Utility of repeat colonoscopy attempt after failed colonoscopy: a systematic review and pooled analysis

Colonoscopy stands out as a reliable tool offering comprehensive visualization of the colon, coupled with the potential for therapeutic intervention. The failure to attain complete colonoscopy heightens the risk of subsequent proximal colon cancer following the procedure. Often, in unsuccessful cecal intubation, the alternative approaches of barium enema or CT colonography are pursued instead of a repeat endoscopic assessment, even though these alternatives do not provide direct visualization or the opportunity for therapeutic intervention. We aimed to conduct a systematic review and meta-analysis to assess the outcomes of repeat colonoscopy after a previous incomplete procedure.

A comprehensive literature search using major databases was conducted, and studies with patients undergoing reattempt endoscopy after a previous failed attempt unrelated to poor bowel preparation were included. Pooled rates were calculated for multiple variables, with a 95% CI, and meta-regression was carried out with statistically significant P < .05. Data were analyzed via Open Meta Analyst software (Center for Evidence-based Medicine, Brown University, Providence, RI, USA).

A total of 26 studies involving 1647 patients (61% female) met the inclusion criteria. The pooled overall cecal intubation rate (CIR) on repeat attempt was 95.7% (95% CI, 94.2%-97.2%), P < .001, I² = 58%; with standard colonoscope, it was 96.2% (95% CI, 94.1%-98.4%); with single-balloon enteroscopy, 96.8% (95% CI, 95%-98.7%); and with double-balloon enteroscopy, 93% (95% CI, 88.7%-97.3%). Meta regression, when controlled for variables including female gender (P = .81) and age (P = .52), did not reveal any significant covariates.

Repeat colonoscopy attempt in cases of incomplete colonoscopy yielded a commendable CIR of 95%. Importantly, this also enables potential therapeutic intervention of neoplasia and adenomas.