Spiral overtube-assisted colonoscopy after incomplete colonoscopy in the redundant colon

Abstract

Background: A redundant colon can lead to incomplete colonoscopy. A variety of tools and techniques are available to complete colonoscopy but have limitations.

Objective: To determine the feasibility and safety of using a spiral overtube to complete a difficult colonoscopy.

Design: Retrospective review of a prospectively collected database.

Setting: Single tertiary institution.

Patients: Twenty-four patients with incomplete colonoscopy because of redundant colons underwent 26 procedures. The median age was 68 years, and 58% were men.

Interventions: All patients underwent colonoscopy performed with a 90-cm flexible threaded overtube and a variable-stiffness pediatric colonoscope. Four individuals (18%) required exchanging the colonoscope for an enteroscope.

Main outcome measurements: Successful cecal intubation, polyp identification and removal, time to reach the cecum, sedation needed, and complications.

Results: Cecal intubation was achieved in 22 patients (92%). Failures occurred in 2 patients with large hernias. The median time from insertion of the colonoscope to reaching the cecum was 14.5 minutes. All procedures were performed by using conscious sedation with midazolam (median dose 7 mg) and fentanyl (median dose 150 μg). Significant findings were encountered in 17 of 22 patients (77%) including 1 cancer and 2 advanced polyps. A median of 3 polyps was removed from each patient who had polyps. All noncancerous polyps were removed during the procedure. There were no complications.

Limitations: Retrospective design, no control group, single center.

Conclusion: Spiral overtube-assisted colonoscopy can enable cecal intubation in the majority of patients in whom standard colonoscopy fails because of a redundant colon.