Rajesh N Keswani1. 1. Division of Gastroenterology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA. raj-keswani@northwestern.edu
Abstract
BACKGROUND:Optical colonoscopy is the only examination allowing complete visualization of the colon with simultaneous polyp removal. In a minority of patients, a complete examination is unsuccessful. It is unknown whether single-balloon, overtube-assisted colonoscopy (SBC) is superior to simply repeating a standard colonoscopy (SC) on an alternate day. OBJECTIVE: To compare the success rates of SC and SBC in patients with previous incomplete examinations. DESIGN: Randomized, controlled trial. SETTING:Tertiary care academic center. PATIENTS: Thirty subjects with previous incomplete colonoscopy. INTERVENTIONS:Repeat colonoscopy either by SC or SBC. If cecal intubation was unsuccessful, subjects were crossed over to the alternate group. RESULTS:Thirty subjects (73.3% female, mean age 59.2 years) with previous incomplete colonoscopy were randomized (SBC, 14 subjects; SC, 16 subjects). Cecal intubation was significantly more successful with SBC (92.9%) than with SC (50%) (P = .016). For all SC failures, cecal intubation was successful after crossover to the SBC group (100%). Cecal intubation time was similar in both groups. Proximal colon adenomas were detected in 38.1% of subjects. There were no procedure-related complications. LIMITATIONS: Singe endoscopist performing all procedures; inability to ensure all incomplete colonoscopies were included in the study. CONCLUSIONS: For patients with a previous incomplete colonoscopy, balloon colonoscopy performed by using the single-balloon enteroscope with an overtube was superior to a repeat attempt with a standard colonoscope. For patients with a previous incomplete examination, consideration should be given to a repeat attempt with balloon colonoscopy if available. ( CLINICAL TRIAL REGISTRATION NUMBER: STU00008540.).
RCT Entities:
BACKGROUND: Optical colonoscopy is the only examination allowing complete visualization of the colon with simultaneous polyp removal. In a minority of patients, a complete examination is unsuccessful. It is unknown whether single-balloon, overtube-assisted colonoscopy (SBC) is superior to simply repeating a standard colonoscopy (SC) on an alternate day. OBJECTIVE: To compare the success rates of SC and SBC in patients with previous incomplete examinations. DESIGN: Randomized, controlled trial. SETTING: Tertiary care academic center. PATIENTS: Thirty subjects with previous incomplete colonoscopy. INTERVENTIONS: Repeat colonoscopy either by SC or SBC. If cecal intubation was unsuccessful, subjects were crossed over to the alternate group. RESULTS: Thirty subjects (73.3% female, mean age 59.2 years) with previous incomplete colonoscopy were randomized (SBC, 14 subjects; SC, 16 subjects). Cecal intubation was significantly more successful with SBC (92.9%) than with SC (50%) (P = .016). For all SC failures, cecal intubation was successful after crossover to the SBC group (100%). Cecal intubation time was similar in both groups. Proximal colon adenomas were detected in 38.1% of subjects. There were no procedure-related complications. LIMITATIONS: Singe endoscopist performing all procedures; inability to ensure all incomplete colonoscopies were included in the study. CONCLUSIONS: For patients with a previous incomplete colonoscopy, balloon colonoscopy performed by using the single-balloon enteroscope with an overtube was superior to a repeat attempt with a standard colonoscope. For patients with a previous incomplete examination, consideration should be given to a repeat attempt with balloon colonoscopy if available. ( CLINICAL TRIAL REGISTRATION NUMBER: STU00008540.).
Authors: Ivana Dzeletovic; M Edwyn Harrison; Shabana F Pasha; Michael D Crowell; G Anton Decker; Suryakanth R Gurudu; Jonathan A Leighton Journal: Dig Dis Sci Date: 2012-05-22 Impact factor: 3.199