A prospective randomised study comparing double-balloon colonoscopy and conventional colonoscopy in pre-defined technically difficult cases.
OBJECTIVE
Technically 'difficult' (TD) colonoscopy is associated with incomplete colonoscopy, discomfort and longer procedures. Double-balloon colonoscopy (DBC) may facilitate TD colonoscopy. The primary outcome was to compare the time taken to achieve caecal intubation during conventional colonoscopy (CC) and DBC in patient with a TD colon.


METHODS
We performed a prospective, randomised study comparing DBC and CC for TD colonoscopy. Patients were screened for parameters predictive of TD colonoscopy using an original scoring system and randomised to DBC or CC. Pain, sedation dose, colonoscopy completeness, time taken for cecal intubation, procedure completion, recovery time and patient satisfaction were recorded.


RESULTS
Forty-four patients were recruited (DBC=22; CC=22). DBC facilitated total colonoscopy in 22 cases whereas 9 CC procedures were incomplete (P=0.019). Median pre-procedure difficulty scores were equal for both groups (4.0 vs. 4.0). Mean patient discomfort, pain scores and recovery time were significantly lower for the DBC group (2.3 vs. 5.5, P=0.001; 2.0 vs. 5.9, P=0.005; 5 vs. 20min, P=0.014 respectively). Mean time taken for cecal intubation was similar (17.5 vs. 14min, P=0.18); CONCLUSION: DBC facilitates colonoscopy completion and may be a more comfortable alternative to CC for TD cases although the time taken to achieve caecal intubation was similar.
Royal Free Unit for Endoscopy and Centre for Gastroenterology, UCL Institute for Liver and Digestive Health, Royal Free NHS Foundation Trust, London, United Kingdom; Wolfson Unit for Endoscopy, St Mark's Hospital and Academic Institute, Imperial College London, London, United Kingdom. Electronic address: edward.despott@nhs.net.
Edward J
EJ
Despott
Royal Free Unit for Endoscopy and Centre for Gastroenterology, UCL Institute for Liver and Digestive Health, Royal Free NHS Foundation Trust, London, United Kingdom; Wolfson Unit for Endoscopy, St Mark's Hospital and Academic Institute, Imperial College London, London, United Kingdom.
Alberto
A
Murino
Wolfson Unit for Endoscopy, St Mark's Hospital and Academic Institute, Imperial College London, London, United Kingdom; Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Masanao
M
Nakamura
Wolfson Unit for Endoscopy, St Mark's Hospital and Academic Institute, Imperial College London, London, United Kingdom; Department of Gastroenterology, Creta Interclinic, Heraklion, Crete, Greece.
Leonidas
L
Bourikas
Wolfson Unit for Endoscopy, St Mark's Hospital and Academic Institute, Imperial College London, London, United Kingdom; Department of Gastroenterology, The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.
Chris
C
Fraser
D015746:Abdominal Pain / Q000175:diagnosis / Q000209:etiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002432:Cecum / Q000473:pathology; D002983:Clinical Competence; D020685:Colonoscopes; D003113:Colonoscopy; D058582:Double-Balloon Enteroscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011446:Prospective Studies; D006113:United Kingdom; D055815:Young Adult
Caecal intubation; Difficult colonoscopy; Double-balloon colonoscopy