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Watahiki Y, Kawashima K, Hikichi T, Takagi T, Onizawa M, Gunji N, Watanabe C, Wada J, Oka Y, Hashimoto Y, Ohira H. A balloon-assisted endoscopic submucosal dissection using long colonoscope and guidewire. DEN OPEN 2024; 4:e259. [PMID: 37333980 PMCID: PMC10272917 DOI: 10.1002/deo2.259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/24/2023] [Accepted: 06/05/2023] [Indexed: 06/20/2023]
Abstract
Balloon-assisted endoscopy enables stable endoscopic maneuverability. Balloon-assisted endoscopic submucosal dissection (BA-ESD) is useful in the treatment of proximal colorectal tumors where scope maneuverability is poor. Herein, we reported a case in which BA-ESD was successfully performed using a long colonoscope with a guidewire, although the lesion could not be reached using the balloon-assisted endoscopy technique with a therapeutic colonoscopy. A 50-year-old man underwent a colonoscopy that revealed a tumor in the ascending colon. BA-ESD was performed using a conventional therapeutic endoscope due to excessive intestinal elongation and poor endoscopic maneuverability. However, the transverse colon loop could not be reduced, and the total colonoscopy failed despite using balloon-assisted endoscopy. The scope was then changed from a conventional colonoscope to a long colonoscope, inserted into the terminal ileum, and the loop was reduced. After the guidewire was placed at the terminal ileum and the long colonoscope was removed, a therapeutic colonoscopy with an overtube was inserted into the ascending colon without reforming the colonic loop, allowing safe BA-ESD.
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Affiliation(s)
- Yu Watahiki
- Department of GastroenterologyFukushima Medical University School of MedicineFukushimaJapan
| | - Kazumasa Kawashima
- Department of GastroenterologyFukushima Medical University School of MedicineFukushimaJapan
| | - Takuto Hikichi
- Department of EndoscopyFukushima Medical University HospitalFukushimaJapan
| | - Tadayuki Takagi
- Department of GastroenterologyFukushima Medical University School of MedicineFukushimaJapan
| | - Michio Onizawa
- Department of GastroenterologyFukushima Medical University School of MedicineFukushimaJapan
| | - Naohiko Gunji
- Department of GastroenterologyFukushima Medical University School of MedicineFukushimaJapan
| | - Chiharu Watanabe
- Department of GastroenterologyFukushima Medical University School of MedicineFukushimaJapan
| | - Jun Wada
- Department of GastroenterologyFukushima Medical University School of MedicineFukushimaJapan
| | - Yuka Oka
- Department of Diagnostic PathologyFukushima Medical University School of MedicineFukushimaJapan
| | - Yuko Hashimoto
- Department of Diagnostic PathologyFukushima Medical University School of MedicineFukushimaJapan
| | - Hiromasa Ohira
- Department of GastroenterologyFukushima Medical University School of MedicineFukushimaJapan
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Cheng TF, Cheng KS. A randomized prospective study comparing single-balloon-assisted colonoscopy and cap-assisted colonoscopy in patients with previous incomplete conventional colonoscopy. J Gastroenterol Hepatol 2023; 38:225-232. [PMID: 36398729 DOI: 10.1111/jgh.16062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/01/2022] [Accepted: 11/14/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Cecal intubation may be unsuccessful by conventional colonoscopy in some patients. Single-balloon-assisted colonoscopy (SBC) and cap-assisted colonoscopy (CAC) were studied to solve this problem. There was no head-to-head comparison between them. METHODS We conducted a randomized study from 2018 to 2021 to compare cecal intubation rate of SBC and CAC in patients with previous incomplete conventional colonoscopy. We recruited patients with incomplete conventional colonoscopy in two hospitals in Hong Kong. Patients were randomized into SBC group and CAC group in 1:1 ratio. In the case of failure in cecal intubation by allocated method, alternative modality would be performed as rescue. RESULTS Forty-four patients were recruited. Cecal intubation rate was superior in SBC group (22/22, 100%) than CAC group (16/22, 72.7%) (P = 0.02). No difference in cecal intubation time, polyp detection rate, and diagnostic gain in area not examined previously. SBC induced less discomfort (modified Gloucester comfort score 2.14 vs 2.63, P = 0.03) with use of comparable amount of midazolam and fentanyl as CAC. For patients failed cecal intubation by CAC, all (n = 6) were rescued successfully by SBC. Body weight, body mass index (BMI), and waist circumference were greater in rescue subgroup. More patients were obese (BMI ≥ 25 kg/m) in rescue subgroup (67% vs 19%). None in rescue subgroup had history of successful cecal intubation by conventional colonoscopy (0% vs 56%, P = 0.046). However, we failed to demonstrate significant association in multivariate analysis owing to small sample size. No adverse event was noted. CONCLUSION SBC is superior to CAC in cecal intubation in patients with previous incomplete conventional colonoscopy.
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Affiliation(s)
- Tsz Fai Cheng
- Department of Medicine and Geriatrics, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - Ka Shing Cheng
- Department of Medicine and Geriatrics, Tuen Mun Hospital, Tuen Mun, Hong Kong
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Al-Toma A, Oude Hergelink DM, Tenthof van Noorden J, Koornstra JJ. Prospective evaluation of the motorized spiral enteroscope for previous incomplete colonoscopy. Endosc Int Open 2022; 10:E1112-E1117. [PMID: 36238532 PMCID: PMC9552671 DOI: 10.1055/a-1869-2541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 05/30/2022] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
- Abdulbaqi Al-Toma
- Department of Gastroenterology and hepatology, St. Antonius hospital, Nieuwegein, the Netherlands
| | - Dorien M. Oude Hergelink
- Department of Gastroenterology & Hepatology, University Medical Centre Groningen, University of Groningen, The Netherlands
| | | | - Jan Jacob Koornstra
- Department of Gastroenterology & Hepatology, University Medical Centre Groningen, University of Groningen, The Netherlands
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Balloon-Assisted Colonoscopy after Incomplete Conventional Colonoscopy-Experience from Two European Centres with A Comprehensive Review of the Literature. J Clin Med 2020; 9:jcm9092981. [PMID: 32942749 PMCID: PMC7564861 DOI: 10.3390/jcm9092981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/03/2020] [Accepted: 09/11/2020] [Indexed: 12/22/2022] Open
Abstract
Background: Conventional colonoscopy (CC) allows access for colonic investigation and intervention; in the small group in whom CC is unsuccessful alternative imaging is often sufficient. There remains a subset, however, requiring full colonic visualisation or intervention. Balloon-assisted colonoscopy (BAC) gives a further option when access is difficult. Aims: This study aims to present the experience with BAC of two European tertiary referral centres. Methods: Procedures were carried out under local protocol over 15-years (2006–2020). Markers of procedural quality such as caecal intubation, complications and comfort were retrospectively compiled and analysed. Published evidence was summarised for comparison. Results: 122 procedures were undertaken, with polyps the most frequent indication and 90.2% having at least one previously incomplete CC. Features associated with difficult colonoscopy were common, including intraabdominal surgery (32.0%). 92.6% reached the caecum; completion was higher (96.3%) in those failing CC due to discomfort and lower in those failing due to anatomical difficulties (90.7%) or previous surgery (84.6%). Mean time to the caecum was 20.9 minutes and mean midazolam and fentanyl doses were 2.6 mg and 49.9 µg with low discomfort scores. Conclusion(s): Balloon-assisted colonoscopy is successful in >90% of patients, is well-tolerated, and is safe.
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Parsa N, Vemulapalli KC, Rex DK. Performance of radiographic imaging after incomplete colonoscopy for nonmalignant causes in clinical practice. Gastrointest Endosc 2020; 91:1371-1377. [PMID: 32032619 DOI: 10.1016/j.gie.2020.01.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 01/22/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS CT colonography (CTC) or barium enema are commonly ordered to complete colorectal imaging after an incomplete colonoscopy. We evaluated the sensitivity of radiographic studies performed for this purpose in clinical practice outside clinical trials. METHODS Adult patients referred to an expert endoscopist for incomplete colonoscopy because of a redundant colon or a difficult sigmoid and who underwent previous radiographic imaging between July 2001 and July 2019 were identified. None of the patients had a malignant obstruction as the cause of incomplete colonoscopy. Data on polyp size, location, and pathology were obtained from colonoscopy and radiology reports. Polyps identified on imaging and colonoscopy were matched based on polyp size and location. RESULTS Among 769 patients referred for incomplete colonoscopy, we identified 65 with a radiographic examination performed within 36 months of colonoscopy at our center. Per-patient sensitivity for CTC was suboptimal (70%) and was very low for barium enema (26.7%). Per-polyp sensitivity for both CTC and barium enema was poor (23.8% and 7.6%). Quality of the examination did not seem to affect procedure sensitivity. CONCLUSIONS Radiographic imaging after incomplete colonoscopy for reasons other than malignant obstruction had poor sensitivity for polyps. Patients with incomplete colonoscopies should be considered for repeat colonoscopy by an expert.
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Affiliation(s)
- Nasim Parsa
- Division of Gastroenterology and Hepatology, University of Missouri, Columbia, Missouri, USA
| | - Krishna C Vemulapalli
- Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Douglas K Rex
- Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Girotra M, Sethi S, Barakat MT, Huang RJ, Friedland S, Ladabaum U, Banerjee S. When Experts Fail: Use of a Short Turning Radius Colonoscope Facilitates Successful Completion of Colonoscopy in Patients with Bowel Fixity. Dig Dis Sci 2020; 65:1429-1435. [PMID: 31630343 DOI: 10.1007/s10620-019-05882-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 10/09/2019] [Indexed: 12/09/2022]
Abstract
BACKGROUND Rates of incomplete colonoscopy in non-expert settings range up to 13%. Expert colonoscopists can complete ~ 95% colonoscopies when other endoscopists fail; however, a small number remain incomplete even in expert hands, typically due to bowel fixity. AIMS Pentax Retroview™ (EC-3490TLi) is a new slim colonoscope with a short turning radius (STR) and greater tip deflection (210°), which allows easy maneuverability across sharply angulated/fixed colonic bends. We evaluated the utility of this colonoscope for completing colonoscopies that fail even in the hands of expert colonoscopists. METHODS Retrospective chart review was performed, and main outcomes measured included cecal intubation rate, lesions detected, dosage of sedation used, and complications. RESULTS Using the STR colonoscope, complete colonoscopy to the cecum was possible in 34/37 patients (91.9%). No loss of lumen/blind advancement was necessary in any of the procedures. No adverse events occurred. Among the completed colonoscopies, 6/34 (17.6%) patients had adenomas, all proximal to the site of prior failure, including one advanced adenoma. All failures (n = 3, 8.1%) had a history of cancer surgeries, with peritoneal carcinomatosis/extensively fixed/frozen bowel (two patients) and an additional diverticular stricture with colo-vesical fistula (one patient). CONCLUSION STR colonoscope facilitates completion of a high proportion (91.9%) of colonoscopies that previously failed in expert hands. Its STR allows easy maneuverability across segments of sharp angulation with bowel fixity without need for blind advancement. The use of this colonoscope led to the detection of adenomas in 17.6% of patients, all proximal to the site of prior failed colonoscopy.
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Affiliation(s)
- Mohit Girotra
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 300 Pasteur Drive, MC: 5244, Stanford, CA, 94305, USA
| | - Saurabh Sethi
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 300 Pasteur Drive, MC: 5244, Stanford, CA, 94305, USA
| | - Monique T Barakat
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 300 Pasteur Drive, MC: 5244, Stanford, CA, 94305, USA
| | - Robert J Huang
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 300 Pasteur Drive, MC: 5244, Stanford, CA, 94305, USA
| | - Shai Friedland
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 300 Pasteur Drive, MC: 5244, Stanford, CA, 94305, USA
| | - Uri Ladabaum
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 300 Pasteur Drive, MC: 5244, Stanford, CA, 94305, USA
| | - Subhas Banerjee
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 300 Pasteur Drive, MC: 5244, Stanford, CA, 94305, USA.
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Purchiaroni F, Conti S, Valerii G, Costamagna G, Riccioni ME. Use of enteroscope without the overtube in incomplete colonoscopies. Scand J Gastroenterol 2020; 55:100-104. [PMID: 31852356 DOI: 10.1080/00365521.2019.1703034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
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.
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Affiliation(s)
- Flaminia Purchiaroni
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Silvia Conti
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giorgio Valerii
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Guido Costamagna
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Elena Riccioni
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
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Pediatric Endoscopy and High-risk Patients: A Clinical Report From the NASPGHAN Endoscopy Committee. J Pediatr Gastroenterol Nutr 2019; 68:595-606. [PMID: 30664560 PMCID: PMC8597353 DOI: 10.1097/mpg.0000000000002277] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Pediatric gastrointestinal endoscopy has been established as safe and effective for diagnosis and management of many pediatric gastrointestinal diseases. Nevertheless, certain patient and procedure factors should be recognized that increase the risk of intra- and/or postprocedural adverse events (AEs). AEs associated with endoscopic procedures can broadly be categorized as involving sedation-related physiological changes, bleeding, perforation, and infection. Factors which may increase patient risk for such AEs include but are not limited to, cardiopulmonary diseases, anatomical airway or craniofacial abnormalities, compromised intestinal luminal wall integrity, coagulopathies, and compromised immune systems. Examples of high-risk patients include patients with congenital heart disease, craniofacial abnormalities, connective tissues diseases, inflammatory bowel disease, and children undergoing treatment for cancer. This clinical report is intended to help guide clinicians stratify patient risks and employ clinical practices that may minimize AEs during and after endoscopy. These include use of CO2 insufflation, endoscopic techniques for maneuvers such as biopsies, and endoscope loop-reduction to mitigate the risk of such complications such as bleeding and intestinal perforation. Endoscopic infection risk and guidance regarding periprocedural antibiotics are also discussed.
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Single Balloon-assisted Colonoscopy for Placement of Colonic Manometry Catheters: Initial Experience in Children. J Pediatr Gastroenterol Nutr 2018; 67:194-197. [PMID: 29570555 DOI: 10.1097/mpg.0000000000001944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Colonic manometry is used frequently in children with long standing and difficult to manage constipation to aid in management decisions. Accurate analysis requires placement of the colonic manometry catheter in the colon without looping. This is technically difficult due to the long-standing nature of the constipation in most patients leading to sigmoid and other colonic redundancy. Single balloon colonoscopy has been successfully used in adult in cases of difficult colonoscopy. We report the first series of single balloon-assisted colonoscopy for performing difficult colonoscopy in children and placing colonic manometry catheters. METHODS Retrospective chart review was performed to identify patients undergoing the procedure. All patients had prior preparation with nasogastric golytely. RESULTS Using the single balloon technique, 36 patients underwent placement of the colonic manometry catheter (ages ranging from 3 to 16 years, weights 12 to 95 kg). Catheter placement was successful in all cases with procedure times of 20 to 105 minutes. No major complications were noted. CONCLUSIONS This is the first reported series of using single balloon-assisted colonoscopy to perform difficult colonoscopy in children and place colonic manometry catheters. It may have other therapeutic implications in children such as removal of polyps or placement of similar catheters.
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Trindade AJ, Lichtenstein DR, Aslanian HR, Bhutani MS, Goodman A, Melson J, Navaneethan U, Pannala R, Parsi MA, Sethi A, Sullivan S, Thosani N, Trikudanathan G, Watson RR, Maple JT. Devices and methods to improve colonoscopy completion (with videos). Gastrointest Endosc 2018; 87:625-634. [PMID: 29454445 DOI: 10.1016/j.gie.2017.12.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 12/22/2017] [Indexed: 02/08/2023]
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Ponte A, Pinho R, Rodrigues A, Proença L, Silva J, Rodrigues JP, Sousa M, Carlos Silva J, Carvalho J. High Efficacy of Repeating Colonoscopy by an Advanced Endoscopist after an Incomplete Colonoscopy. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2018; 25:285-290. [PMID: 30480045 DOI: 10.1159/000485803] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 11/28/2017] [Indexed: 12/25/2022]
Abstract
Background and Aims This study aims to evaluate the role of an advanced endoscopist to study the entire colon after an incomplete colonoscopy. Methods All patients with an elective incomplete colonoscopy performed under deep sedation in our department between January 2010 and October 2016 were included. Patients with a colonic stenosis, an inadequate bowel preparation, or a colonoscopy performed without deep sedation were excluded. Included patients were followed up to evaluate if and what type of subsequent examinations (colonoscopy by an advanced endoscopist, single-balloon enteroscopy [SBE], and/or CT colonography) was performed to complete the study of the entire colon. Lesions found during these subsequent examinations were also recorded. Results Ninety-three patients had an incomplete colonoscopy, with no diagnosis of colorectal cancer (CRC) and a high-risk polyp rate of 5.4% (n = 5). Seventy-seven patients with incomplete colonoscopies underwent subsequent examinations, namely CT colonography in 45.5% (n = 35), colonoscopy by an advanced endoscopist in 53.2% (n = 41), and SBE in 13% (n = 10). In the 49 patients who performed either colonoscopy (n = 39) or SBE (n = 10) by an advanced endoscopist, the cecal intubation rate was 100%, and high-risk polyps were found in 26.5% (n = 13) and CRC in 4.1%. CT colonography revealed findings consistent with polyps and CRC in 22.9% (n = 8) and 2.9% (n = 1) of the cases, respectively. Colonoscopy was further repeated in 6 patients with suspected polyps in CT colonography, confirming the initial diagnosis in 5 patients. Conclusions Colonoscopy by an advanced endoscopist achieved cecal intubation in all patients, representing a good choice after an incomplete colonoscopy.
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Affiliation(s)
- Ana Ponte
- Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Rolando Pinho
- Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Adélia Rodrigues
- Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Luísa Proença
- Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Joana Silva
- Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Jaime P Rodrigues
- Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Mafalda Sousa
- Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - João Carlos Silva
- Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - João Carvalho
- Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
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Tan M, Lahiff C, Bassett P, Bailey AA, East JE. Efficacy of Balloon Overtube-Assisted Colonoscopy in Patients With Incomplete or Previous Difficult Colonoscopies: A Meta-analysis. Clin Gastroenterol Hepatol 2017; 15:1628-1630. [PMID: 28433783 DOI: 10.1016/j.cgh.2017.04.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 04/13/2017] [Accepted: 04/14/2017] [Indexed: 02/07/2023]
Affiliation(s)
- Malcolm Tan
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore; Translational Gastroenterology Unit, Experimental Medicine Division, Nuffield Department of Clinical Medicine, John Radcliffe Hospital, University of Oxford, Headington, United Kingdom
| | - Conor Lahiff
- Translational Gastroenterology Unit, Experimental Medicine Division, Nuffield Department of Clinical Medicine, John Radcliffe Hospital, University of Oxford, Headington, United Kingdom
| | - Paul Bassett
- Statsconsultancy, Ltd, Buckinghamshire, United Kingdom
| | - Adam A Bailey
- Translational Gastroenterology Unit, Experimental Medicine Division, Nuffield Department of Clinical Medicine, John Radcliffe Hospital, University of Oxford, Headington, United Kingdom
| | - James E East
- Translational Gastroenterology Unit, Experimental Medicine Division, Nuffield Department of Clinical Medicine, John Radcliffe Hospital, University of Oxford, Headington, United Kingdom.
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Despott EJ, Murino A, Nakamura M, Bourikas L, Fraser C. A prospective randomised study comparing double-balloon colonoscopy and conventional colonoscopy in pre-defined technically difficult cases. Dig Liver Dis 2017; 49:507-513. [PMID: 28314604 DOI: 10.1016/j.dld.2017.01.139] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 12/22/2016] [Accepted: 01/05/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUNDS AND AIM Technically 'difficult' (TD) colonoscopy is associated with incomplete colonoscopy, discomfort and longer procedures. Double-balloon colonoscopy (DBC) may facilitate TD colonoscopy. The primary outcome was to compare the time taken to achieve caecal intubation during conventional colonoscopy (CC) and DBC in patient with a TD colon. METHODS We performed a prospective, randomised study comparing DBC and CC for TD colonoscopy. Patients were screened for parameters predictive of TD colonoscopy using an original scoring system and randomised to DBC or CC. Pain, sedation dose, colonoscopy completeness, time taken for cecal intubation, procedure completion, recovery time and patient satisfaction were recorded. RESULTS Forty-four patients were recruited (DBC=22; CC=22). DBC facilitated total colonoscopy in 22 cases whereas 9 CC procedures were incomplete (P=0.019). Median pre-procedure difficulty scores were equal for both groups (4.0 vs. 4.0). Mean patient discomfort, pain scores and recovery time were significantly lower for the DBC group (2.3 vs. 5.5, P=0.001; 2.0 vs. 5.9, P=0.005; 5 vs. 20min, P=0.014 respectively). Mean time taken for cecal intubation was similar (17.5 vs. 14min, P=0.18); CONCLUSION: DBC facilitates colonoscopy completion and may be a more comfortable alternative to CC for TD cases although the time taken to achieve caecal intubation was similar.
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Affiliation(s)
- Edward J Despott
- Royal Free Unit for Endoscopy and Centre for Gastroenterology, UCL Institute for Liver and Digestive Health, Royal Free NHS Foundation Trust, London, United Kingdom; Wolfson Unit for Endoscopy, St Mark's Hospital and Academic Institute, Imperial College London, London, United Kingdom.
| | - Alberto Murino
- Royal Free Unit for Endoscopy and Centre for Gastroenterology, UCL Institute for Liver and Digestive Health, Royal Free NHS Foundation Trust, London, United Kingdom; Wolfson Unit for Endoscopy, St Mark's Hospital and Academic Institute, Imperial College London, London, United Kingdom
| | - Masanao Nakamura
- Wolfson Unit for Endoscopy, St Mark's Hospital and Academic Institute, Imperial College London, London, United Kingdom; Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Leonidas Bourikas
- Wolfson Unit for Endoscopy, St Mark's Hospital and Academic Institute, Imperial College London, London, United Kingdom; Department of Gastroenterology, Creta Interclinic, Heraklion, Crete, Greece
| | - Chris Fraser
- Wolfson Unit for Endoscopy, St Mark's Hospital and Academic Institute, Imperial College London, London, United Kingdom; Department of Gastroenterology, The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
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Abstract
A thorough and complete colonoscopy is critically important in preventing colorectal cancer. Factors associated with difficult and incomplete colonoscopy include a poor bowel preparation, severe diverticulosis, redundant colon, looping, adhesions, young and female patients, patient discomfort, and the expertise of the endoscopist. For difficult colonoscopy, focusing on bowel preparation techniques, appropriate sedation and adjunct techniques such as water immersion, abdominal pressure techniques, and patient positioning can overcome many of these challenges. Occasionally, these fail and other alternatives to incomplete colonoscopy have to be considered. If patients have low risk of polyps, then noninvasive imaging options such as computed tomography (CT) or magnetic resonance (MR) colonography can be considered. Novel applications such as Colon Capsule™ and Check-Cap are also emerging. In patients in whom a clinically significant lesion is noted on a noninvasive imaging test or if they are at a higher risk of having polyps, balloon-assisted colonoscopy can be performed with either a single- or double-balloon enteroscope or colonoscope. The application of these techniques enables complete colonoscopic examination in the vast majority of patients.
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Asayama N, Oka S, Tanaka S, Sumimoto K, Hirano D, Tamaru Y, Ninomiya Y, Shigita K, Hayashi N, Nishiyama S, Chayama K. Clinical usefulness of a single-use splinting tube for poor endoscope operability in deep colonic endoscopic submucosal dissection. Endosc Int Open 2016; 4:E614-7. [PMID: 27556066 PMCID: PMC4993897 DOI: 10.1055/s-0042-105434] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 03/07/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Poor endoscope operability remains a significant challenge during colorectal endoscopic submucosal dissection (ESD). We retrospectively evaluated the experience and clinical usefulness of a new single-use splinting tube in deep colonic ESD in the setting of poor scope operability. PATIENTS AND METHODS Among 691 patients with colorectal tumors treated with ESD at Hiroshima University Hospital between November 2009 and July 2015, we analyzed 20 consecutive patients who underwent deep colonic ESD using a single-use splinting tube because of poor scope operability. Poor operability was defined as paradoxical movement of the endoscope, poor control with adhesions, and lesion motion with heartbeat or breathing. Technical and clinical success rates and adverse events were assessed. RESULTS Paradoxical movement and poor control with adhesions were improved in all cases using the single-use splinting tube. The en bloc resection rate was 95 % (19/20) and histological en bloc resection rate was 100 % (20/20). There were no complications related to use of the splinting tube. CONCLUSIONS Use of a single-use splinting tube helped to overcome poor scope operability in deep colonic ESD.
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Affiliation(s)
- Naoki Asayama
- Departments of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Shiro Oka
- Departments of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan ,Corresponding author Shiro Oka Department of EndoscopyHiroshima University1-2-3 Kasumi, Minami-kuHiroshima 734-8551Japan+81-82-257-5939
| | - Shinji Tanaka
- Departments of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Kyoku Sumimoto
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Daiki Hirano
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Yuzuru Tamaru
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Yuki Ninomiya
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Kenjiro Shigita
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Nana Hayashi
- Departments of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Soki Nishiyama
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Kazuaki Chayama
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
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Bick BL, Vemulapalli KC, Rex DK. Regional center for complex colonoscopy: yield of neoplasia in patients with prior incomplete colonoscopy. Gastrointest Endosc 2016; 83:1239-44. [PMID: 26584785 DOI: 10.1016/j.gie.2015.10.053] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 10/29/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Incomplete colonoscopy increases the risk of incident proximal colon cancer postcolonoscopy. Incomplete colonoscopy is often followed by barium enema or CT colonography. We sought to describe the yield of completion colonoscopy in a regional center for complex colonoscopy. METHODS This is a retrospective cohort study of 520 consecutive patients referred to a single colonoscopist over a 14-year period for completion colonoscopy after a previous incomplete examination. RESULTS Colonoscopy was completed to the cecum in 506 of 520 patients (97.3%). A total of 913 conventional adenomas was removed in 277 patients (adenoma detection rate 53.3%). There were 184 adenomas ≥ 1 cm in size or with advanced pathology. There were 525 serrated-class lesions removed in 175 patients, including 54 sessile serrated polyps in 26 patients and 41 hyperplastic polyps greater than 1 cm in 26 patients. Nine colorectal cancers were found. We estimated that approximately 57% of the conventional adenomas, 58% of the sessile serrated polyps, 27% of the hyperplastic polyps, and all 9 cancers detected by the completion colonoscopy were beyond the extent of the previous examination. CONCLUSIONS The yield of completion colonoscopy in a cohort of patients with previous failed cecal intubation was substantial. Regional centers for complex colonoscopy can provide high rates of cecal intubation in cases of incomplete colonoscopy and high yields of lesions in these cases. The regional center for complex colonoscopy is an important medical service.
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Affiliation(s)
- Benjamin L Bick
- Department of Medicine, Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Krishna C Vemulapalli
- Department of Medicine, Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Douglas K Rex
- Department of Medicine, Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Sulz MC, Frei R, Semadeni GM, Sawatzki M, Borovicka J, Meyenberger C. The role of single-balloon colonoscopy for patients with previous incomplete standard colonoscopy: Is it worth doing it? Surg Endosc 2015; 30:1876-82. [PMID: 26183958 DOI: 10.1007/s00464-015-4405-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Accepted: 07/02/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND 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. METHODS 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. RESULTS The study included 100 consecutive patients (median age 70 years; range 38-87 years; 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 54 min (range 15-119 min); the median time to reach the cecal pole was 27.5 min (range 4-92 min). 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. CONCLUSIONS 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.
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Affiliation(s)
- Michael Christian Sulz
- Division of Gastroenterology and Hepatology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland.
| | - Remus Frei
- Division of Gastroenterology and Hepatology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
| | - Gian-Marco Semadeni
- Division of Gastroenterology and Hepatology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
| | - Mikael Sawatzki
- Division of Gastroenterology and Hepatology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
| | - Jan Borovicka
- Division of Gastroenterology and Hepatology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
| | - Christa Meyenberger
- Division of Gastroenterology and Hepatology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
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Gan T, Yang JL, Wu JC, Wang YP, Yang L. When and why a colonoscopist should discontinue colonoscopy by himself? World J Gastroenterol 2015; 21:7834-7841. [PMID: 26167083 PMCID: PMC4491970 DOI: 10.3748/wjg.v21.i25.7834] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 04/03/2015] [Accepted: 05/21/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate when and why a colonoscopist should discontinue incomplete colonoscopy by himself.
METHODS: In this cross-sectional study, 517 difficult colonoscope insertions (Grade C, Kudo’s difficulty classification) screened from 37800 colonoscopy insertions were collected from April 2004 to June 2014 by three 4th-level (Kudo’s classification) colonoscopists. The following common factors for the incomplete insertion were excluded: structural obstruction of the colon or rectum, insufficient colon cleansing, discontinuation due to patient’s discomfort or pain, severe colon disease with a perforation risk (e.g., severe ischemic colonopathy). All the excluded patients were re-scheduled if permission was obtained from the patients whose intubation had failed. If the repeat intubations were still a failure because of the difficult operative techniques, those patients were also included in this study. The patient’s age, sex, anesthesia and colonoscope type were recorded before colonoscopy. During the colonoscopic examination, the influencing factors of fixation, tortuosity, laxity and redundancy of the colon were assessed, and the insertion time (> 10 min or ≤ 10 min) were registered. The insertion time was analyzed by t-test, and other factors were analyzed by univariate and multivariate logistic regression.
RESULTS: Three hundred and twenty-two (62.3%) of the 517 insertions were complete in the colonoscope insertion into the ileocecum, but 195 (37.7%) failed in the insertion. Fixation, tortuosity, laxity or redundancy occurred during the colonoscopic examination. Multivariate logistic regression analysis revealed that fixation (OR = 0.06, 95%CI: 0.03-0.16, P < 0.001) and tortuosity (OR = 0.04, 95%CI: 0.02-0.08, P < 0.001) were significantly related to the insertion into the ileocecum in the left hemicolon; multivariate logistic regression analysis also revealed that fixation (OR = 0.16, 95%CI: 0.06-0.39, P < 0.001), tortuosity (OR 0.23, 95%CI: 0.13-0.43, P < 0.001), redundancy (OR = 0.12, 95%CI: 0.05-0.26, P < 0.001) and sex (OR = 0.35, 95%CI: 0.20-0.63, P < 0.001) were significantly related to the insertion into the ileocecum in the right hemicolon. Prolonged insertion time (> 10 min) was an unfavorable factor for the insertion into the ileocecum.
CONCLUSION: Colonoscopy should be discontinued if freedom of the colonoscope body’s insertion and rotation is completely lost, and the insertion time is prolonged over 30 min.
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Jia H, Wang L, Luo H, Yao S, Wang X, Zhang L, Huang R, Liu Z, Kang X, Pan Y, Guo X. Difficult colonoscopy score identifies the difficult patients undergoing unsedated colonoscopy. BMC Gastroenterol 2015; 15:46. [PMID: 25886845 PMCID: PMC4397830 DOI: 10.1186/s12876-015-0273-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 03/23/2015] [Indexed: 12/20/2022] Open
Abstract
Background Many factors have been found to affect the difficulty of colonoscope insertion, such as age, gender, body mass index (BMI), history of abdominal surgery and operator etc. However, a scoring system may be more useful to predict the difficulty during colonoscopy. Methods The individual and procedure-related data of 616 patients undergoing colonoscopy were prospectively collected from December 2013 through February 2014 in Xijing Hospital of Digestive Diseases. Cox regression analysis was used to identify high-risk factors associated with difficulty of colonoscopy. A predicting model with the difficult colonoscopy score (DCS) was developed. Results Total cecum intubation rate was 98.9% (609/616). Advanced age, lower BMI, inexperienced operator and fair or poor sleep quality were identified as independent factors of prolonged insertion time (all p < 0.05), which were used to develop the DCS. Based on the score, patients could be divided into high-risk and low-risk groups with distinct incomplete rates within 10 min (42.0% vs. 16.5%, p < 0.001). Compared with those with DCS ≤ 1, patients with DCS > 1 had increased insertion time (10.6 ± 0.7 min vs. 6.9 ± 0.2 min, p < 0.001) and pain score (1.9 ± 1.5 vs. 1.4 ± 1.4, p = 0.002). More abdominal compression (36.9% vs. 16.8%, p < 0.001) and position change (51.4% vs. 22.6%, p < 0.001) were needed in this group of patients. Conclusion Patients with DCS > 1 had longer insertion time, higher pain score and needed more abdominal compression and position changes. DCS was useful for predicting the difficulty of colonoscope intubation. (ClinicalTrials.gov NCT02105025 05/05/2014). Electronic supplementary material The online version of this article (doi:10.1186/s12876-015-0273-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hui Jia
- Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xian, China.
| | - Limei Wang
- Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xian, China. .,Shannxi Second People's Hospital, Xian, China.
| | - Hui Luo
- Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xian, China.
| | - Shaowei Yao
- Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xian, China.
| | - Xiangping Wang
- Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xian, China.
| | - Linhui Zhang
- Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xian, China.
| | - Rui Huang
- Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xian, China.
| | - Zhiguo Liu
- Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xian, China.
| | - Xiaoyu Kang
- Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xian, China.
| | - Yanglin Pan
- Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xian, China.
| | - Xuegang Guo
- Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xian, China.
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Double-balloon endoscopy: an effective rescue procedure after incomplete conventional colonoscopy. Eur J Gastroenterol Hepatol 2014; 26:519-22. [PMID: 24584269 DOI: 10.1097/meg.0000000000000067] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE A significant percentage of colonoscopies remain incomplete because of a failure to intubate the caecum. By double-balloon endoscopy (DBE), originally developed for deep enteroscopy, an otherwise incomplete examination of the colon might be completed. We evaluated the success rate of caecal intubation, the reasons for its failure and the therapeutic consequences of using DBE after incomplete conventional colonoscopy. METHODS We report our single-centre experience of using DBE to complete an otherwise incomplete colonoscopy. A total of 114 consecutive patients, 45 male and 69 female, with a mean age of 64.8 years, who had undergone 116 procedures, were evaluated retrospectively by a review of their medical records. RESULTS The main causes for failed caecal intubation using a conventional colonoscope were loop formation in 70 patients (61.4%) and an adhesive angulated sigmoid in 33 (28.9%). Caecal intubation by DBE was successful in 101 patients (88.6%). The rate of failure was not associated with the cause of failure of the previous colonoscopy. In 55 patients (48.2%) a relevant new diagnosis was made in the previously inaccessible part of the colon: carcinoma (n=4; 3.5%), one or more adenomas (n=48; 42.1%) and caecal flat hyperplastic polyps (n=4; 3.5%). Endoscopic polypectomy was performed in 51 patients (44.7%); two complications occurred, both being mild postpolypectomy bleedings. In seven patients (6.1%) a subsequent surgical resection was performed. CONCLUSION Colonoscopy by DBE was useful in most patients in whom conventional colonoscopy was incomplete, irrespective of the cause of the failure. In nearly half the patients, a relevant new diagnosis was made with therapeutic consequences.
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21
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Gawron AJ, Veerappan A, Keswani RN. High success rate of repeat colonoscopy with standard endoscopes in patients referred for prior incomplete colonoscopy. BMC Gastroenterol 2014; 14:56. [PMID: 24679009 PMCID: PMC3986859 DOI: 10.1186/1471-230x-14-56] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 03/21/2014] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND In 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. METHODS We 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. RESULTS Cecal 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). CONCLUSIONS Repeat 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.
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Affiliation(s)
| | | | - Rajesh N Keswani
- Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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22
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Colonoscopy with magnetic control system to navigate the forepart of colonoscope shortens the cecal intubation time. Surg Endosc 2014; 28:2480-3. [PMID: 24648105 DOI: 10.1007/s00464-014-3460-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Accepted: 01/21/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Colonoscopy is considered the most effective method for diagnosing colorectal diseases, but its application is sometimes limited due to invasiveness, patient intolerance, and the need for sedation. OBJECTIVE The aim of this study was to improve the problem of loop formation and shorten the cecal intubation time of colonoscopy by using a magnetic control system (MCS). METHODS Two experienced gastroenterologists, three trainees, and a novice repeated colonoscopy without or with MCS on three colonoscopy training model simulator cases. These cases were divided into introductory (case 2) and challenging levels (cases 4 and 5). The cecal intubation times were recorded. RESULTS For all cases, the average cecal intubation times for the experienced gastroenterologists with MCS were significantly shorter than without MCS (case 2: 52.45 vs. 27.65 s, p < 0.001; case 4: 166.7 vs. 120.55 s, p < 0.01; case 5: 130.35 vs. 100.2 s, p < 0.05). Those of the trainees also revealed significantly shorter times with MCS (case 2: 67.27 vs. 51 s, p < 0.01; case 4: 253.27 vs. 170.97 s, p < 0.001; case 5: 144.1 vs. 85.57 s, p < 0.001). CONCLUSION Conducting colonoscopy with MCS is safe and smooth, and shortens the cecal intubation time by navigating the forepart of the colonoscope. In addition, all diagnostic and therapeutic benefits of conventional colonoscopy are retained.
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Yamada A, Watabe H, Takano N, Togo G, Yamaji Y, Yoshida H, Kawabe T, Omata M, Koike K. Utility of single and double balloon endoscopy in patients with difficult colonoscopy: A randomized controlled trial. World J Gastroenterol 2013; 19:4732-4736. [PMID: 23922470 PMCID: PMC3732845 DOI: 10.3748/wjg.v19.i29.4732] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 04/15/2013] [Accepted: 05/17/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare the utility of single-balloon colonoscopy (SBC) or double-balloon colonoscopy (DBC) for difficult colonoscopies.
METHODS: Between August 2008 and June 2010, patients in whom total colonoscopy failed within 30 min of insertion were assigned randomly to undergo either SBC or DBC. No sedatives were used. After the endoscopy, all patients were asked to evaluate pain during the procedure on a 10-point analog scale (1 = no pain; 10 = worst imaginable pain) with a questionnaire. The study outcomes were the cecal intubation rate and time, endoscopic findings, complications, and pain score.
RESULTS: The SBC and DBC groups included 11 and 10 patients, respectively. All but one SBC patient achieved total colonoscopy successfully. The cecal intubation times were 18 min (range: 10-85 min) and 12.8 min (range: 9.5-42 min) in the SBC and DBC groups, respectively (P = 0.17). No difference was observed in the prevalence of colon polyps between the SBC and DBC groups (45% vs 30%, P = 0.66). SBC showed advanced colon cancer in the ascending colon, which was inaccessible using conventional colonoscopy. The respective pain scores were 5 (1-10) [median (range)] and 5 (1-6) in the SBC and DBC groups (P = 0.64). No complications were noted in any patient.
CONCLUSION: The utility of single- and double-balloon endoscopy for colonoscopy seems comparable in patients with incomplete colonoscopy using a conventional colonoscope.
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Renewed attention for overtube-assisted colonoscopy to prevent incomplete endoscopic examination of the colon. Dis Colon Rectum 2013; 56:1013-8. [PMID: 23838871 DOI: 10.1097/dcr.0b013e3182962636] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Colonoscopy is the standard examination to detect mucosal pathology in the colon. However, failure to complete colonoscopy may reach more than 10% in population-based endoscopy practices. The reasons for incomplete conventional colonoscopy are diverse and result in missed diagnosis of colonic polyps and carcinoma. OBJECTIVE Recent endoscopic developments have shown that the use of specialized overtubes may help to reach the cecum in the case of a difficult colonoscopy, even with less discomfort. Several types of overtubes are currently available, whereas other types are being developed and clinically evaluated. The current review highlights the development of overtubes for colonoscopy and the available clinical data on overtube-assisted colonoscopy in the case of incomplete conventional colonoscopy. DATA SOURCES Data were derived from a PubMed search through November 2012. STUDY SELECTION Available clinical literature data on recent developments in overtube-assisted colonoscopy were studied. INTERVENTION A descriptive comparison was made of currently available endoscopy systems used for overtube-assisted colonoscopy. MAIN OUTCOME MEASURES The primary outcomes measured were the feasibility and safety of different endoscopy systems to perform overtube-assisted colonoscopy. RESULTS Several overtube-assisted colonoscopy systems have recently been developed to complete colonoscopy in the case of difficult conventional colonoscopy. Literature data show excellent feasibility to reach the cecum with very low complication rates and good patient tolerance for the different overtube systems. LIMITATIONS The majority of available studies are uncontrolled case series describing 7 to 110 patients undergoing overtube-assisted colonoscopy with only 1 direct comparison between 2 overtube systems. CONCLUSIONS Overtube-assisted colonoscopy has been shown to be useful in performing colonoscopy by increasing the cecal intubation rate and patient tolerance and by decreasing the need for sedation. There is no standardized superior overtube system at this moment.
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Impact of an incomplete colonoscopy referral program on recommendations after incomplete colonoscopy. Dig Dis Sci 2013; 58:1849-55. [PMID: 23456503 DOI: 10.1007/s10620-013-2605-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 02/14/2013] [Indexed: 01/14/2023]
Abstract
BACKGROUND There are limited data on recommendations and adherence to complete colon evaluation (CCE) after incomplete colonoscopy (IC). AIMS Our objectives were to (1) identify recommendations and adherence to recommendations after IC, (2) determine the diagnostic yield of CCE after IC, and (3) determine the effect of an IC referral program on recommendations for CCE. METHODS We conducted a retrospective review of IC procedures at a teaching hospital over two time periods (January 1 to May 1 2004 and July 1 to November 1 2010). A referral process for repeat colonoscopy after IC was instituted in April 2009. Outcomes included (1) recommendations (2) adherence, and (3) yield of CCE after IC. RESULTS A total of 222 patients underwent at least one IC (overall rate of 2.5 %). In 120 patients (54.1 %), CCE was recommended within 1 year; the rate did not change from 2004 to 2010. Patients with IC due to poor preparation were more likely to have specific CCE recommendations (85.5 vs. 72.2 %, P = 0.03) and recommendations of endoscopic follow-up (76.3 vs. 10.4 %, P < 0.0001) than those with IC due to difficult anatomy. When IC was due to difficult colonoscopy, there was increase in endoscopic follow-up recommended (16.3 vs. 2.8 %, P = 0.01) in 2010 compared to 2004. Adherence to recommendations was similar regardless of modality recommended, inpatient/outpatient status, polyps on initial exam, or extent of initial exam. Polyp detection rate was greater utilizing colonoscopy than barium enema (34.3 vs. 3.6 %, P < 0.0001). CONCLUSIONS There is a lack of consensus in management strategies for patients after IC. Implementation of a referral program has had minimal impact on provider recommendations.
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Kobayashi K, Mukae M, Ogawa T, Yokoyama K, Sada M, Koizumi W. Clinical usefulness of single-balloon endoscopy in patients with previously incomplete colonoscopy. World J Gastrointest Endosc 2013; 5:117-121. [PMID: 23515370 PMCID: PMC3600547 DOI: 10.4253/wjge.v5.i3.117] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 12/04/2012] [Accepted: 01/24/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the clinical usefulness of single-balloon endoscopy (SBE) in patients in whom a colonoscope was technically difficult to insert previously.
METHODS: The study group comprised 15 patients (8 men and 7 women) who underwent SBE for colonoscopy (30 sessions). The number of SBE sessions was 1 in 7 patients, 2 in 5 patients, 3 in 1 patient, 4 in 1 patient, and 6 in 1 patient. In all patients, total colonoscopy was previously unsuccessful. The reasons for difficulty in scope passage were an elongated colon in 6 patients, severe intestinal adhesions after open surgery in 4, an elongated colon and severe intestinal adhesions in 2, a left inguinal hernia in 2, and multiple diverticulosis of the sigmoid colon in 1. Three endoscopists were responsible for SBE. The technique for inserting SBE in the colon was basically similar to that in the small intestine. The effectiveness of SBE was assessed on the basis of the success rate of total colonoscopy and the presence or absence of complications. We also evaluated the diagnostic and treatment outcomes of colonoscopic examinations with SBE.
RESULTS: Total colonoscopy was successfully accomplished in all sessions. The mean insertion time to the cecum was 22.9 ± 8.9 min (range 9 to 40). Abnormalities were found during 21 sessions of SBE. The most common abnormality was colorectal polyps (20 sessions), followed by radiation colitis (3 sessions) and diverticular disease of the colon (3 sessions). Colorectal polyps were resected endoscopically in 15 sessions. A total of 42 polyps were resected endoscopically, using snare polypectomy in 32 lesions, hot biopsy in 7 lesions, and endoscopic mucosal resection in 3 lesions. Fifty-six colorectal polyps were newly diagnosed on colonoscopic examination with SBE. Histopathologically, these lesions included 2 intramucosal cancers, 42 tubular adenomas, and 2 tubulovillous adenomas. The mean examination time was 48.2 ± 20.0 min (range 25 to 90). Colonoscopic examination or endoscopic treatment with SBE was not associated with any serious complications.
CONCLUSION: SBE is a useful and safe procedure in patients in whom a colonoscope is technically difficult to insert.
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Single- versus double-balloon-assisted colonoscopy after previous incomplete standard colonoscopy. Dig Dis Sci 2012; 57:2490-2. [PMID: 22833382 DOI: 10.1007/s10620-012-2318-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Accepted: 07/06/2012] [Indexed: 12/22/2022]
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Vemulapalli KC, Rex DK. Water immersion simplifies cecal intubation in patients with redundant colons and previous incomplete colonoscopies. Gastrointest Endosc 2012; 76:812-7. [PMID: 22901988 DOI: 10.1016/j.gie.2012.05.033] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Accepted: 05/23/2012] [Indexed: 12/19/2022]
Abstract
BACKGROUND Interest in effective ways to complete colon examinations in patients who had previously undergone failed colonoscopies has increased recently. OBJECTIVE To determine whether water immersion decreased the need for ancillary equipment to achieve cecal intubation in patients who had previously undergone incomplete colonoscopies. DESIGN Retrospective cohort study. SETTING Tertiary academic center. PATIENTS A total of 345 consecutive patients referred to a tertiary center for the indication of a previous incomplete colonoscopy. INTERVENTIONS Colonoscopy with or without water immersion insertion. MAIN OUTCOME MEASUREMENTS Cecal intubation rates, type of equipment, and maneuvers used. RESULTS Cecal intubation was achieved in 332 of 345 patients (96.2%) and was similar in those with and without water immersion (170/178, 95.5% vs 162/167, 97%, P = .58). An external straightening device was used in 6 of 178 cases with water immersion (3.4%) compared with 25 of 168 cases with air insufflation (15%) (P < .0001). Among patients with a redundant colon as the sole cause of previously incomplete examinations, water immersion required an external straightener in 7% compared with 37% with air insufflation during insertion (P < .0001), and position change was required in 5% of those with water immersion compared with 22% with air insufflation (P = .01). LIMITATIONS Retrospective review; single-center, single-endoscopist study. CONCLUSION Water immersion decreases the need for external straightening devices and position change maneuvers in patients with redundant colons and previously incomplete colonoscopies.
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Affiliation(s)
- Krishna C Vemulapalli
- Department of Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Dzeletovic I, Harrison ME, Pasha SF, Crowell MD, Decker GA, Gurudu SR, Leighton JA. Comparison of single- versus double-balloon assisted-colonoscopy for colon examination after previous incomplete standard colonoscopy. Dig Dis Sci 2012; 57:2680-6. [PMID: 22615017 DOI: 10.1007/s10620-012-2227-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Accepted: 04/30/2012] [Indexed: 02/06/2023]
Abstract
BACKGROUND 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. AIM To compare the completion rates of SBC and DBC in patients with previous incomplete conventional colonoscopy. METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Ivana Dzeletovic
- Division of Gastroenterology and Hepatology, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ 85259, USA.
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Teshima CW, May G. Small bowel enteroscopy. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2012; 26:269-75. [PMID: 22590700 PMCID: PMC3352842 DOI: 10.1155/2012/571235] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2011] [Accepted: 07/25/2011] [Indexed: 12/17/2022]
Abstract
Over the past decade, the advent of capsule endoscopy and balloon-assisted enteroscopy has revolutionized the approach to small intestinal diseases. The small bowel is no longer out of reach, and has fallen within the diagnostic and therapeutic realm of the gastrointestinal endoscopist. Double-balloon enteroscopy was the first type of balloon-assisted endoscopy and is the method for which there are the most data. Single-balloon enteroscopy has since been introduced as an alternative balloon-assisted method, followed more recently by the development of spiral overtube-assisted enteroscopy. The purpose of the present article is to review these methods of small bowel enteroscopy and to discuss the latest developments. While the investigation of small bowel diseases cannot be addressed without considering the central role of capsule endoscopy, a detailed assessment is beyond the scope of the present article, and capsule endoscopy will only be discussed as it pertains to enteroscopy.
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Affiliation(s)
- Christopher W Teshima
- Division of Gastroenterology, University of Alberta, Edmonton, Alberta T6G 2X8, Canada.
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Hotta K, Katsuki S, Ohata K, Abe T, Endo M, Shimatani M, Nagaya T, Kusaka T, Matsuda T, Uraoka T, Yamaguchi Y, Murakami Y, Saito Y. 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. [PMID: 22284085 DOI: 10.1016/j.gie.2011.11.020] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Accepted: 11/17/2011] [Indexed: 02/08/2023]
Abstract
BACKGROUND 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. OBJECTIVE To demonstrate the effectiveness and safety of using short DBEs in patients who previously underwent incomplete colonoscopies. DESIGN A multicenter, prospective trial. SETTING Four tertiary care academic centers and 6 community hospitals. PATIENTS 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. INTERVENTION Total colonoscopies using short DBEs were attempted in all patients. MAIN OUTCOME MEASUREMENTS Primary endpoint was the cecal intubation rate. Secondary endpoints were time to cecal intubation, complications, and tolerability. RESULTS 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. LIMITATION Uncontrolled trial. CONCLUSION The use of a short DBE is an effective and safe method for total colonoscopy in patients who previously underwent incomplete colonoscopies. ( CLINICAL TRIAL REGISTRATION NUMBER UMIN3464.).
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Affiliation(s)
- Kinichi Hotta
- Department of Gastroenterology, Saku Central Hospital, Saku, Japan
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Arai Y, Kato T, Arihiro S, Itagaki M, Komoike N, Odagi I, Saruta M, Matsuoka M, Suzuki T, Tajiri H. Utility of single balloon enteroscopy (SBE) for difficult cases of total colonoscopy. JOURNAL OF INTERVENTIONAL GASTROENTEROLOGY 2012; 2:12-14. [PMID: 22586543 DOI: 10.4161/jig.20127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 08/07/2011] [Accepted: 12/20/2011] [Indexed: 12/22/2022]
Abstract
Balloon enteroscopy (BE) was originally developed for observation of the deep small intestine, and has recently been utilized for difficult cases of total colonoscopy due to reasons such as adhesions and elongation. In this report, we present our experience with single balloon enteroscopy (SBE) to facilitate successful colonoscopy when standard techniques failed. In two cases, early colon cancers were detected in the cecum by SBE and were removed endoscopically or surgically. A third case is discussed in which SBE was attempted but was ultimately not successful. In that case, total colonoscopy was not performed because of looping in the sigmoid and transverse colon. A fourth case in which SBE was performed in order to remove colonic gas in a patient with megacolon. In that case, total colonoscopy could not be completed because the SBE balloon could not "grab" the dilated colon and therefore could not advance. SBE is a useful adjunct to standard colonoscopy in challenging cases, but has limitations and does not always ensure success.
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Affiliation(s)
- Yoshinori Arai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine; The Jikei University School of Medicine, Tokyo, Japan
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Leung FW, Mann SK, Leung JW, Siao-Salera RM, Guy J. The water method is effective in difficult colonoscopy - it enhances cecal intubation in unsedated patients with a history of abdominal surgery. JOURNAL OF INTERVENTIONAL GASTROENTEROLOGY 2011; 1:172-176. [PMID: 22586531 DOI: 10.4161/jig.19960] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2011] [Accepted: 01/18/2012] [Indexed: 12/25/2022]
Abstract
BACKGROUND: Colonoscopy in unsedated patients in the US is considered to be difficult. Success rate of cecal intubation is limited by discomfort. Colonoscopy in patients with a history of abdominal surgery is also considered to be difficult due to adhesion-related bowel angulations. The water method has been shown to significantly reduce pain during colonoscopy. OBJECTIVE: To test the hypothesis that the water method enhances the completion of colonoscopy in unsedated patients with a history of abdominal surgery. DESIGN: The data bases of two parallel RCT were combined and analyzed. SETTING: Two Veterans Affairs endoscopy units. PATIENT AND METHODS: The water and air methods were compared in these two parallel RCT examining unsedated patients. Those with a history of abdominal surgery were selected for evaluation. MAIN OUTCOME MEASUREMENTS: Completion of unsedated colonoscopy. RESULTS: Among patients with a history of abdominal surgery, the proportion completing unsedated colonoscopy in the water group (19 of 22) was significantly higher than that (11 of 22) in the air group (p=0.0217, Fisher's exact test). LIMITATIONS: Small number of predominantly male veterans, unblinded colonoscopists, not all types of abdominal surgery (e.g. hysterectomy, gastrectomy) predisposing to difficult colonoscopy were represented. CONCLUSION: This proof-of-principle assessment confirms that in patients with a history of abdominal surgery the water method significantly increases the proportion able to complete unsedated colonoscopy. The water method deserves to be evaluated in patients with other factors associated with difficult colonoscopy.
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Affiliation(s)
- Felix W Leung
- Gastroenterology, Sepulveda ACC, VAGLAHS, North Hill
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Abstract
Colonoscopy is considered the 'gold standard' for detection and removal of premalignant lesions in the colon. However, studies suggest that colonoscopy is less protective for right-sided than for left-sided colorectal cancer. Optimizing the effectiveness of colonoscopy is a continuous process, and during the past decade several important quality indicators have been defined that can be used to measure the performance of colonoscopy and to identify areas for quality improvement. The quality of bowel preparation can be enhanced by split-dose regimens, which are superior to single-dose regimens. Cecal intubation rates should approximate 95% and can be optimized by good technique. In selected patients, specific devices can be used to facilitate cecal intubation. Adenoma detection rates should be monitored and exceed a minimum of 25% in men and 15% in women. To this aim, optimal withdrawal technique and adequate time for inspection are of utmost importance. Of all advanced imaging techniques, chromoendoscopy is the only technique with proven benefit for adenoma detection. Finally, the technique of polypectomy affects the number of complications as well as the success of completely removing a lesion. In this Review, we provide an overview of both standard and novel colonoscopy techniques and their impact on quality indicators.
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Affiliation(s)
- Yark Hazewinkel
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, PO Box 22700, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands
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Spending less for rescuing a failed colonoscopy. Gastrointest Endosc 2011; 74:451-2; author reply 452-3. [PMID: 21802596 DOI: 10.1016/j.gie.2011.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2011] [Accepted: 04/05/2011] [Indexed: 02/08/2023]
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Jackson CS, Haq T, Olafsson S. Push enteroscopy has a 96% cecal intubation rate in colonoscopies that failed because of redundant colons. Gastrointest Endosc 2011; 74:341-6. [PMID: 21689815 DOI: 10.1016/j.gie.2011.04.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Accepted: 04/14/2011] [Indexed: 01/13/2023]
Abstract
BACKGROUND Performing a complete colonoscopy to the cecum is important for ruling out malignancy and other lesions, but failure rates are significant with a standard colonoscope. A previous study using a push enteroscope for failed colonoscopies had a completion rate of 68.7%. OBJECTIVE To improve the cecal intubation rate by using a newer version of a push enteroscope. DESIGN Retrospective study at first, then a prospective study. SETTING Single-center veterans health care system. PATIENTS A total of 47 patients in whom the cecum was not reached with a regular adult colonoscope between January 2007 and December 2010 were included. Those with poor bowel preparation were excluded. INTERVENTIONS Repeat colonoscopy using a new version of a push enteroscope. MAIN OUTCOME MEASUREMENTS The rate of cecal intubation and additional pathological findings. RESULTS The cecum or terminal ileum was reached in 45 patients (96%). Additional significant pathological findings in the previously unexamined colon were seen in 18 patients (38%). LIMITATIONS Small sample size, lack of comparison with other endoscopes. CONCLUSIONS Colonoscopy with a push enteroscope could be advanced to either the terminal ileum or cecum in 96% of patients, which is one of the highest known completion rates in patients in whom colonoscopy failed. Clinical management changed in all patients with additional findings.
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Affiliation(s)
- Christian S Jackson
- VA Loma Linda Healthcare System, Loma Linda University Medical Center, Loma Linda, California, USA
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Hollerbach S. Caught in the colon: breaking the chains. Gastrointest Endosc 2011; 73:513-4. [PMID: 21353847 DOI: 10.1016/j.gie.2010.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Accepted: 11/04/2010] [Indexed: 02/08/2023]
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