Cecal intubation rates, techniques, and neoplasia yields associated with repeat colonoscopy performed with standard endoscopes in 1334 patients referred after prior incomplete colonoscopy

BACKGROUND: Cecal intubation rate (CIR) of ≥ 95% is a key quality metric for colonoscopy. After incomplete colonoscopy, patients are often referred for radiographic studies or centers performing balloon enteroscopy. OBJECTIVE: To determine the success of repeat colonoscopy with standard non-balloon endoscopes after a failed colonoscopy. DESIGN: We reviewed 1,334 consecutive patients referred to our center after colonoscopy with failed cecal intubation. Based on the outside procedure report, we classified causes of previous failure as difficult sigmoid, redundant colon, or hernia. We reviewed success rates of cecal intubation at our center, tools and techniques used in successful cases, and the sensitivity of outside radiographic studies performed prior to referral. RESULTS: We achieved CIR in 96.1% of cases - 97.0% in 626 difficult sigmoid colons, 96.9% in 677 redundant colons, and 67.7% in 31 hernia cases (100% in left inguinal, 29% in ventral hernia). Most difficult sigmoid cases were completed with pediatric or ultrathin colonoscopes. Most redundant colon cases were completed with adult colonoscopes. Twenty of 32 lesions ≥ 20 mm in size found on colonoscopy were not identified by prior radiographic studies. CONCLUSION: In the largest reported series of colonoscopies performed for prior incomplete examinations, we found nearly all cases, except a ventral hernia containing transverse colon, could be completed using standard endoscopic equipment and techniques. In this setting, radiographic studies have low sensitivity for large polyps. We recommend repeat colonoscopy at a referral center or using techniques described herein should be the first approach to a prior incomplete colonoscopy.