Usefulness of a pediatric colonoscope for colonoscopy in adults

Background: There are few published data on how different types of colonosc opes affect success in reaching the cecum and patient comfort. We examined the feasibility of using a pediatric colonoscope for routine colonoscopy in adults and investigated whether there were subgroups of patients in whom u se of this instrument was preferable. Methods: One-hundred fifty adults undergoing outpatient colonoscopy were ra ndomized to colonoscopy with a standard colonoscope (Olympus CF-100L) or wi th a pediatric colonoscope (Olympus PCF-100). All procedures were performed by a faculty endoscopist and timed by an independent observer. After exami nations, the endoscopist graded procedure difficulty and patients were give n a questionnaire that assessed their experience. Results: The adult (n = 77) and pediatric (n = 73) colonoscope groups were comparable in all outcomes measured, including success in reaching the cecu m (91% vs. 93%, p = 0.61), mean time to reach the cecum (11.4 vs. 9.7 min, p = 0.07), mean total procedure time (21.8 vs. 21.9 min, p = 0.95), mean me peridine dose (55 vs. 52 mg, p = 0.17); median midazolam dose (2.0 mg in bo th groups, p = 0.10), the endoscopists' perception of procedure difficulty, and patient comfort scales. Of the 7 patients in whom colonoscopy with the adult colonoscope was unsuccessful, the cecum was reached in 4 by switchin g to a pediatric colonoscope (all women, 3 of whom had prior hysterectomy). In the 5 patients in whom colonoscopy with the pediatric colonoscope was u nsuccessful, the cecum was reached in 1 by switching to an adult colonoscop e. Including the cases in which the cecum was reached by switching to the a lternative colonoscope, the overall frequency of cecal intubation was 143 o f 150 (95%). Subgroup analysis disclosed no difference between the 2 groups in outcomes when gender, presence of diverticulosis, and patient size were considered. Colonoscopy with the pediatric colonoscope was more successful than with the adult instrument in reaching the cecum in women with prior h ysterectomy (11 of 12 [92%] vs. 15 of 21 [71%]); however, the numbers in ea ch group were relatively small and the difference was not significant (p = 0.22). Conclusions: The pediatric colonoscope is suitable for routine colonoscopy in adults. It is also useful in patients in whom colonoscopy with the adult colonoscope is unsuccessful in reaching the cecum (particularly in women). Additional study is needed to see if the pediatric colonoscope is actually superior to the adult colonoscopy for routine colonoscopy in women with pr ior hysterectomy.