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?"
BACKGROUND AND
AIMS:
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
METHODS:
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.
RESULTS:
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.
CONCLUSIONS:
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.
Affiliation
Gastroenterology and Digestive Endoscopy, Nuovo Regina Margherita Hospital, Rome, Italy, sergio.morini@gmail.com.
Journal Details
This article was published in the following journal.
Name: International journal of colorectal disease
ISSN: 1432-1262
Pages:
Links
- 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
Colonoscopy
Endoscopic examination, therapy or surgery of the luminal surface of the colon.
Practice Management
Business management of medical and dental practices that may include capital financing, utilization management, and arrangement of capitation agreements with other parties.
Lung Compliance
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
The organization and operation of the business aspects of a physician's practice.
Management Service Organizations
Voluntarily-formed groups of healthcare professionals who join for common management services and other benefits such as collective bargaining agreements with reimbursement agents. The physical assets of a practice are controlled by the MSO which also provides billing, collections, and similar services. The practitioner retains control of patient records and management of patient care.
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