(Technically) Difficult colonoscope insertion – Tips and tricks

Rodrigues‐Pinto, Eduardo; Ferreira‐Silva, Joel; Macedo, Guilherme; Rex, Douglas K.

doi:10.1111/den.13465

Cited by 10 publications

(11 citation statements)

References 20 publications

(54 reference statements)

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“…Colonoscopy is the gold standard for the detection and removal of colorectal cancer and its precursor lesions 5 . However, cecal intubation can sometimes be difficult during colonoscopy, occurring in 5–20% of cases among colonoscopists with average experience (1000–5000 procedures) 6 . The cecal insertion time is often used as an indicator of the difficulty of cecal intubation during colonoscopy 7 …”

Section: Introductionmentioning

confidence: 99%

“…5 However, cecal intubation can sometimes be difficult during colonoscopy, occurring in 5-20% of cases among colonoscopists with average experience (1000-5000 procedures). 6 The cecal insertion time is often used as an indicator of the difficulty of cecal intubation during colonoscopy. 7 Prolonged cecal insertion time increases the turnover time and decreases the efficiency of an endoscopy room.…”

Section: Introductionmentioning

confidence: 99%

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Factors associated with prolonged cecal insertion time in patients undergoing water exchange colonoscopy

Hsieh

Koo

Tseng

2022

J of Gastro and Hepatol

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Background and Aim Water exchange is superior to air insufflation in reducing discomfort and increasing adenoma detection during colonoscopy. However, prolonged cecal insertion time is a drawback. This study aims to investigate the factors affecting cecal insertion during water exchange colonoscopy. Methods We pooled data from five randomized clinical trials that included patients undergoing water exchange colonoscopy. Logistic analysis was performed to determine the independent factors associated with prolonged cecal insertion time (> 15 min). Results The cohort included 912 patients (493 men and 419 women) with a median age of 57 years (interquartile range, 49–64 years). The median cecal insertion time was 13.5 min (interquartile range, 10.9–17.0 min). Multivariate logistic regression analysis indicated that female sex, body mass index < 25 kg/m2, a history of constipation, no sedation, less experienced endoscopist, Boston Bowel Preparation Scale score ≤ 6, infused water volume during insertion ≥ 1000 mL, and scope length at the cecum ≥ 85 cm were associated with prolonged cecal insertion time. With increasing volume of infused water (1000–2000 mL), the median cecal insertion time increased gradually from 11.4 to 23.0 min (P < 0.001). Conclusions The current study identified independent factors associated with prolonged cecal insertion time during water exchange colonoscopy. Several factors are modifiable to achieve a shorter insertion time, including better bowel preparation, the use of sedation, more experienced endoscopist, infusing less water during insertion, and maintaining a shorter scope length.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Factors associated with prolonged cecal insertion time in patients undergoing water exchange colonoscopy

Hsieh

Koo

Tseng

2022

J of Gastro and Hepatol

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“…However, incomplete colonoscopies, termed difficult colonoscopies, may range from 5% to 20% [ 13 , 14 ]. Additionally, obesity is a critical factor contributing to incomplete colonoscopies because it is challenging to minimize looping in an obese abdomen [ 15 ]. However, abdominal compression is a useful ancillary maneuver in colonoscopy, which can help reduce the loop [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Impact of an Abdominal Compression Bandage on the Completion of Colonoscopy for Obese Adults: A Prospective Randomized Controlled Trial

Liu

Meng

Xiong

et al. 2022

Canadian Journal of Gastroenterology and Hepatology

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Background and Aim. Obesity has been linked to incomplete colonoscopy. In the present study, we aimed to determine whether an abdominal compression bandage could improve the complete colonoscopy rate (CCR) of obese patients. Methods. Eligible patients were randomly allocated into the abdominal bandage and conventional groups during a routine colonoscopy. The primary outcome was CCR. Results. A total of 250 eligible patients were randomly assigned to the abdominal bandage and conventional groups from January 2021 to April 2021. Eleven patients (five in the abdominal bandage group and six in the conventional group) were excluded due to schedule cancellation after randomization, and 239 patients were eventually included in the final analysis. There were no significant differences between the two groups regarding baseline characteristics (P > 0.05). Furthermore, no significant differences were observed in terms of advanced adenoma detection rate (AADR), polyp detection rate (PDR), bowel preparation scale (BBPS), bubble scale (BS), and withdrawal time between the two groups (P > 0.05). However, compared with the conventional group, the cecal insertion time (CIT) of the abdominal bandage group was significantly shortened (279.00 (234.50–305.75) vs. 421.00 (327.00–485.00), P < 0.001), and the CCR (96.7% vs. 88.2%, P = 0.01) and adenoma detection rate (ADR) (47.5% vs. 32.8%, P < 0.001) were improved. Besides, logistic regression analysis showed that body mass index (BMI) and abdominal compression bandage were associated with CCR. Conclusions. Abdominal compression bandages could effectively shorten CIT and improve CCR and ADR for obese patients during a routine colonoscopy. This trial is registered with the Chinese Clinical Trial Registry (No. ChiCTR2100043556).

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“…Nevertheless, colonic intubation is still sometimes challenging in clinical practice, although various helpful strategies have been demonstrated in recent years. 1,2 The axis-keeping shortening technique (AKS) was first developed by Professor Shin-ei Kudo and has been widely recognized among endoscopists in Japan as the most ideal colonic intubation method. 3,4 Knowledge of this technique, however, remains limited outside of Japan.…”

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confidence: 99%

“…Nevertheless, colonic intubation is still sometimes challenging in clinical practice, although various helpful strategies have been demonstrated in recent years. 1 , 2 …”

mentioning

confidence: 99%