USE OF A PEDIATRIC COLONOSCOPE IMPROVES THE SUCCESS OF TOTAL COLONOSCOPY IN SELECTED ADULT PATIENTS

Background: Colonoscopy using a standard adult colonoscope can be diff icult or impossible when there is a fixed, angulated sigmoid colon or stricture. It is sometimes possible to traverse such segments using a smaller-diameter, more flexible pediatric colonoscope. Methods: For th is prospective study, one endoscopist started 645 consecutive, electiv e colonoscopies with a standard adult Olympus CF-100L colonoscope (52% women, 48% men). There were 36 examinations (5.6%) in which the adult colonoscope could not be passed through a fixed, angulated sigmoid co lon (n = 34) or a sigmoid colonic stricture (n = 2). In such instances (33 women and 3 men), the endoscopist switched to a pediatric colonos cope. Results: The pediatric colonoscope successfully reached the cecu m in 21 of the 36 cases (58.3%). The figure was 38.5% for the older Ol ympus CF-P20L fiberoptic colonoscope (n = 13) and 69.6% for the newer Olympus PCF-100 videocolonoscope (n = 23). Concomitant conditions in t he 34 patients in whom the pediatric colonoscope was used because of a fixed, angulated sigmoid included previous pelvic surgery in 22, pelv ic radiation therapy in 2, pelvic endometriosis in 3, and two with pre vious sigmoid diverticulitis. Conclusions: The pediatric colonoscope, and particularly the newer Olympus PCF-100 colonoscope, is very useful in adult patients in whom it is not possible to traverse a fixed, ang ulated sigmoid colon or stricture using the standard adult colonoscope . This is predominantly a problem of female patients. Previous pelvic surgery may be an important causative factor in this regard.