Use of a Variable-Stiffness Colonoscope Allows Completion of Colonoscopy after Failure with the Standard Adult Colonoscope

Background and Study Aims: Experts fail to reach the cecum in 2 - 10 % of colonoscopies. The purpose of this case series was to evaluate the efficacy of a small-caliber, variable-stiffness colonoscope in patients with incomplete colonoscopy.
Patients and Methods: The variable-stiffness colonoscope (Olympus America XPCF-140AL) was used by the same examiner to reattempt colonoscopy immediately in all patients in whom colonoscopy to the cecum with the standard colonoscope was incomplete.
Results: Sixteen of 385 attempted colonoscopies (4.2 %) did not reach the cecum with the standard colonoscope due to looping (n = 12), fixed angulation of the sigmoid colon (n = 3), and diverticulosis (n = 1). The procedures were deemed a failure after a mean of 28 min, despite the use of abdominal pressure and positional change in all patients. Fifteen of the 16 patients (94 %) had a complete colonoscopy with the variable-stiffness colonoscope. One patient had an incomplete colonoscopy with the variable-stiffness colonoscope due to an obstructing mass in the transverse colon that was not reached by the standard colonoscope. With the variable-stiffness colonoscope, the mean time to cecal intubation was 10.3min; four patients (25 %) required a change in patient position, and six patients (37.5 %) required abdominal pressure.
Conclusions: A variable-stiffness colonoscope allowed completion of colonoscopy in all patients without obstruction who had an incomplete colonoscopy with the standard colonoscope. Further study is needed to determine whether the variable-stiffness colonoscope should be used routinely for colonoscopy.

References

• 1 Church J M. Complete colonoscopy: How often? And if not, why not?.  Am J Gastroenterol. 1994;  89 556-560
• 2 Marshall J B, Barthel J S. The frequency of total colonoscopy and terminal ileal intubation in the 1990s.  Gastrointest Endosc. 1993;  39 518-520
• 3 Waye J D, Bashkoff E. Total colonoscopy: Is it always possible?.  Gastrointest Endosc. 1991;  37 152-154
• 4 Lehman G A. Upper and lower gastrointestinal endoscopy: Are thinner endoscopes preferable?.  Endoscopy. 1996;  28 436-437
• 5 Saiffudin T, Trivedi M, King P D. et al . Usefulness of a pediatric colonoscope for colonoscopy in adults.  Gastrointest Endosc. 2000;  51 314-317
• 6 Kozarek R A, Botoman V A, Patterson D J. Prospective evaluation of a small caliber upper endoscope for colonoscopy after unsuccessful standard examination.  Gastrointest Endosc. 1989;  35 333-335
• 7 Bat L, Williams C B. Usefulness of pediatric colonoscopes in adult colonoscopy.  Gastrointest Endosc. 1989;  35 329-332
• 8 Lichtenstein G R, Park P D, Long W B. et al . Use of a push enteroscope improves ability to perform total colonoscopy in previously unsuccessful attempts at colonoscopy in adult patients.  Am J Gastroenterol. 1999;  94 187-190
• 9 Marshall J B. Use of a pediatric colonoscope improves success of total colonoscopy in selected adult patients.  Gastrointest Endosc. 1996;  44 675-678
• 10 Brooker J C, Saunders B P, Shah S G, Williams C B. A new variable stiffness colonoscope makes colonoscopy easier: A randomised controlled trial.  Gut. 2000;  46 801-805
• 11 Howell D A, Ku P M, Desilets D J, Campana J M. A comparative trial of variable stiffness colonoscopes [abstract].  Gastrointest Endosc. 2000;  51 AB58 (abstract 2448)