title: Inadequacy of colonoscopy revealed by three-dimensional electromagnetic imaging.
abstract: BACKGROUND
  It is generally accepted that clinicians performing colonoscopy should reach the cecum in at least 90 percent of examinations. However, little attention has been paid to whether the endoscopist correctly estimates the amount of colon actually seen.
  
  
  METHODS
  During colonoscopy, endoscopists were asked to state how far they had reached. This was compared with the amount of colon actually seen, as assessed by a novel electromagnetic imaging device that recorded a three-dimensional position of the scope within a magnetic field pervading the patient's abdomen. If electromagnetic imaging showed that the cecum had not been reached, the endoscopist was asked to use the electromagnetic imaging system to determine whether it helped advance the colonoscope further.
  
  
  RESULTS
  In 119 patients undergoing colonoscopy, clinical assessment of position reached was correct in only 92 (77.3 percent). When the endoscopists stated that cecal landmarks had been seen (n = 85), the scope was distal to the cecum in seven cases (8.2 percent). When cecal landmarks had not been seen (n = 34), the endoscopist's assessment of the position of the scope was accurate in only 14 (41.2 percent). The use of electromagnetic imaging in this latter group assisted passage to the cecum in 26 cases (76.5 percent).
  
  
  CONCLUSIONS
  Despite assumed visualization of the cecum, inadequate colonoscopy highlights the potential for missing significant pathology in the right colon.
authors.affiliation: Colorectal Surgical Unit, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, United Kingdom.
authors.forename: I J
authors.initials: IJ
authors.lastname: Adam
authors.forename: Z
authors.initials: Z
authors.lastname: Ali
authors.forename: A J
authors.initials: AJ
authors.lastname: Shorthouse
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001466:Barium Sulfate; D002432:Cecum / Q000033:anatomy & histology*; D003113:Colonoscopy / Q000379:methods / Q000592:standards*; D003952:Diagnostic Imaging; D055590:Electromagnetic Phenomena; D004733:Enema; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011361:Professional Competence
chemical_list: D001466:Barium Sulfate