• Colorectal cancer
• bowel preparation
• colorectal cancer screening
• comorbidity
• incomplete colonoscopy

• Humans
• Male
• Colonoscopy/statistics & numerical data
• Female
• Middle Aged
• Colorectal Neoplasms/diagnosis
• Colorectal Neoplasms/epidemiology
• Aged
• Denmark/epidemiology
• Early Detection of Cancer/methods
• Early Detection of Cancer/statistics & numerical data
• Comorbidity
• Logistic Models
• Occult Blood
• Registries
• Risk Factors
• Multivariate Analysis
• Odds Ratio

• Benin (South-South Nigeria)
• colonoscopy finding
• haematochezia

• colonoscopy
• colonoscopy quality
• colorectal cancer
• screening

• Humans
• Colonoscopy
• Cecum
• Artificial Intelligence
• Quality Indicators, Health Care
• Early Detection of Cancer
• Colorectal Neoplasms/diagnosis
• Colorectal Neoplasms/prevention & control
• Adenoma/diagnosis

During endoscopy, an endoscopist is inevitably faced with the occasional “difficult colonoscopy,” in which the endoscopist finds it challenging to advance the endoscope to the cecum. Beyond optimization of technique, with minimized looping, minimal insufflation, sufficient sedation, and abdominal splinting when needed, sometimes additional tools may be needed. In this review, we cover available techniques and technologies to help navigate the difficult colonoscopy, including the ultrathin colonoscope, rigidizing overtube, balloon-assisted colonoscopy and the abdominal compression device.

• Difficult colonoscopy
• Incomplete colonoscopy
• Overtube
• Water immersion
• Colonoscopy
• Balloon enteroscopy

• artificial intelligence
• capsule endoscopy
• colonic disease
• endoscopy
• routine diagnostic test
• wireless capsule endoscopy

• colonoscopy
• colorectal cancer
• faecal haemoglobin
• faecal immunochemical test
• risk-scoring
• screening

• Colonoscopy
• Colorectal Neoplasms
• Early Detection of Cancer
• Feces
• Female
• Hemoglobins
• Humans
• Male
• Mass Screening
• Occult Blood

• Colonoscopy
• Gastrectomy
• Position
• Stomach neoplasm

Colonic capsule endoscopy (CCE) derived from the video capsule endoscopy, initially proposed to explore the small bowel, has demonstrated high sensitivity and specificity for colonic polyp detection. The primary outcome of the study was to assess the safety, feasibility, and reliability of CCE after colorectal surgery. Secondary outcomes were to identify the detection rate of colonic lesions and recognition of the surgical anastomosis as compared to colonoscopy.

This is a prospective single-center study conducted over a 2-year period. Thirty-seven patients with a history of colorectal surgery were prospectively included in this study. Each patient received both CCE and colonoscopy, performed by different operators blinded to each other’s results.

Thirty-two patients (86.5%) completed the study and were included in the final analysis. All capsules were naturally expelled. In three patients (9.4%), the anal verge was not identified during the CCE recording and the examination of the colon was considered incomplete. Surgical anastomosis was accurately identified by CCE in 78.2% of the patients versus 93.8% for colonoscopy (P = 0.65). Thirty-eight lesions were detected in 14 patients. The sensitivity of CCE to detect colonic polyps was 95.2% (95% confidence interval (CI): 77.3-99.2%), the specificity 82.4% (95% CI: 59.0-93.8%). Positive predictive value (PPV) and negative predictive value (NPV) of CCE to detect colonic polyps were 87.0% and 93.3%, respectively. No complications related to the passage of the capsule through the intestinal anastomosis were detected.

CCE proved to be safe and feasible, reporting a similar detection rate of colonic lesion compared to colonoscopy.

• Colonic anastomosis
• Colonic capsule endoscopy
• Colonoscopy
• Colorectal cancer screening
• Follow-up after colorectal surgery
• Video

The significance of the distal tip extension mechanism (DTEM) arises when the insertion tube of the colonoscope is no longer able to move further inside the colon, and when a longer insertion tube is needed. The main focus of this research is to investigate the development of a novel distal tip extension mechanism (DTEM).

To characterize the performance of the DTEM, the ability of the DTEM to extend the distal tip of the colonoscope 16 cm is investigated. To determine the maximum number of turns that the extension knob needs to make in order to move the distal tip 16 cm, the DTEM is used to displace the distal tip in different colon configurations using the silicon tube of a colonoscopy training model (CTM). The experimentally collected data was presented and discussed to characterize the performance of the DTEM.

The results showed that the DTEM is able to extend the distal tip 16 cm while the colon is in various configurations. Additionally, the impact of implanting the DTEM on the flexibility of the insertion tube was determined.

The results of this research suggest that the DTEM will be an effective tool to help colonoscopists performing better colonoscopies.

• colonoscope
• distal tip
• extension mechanism
• intubation

To review the indications for computed tomography colonography (CTC) performed on patients referred via the 2-week wait colorectal pathway (2WWCP).

A retrospective study was performed on all patients referred through the 2WWCP between October 2018 and September 2019. The referrals were audited against the National Institute for Health and Care Excellence (NICE) NG12/DG30 guidelines for referral to the 2WWCP, and against the Royal College of Radiologists (RCR) 2017 guidelines for CTC.

Over the study period, there were 1,707 2WWCP referrals, and 362 (21.2%) of these patients underwent CTC. The median age was 66 years, and 55% were female. Forty-six patients did not meet the NICE NG12/DG30 guidelines for referral to the 2WWCP, and a further 268, although meeting the NICE guidelines, did not meet the RCR 2017 guidelines for CTC. In total, only 13% of CTCs performed complied with both guidelines.

This audit demonstrated a significant opportunity to reallocate CTC resources in the recovery stage of the COVID-19 pandemic. To improve outcomes for colorectal cancer (CRC) in the UK, establishing a selective straight-to-test CTC 2WWCP should be considered. Documented consent detailing the risks and benefits of CTC versus colonoscopy should take place in order to assist the patient in making an informed choice.

• Adult
• Aged
• Aged, 80 and over
• COVID-19/epidemiology
• Colonography, Computed Tomographic/statistics & numerical data
• Female
• Guideline Adherence
• Humans
• Male
• Middle Aged
• Retrospective Studies
• SARS-CoV-2
• Waiting Lists

• Colorectal cancer
• colorectal curative surgery
• colorectal polyps
• computed tomography colonography
• postoperative surveillance
• standard optical colonoscopy

• Colon cancer
• Colonoscope retroflexion
• Failed colonoscopy
• Incomplete colonoscopy
• New colonoscope
• Short turning radius colonoscope

• CT colonography
• Colorectal cancer
• Optical colonoscopy
• Same day CT colonography

• Adult
• Aged
• Colon/diagnostic imaging
• Colonography, Computed Tomographic
• Colonoscopy/statistics & numerical data
• Contrast Media
• Diatrizoate Meglumine
• Female
• Humans
• Incidence
• Male
• Middle Aged
• Retrospective Studies
• Risk Factors

• Chronic Disease/epidemiology
• Comorbidity
• Decision Making/physiology
• Early Detection of Cancer/methods
• Humans
• Neoplasms/complications
• Neoplasms/diagnosis
• Neoplasms/epidemiology
• Patient Participation/statistics & numerical data
• Risk Factors

• 18525 Cancer Research UK
• 18180 Cancer Research UK
• C8640/A23385 Cancer Research UK
• 11700 Cancer Research UK
• 18667 Cancer Research UK

The aim of this study was to investigate the effect of response time from the Fecal Immunochemical Test (FIT) based screening invitation to the conclusive screening Optical Colonoscopy (OC) on the risk of detecting colorectal cancer (CRC), advanced stage disease and precursor lesions.

We used a cross-sectional study design and included all 62,554 screening participants registered in the Danish Colorectal Cancer Screening Database who tested FIT-positive between March 2014 and December 2016. The main exposure was response time, measured as the time from initial invitation to the conclusive OC. Our main outcomes were the probability of being diagnosed with CRC, advanced stage disease or precursor lesions.

Of the 62,554 FIT-positive participants, 53,171 (85%) received an OC and were eligible for analysis (median age 63.7 years, 56% men). In this group, 3,639 cancers were registered, 2,890 of which were registered with a defined stage of disease (79%), and 1,042 (36%) of these were advanced stage (UICC III & IV). In addition, 17,732 high-risk and 10,605 low-risk adenomas were identified. Compared to participants receiving the conclusive examination within 30 days, those receiving the examination more than 90 days after initial invitation were 3.49 times more likely to be diagnosed with any CRC (OR 3.49 [95% CI, 3.13–3.89]) and 2.10 times more likely to have advanced stage disease (OR 2.10 [95% CI, 1.73–2.56]). Those waiting for the longest were also more likely to have one or more high-risk adenomas (OR 1.59 [95% CI, 1.50–1.68]).

Increased screening response time was associated with a higher probability of detecting high-risk adenomas, any stage CRC and advanced stage cancer. More research is needed to explain what causes these associations.

• colorectal cancer screening
• delayed participation
• screening response time
• screening uptake

To evaluate the ability of PillCamColon2 to visualize colonic segments missed by incomplete optical colonoscopy (OC) and to assess the diagnostic yield.

This prospective multicentre study included 81 patients from nine centres who underwent second-generation colon capsule endoscopy (CCE) following incomplete OC performed by an experienced gastroenterologist (> 1000 colonoscopies). Patients with stenosis were excluded. According to patient preferences, CCE was performed the following day (protocol A) after staying on clear liquids and 0.75 L Moviprep in the morning or within 30 d after new split-dose Moviprep (protocol B). Boosts consisted of 0.75 L and 0.25 L Moviprep, and phospho-soda was given as a rescue if the capsule was not excreted after seven hours.

Seventy-four patients were analysed (51% of them in group A; 49% in group B). Bowel cleansing was adequate in 67% of cases, and CCE could visualize colonic segments missed by incomplete colonoscopy in 90% of patients under protocol A and 97% of patients under protocol B (P = 0.35, n.s.). Significant polyps including adenocarcinoma were detected in 24% of cases. Detection rates for all polyps and significant polyps per patient were similar in both protocols. Polyps were found predominantly in the right colon (86%) in segments that were not reached by OC. Extracolonic findings - such as reflux esophagitis, suspected Barrett esophagus, upper GI-bleeding, gastric polyps, gastric erosions and angiectasia - were detected in eight patients. PillCamColon2 capsule was retained in the ileum of one patient (1.4%) without symptoms and removed during an uneventful resection for unknown Crohn’s disease that was diagnosed as the cause of anemia, which was the indication for colonoscopy. CCE was well tolerated. One patient suffered from self-limiting vomiting after consuming the phospho-soda.

Second-generation CCE using a low-volume preparation is useful after incomplete OC, and it allows for the detection of additional relevant findings, but cleansing efficiency could be improved.

• Colon capsule endoscopy
• PillCamColon2
• Incomplete colonoscopy
• Low volume prep
• Moviprep
• Phospho-soda
• Cleanliness level
• Complementation rate
• Polyps

• Adenocarcinoma/diagnostic imaging
• Adenocarcinoma/pathology
• Aged
• Capsule Endoscopes
• Capsule Endoscopy/adverse effects
• Capsule Endoscopy/instrumentation
• Capsule Endoscopy/methods
• Cathartics/administration & dosage
• Colon/diagnostic imaging
• Colon/pathology
• Colonic Polyps/diagnostic imaging
• Colonic Polyps/pathology
• Colonoscopy/adverse effects
• Colonoscopy/instrumentation
• Colonoscopy/methods
• Female
• Humans
• Male
• Middle Aged
• Patient Preference
• Polyethylene Glycols/administration & dosage
• Prospective Studies
• Vomiting/epidemiology
• Vomiting/etiology

Colorectal cancer (CRC) is the third most common cancer and second leading cause of cancer-related death in the United States. Colonoscopy is widely preferred for CRC screening and is the most commonly used method in the United States. Adequate bowel preparation is essential for successful colonoscopy CRC screening. However, up to one-quarter of colonoscopies are associated with inadequate bowel preparation, which may result in reduced polyp and adenoma detection rates, unsuccessful screens, and an increased likelihood of repeat procedure. In addition, standardized criteria and assessment scales for bowel preparation quality are lacking. While several bowel preparation quality scales are referred to in the literature, these differ greatly in grading methodology and categorization criteria. Published reliability and validity data are available for five bowel preparation quality assessment scales, which vary in several key attributes. However, clinicians and researchers continue to use a variety of bowel preparation quality measures, including nonvalidated scales, leading to potential confusion and difficulty when comparing quality results among clinicians and across clinical trials. Optimal clinical criteria for bowel preparation quality remain controversial. The use of validated bowel preparation quality scales with stringent but simple scoring criteria would help clarify clinical trial data as well as the performance of colonoscopy in clinical practice related to quality measurements.

• Colonoscopy
• Bowel preparation
• Aronchick scale
• Ottawa Bowel Preparation Scale
• Boston Bowel Preparation Scale

• Cathartics/administration & dosage
• Colonoscopy/methods
• Colonoscopy/standards
• Colorectal Neoplasms/diagnostic imaging
• Early Detection of Cancer/methods
• Early Detection of Cancer/standards
• False Negative Reactions
• Humans
• Practice Guidelines as Topic
• Quality Assurance, Health Care/methods
• Quality Assurance, Health Care/standards

• Aronchick scale
• Boston Bowel Preparation Scale
• Bowel preparation
• Colonoscopy
• Ottawa Bowel Preparation Scale

• Cecum
• Colon carcinoma
• Colon visualization
• Colonography, computed tomographic
• Double-balloon colonoscopy

• CT
• CT colonography
• cancer staging
• colon cancer
• colonoscopy

Patient: Male, 62

Final Diagnosis: Spigelian hernia

Symptoms: Abdominal discomfort

Medication: —

Clinical Procedure: Hernia repair and colonoscopy

Specialty: Gastroenterology and Hepatology

• Colonoscopy
• Double-balloon enteroscopy
• Endoscopy
• Training technics

• body mass index
• capsule endoscopy
• colon
• constipation
• gastrointestinal endoscopy
• water intake

• Crohn’s disease
• Inflammatory bowel disease
• MR colonography
• MR imaging
• Ulcerative colitis

• Adult
• Barium Sulfate/administration & dosage
• Colonoscopy/instrumentation
• Colonoscopy/methods
• Contrast Media
• Enema/methods
• Female
• Humans
• Inflammatory Bowel Diseases/diagnosis
• Inflammatory Bowel Diseases/diagnostic imaging
• Magnetic Resonance Imaging/methods
• Male
• Middle Aged
• Reproducibility of Results
• Water

• CT colonography
• abdominal CT
• acute diverticulitis
• colonoscopy
• diverticular disease

Factors that affect caecal intubation during colonoscopy include age and sex of the patient, quality of bowel preparation, prior abdominal or pelvic surgery and pelvic inflammatory disease, among others. The aim of this prospective study was to evaluate the effects of patients' demography such as age and sex, as well as anthropometry (height, weight and body mass index (BMI)) on caecal intubation time (CIT).

All consecutive patients referred for colonoscopy over a period of 6 months were recruited into the study. Prior to the procedure, patients' demographic data as well as history of prior abdominal or pelvic surgery were recorded. The height and weight of each patient were taken, and the BMI calculated. CIT was measured from the time of insertion of the colonoscope into the anal canal to the time when the base of the caecum was intubated.

A total of 167 patients comprising 99 (59.3%) males and 68 (40.7%) females were studied. The mean CIT of the procedures was 912.5±477.1 s with a range of 180–3180 s. It was more prolonged in patients older than 65 years of age, in males and in those with prior abdominal/pelvic surgery, although no significant difference was observed among the groups. Multivariate logistic regression analysis showed that increased BMI and non-usage of additional manoeuvres independently reduced CIT.

Older age, male gender, prior abdominal/pelvic surgery, use of additional manoeuvres and lower BMI were found to prolong CIT.

• COLONOSCOPY
• ENDOSCOPY
• OBESITY

AIM: To investigate when and why a colonoscopist should discontinue incomplete colonoscopy by himself.

METHODS: In this cross-sectional study, 517 difficult colonoscope insertions (Grade C, Kudo’s difficulty classification) screened from 37800 colonoscopy insertions were collected from April 2004 to June 2014 by three 4^th-level (Kudo’s classification) colonoscopists. The following common factors for the incomplete insertion were excluded: structural obstruction of the colon or rectum, insufficient colon cleansing, discontinuation due to patient’s discomfort or pain, severe colon disease with a perforation risk (e.g., severe ischemic colonopathy). All the excluded patients were re-scheduled if permission was obtained from the patients whose intubation had failed. If the repeat intubations were still a failure because of the difficult operative techniques, those patients were also included in this study. The patient’s age, sex, anesthesia and colonoscope type were recorded before colonoscopy. During the colonoscopic examination, the influencing factors of fixation, tortuosity, laxity and redundancy of the colon were assessed, and the insertion time (> 10 min or ≤ 10 min) were registered. The insertion time was analyzed by t-test, and other factors were analyzed by univariate and multivariate logistic regression.

RESULTS: Three hundred and twenty-two (62.3%) of the 517 insertions were complete in the colonoscope insertion into the ileocecum, but 195 (37.7%) failed in the insertion. Fixation, tortuosity, laxity or redundancy occurred during the colonoscopic examination. Multivariate logistic regression analysis revealed that fixation (OR = 0.06, 95%CI: 0.03-0.16, P < 0.001) and tortuosity (OR = 0.04, 95%CI: 0.02-0.08, P < 0.001) were significantly related to the insertion into the ileocecum in the left hemicolon; multivariate logistic regression analysis also revealed that fixation (OR = 0.16, 95%CI: 0.06-0.39, P < 0.001), tortuosity (OR 0.23, 95%CI: 0.13-0.43, P < 0.001), redundancy (OR = 0.12, 95%CI: 0.05-0.26, P < 0.001) and sex (OR = 0.35, 95%CI: 0.20-0.63, P < 0.001) were significantly related to the insertion into the ileocecum in the right hemicolon. Prolonged insertion time (> 10 min) was an unfavorable factor for the insertion into the ileocecum.

CONCLUSION: Colonoscopy should be discontinued if freedom of the colonoscope body’s insertion and rotation is completely lost, and the insertion time is prolonged over 30 min.

• Colonoscopy
• Colonoscope insertion
• Insertion technique

• Clinical Competence
• Colonoscopes
• Colonoscopy/adverse effects
• Colonoscopy/instrumentation
• Cross-Sectional Studies
• Equipment Design
• Humans
• Logistic Models
• Multivariate Analysis
• Odds Ratio
• Risk Assessment
• Risk Factors
• Time Factors