title: Endoscopic management of failed colonoscopy in clinical practice: to change endoscopist, instrument, or both?
abstract: OBJECTIVE
  Caecal intubation fails up to 20% of colonoscopy in clinical practice. We aimed to assess whether (1) in patients with a prior incomplete colonoscopy with a standard adult colonoscope, a subsequent caecal intubation may be achieved with the same instrument; (2) there are factors predicting a repeated unsuccessful colonoscopy; and (3) how frequently completion can be further achieved by shifting to a standard gastroscope.
  
  
  METHODS
  Data of patients with a previously failed bowel examination referred to our community hospital for a further colonoscopy were reviewed. When caecal intubation still failed with standard colonoscope, complete colonoscopy was usually attempted by shifting to a gastroscope.
  
  
  RESULTS
  Overall, 451 patients with a prior colonoscopy were considered. By using a standard colonoscope, caecal intubation rate was achieved in 285 out of 296 patients with prior complete examination and in 121 out of 155 patients with a prior failed colonoscopy (96.3% vs. 78.1%, p < .001). Caecum visualization was significantly lower when prior colonoscopy was stopped in the sigmoid tract as compared to any other proximal tract (65.1% vs. 86.9%, p < .001). After a second failed examination, colonoscopy was completed in 15 (51.7%) out of 29 cases by shifting to a standard gastroscope. No procedure-related complications were observed in the study.
  
  
  CONCLUSIONS
  After incomplete colonoscopy with a standard adult colonoscope, a further colonoscopy may be completed with same standard colonoscope or by using a gastroscope in the same session. A prior failed colonoscopy, particularly when stopped in the sigmoid tract, is significantly associated with a lower caecal intubation rate at second colonoscopy.
authors.affiliation: Gastroenterology and Digestive Endoscopy, Nuovo Regina Margherita Hospital, Rome, Italy. sergio.morini@gmail.com
authors.forename: Sergio
authors.initials: S
authors.lastname: Morini
authors.forename: Angelo
authors.initials: A
authors.lastname: Zullo
authors.forename: Cesare
authors.initials: C
authors.lastname: Hassan
authors.forename: Roberto
authors.initials: R
authors.lastname: Lorenzetti
authors.forename: Salvatore M A
authors.initials: SM
authors.lastname: Campo
mesh_terms: D002983:Clinical Competence; D003108:Colonic Diseases / Q000601:surgery / Q000628:therapy*; D003113:Colonoscopy / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017211:Treatment Failure