Cecal Intubation Rates, Techniques, and Neoplasia Yields Associated With Repeat Colonoscopy Performed With Standard...

Cecal intubation rate of ≥95% is a key quality metric for colonoscopy. After incomplete colonoscopy, patients are often referred for radiographic studies or to centers performing balloon enteroscopy. We aimed to determine the success of repeat colonoscopy with standard nonballoon endoscopes after a failed colonoscopy.

We reviewed 1,334 consecutive patients referred to our center after colonoscopy with failed cecal intubation. Based on the outside procedure report, we classified causes of previous failure as difficult sigmoid, redundant colon, or hernia. We reviewed success rates of cecal intubation at our center, tools and techniques used in successful cases, and the sensitivity of outside radiographic studies performed before referral.

We achieved cecal intubation rate in 96.3% of cases-96.7% in 642 difficult sigmoid colons, 97.1% in 661 redundant colons, and 67.7% in 31 hernia cases (100% in left inguinal, 28.6% in ventral hernia). Most difficult sigmoid cases were completed with pediatric or ultrathin colonoscopes. Most redundant colon cases were completed with adult colonoscopes. Twenty of 32 lesions ≥20 mm in size found on colonoscopy were not identified by previous radiographic studies.

In the largest reported series of colonoscopies performed for previous incomplete examinations, we found nearly all cases, except a ventral hernia containing transverse colon, could be completed using standard endoscopic equipment and techniques. In this setting, radiographic studies have low sensitivity for large polyps. We recommend repeat colonoscopy at a referral center or using techniques described herein should be the first approach to a previous incomplete colonoscopy.