Comfort and efficacy of a longer and thinner endoscope for average risk colon cancer screening

The aim of this prospective study was to assess patient comfort during nonsedated screening sigmoidoscopy with the use of a standard 60-cm sigmoidoscope compared with a thinner 100-cm upper endoscope. Patients undergoing routine colon cancer screening with sigmoidoscopy were randomly assigned to either a 60-cm sigmoidoscope or a 100-cm upper endoscope. The procedure time, depth of insertion, anatomic landmarks, and presence of polyps were documented. Likert 7-point scales and visual analog scales (VAS) were performed to measure comfort and symptoms immediately after the procedure and again in 1 week. These scales, procedure time, insertion depth, percent reaching transverse colon, and percent with polyps were analyzed. Eighty-one patients were enrolled with 38 in the 100-cm group and 43 in the 60-cm group. Patients in the 100-cm group reported greater comfort on the VAS compared with the 60-cm group (P = .035) as well as less cramping on the initial Likert scale (P = .017). One week later, the 100-cm group reported higher comfort (P = .015) and less bloating (P = .040). Procedure time was longer for the 100-cm group (8.8 versus 5.9 minutes; P = .001). Insertion depth was 74 versus 56 cm (P = .001), and percent reaching splenic flexure was 76% versus 35% (P = .001) in the 100 and 60 cm groups, respectively. More adenomas were found with the 100-cm scope (P = .035). The use of a thinner and longer endoscope is more comfortable than a standard sigmoidoscope. Although a 100-cm endoscope procedure takes longer to perform, it allows better evaluation of the colon and misses fewer adenomas.