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When Experts Fail: Use of a Short Turning Radius Colonoscope Facilitates Successful Completion of Colonoscopy in Patients with Bowel Fixity

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Abstract

Background

Rates of incomplete colonoscopy in non-expert settings range up to 13%. Expert colonoscopists can complete ~ 95% colonoscopies when other endoscopists fail; however, a small number remain incomplete even in expert hands, typically due to bowel fixity.

Aims

Pentax Retroview™ (EC-3490TLi) is a new slim colonoscope with a short turning radius (STR) and greater tip deflection (210°), which allows easy maneuverability across sharply angulated/fixed colonic bends. We evaluated the utility of this colonoscope for completing colonoscopies that fail even in the hands of expert colonoscopists.

Methods

Retrospective chart review was performed, and main outcomes measured included cecal intubation rate, lesions detected, dosage of sedation used, and complications.

Results

Using the STR colonoscope, complete colonoscopy to the cecum was possible in 34/37 patients (91.9%). No loss of lumen/blind advancement was necessary in any of the procedures. No adverse events occurred. Among the completed colonoscopies, 6/34 (17.6%) patients had adenomas, all proximal to the site of prior failure, including one advanced adenoma. All failures (n = 3, 8.1%) had a history of cancer surgeries, with peritoneal carcinomatosis/extensively fixed/frozen bowel (two patients) and an additional diverticular stricture with colo-vesical fistula (one patient).

Conclusion

STR colonoscope facilitates completion of a high proportion (91.9%) of colonoscopies that previously failed in expert hands. Its STR allows easy maneuverability across segments of sharp angulation with bowel fixity without need for blind advancement. The use of this colonoscope led to the detection of adenomas in 17.6% of patients, all proximal to the site of prior failed colonoscopy.

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Fig. 1

(Picture used with permission from Pentax Medical, Montvale, NJ)

Fig. 2

(Picture used with permission from Pentax Medical, Montvale, NJ)

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Acknowledgments

The authors thank Pentax Corporation for providing the Retroview™ STR colonoscope (EC-3490TLi).

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 300 Pasteur Drive, MC: 5244, Stanford, CA, 94305, USA

    Mohit Girotra, Saurabh Sethi, Monique T. Barakat, Robert J. Huang, Shai Friedland, Uri Ladabaum & Subhas Banerjee

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  1. Mohit Girotra
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  2. Saurabh Sethi
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  3. Monique T. Barakat
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  4. Robert J. Huang
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Correspondence to Subhas Banerjee.

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Conflict of interest

An abstract from portion of these data was presented as a poster at Digestive Diseases Week (DDW) 2017, Chicago, IL, USA. None of the authors have any conflicts of interest pertaining to the study to disclose.

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Girotra, M., Sethi, S., Barakat, M.T. et al. When Experts Fail: Use of a Short Turning Radius Colonoscope Facilitates Successful Completion of Colonoscopy in Patients with Bowel Fixity. Dig Dis Sci 65, 1429–1435 (2020). https://doi.org/10.1007/s10620-019-05882-2

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  • DOI: https://doi.org/10.1007/s10620-019-05882-2

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