o that you may print a certificate at any time. The complete articles, detailed instructions for completion, as well as past Journal CME ctivities can also be found at this site.

A multicenter, prospective trial of total colonoscopy using a short double-balloon endoscope in patients with previous incomplete colonoscopy

There is no specific insertion method for patients who previously underwent an incomplete colonoscopy. No multicenter prospective study using a double-balloon endoscope (DBE) for total colonoscopy was previously performed. To demonstrate the effectiveness and safety of using short DBEs in patients who previously underwent incomplete colonoscopies. A multicenter, prospective trial. Four tertiary care academic centers and 6 community hospitals. Patients with a history of incomplete colonoscopy, ages 20 to 79 years, were included. Exclusion criteria were colonoscopy performed by endoscopists with experience in fewer than 1000 cases, history of colectomy, poor bowel preparation, inflammatory bowel disease, active bowel obstruction, and active bleeding. Total colonoscopies using short DBEs were attempted in all patients. Primary endpoint was the cecal intubation rate. Secondary endpoints were time to cecal intubation, complications, and tolerability. A total of 110 patients (62 males, median age 66.5 years) were included. Fifty-four patients had a history of abdominal surgery. The cecal intubation rate was 100% (110/110). Median intubation time was 12 minutes (range 4-47 minutes). Mild mucosal tears without symptoms occurred in 1 patient. For 64.5% of patients, intravenous sedatives and/or analgesics were used during examinations. Based on questionnaires, 50.9% had no pain, 31.8% slight pain, and 17.3% tolerable pain. Moreover, 96.4% of patients answered that their examination was more comfortable than their previous colonoscopy. Uncontrolled trial. The use of a short DBE is an effective and safe method for total colonoscopy in patients who previously underwent incomplete colonoscopies. ( UMIN3464.).

Incomplete Colonoscopy: Maximizing Completion Rates of Gastroenterologists

Cecal intubation is one of the goals of a quality colonoscopy; however, many factors increasing the risk of incomplete colonoscopy have been implicated. The implications of missed pathology and the demand on health care resources for return colonoscopies pose a conundrum to many physicians. The optimal course of action after incomplete colonoscopy is unclear. To assess endoscopic completion rates of previously incomplete colonoscopies, the methods used to complete them and the factors that led to the previous incomplete procedure. All patients who previously underwent incomplete colonoscopy (2005 to 2010) and were referred to St Paul's Hospital (Vancouver, British Columbia) were evaluated. Colonoscopies were re-attempted by a single endoscopist. Patient charts were reviewed retrospectively. A total of 90 patients (29 males) with a mean (± SD) age of 58 ± 13.2 years were included in the analysis. Thirty patients (33%) had their initial colonoscopy performed by a gastroenterologist. Indications for initial colonoscopy included surveillance or screening (23%), abdominal pain (15%), gastrointestinal bleeding (29%), change in bowel habits or constitutional symptoms (18%), anemia (7%) and chronic diarrhea (8%). Reasons for incomplete colonoscopy included poor preparation (11%), pain or inadequate sedation (16%), tortuous colon (30%), diverticular disease (6%), obstructing mass (6%) and stricturing disease (10%). Reasons for incomplete procedures in the remaining 21% of patients were not reported by the referring physician. Eighty-seven (97%) colonoscopies were subsequently completed in a single attempt at the institution. Seventy-six (84%) colonoscopies were performed using routine manoeuvres, patient positioning and a variable-stiffness colonoscope (either standard or pediatric). A standard 160 or 180 series Olympus gastroscope (Olympus, Japan) was used in five patients (6%) to navigate through sigmoid diverticular disease; a pediatric colonoscope was used in six patients (7%) for similar reasons. Repeat colonoscopy on the remaining three patients (3%) failed: all three required surgery for strictures (two had obstructing malignant masses and one had a severe benign obstructing sigmoid diverticular stricture). Most patients with previous incomplete colonoscopy can undergo a successful repeat colonoscopy at a tertiary care centre with instruments that are readily available to most gastroenterologists. Other modalities for evaluation of the colon should be deferred until a second attempt is made at an expert centre.

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

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.