A randomized controlled trial of comparison on time and rate of cecal and termianl Ileal intubation according to adult-colonoscope length: intermediate versus long

Abstract

For a complete colonoscopic examination, a high intubation rate and a short intubation time have been demanded to colonoscopists, if possible. The aim of the present study was to compare these examination parameters, intubation time and rate, according to the length of colonoscope. A total of 507 healthy Korean subjects were randomly assigned into two groups: intermediate length adult-colonoscope (n=254) and long length adult-colonoscope (n=253). There were significant differences in cecal intubation time and in terminal ileal intubation rate according to the length of the colonoscope. Time-to-cecal intubation was shorter for the intermediate-scope group than for the long-scope group (234.2 ± 115.0 sec vs 280.7 ± 135.0 sec, P < 0.001). However, the success rate of terminal ileal intubation was higher in the long-scope group than in the intermediate-scope group (95.3% vs 84.3%, P < 0.001). There were no significant differences in other colonoscopic parameters between the two groups. The intermediate length adult-colonoscope decreased the time to reach the cecum, whereas the long-scope showed a success rate of terminal ileal intubation. These findings suggest that it is reasonable to prepare and use these two types of colonoscope appropriate to the needs of the patient and examination, instead of employing only one type of colonoscope.

Keywords: Colonoscope Length; Colonoscopy; Intubation Rate; Intubation Time.

Fig. 1

Flow chart of study design. IBD, inflammatory bowel disease.

Fig. 2

Serial photographs from the colonoscope during insertion into the anus shows the beginning of time-recording. (A) The initial red-out phenomenon is usually seen on the monitor immediately after the colonoscope is inserted into the anus. (B) After air insufflation, the anal lumen is distended and identified. (C) At this time, the stopwatch function of the colonoscopic equipment was activated by an assistant nurse. Yellow dotted box is the time measured by the colonoscopic stopwatch.

Fig. 3

Colonoscopic landmarks in photographic documentation of complete cecal and terminal intubation. (A) Ileocecal valve (yellow arrow). (B) Appendiceal orifice (yellow arrow). (C) Terminal ileum. Villi were seen in the terminal ileum (water-filling method). (D) Terminal ileum. Villi were seen in the terminal ileum (narrow-band imaging method).

Fig. 4

The plot of time to cecal intubation and ileal intubation by the number of cases. (A) Cecal intubation time. (B) Terminal ileal intubation time.

Fig. 5

Comparison of cecal intubation time and terminal ileal intubation rate according to adult-colonoscope length (intermediate versus long). (A) Cecal intubation time. (B) Terminal ileal intubation rate. ILAC, intermediate length adult-colonoscope; LLAC, long length adult-colonoscpe; CIT, cecal intubation time; TIIR, terminal ileal intubation rate.