Routine colonoscopy with a standard gastroscope. A randomized comparative trial in a western population

Colorectal cancer screening increased the workload of colonoscopic procedures in endoscopic units. Recent developments advocated the use of smaller and more flexible scopes to achieve the goal of a complete examination to the cecum. Therefore, the use of an upper GI scope for colonoscopy can be considered.

Six-hundred and fifty consecutive patients (age, 64 +/- 20 years, 395 women) undergoing routine colonoscopy were examined with either a standard colonoscope or an upper GI scope in randomized order. In case of an incomplete examination, colonoscopy was repeated with the alternative instrument in the same session. All patients underwent bowel preparation with 4 1 of a polyethylene glycol solution, and the examinations were performed under conscious sedation (midazolam and pethidine i.v.) by a single investigator.

Because of insufficient colonic preparation or refusal to participate, 28 patients had to be excluded. Both groups (colonoscope group, n = 315, upper GI scope group, n = 307) were well comparable with respect to their demographic data, previous abdominal surgery, the presence of diverticulosis, and the number of former colonoscopic examinations, respectively. Successful cecum intubation was achieved in 96% of the cases in the colonoscope group and in 93% of the patients from the upper GI scope group (p = 0.82). However, the time until the cecum was reached was prolonged to 8.7 +/- 2.4 min when using the upper GI scope compared with 8.2 +/- 2.3 min in the colonoscope group (p = 0.006). In the colonoscope group, a switch to the upper GI scope enables a complete colonoscopy in all but three cases (11/14, 79%) whereas this aim was only achieved vice versa in the upper GI scope group (using a colonoscope) in 7 of 21 patients (33%, p = 0.04).

Routine colonoscopy can be performed effectively with standard upper GI scopes in a western population if no colonoscope is available.