title: Spiral overtube-assisted colonoscopy after incomplete colonoscopy in the redundant colon.
abstract: BACKGROUND
  A redundant colon can lead to incomplete colonoscopy. A variety of tools and techniques are available to complete colonoscopy but have limitations.
  
  
  OBJECTIVE
  To determine the feasibility and safety of using a spiral overtube to complete a difficult colonoscopy.
  
  
  METHODS
  Retrospective review of a prospectively collected database.
  
  
  METHODS
  Single tertiary institution.
  
  
  METHODS
  Twenty-four patients with incomplete colonoscopy because of redundant colons underwent 26 procedures. The median age was 68 years, and 58% were men.
  
  
  METHODS
  All patients underwent colonoscopy performed with a 90-cm flexible threaded overtube and a variable-stiffness pediatric colonoscope. Four individuals (18%) required exchanging the colonoscope for an enteroscope.
  
  
  METHODS
  Successful cecal intubation, polyp identification and removal, time to reach the cecum, sedation needed, and complications.
  
  
  RESULTS
  Cecal intubation was achieved in 22 patients (92%). Failures occurred in 2 patients with large hernias. The median time from insertion of the colonoscope to reaching the cecum was 14.5 minutes. All procedures were performed by using conscious sedation with midazolam (median dose 7 mg) and fentanyl (median dose 150 μg). Significant findings were encountered in 17 of 22 patients (77%) including 1 cancer and 2 advanced polyps. A median of 3 polyps was removed from each patient who had polyps. All noncancerous polyps were removed during the procedure. There were no complications.
  
  
  CONCLUSIONS
  Retrospective design, no control group, single center.
  
  
  CONCLUSIONS
  Spiral overtube-assisted colonoscopy can enable cecal intubation in the majority of patients in whom standard colonoscopy fails because of a redundant colon.
authors.affiliation: Swedish Gastroenterology, 1221 Madison Street, Seattle, WA 98104, USA. drew.schembre@swedish.org
authors.forename: Drew B
authors.initials: DB
authors.lastname: Schembre
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Ross
authors.forename: Michael N
authors.initials: MN
authors.lastname: Gluck
authors.forename: John J
authors.initials: JJ
authors.lastname: Brandabur
authors.forename: Susan E
authors.initials: SE
authors.lastname: McCormick
authors.forename: Otto S
authors.initials: OS
authors.lastname: Lin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002432:Cecum; D003106:Colon / Q000033:anatomy & histology*; D020685:Colonoscopes; D003113:Colonoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies