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 22 January 2018

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Impact of bending section length on colonoscopy insertion

Short bending sections facilitate proximal colon retroflexion for pediatric and adult colonoscopies, however, it can negatively impact cecal insertion and terminal ileal intubation in pediatric colonoscopies, reports the American Journal of Gastroenterology.

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Colonoscopes with short bending sections facilitate retroflexion but their effect on other aspects of colonoscope insertion are unknown.

Dr William Kessler and Dr Douglas Rex determined the impact of short bending on cecal insertion, terminal ileal intubation, and proximal colon retroflexion.

Deeper ileal intubation occurred with the normal bending in 2 directions versus short bending in 4 directions
American Journal of Gastroenterology

The researchers performed 2 studies.

In Study 1, the research team randomized 104 adult patients with intact colons to 3 different interventions including colonoscopy with a standard pediatric colonoscope.

Patients in Study 1 were randomized to a prototype pediatric colonoscope with short bending in 4 directions (Group 1), or short bending in 2 directions (Group 2), and normal bending in 2 directions (Group 3).

In Study 2, the team randomized 70 patients with intact colons to undergo colonoscopy with a prototype 170° wide angle colonoscope.

The randomization in Study 2 occurred either to a standard bending section length or to a prototype 170° colonoscope with a short bending section.

The researchers reported that in Study 1, the cecum was reached in all patients.

Short bending in 4 directions had a longer cecal intubation when compared to the standard pediatric colonoscope and the normal bending in 2 directions.

The researchers found that short bending in 4 directions required the application of abdominal pressure and activation of the variable stiffness device.

The team noted that activation of the variable stiffness device was less frequent with both the standard pediatric colonoscope and normal bending in 2 directions.

Successful cecal retroflexion was less possible with standard pediatric colonoscope compared to short bending in 4 directions or normal bending in 2 directions.

The researchers observed that the ability to intubate the terminal ileum was similar in Groups 1 to 3 as was the time needed to intubate.

The research team noted that depth of intubation was deeper for standard pediatric colonoscope compared to short bending in 4 directions or normal bending in 2 directions.

The team observed a trend toward deeper ileal intubation with the normal bending in 2 directions compared to the short bending in 4 directions.

In Study 2, the researchers found no difference in cecal intubation time or in frequency of application of abdominal pressure or position change.

In addition, the research team noted no difference in activation of the stiffening device in Study 2.

Cecal retroflexion was successful more often when using the colonoscope with a short bending section compared to a wide angle colonoscope.

Dr Kessler and colleague concluded, “Short bending sections facilitate proximal colon retroflexion for both pediatric and adult colonoscopies.”

“However, it can negatively impact cecal insertion and terminal ileal intubation in pediatric colonoscopes.”

“A pediatric colonoscope with short bending in only two directions had good function for both cecal insertion and proximal colon retroflexion.”

Am J Gastroenterol 2005: 100(6): 1290
09 June 2005

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