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In such patients, a 2-day extended preparation, with larger volumes of bowel preparation, can be considered. 23Ĭertain patients are at risk for inadequate bowel preparation, including patients with a history of suboptimal bowel preparation, diabetes, chronic constipation, or abdominal surgery, as well as patients on medications that slow gut motility (eg, tricyclic antidepressants, opiates). 22 A subsequent study confirmed a high yield of lesions in colonoscopies with better bowel preparation. 21 A 2016 retrospective study of 28,368 colonoscopies showed that better bowel preparation significantly increased the rate of examination completion, with 99.5% completed colonoscopies from adequate bowel preparation vs 88.4% completed colonoscopies from poor bowel preparation. A prospective study evaluating 10,571 colonoscopies found that the completion rate of colonoscopies in patients with satisfactory bowel preparation was 67.5% compared with 36.0% in patients with poor bowel preparation (odds ratio, 3.76 P=.0005). Patient education regarding adequate bowel preparation, such as the importance of colon cleansing and specific instructions on how best to prepare for the colonoscopy, is vital. 19 The competency of the endoscopist appears to be a significant factor in determining the success of colonoscopy as well the American Society for Gastrointestinal Endoscopy (ASGE) guidelines state that for trainees, 500 colonoscopies may be required to consistently achieve cecal intubation in 90% of procedures. For example, one study showed that colonoscopies performed later in the day had higher rates of incompletion, suggesting operator fatigue to be an important factor. 14 - 18 Operator factors may also play a role according to the expertise of the endoscopist or technician.
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Technical factors include diverticulosis, tortuosity, adhesions due to previous surgeries, angulation or fixation of bowel loops, and ineffective sedation. Common patient factors include inadequate bowel preparation, discomfort and intolerance, low body mass, female sex, and young age. Multiple issues contribute to an incomplete colonoscopy in clinical practice, including patient, technical, and operator factors ( Table). It also highlights the management of incomplete colonoscopy and discusses new techniques and technologies that can be utilized to improve visualization of the entire colon.įactors Contributing to an Incomplete Colonoscopy 10 - 13 This article reviews the potential factors of an incomplete colonoscopy and the strategies for preventing such a situation. Incomplete colonoscopy rates vary from 4% to 25%. In certain situations, an endoscopist will encounter difficulty in advancing the colonoscope through the colon, leading to incomplete colonoscopy. 8 Current guidelines propose targets for successful cecal intubation rates of at least 90% for all colonoscopies and at least 95% for screening colonoscopies, with the knowledge that the majority of clinicians will exceed these minimal standards. 7 Therefore, complete colonoscopy can reduce the rates of interval proximal colon cancer. 6 Another study found that the risk of proximal cancer increased 2-fold when colonoscopy was not complete.
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A large, multicenter trial of patients undergoing screening colonoscopy found that 50% of patients had significant dysplastic lesions in the proximal colon. 5 Performing a complete colonoscopy is vital for minimizing polyp miss rates in all segments of the colon, including right-sided lesions. Cecal intubation is defined as the advancement of the colonoscope tip to a point proximal to the ileocecal valve so that the whole cecal caput, including the medial wall of the cecum, is seen. 2 - 4 The overall success of screening colonoscopy depends upon several parameters such as bowel preparation, cecal intubation rate, withdrawal time, and adenoma detection rate. In addition, colonoscopy with polypectomy reduces the incidence of CRC by up to 90%. The advantages of colonoscopy include complete visualization of the colon, detection and removal of polyps, and tissue sampling of significant lesions.
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1 Since the introduction of colonoscopy in the 1960s, the technology associated with this procedure has progressed considerably. Colonoscopy is the most widely used screening modality for the detection and removal of colon polyps and for the prevention of colorectal cancer (CRC).