title: The role of single-balloon colonoscopy for patients with previous incomplete standard colonoscopy: Is it worth doing it?
abstract: BACKGROUND
  The rate of cecal intubation is a well-recognized quality measure of successful colonoscopy. Infrequently, the standard colonoscopy techniques fail to achieve complete examination. The role of single-balloon overtube-assisted colonoscopy (SBC) in these situations has only been sparsely studied. This prospective single-center study aimed to investigate the technical success (rate of cecal intubation) and the diagnostic gain of SBC.
  
  
  METHODS
  The study recruited consecutive patients with previous incomplete standard colonoscopy who were admitted for SBC at our tertiary center in Eastern Switzerland between February 2008 and October 2014. The primary outcome was defined as successful cecal intubation. Data on patient characteristics, indication, technical details of procedure, and outcome were collected prospectively. The Olympus enteroscope SIF-Q180 was used.
  
  
  RESULTS
  The study included 100 consecutive patients (median age 70 years; range 38-87 years; 54 % female) who were examined using a single-balloon overtube-assisted technique. The cecal intubation rate was 98 % (98/100). The median time of total procedure was 54 min (range 15-119 min); the median time to reach the cecal pole was 27.5 min (range 4-92 min). Passage of the sigmoid colon was not possible in two cases with a fixed, angulated sigmoid colon. The diagnostic gain was 21 % regarding adenomatous polyps in the right colon. The complication rate was 2 % (2/100, minor) without need for surgery.
  
  
  CONCLUSIONS
  This prospective patient cohort study shows that single-balloon colonoscopy is a safe and effective procedure to achieve a complete endoscopic examination in patients with a previous failed standard colonoscopy. A significant diagnostic and therapeutic gain in the right colon justifies additional procedure time.
authors.affiliation: Division of Gastroenterology and Hepatology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland. michael.sulz@kssg.ch.
authors.forename: Michael Christian
authors.initials: MC
authors.lastname: Sulz
authors.affiliation: Division of Gastroenterology and Hepatology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland.
authors.forename: Remus
authors.initials: R
authors.lastname: Frei
authors.affiliation: Division of Gastroenterology and Hepatology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland.
authors.forename: Gian-Marco
authors.initials: GM
authors.lastname: Semadeni
authors.affiliation: Division of Gastroenterology and Hepatology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland.
authors.forename: Mikael
authors.initials: M
authors.lastname: Sawatzki
authors.affiliation: Division of Gastroenterology and Hepatology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland.
authors.forename: Jan
authors.initials: J
authors.lastname: Borovicka
authors.affiliation: Division of Gastroenterology and Hepatology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland.
authors.forename: Christa
authors.initials: C
authors.lastname: Meyenberger
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002432:Cecum / Q000000981:diagnostic imaging; D020685:Colonoscopes; D003113:Colonoscopy / Q000379:methods* / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
keywords: Cecal intubation; Colonoscopy; Incomplete; Single-balloon