Quality of air contrast barium enema performed the same day as incomplete colonoscopy with air insufflation

Magnifying gastroscopy using a soft black hood for difficult colonoscopy

BACKGROUND

Various methods are reported as aids to cecal intubation for cases in which colonoscopy is difficult. This study aimed to investigate prospectively whether a gastroscope with magnification function, narrow-band imaging (NBI), and a soft black hood can aid insertion in cases of difficult colonoscopy and facilitate both accurate diagnosis and safe treatment.

METHODS

This prospective study recruited 177 patients. All were examined with a magnifying gastroscope. A commercially available soft black hood was attached to the gastroscope during insertion and magnification. Difficult colonoscopy was anticipated before colonoscopy in cases of patients with at least one of the following factors: low BMI (<20 kg/m(2)), adhesion due to previous surgery, or previous colonoscopy that could not reach to the cecum. The success rate and duration of cecal intubation then were assessed. All detected lesions were evaluated by magnifying NBI and then classified as non-neoplastic or neoplastic for endoscopic diagnosis. Subsequently, all the lesions were removed and examined histologically for comparison.

RESULTS

The overall success rate of cecal intubation was 100% (177/177), and the mean time taken to reach the cecum was 5.9 min. A total of 156 lesions were detected endoscopically, and the overall diagnostic accuracy of NBI with magnification was 98.7%. No associated complications occurred.

CONCLUSION

Magnifying gastroscopy using a soft black hood and NBI is useful for cecal intubation in cases wherein colonoscopy is difficult, facilitating accurate diagnosis and safe treatment.

Spiral overtube-assisted colonoscopy after incomplete colonoscopy in the redundant colon

BACKGROUND

A redundant colon can lead to incomplete colonoscopy. A variety of tools and techniques are available to complete colonoscopy but have limitations.

OBJECTIVE

To determine the feasibility and safety of using a spiral overtube to complete a difficult colonoscopy.

DESIGN

Retrospective review of a prospectively collected database.

SETTING

Single tertiary institution.

PATIENTS

Twenty-four patients with incomplete colonoscopy because of redundant colons underwent 26 procedures. The median age was 68 years, and 58% were men.

INTERVENTIONS

All patients underwent colonoscopy performed with a 90-cm flexible threaded overtube and a variable-stiffness pediatric colonoscope. Four individuals (18%) required exchanging the colonoscope for an enteroscope.

MAIN OUTCOME MEASUREMENTS

Successful cecal intubation, polyp identification and removal, time to reach the cecum, sedation needed, and complications.

RESULTS

Cecal intubation was achieved in 22 patients (92%). Failures occurred in 2 patients with large hernias. The median time from insertion of the colonoscope to reaching the cecum was 14.5 minutes. All procedures were performed by using conscious sedation with midazolam (median dose 7 mg) and fentanyl (median dose 150 μg). Significant findings were encountered in 17 of 22 patients (77%) including 1 cancer and 2 advanced polyps. A median of 3 polyps was removed from each patient who had polyps. All noncancerous polyps were removed during the procedure. There were no complications.

LIMITATIONS

Retrospective design, no control group, single center.

CONCLUSION

Spiral overtube-assisted colonoscopy can enable cecal intubation in the majority of patients in whom standard colonoscopy fails because of a redundant colon.

Colonoscopy technique in consecutive patients referred for prior incomplete colonoscopy

BACKGROUND & AIMS

Cecal intubation is one of the goals of colonoscopy. In some patients cecal intubation is unsuccessful. The aim of this study was to describe the approach used by a gastroenterologist with special interest in colonoscopy to perform colonoscopy in patients with a prior incomplete colonoscopy.

METHODS

The demographic features and colonoscopy methods and findings are described in 119 consecutive patients in whom a prior incomplete colonoscopy was performed by a gastroenterologist or surgeon.

RESULTS

Most patients could be characterized as to the cause of previous failure, based on medical records or an initial attempt to pass the colonoscope, as redundant colon (n = 54), difficult sigmoid colon (n = 33), or difficult to sedate (n = 8). Colonoscopy was successful to the cecum (n = 116) or an ileocolonic anastomosis (n = 1) in 117 of the 119 patients. Standard adult (n = 51) and pediatric colonoscopes (n = 35) and attention to careful technique were successful in 86 cases, although these included 7 cases in which the use of propofol sedation appeared to be the critical factor allowing success. Special equipment was needed in 31 cases: external straighteners (n = 9), upper endoscopes alone (n = 9), pediatric colonoscope after guidewire exchange (n = 8), and an enteroscope with (n = 4) or without (n = 1) an external straightener.

CONCLUSIONS

Most patients with a prior incomplete colonoscopy can be colonoscoped successfully if an array of tools and techniques are used. The approach varies depending on characterization of the problem as redundant colon vs difficult sigmoid colon. The approach and techniques described here may be of value to others in cases of a difficult or challenging colonoscopy.

Quality of virtual colonoscopy in patients who have undergone radiation therapy or surgery: how successful are we?

OBJECTIVE

In patients who have a history of abdominopelvic radiation, surgery, or both, conventional colonoscopy may fail to examine the entire colon. The purpose of this study is to assess whether high-quality virtual colonoscopy can be achieved in this patient population.

MATERIALS AND METHODS

After colonic cleansing, 61 patients (16 men and 45 women; mean age, 64 years; age range, 27-81 years) underwent 63 virtual colonoscopy examinations after using either single- or multidetector CT (slice thickness, 3.75-5.0 mm; table speed, 1.7-11.25 cm/sec; pitch, 1.5-3.0; and overlapped reconstructions, 1.95-2.5 cm) in supine and prone positions after IV administration of 1 mg of glucagon and rectal air insufflation. Conventional two-dimensional axial images were analyzed on a PACS (picture archiving and communication system) workstation. Two radiologists, who were unaware of patient history, independently evaluated the colonic distention on a 4-point scale (4 = optimal distention) and fluid retention on a 3-point scale (3 = no fluid) for all segments of the colon in patients who were imaged in both the supine and prone positions. Segmental and total average colon scores were calculated.

RESULTS

Forty-one patients (65%; 43 examinations, 67%) underwent prior surgery, radiation, or both (surgery, n = 29; radiation, n = 3; both, n = 11). The average overall colonic distention and fluid retention for this group was 3.13 and 2.38, respectively, versus 3.24 and 2.3 in the control group (p = not significant).

CONCLUSION

High-quality examinations were achieved in patients who had previously undergone radiation, surgery, or both with no clinically significant difference in distention or fluid retention compared with the controls.

Method of colonoscopy in 42 consecutive patients presenting after prior incomplete colonoscopy

OBJECTIVES

Cecal intubation is one of the goals of colonoscopy. We sought to describe the methodology used by a single experienced examiner to perform colonoscopy in a consecutive group of patients with challenging colons.

METHODS

Records of 42 consecutive patients with one or more prior unsuccessful attempts at colonoscopy by a gastroenterologist or surgeon and referred for a repeat attempt at colonoscopy were reviewed.

RESULTS

Colonoscopy was complete to the cecum in 40 of the 42 patients (95%). An array of methods was employed, including propofol sedation (n = 2), pediatric colonoscope (n = 8), an external straightener (n = 9), external straightener with pediatric colonoscope (n = 2), upper endoscope (n = 8), guidewire exchange (n = 3), and enteroscope with a colon straightener (n = 1) or an enteroscope straightener (n = 1).

CONCLUSIONS

A variety of methods and instruments were employed to achieve a high cecal intubation rate during colonoscopy in a group of patients with prior incomplete colonoscopies. Others may find one or more of these methods useful in patients with challenging colons.

Barium enema following incomplete colonoscopy

The purpose of this article is to describe our findings on barium enema in patients who have had incomplete colonoscopy. For patients undergoing colonoscopy and barium enema within 6-months of each other between 1991 and 1997, barium enemas were reevaluated for redundant anatomy as well as lesions. Seventy-seven women and 30 men underwent 108 barium enemas. The most common finding was a redundant colon in 68% (55/81) of study patients, but only 33% (9/27) of control (complete colonoscopy) patients.