Swedish Gastroenterology, 1221 Madison Street, Seattle, WA 98104, USA.
Gastrointest Endosc. 2011 Mar;73(3):515-9. doi: 10.1016/j.gie.2010.11.047.
A redundant colon can lead to incomplete colonoscopy. A variety of tools and techniques are available to complete colonoscopy but have limitations.
To determine the feasibility and safety of using a spiral overtube to complete a difficult colonoscopy.
Retrospective review of a prospectively collected database.
Single tertiary institution.
Twenty-four patients with incomplete colonoscopy because of redundant colons underwent 26 procedures. The median age was 68 years, and 58% were men.
All patients underwent colonoscopy performed with a 90-cm flexible threaded overtube and a variable-stiffness pediatric colonoscope. Four individuals (18%) required exchanging the colonoscope for an enteroscope.
Successful cecal intubation, polyp identification and removal, time to reach the cecum, sedation needed, and complications.
Cecal intubation was achieved in 22 patients (92%). Failures occurred in 2 patients with large hernias. The median time from insertion of the colonoscope to reaching the cecum was 14.5 minutes. All procedures were performed by using conscious sedation with midazolam (median dose 7 mg) and fentanyl (median dose 150 μg). Significant findings were encountered in 17 of 22 patients (77%) including 1 cancer and 2 advanced polyps. A median of 3 polyps was removed from each patient who had polyps. All noncancerous polyps were removed during the procedure. There were no complications.
Retrospective design, no control group, single center.
Spiral overtube-assisted colonoscopy can enable cecal intubation in the majority of patients in whom standard colonoscopy fails because of a redundant colon.
多余的结肠可能导致结肠镜检查不完全。有多种工具和技术可用于完成结肠镜检查，但都存在局限性。
确定使用螺旋外套管完成困难结肠镜检查的可行性和安全性。
前瞻性收集数据库的回顾性研究。
单一的三级医疗机构。
24 例因结肠冗长而导致结肠镜检查不完全的患者接受了 26 例检查。患者的中位年龄为 68 岁，58%为男性。
所有患者均接受 90cm 柔性螺纹外套管和可变硬度小儿结肠镜进行结肠镜检查。有 4 名患者（18%）需要将结肠镜更换为内镜。
盲肠插管成功、息肉识别和切除、到达盲肠的时间、所需镇静剂以及并发症。
22 例患者（92%）成功插管盲肠。2 例有大疝的患者插管失败。从插入结肠镜到到达盲肠的中位时间为 14.5 分钟。所有操作均使用咪达唑仑（中位剂量 7mg）和芬太尼（中位剂量 150μg）进行清醒镇静。22 例患者中有 17 例（77%）发现了显著病变，包括 1 例癌症和 2 例高级别息肉。每位有息肉的患者平均切除 3 个息肉。所有非癌性息肉均在手术过程中切除。无并发症。
回顾性设计、无对照组、单中心。
螺旋外套管辅助结肠镜检查可使大多数因结肠冗长而导致标准结肠镜检查失败的患者插管盲肠。
