Endoscopic management of failed colonoscopy in clinical practice: to change endoscopist, instrument, or both?
Summary of "Endoscopic management of failed colonoscopy in clinical practice: to change endoscopist, instrument, or both?"
Caecal intubation fails up to 20% of colonoscopy in clinical practice. We aimed to assess whether (1) in patients with a prior incomplete colonoscopy with a standard adult colonoscope, a subsequent caecal intubation may be achieved with the same instrument; (2) there are factors predicting a repeated unsuccessful colonoscopy; and (3) how frequently completion can be further achieved by shifting to a standard gastroscope. MATERIALS AND
Data of patients with a previously failed bowel examination referred to our community hospital for a further colonoscopy were reviewed. When caecal intubation still failed with standard colonoscope, complete colonoscopy was usually attempted by shifting to a gastroscope.
Overall, 451 patients with a prior colonoscopy were considered. By using a standard colonoscope, caecal intubation rate was achieved in 285 out of 296 patients with prior complete examination and in 121 out of 155 patients with a prior failed colonoscopy (96.3% vs. 78.1%, p < .001). Caecum visualization was significantly lower when prior colonoscopy was stopped in the sigmoid tract as compared to any other proximal tract (65.1% vs. 86.9%, p < .001). After a second failed examination, colonoscopy was completed in 15 (51.7%) out of 29 cases by shifting to a standard gastroscope. No procedure-related complications were observed in the study.
After incomplete colonoscopy with a standard adult colonoscope, a further colonoscopy may be completed with same standard colonoscope or by using a gastroscope in the same session. A prior failed colonoscopy, particularly when stopped in the sigmoid tract, is significantly associated with a lower caecal intubation rate at second colonoscopy.
Gastroenterology and Digestive Endoscopy, Nuovo Regina Margherita Hospital, Rome, Italy, email@example.com.
This article was published in the following journal.
Name: International journal of colorectal disease
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/20686778
- DOI: http://dx.doi.org/10.1007/s00384-010-1016-4
Medical and Biotech [MESH] Definitions
Endoscopic examination, therapy or surgery of the luminal surface of the colon.
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The capability of the LUNGS to distend under pressure as measured by pulmonary volume change per unit pressure change. While not a complete description of the pressure-volume properties of the lung, it is nevertheless useful in practice as a measure of the comparative stiffness of the lung. (From Best & Taylor's Physiological Basis of Medical Practice, 12th ed, p562)
Practice Management, Medical
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