title: Push-and-pull enteroscopy using a single-balloon technique for difficult colonoscopy.
abstract: OBJECTIVE
  Several factors predict difficult or incomplete colonoscopy with a standard colonoscope, including female gender, low body mass index, extensive diverticulosis, and prior pelvic surgery.
  
  
  METHODS
  A push-and-pull enteroscopy device and a single-balloon technique was used in 14 patients (six men, eight women; mean age 62 +/- 15 years) after failure of ileocolonoscopy or endoscopic therapy using either a standard or a pediatric colonoscope. The original ileocolonoscopy had been performed to investigate colon polyps (n = 6), an obscure inflammatory process in the ileocecal region (n = 6), or iron deficiency anemia with a positive fecal occult stool test (n = 2).
  
  
  RESULTS
  Ileocolonoscopy was successfully performed using this push-and-pull technique in all 14 patients without technical problems or complications. All the endoscopic therapeutic interventions that were required were also performed without complications, with the exception of one instance of bleeding. Multiple polyps were found in six patients; a colon cancer was found in one patient; appendicitis combined with a carcinoid tumour of the appendix was diagnosed in one patient; ileocolitis was observed in two patients; one patient with Crohn's disease had stenoses in the region of an anastomosis; and in three patients no relevant pathological finding was seen.
  
  
  CONCLUSIONS
  It was possible to perform ileocolonoscopy with therapeutic interventions using this new thin push-and-pull enteroscopy device with a single-balloon technique in patients who had previously undergone incomplete colonoscopy using a standard colonoscope.
authors: Department of Internal Medicine II, HSK Wiesbaden (Teaching Hospital of the University of Mainz), Wiesbaden, Germany. ADinahMay@aol.com
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authors: Nachbar
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