title: Double-balloon colonoscopy carried out by a trainee after  incomplete conventional colonoscopy.
abstract: OBJECTIVE
  It has been reported that double-balloon colonoscopy (DBC) is useful for patients after failed colonoscopy. In most cases previously reported, expert colonoscopists have carried out DBC. However, DBC may not require significant expertise. The objective of the present study is to assess DBC carried out by an inexperienced colonoscopist in patients referred after previously incomplete colonoscopy.
  
  
  METHODS
  In a single center between June 2011 and September 2012, we enrolled 28 consecutive patients referred following incomplete conventional colonoscopy. The reported reasons for previous failed colonoscopy were severe pain during the procedure in 15, long redundant colon in 13 and sigmoid fixation in eight. Under instruction by an experienced colonoscopist, all procedures were carried out by a gastroenterology trainee with little colonoscopy experience. A double-balloon instrument with carbon dioxide insufflation was used under fluoroscopic guidance, with i.v. sedation. Cecal intubation rate, time to cecum and patient-reported pain using a visual analog scale (0 to 10) were evaluated.
  
  
  RESULTS
  The trainee achieved a cecal intubation in all patients (100%) without primary involvement by the experienced colonoscopist. Time to cecum ranged from 6 min to 66 min (median time to cecum 15 min 55 s). No patients required additional sedation. Visual analogue pain scores ranged from 0/10 to 10/10 (median score 2.5/10). There were no complications.
  
  
  CONCLUSIONS
  DBC may enable inexperienced colonoscopists to achieve total colonoscopy after previously incomplete conventional colonoscopy.
authors.forename: Daiki
authors.initials: D
authors.lastname: Nemoto
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Isohata
authors.forename: Ken-ichi
authors.initials: K
authors.lastname: Utano
authors.forename: David G
authors.initials: DG
authors.lastname: Hewett
authors.forename: Kazutomo
authors.initials: K
authors.lastname: Togashi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence; D003113:Colonoscopy / Q000009:adverse effects* / Q000295:instrumentation* / Q000379:methods; D058582:Double-Balloon Enteroscopy / Q000193:education / Q000379:methods*; D004503:Education, Medical, Graduate / Q000379:methods; D005260:Female; D006801:Humans; D007564:Japan; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D019233:Retreatment; D018570:Risk Assessment; D012494:Sampling Studies; D017211:Treatment Failure