Skip to main content

Advertisement

SpringerLink
Log in

The role of single-balloon colonoscopy for patients with previous incomplete standard colonoscopy: Is it worth doing it?

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

The rate of cecal intubation is a well-recognized quality measure of successful colonoscopy. Infrequently, the standard colonoscopy techniques fail to achieve complete examination. The role of single-balloon overtube-assisted colonoscopy (SBC) in these situations has only been sparsely studied. This prospective single-center study aimed to investigate the technical success (rate of cecal intubation) and the diagnostic gain of SBC.

Methods

The study recruited consecutive patients with previous incomplete standard colonoscopy who were admitted for SBC at our tertiary center in Eastern Switzerland between February 2008 and October 2014. The primary outcome was defined as successful cecal intubation. Data on patient characteristics, indication, technical details of procedure, and outcome were collected prospectively. The Olympus enteroscope SIF-Q180 was used.

Results

The study included 100 consecutive patients (median age 70 years; range 38–87 years; 54 % female) who were examined using a single-balloon overtube-assisted technique. The cecal intubation rate was 98 % (98/100). The median time of total procedure was 54 min (range 15–119 min); the median time to reach the cecal pole was 27.5 min (range 4–92 min). Passage of the sigmoid colon was not possible in two cases with a fixed, angulated sigmoid colon. The diagnostic gain was 21 % regarding adenomatous polyps in the right colon. The complication rate was 2 % (2/100, minor) without need for surgery.

Conclusions

This prospective patient cohort study shows that single-balloon colonoscopy is a safe and effective procedure to achieve a complete endoscopic examination in patients with a previous failed standard colonoscopy. A significant diagnostic and therapeutic gain in the right colon justifies additional procedure time.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Davila RE, Rajan E, Baron TH, Adler DG, Egan JV, Faigel DO, Gan SI, Hirota WK, Leighton JA, Lichtenstein D, Qureshi WA, Shen B, Zuckerman MJ, VanGuilder T, Fanelli RD (2006) ASGE guideline: colorectal cancer screening and surveillance. Gastrointest Endosc 63:546–557

    Article  PubMed  Google Scholar 

  2. Rex DK, Petrini JL, Baron TH, Chak A, Cohen J, Deal SE, Hoffman B, Jacobson BC, Mergener K, Petersen BT, Safdi MA, Faigel DO, Pike IM, ASGE/ACG Taskforce on Quality in Endoscopy, (2006) Quality indicators for colonoscopy. Am J Gastroenterol 101:873–885

    PubMed  Google Scholar 

  3. Marshall JB, Barthel JS (1993) The frequency of total colonoscopy and terminal ileal intubation in the 1990s. Gastrointest Endosc 39:518–520

    Article  CAS  PubMed  Google Scholar 

  4. Aslinia F, Uradomo L, Steele A, Greenwald BD, Raufman JP (2006) Quality assessment of colonoscopic cecal intubation: an analysis of 6 years of continuous practice at a university hospital. Am J Gastroenterol 101:721–731

    Article  PubMed  Google Scholar 

  5. Anderson JC, Messina CR, Cohn W, Gottfried E, Ingber S, Bernstein G, Coman E, Polito J (2001) Factors predictive of difficult colonoscopy. Gastrointest Endosc 545:558–562

    Article  Google Scholar 

  6. Loffeld RJ, van der Putten AB (2009) The completion rate of colonoscopy in normal daily practice: factors associated with failure. Digestion 80:267–270

    Article  CAS  PubMed  Google Scholar 

  7. Anderson JC, Gonzalez JD, Messina CR, Pollack BJ (2000) Factors that predict incomplete colonoscopy: thinner is not always better. Am J Gastroenterol 95:2784–2787

    Article  CAS  PubMed  Google Scholar 

  8. Kaltenbach T, Soetikno R, Friedland S (2006) Use of a double balloon enteroscope facilitates caecal intubation after incomplete colonoscopy with a standard colonoscope. Dig Liver Dis 38:921–925

    Article  CAS  PubMed  Google Scholar 

  9. Kita H, Yamamoto H (2007) New indications of double balloon endoscopy. Gastrointest Endosc 66(3 Suppl):S57–S59

    Article  PubMed  Google Scholar 

  10. Mönkemüller K, Knippig C, Rickes S, Fry LC, Schulze A, Malfertheiner P (2007) Usefulness of the double-balloon enteroscope in colonoscopies performed in patients with previously failed colonoscopy. Scand J Gastroenterol 42:277–278

    Article  PubMed  Google Scholar 

  11. Pasha SF, Harrison ME, Das A, Corrado CM, Arnell KN, Leighton JA (2007) Utility of double-balloon colonoscopy for completion of colon examination after incomplete colonoscopy with conventional colonoscope. Gastrointest Endosc 65:848–853

    Article  PubMed  Google Scholar 

  12. Moreels TG, Macken EJ, Roth B, Van Outryve MJ, Pelckmans PA (2010) Cecal intubation rate with the double-balloon endoscope after incomplete conventional colonoscopy: a study in 45 patients. J Gastroenterol Hepatol 25:80–83

    Article  PubMed  Google Scholar 

  13. Keswani R (2011) Single-balloon colonoscopy versus repeat standard colonoscopy for previous incomplete colonoscopy: a randomized, controlled trial. Gastrointest Endosc 73:507–512

    Article  PubMed  Google Scholar 

  14. Teshima C, Aktas H, Haringsma J, Kuipers EJ, Mensink PB (2010) Single-balloon-assisted colonoscopy in patients with previously failed colonoscopy. Gastrointest Endosc 71:1319–1323

    Article  PubMed  Google Scholar 

  15. May A, Nachbar L, Ell C (2006) Push-and-pull enteroscopy using a single-balloon technique for difficult colonoscopy. Endoscopy 38:395–398

    Article  CAS  PubMed  Google Scholar 

  16. Ridolfi TJ, Valente MA, Church JM (2014) Achieving a complete colonic evaluation in patients with incomplete colonoscopy is worth the effort. Dis Colon Rectum 57:383–387

    Article  PubMed  Google Scholar 

  17. Rembacken B, Hassan C, Riemann JF, Chilton A, Rutter M, Dumonceau JM, Omar M, Ponchon T (2012) Quality in screening colonoscopy: position statement of the European Society of Gastrointestinal Endoscopy (ESGE). Endoscopy 44:957–968

    Article  CAS  PubMed  Google Scholar 

  18. Shah HA, Paszat LF, Saskin R, Stukel TA, Rabeneck L (2007) Factors associated with incomplete colonoscopy: a population based study. Gastroenterology 132:2297–2303

    Article  PubMed  Google Scholar 

  19. Brahmania M, Park J, Svarta S, Tong J, Kwok R, Enns R (2012) Incomplete colonoscopy: maximizing completion rates of gastroenterologists. Can J Gastroenterol 26:589–592

    Article  PubMed  PubMed Central  Google Scholar 

  20. Gawron AJ, Veerappan A, Keswani RN (2014) High success rate of repeat colonoscopy with standard endoscopes in patients referred for prior incomplete colonoscopy. BMC Gastroenterol. doi:10.1186/1471-230X-14-56

    PubMed  PubMed Central  Google Scholar 

  21. Hsieh YH, Koo M, Leung FW (2014) A patient-blinded randomized, controlled trial comparing air insufflation, water immersion, and water exchange during minimally sedated colonoscopy. Am J Gastroenterol 109:1390–1400

    Article  PubMed  Google Scholar 

  22. Yamada A, Watabe H, Takano N, Togo G, Yamaji Y, Yoshida H, Kawabe T, Omata M, Koike K (2013) Utility of single and double balloon endoscopy in patients with difficult colonoscopy: a randomized controlled trial. World J Gastroenterol 19:4732–4736

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

We wish to thank the statistician Professor Hanno Ulmer, as well as Mrs. Meltem Yilmaz, Mrs. Michela Bazzeghini, and Mr. Matthias Meyenberger for their extraordinary professional technical support.

Author information

Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland

    Michael Christian Sulz, Remus Frei, Gian-Marco Semadeni, Mikael Sawatzki, Jan Borovicka & Christa Meyenberger

Authors
  1. Michael Christian Sulz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Remus Frei
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gian-Marco Semadeni
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mikael Sawatzki
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jan Borovicka
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Christa Meyenberger
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michael Christian Sulz.

Ethics declarations

Disclosures

Drs. Michael Christian Sulz, Remus Frei, Gian-Marco Semadeni, Mikael Sawatzki, Jan Borovicka, and Christa Meyenberger have no conflicts of interest or financial ties to disclose.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sulz, M.C., Frei, R., Semadeni, GM. et al. The role of single-balloon colonoscopy for patients with previous incomplete standard colonoscopy: Is it worth doing it?. Surg Endosc 30, 1876–1882 (2016). https://doi.org/10.1007/s00464-015-4405-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-015-4405-5

Keywords

Search

Navigation