Colonoscopy technique in consecutive patients referred for prior incomplete colonoscopy

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.

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.

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.

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.