Inadequacy of colonoscopy revealed by three-dimensional electromagnetic imaging

INTRODUCTION: It is generally accepted that clinicians performing colonosco py should reach the cecum in at least 90 percent of examinations. However, little attention has been paid to whether the endoscopist correctly estimat es the amount of colon actually seen. METHODS. During colonoscopy, endoscop ists were asked to state how far they had reached. This was compared with t he amount of colon actually seen, as assessed by a novel electromagnetic im aging device that recorded a three-dimensional position of the score within a magnetic field pervading the patient's abdomen. If electromagnetic imagi ng showed that the cecum had not been reached, the endoscopist was asked to use the electromagnetic imaging system to determine whether it helped adva nce the colonoscope further. RESULTS: In 119 patients undergoing colonoscop y, clinical assessment of position reached was correct in only 92 (77.3 per cent). When the endoscopists stated that cecal landmarks had been seen (n = 85), the scope was distal to the cecum in seven cases (8.2 percent). When cecal landmarks had not been seen (n = 34), the endoscopist's assessment of the position of the scope was accurate in only 14 (41.2 percent). The use of electromagnetic imaging in this latter group assisted passage to the cec um in 26 cases (76.5 percent). CONCLUSION: Despite assumed visualization of the cecum, inadequate colonoscopy highlights the potential for missing sig nificant pathology in the right colon.