© Georg Thieme Verlag KG Stuttgart · New York
Double-balloon colonoscopy after failed conventional colonoscopy: a pilot series with a new instrument
submitted 2 February 2007
accepted after revision 22 June 2007
17 August 2007 (online)
Background and study aims: The endoscopes that were developed for double-balloon enteroscopy have been successfully used in cases of failed colonoscopy. This study was a pilot series in which a new colonoscope was tested that utilized this double-balloon principle.
Patients and methods: A total of 29 patients (5 men, 24 women; mean age 54 years) in whom conventional colonoscopy had failed were included in this study. Both the failed colonoscopy and the double-balloon colonoscopy procedures were performed under general anesthesia, the usual practice in France. A prototype instrument (working length 152 cm, diameter 9.4 mm) designed to incorporate the principles of double-balloon enteroscopy was used. The completeness of colonoscopy was assessed according to conventional criteria by the achievement of a stable position in the cecum. The indicatons for the procedure, the time to reach the cecum, the need for fluoroscopic control, and adverse events were recorded.
Results: The previous colonoscopy failed due adhesions (n = 16), or to long or fixed loops (n = 13). Complete colonoscopy using the balloon method was achieved in 28/29 patients, taking an average time of 18 ± 14 minutes; a long sigmoid loop limited the examination to the left flexure in one patient. Balloon colonoscopy using double-balloon methodology was used in 24 patients and the instrument was used without an overtube (i. e. using a single-balloon technique) in five patients. Fluoroscopy was used in 16 patients to monitor endoscope progression. No complications were reported.
Conclusions: Double-balloon colonoscopy enables full colonic examination in almost all patients with a previous incomplete colonoscopy. The overtube should be used in most cases. The use of fluoroscopic assessment of scope progression could be reduced further with increasing experience.
- 1 Micksche M, Lynge E, Diehl V. et al . and Groupe des Experts Cancérologue de l’Union Européenne. Recommendations on cancer screening in the European Union [in French, no abstract]. Bull Cancer. 2001; 88 687-692
- 2 Anderson J C, Gonzalez J D, Messina C R, Pollack B J. Factors that predict incomplete colonoscopy: thinner is not always better. Am J Gastroenterol. 2000; 95 2784-2787
- 3 Waye J D, Yessayan S A, Lewis B S, Fabry T L. The technique of abdominal pressure in total colonoscopy. Gastrointest Endosc. 1991; 37 147-151
- 4 Belaiche J, van Kemseke C, Louis E. Use of the enteroscope for colo-ileoscopy: low yield in unexplained lower gastrointestinal bleeding. Endoscopy. 1999; 31 298-301
- 5 Marshall J B, Perez R A, Madsen R W. Usefulness of a pediatric colonoscope for routine colonoscopy in women who have undergone hysterectomy. Gastrointest Endosc. 2002; 55 838-841
- 6 Rex D K, Goodwine B W. Method of colonoscopy in 42 consecutive patients presenting after prior incomplete colonoscopy. Am J Gastroenterol. 2002; 97 1148-1151
- 7 Ruffolo T A, Lehman G A, Rex D. Colonoscope damage from internal straightener use. Gastrointest Endosc. 1991; 37 107-108
- 8 Yamamoto H, Kita H, Sugano K.
Other applications of double balloon technique.In: Sugano K, Yamamoto H, Kita H (eds). Double balloon endoscopy. Heidelberg; Springer 2006: 101-113
- 9 May A, Nachbar L, Ell C. Push-and-pull enteroscopy using a single-balloon technique for difficult colonoscopy. Endoscopy. 2006; 38 395-398
- 10 Napoleon B, Ponchon T, Lefebvre R. et al . French Society of Digestive Endoscopy (SFED) guidelines on performing a colonoscopy. Endoscopy. 2006; 38 1152-1155
- 11 Yamamoto H, Sekine Y, Sato Y. et al . Total enteroscopy with a nonsurgical steerable double-balloon method. Gastrointest Endosc. 2001; 53 216-220
- 12 Vucelic B, Rex D, Pulanic R. et al . The Aer-O-Scope: proof of concept of a pneumatic, skill-independent, self-propelling, self-navigating colonoscope. Gastroenterology. 2006; 130 672-677
- 13 Horiuchi A, Nakayama Y, Kajiyama M. et al . Usefulness of a small-caliber, variable-stiffness colonoscope as a backup in patients with difficult or incomplete colonoscopy. Am J Gastroenterol. 2004; 99 1936-1940
- 14 Rösch T, Adler A, Wiedenman B H, Hoepffner N. A prospective pilot study to assess technical performance of a new single use colonoscope with inverted sleeve technology [abstract]. Gastrointest Endosc. 2007; 65 AB340
M. Delvaux, MD
Department of Internal Medicine and Digestive Diseases
Hôpitaux de Brabois Adultes
CHU de Nancy
F-54511 Vandoeuvre les Nancy
Email: [email protected]