• Humans
• Colonoscopy/methods
• Cecum
• Colonoscopes
• Colon

• adenoma detection rate
• bowel resection
• colonoscopy
• performance
• quality indicator

The significance of the distal tip extension mechanism (DTEM) arises when the insertion tube of the colonoscope is no longer able to move further inside the colon, and when a longer insertion tube is needed. The main focus of this research is to investigate the development of a novel distal tip extension mechanism (DTEM).

To characterize the performance of the DTEM, the ability of the DTEM to extend the distal tip of the colonoscope 16 cm is investigated. To determine the maximum number of turns that the extension knob needs to make in order to move the distal tip 16 cm, the DTEM is used to displace the distal tip in different colon configurations using the silicon tube of a colonoscopy training model (CTM). The experimentally collected data was presented and discussed to characterize the performance of the DTEM.

The results showed that the DTEM is able to extend the distal tip 16 cm while the colon is in various configurations. Additionally, the impact of implanting the DTEM on the flexibility of the insertion tube was determined.

The results of this research suggest that the DTEM will be an effective tool to help colonoscopists performing better colonoscopies.

• colonoscope
• distal tip
• extension mechanism
• intubation

To evaluate the ability of PillCamColon2 to visualize colonic segments missed by incomplete optical colonoscopy (OC) and to assess the diagnostic yield.

This prospective multicentre study included 81 patients from nine centres who underwent second-generation colon capsule endoscopy (CCE) following incomplete OC performed by an experienced gastroenterologist (> 1000 colonoscopies). Patients with stenosis were excluded. According to patient preferences, CCE was performed the following day (protocol A) after staying on clear liquids and 0.75 L Moviprep in the morning or within 30 d after new split-dose Moviprep (protocol B). Boosts consisted of 0.75 L and 0.25 L Moviprep, and phospho-soda was given as a rescue if the capsule was not excreted after seven hours.

Seventy-four patients were analysed (51% of them in group A; 49% in group B). Bowel cleansing was adequate in 67% of cases, and CCE could visualize colonic segments missed by incomplete colonoscopy in 90% of patients under protocol A and 97% of patients under protocol B (P = 0.35, n.s.). Significant polyps including adenocarcinoma were detected in 24% of cases. Detection rates for all polyps and significant polyps per patient were similar in both protocols. Polyps were found predominantly in the right colon (86%) in segments that were not reached by OC. Extracolonic findings - such as reflux esophagitis, suspected Barrett esophagus, upper GI-bleeding, gastric polyps, gastric erosions and angiectasia - were detected in eight patients. PillCamColon2 capsule was retained in the ileum of one patient (1.4%) without symptoms and removed during an uneventful resection for unknown Crohn’s disease that was diagnosed as the cause of anemia, which was the indication for colonoscopy. CCE was well tolerated. One patient suffered from self-limiting vomiting after consuming the phospho-soda.

Second-generation CCE using a low-volume preparation is useful after incomplete OC, and it allows for the detection of additional relevant findings, but cleansing efficiency could be improved.

• Colon capsule endoscopy
• PillCamColon2
• Incomplete colonoscopy
• Low volume prep
• Moviprep
• Phospho-soda
• Cleanliness level
• Complementation rate
• Polyps

• Adenocarcinoma/diagnostic imaging
• Adenocarcinoma/pathology
• Aged
• Capsule Endoscopes
• Capsule Endoscopy/adverse effects
• Capsule Endoscopy/instrumentation
• Capsule Endoscopy/methods
• Cathartics/administration & dosage
• Colon/diagnostic imaging
• Colon/pathology
• Colonic Polyps/diagnostic imaging
• Colonic Polyps/pathology
• Colonoscopy/adverse effects
• Colonoscopy/instrumentation
• Colonoscopy/methods
• Female
• Humans
• Male
• Middle Aged
• Patient Preference
• Polyethylene Glycols/administration & dosage
• Prospective Studies
• Vomiting/epidemiology
• Vomiting/etiology

• Cecal intubation
• Colonoscopy
• Incomplete
• Single-balloon

AIM: To investigate when and why a colonoscopist should discontinue incomplete colonoscopy by himself.

METHODS: In this cross-sectional study, 517 difficult colonoscope insertions (Grade C, Kudo’s difficulty classification) screened from 37800 colonoscopy insertions were collected from April 2004 to June 2014 by three 4^th-level (Kudo’s classification) colonoscopists. The following common factors for the incomplete insertion were excluded: structural obstruction of the colon or rectum, insufficient colon cleansing, discontinuation due to patient’s discomfort or pain, severe colon disease with a perforation risk (e.g., severe ischemic colonopathy). All the excluded patients were re-scheduled if permission was obtained from the patients whose intubation had failed. If the repeat intubations were still a failure because of the difficult operative techniques, those patients were also included in this study. The patient’s age, sex, anesthesia and colonoscope type were recorded before colonoscopy. During the colonoscopic examination, the influencing factors of fixation, tortuosity, laxity and redundancy of the colon were assessed, and the insertion time (> 10 min or ≤ 10 min) were registered. The insertion time was analyzed by t-test, and other factors were analyzed by univariate and multivariate logistic regression.

RESULTS: Three hundred and twenty-two (62.3%) of the 517 insertions were complete in the colonoscope insertion into the ileocecum, but 195 (37.7%) failed in the insertion. Fixation, tortuosity, laxity or redundancy occurred during the colonoscopic examination. Multivariate logistic regression analysis revealed that fixation (OR = 0.06, 95%CI: 0.03-0.16, P < 0.001) and tortuosity (OR = 0.04, 95%CI: 0.02-0.08, P < 0.001) were significantly related to the insertion into the ileocecum in the left hemicolon; multivariate logistic regression analysis also revealed that fixation (OR = 0.16, 95%CI: 0.06-0.39, P < 0.001), tortuosity (OR 0.23, 95%CI: 0.13-0.43, P < 0.001), redundancy (OR = 0.12, 95%CI: 0.05-0.26, P < 0.001) and sex (OR = 0.35, 95%CI: 0.20-0.63, P < 0.001) were significantly related to the insertion into the ileocecum in the right hemicolon. Prolonged insertion time (> 10 min) was an unfavorable factor for the insertion into the ileocecum.

CONCLUSION: Colonoscopy should be discontinued if freedom of the colonoscope body’s insertion and rotation is completely lost, and the insertion time is prolonged over 30 min.

• Colonoscopy
• Colonoscope insertion
• Insertion technique

• Clinical Competence
• Colonoscopes
• Colonoscopy/adverse effects
• Colonoscopy/instrumentation
• Cross-Sectional Studies
• Equipment Design
• Humans
• Logistic Models
• Multivariate Analysis
• Odds Ratio
• Risk Assessment
• Risk Factors
• Time Factors

AIM: To compare magnetic imaging-assisted colonoscopy (MIC) with conventional colonoscopy (CC).

METHODS: Magnetic imaging technology provides a computer-generated image of the shape and position of the colonoscope onto a monitor to give visual guidance to the endoscopist. It is designed to improve colonoscopy performance and tolerability for patients by enabling visualization of loop formation and endoscope position. Recently, a new version of MIC technology was developed for which there are limited data.To evaluate this latest generation of MIC among experienced rather than inexperienced or trainee endoscopists, a prospective randomized trial was performed using only gastroenterologists with therapeutic endoscopy training. Consecutive patients undergoing elective outpatient colonoscopy were randomized to MIC or CC, with patients blinded to their group assignment. Endoscopic procedural metrics and quantities of conscious sedation medications were recorded during the procedures. The procedure was classified as “usual” or “difficult” by the endoscopist at the conclusion of each case based on the need for adjunctive maneuvers to facilitate endoscope advancement. After more than one hour post-procedure, patients completed a 10 cm visual analogue pain scale to reflect the degree of discomfort experienced during their colonoscopy. The primary outcome was patient comfort expressed by the visual analogue pain score. Secondary outcomes consisted of endoscopic procedural metrics as well as a sedation score derived from standardized dose increments of the conscious sedation medications.

RESULTS: Two hundred fifty-three patients were randomized and underwent MIC or CC between September 2011 and October 2012. The groups were similar in terms of the indications for colonoscopy and patient characteristics. There were no differences in cecal intubation rates (100% vs 99%), insertion distance-to-cecum (82 cm vs 83 cm), time-to-cecum (6.5 min vs 7.2 min), or polyp detection rate (47% vs 52%) between the MIC and CC groups. The primary outcome of mean pain score (1.0 vs 0.9 out of 10, P = 0.41) did not differ between MIC and CC groups, nor did the mean sedation score (8.2 vs 8.5, P = 0.34). Within the subgroup of cases considered more challenging or difficult, time-to-cecum was significantly faster with MIC compared to CC, 10.1 min vs 13.4 min respectively (P = 0.01). Sensitivity analyses confirmed a similar pattern of overall findings when each endoscopist was considered separately, demonstrating that the mean results for the entire group were not unduly influenced by outlier results from any one endoscopist.

CONCLUSION: Although the latest version of MIC resulted in faster times-to-cecum within a subgroup of more challenging cases, overall it was no better than CC in terms of patient comfort, sedation requirements and endoscopic procedural metrics, when performed in experienced hands.

• Colonoscopy
• Conscious sedation
• Magnetic endoscope imaging
• Pain measurement
• Randomized controlled trial

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Alberta
• Ambulatory Care
• Clinical Competence
• Colon/pathology
• Colonoscopy/adverse effects
• Colonoscopy/methods
• Conscious Sedation
• Female
• Humans
• Hypnotics and Sedatives/administration & dosage
• Image Interpretation, Computer-Assisted
• Magnetics
• Male
• Middle Aged
• Pain/etiology
• Pain Measurement
• Predictive Value of Tests
• Prospective Studies
• Young Adult

• Caecal intubation rate
• colonoscopists
• colonoscopy
• colorectal cancer
• patient type
• performance assessment
• quality
• screening
• symptomatic patients

AIM: To evaluate the clinical usefulness of single-balloon endoscopy (SBE) in patients in whom a colonoscope was technically difficult to insert previously.

METHODS: The study group comprised 15 patients (8 men and 7 women) who underwent SBE for colonoscopy (30 sessions). The number of SBE sessions was 1 in 7 patients, 2 in 5 patients, 3 in 1 patient, 4 in 1 patient, and 6 in 1 patient. In all patients, total colonoscopy was previously unsuccessful. The reasons for difficulty in scope passage were an elongated colon in 6 patients, severe intestinal adhesions after open surgery in 4, an elongated colon and severe intestinal adhesions in 2, a left inguinal hernia in 2, and multiple diverticulosis of the sigmoid colon in 1. Three endoscopists were responsible for SBE. The technique for inserting SBE in the colon was basically similar to that in the small intestine. The effectiveness of SBE was assessed on the basis of the success rate of total colonoscopy and the presence or absence of complications. We also evaluated the diagnostic and treatment outcomes of colonoscopic examinations with SBE.

RESULTS: Total colonoscopy was successfully accomplished in all sessions. The mean insertion time to the cecum was 22.9 ± 8.9 min (range 9 to 40). Abnormalities were found during 21 sessions of SBE. The most common abnormality was colorectal polyps (20 sessions), followed by radiation colitis (3 sessions) and diverticular disease of the colon (3 sessions). Colorectal polyps were resected endoscopically in 15 sessions. A total of 42 polyps were resected endoscopically, using snare polypectomy in 32 lesions, hot biopsy in 7 lesions, and endoscopic mucosal resection in 3 lesions. Fifty-six colorectal polyps were newly diagnosed on colonoscopic examination with SBE. Histopathologically, these lesions included 2 intramucosal cancers, 42 tubular adenomas, and 2 tubulovillous adenomas. The mean examination time was 48.2 ± 20.0 min (range 25 to 90). Colonoscopic examination or endoscopic treatment with SBE was not associated with any serious complications.

CONCLUSION: SBE is a useful and safe procedure in patients in whom a colonoscope is technically difficult to insert.

• Single-balloon endoscopy
• Colonoscopy
• Difficult to insert
• Diagnosis
• Endoscopic treatment

Introduction. Endoscopy of the colon and rectum is increasingly used. Aim of the Study. All consecutive endoscopies of the colon and rectum were studied in order to assess the yearly prevalence of significant endoscopic diagnoses. Methods. All consecutive endoscopies of the colon and rectum were included. Endoscopies were done with endoscopes of Olympus. Significant endoscopic diagnoses were defined as colorectal cancer, polyps, diverticuli, large sessile polyps, and inflammatory bowel disease. Results. In 20 years a total of 24431 endoscopies were done. The yearly number of sigmoidoscopies was mean 96, range of 42–370. The number of colonoscopies was mean 1126, range of 643–1912. The number of colonoscopies significantly increased. The number of colonoscopies on request of an internist or gastroenterologist showed a slow but steady increase. Successful caecal intubation rose from 70% to 92% in 2011. Since 1996 there is a steep increase in the percentage of procedures with abnormalities. The number of cancer and polyps increased in twenty years. No great changes were seen in inflammatory bowel disease. Conclusion. Colonoscopy is a procedure with a high diagnostic yield. The number of patients with tumours rose in twenty years.

• Adult
• Aged
• Aged, 80 and over
• Colonic Polyps/diagnosis
• Colonoscopes
• Colonoscopy/instrumentation
• Colonoscopy/methods
• Colonoscopy/standards
• Female
• Humans
• Male
• Middle Aged
• Retrospective Studies

• Adult
• Aged
• Aged, 80 and over
• Colonoscopes
• Colonoscopy/education
• Colonoscopy/instrumentation
• Equipment Design
• Female
• Gastroenterology/education
• Humans
• Male
• Middle Aged
• Young Adult

Since the first reports almost ten years ago, wireless capsule endoscopy has gained new fields of application. Colon capsule endoscopy represents a new diagnostic technology for colonic exploration. Clinical trials have shown that colon capsule endoscopy is feasible, accurate and safe in patients suffering from colonic diseases and might be a valid alternative to conventional colonoscopy in selected cases such as patients refusing conventional colonoscopy or with contraindications to colonoscopy or when colonoscopy is incomplete. Despite the enthusiasm surrounding this new technique, few clinical and randomized controlled trials are to be found in the current literature, leading to heterogeneous or controversial results. Upcoming studies are needed to prove the substantial utility of colon capsule endoscopy for colon cancer screening, especially in a low prevalence of disease population, and for other indications such as inflammatory bowel disease. Possible perspectives are critically analysed and reported in this paper.

• Colonoscopy
• Colorectal cancer
• Inflammatory bowel disease
• PillCam colon capsule
• Polyps
• Preparation

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Catheterization
• Cecum
• Colonoscopes
• Colonoscopy/instrumentation
• Colonoscopy/methods
• Female
• Humans
• Male
• Middle Aged
• Prospective Studies
• Young Adult

• Capsule Endoscopes
• Capsule Endoscopy/instrumentation
• Capsule Endoscopy/methods
• Capsule Endoscopy/standards
• Cathartics
• Colon
• Colonic Diseases/diagnosis
• Evidence-Based Medicine
• Humans

• APACHE
• Adult
• Aged
• Clinical Competence
• Colonoscopes
• Colonoscopy/instrumentation
• Colonoscopy/methods
• Colonoscopy/standards
• Colonoscopy/trends
• Comorbidity
• Female
• Health Status
• Heart Failure/epidemiology
• Hospitalization
• Humans
• Male
• Middle Aged
• Retrospective Studies
• Sigmoidoscopy/statistics & numerical data
• United States

• Adenomatous Polyposis Coli/diagnosis
• Adenomatous Polyposis Coli/surgery
• Analgesics/administration & dosage
• Colonic Polyps/diagnosis
• Colonic Polyps/surgery
• Colonoscopy/adverse effects
• Colonoscopy/methods
• Colonoscopy/standards
• Colorectal Neoplasms/diagnosis
• Colorectal Neoplasms/prevention & control
• Colorectal Neoplasms/surgery
• Computer Simulation
• Conscious Sedation/methods
• Gastroenterology/education
• Gastrointestinal Hemorrhage/etiology
• Humans
• Intestinal Perforation/etiology
• Mass Screening/methods
• Mass Screening/standards
• Medical Records/standards
• Preoperative Care/methods