Accessing proximal aspects of folds and flexures during colonoscopy: impact of a pediatric colonoscope with a short bending section

OBJECTIVE: Accessing the proximal sides of colorectal folds, flexures, and valves can be difficult endoscopically and can contribute to missed lesions and failed therapeutic procedures. The aim of this study was to determine whether a prototype colonoscope with a short bending section could facilitate accessing difficult to reach areas proximal to folds, flexures, and valves. METHODS: In a nonrandomized study, the prototype colonoscope, a standard pediatric colonoscope, and a standard adult colonoscope were used to attempt retroflexion in the cecum and, if unsuccessful, in the right colon. RESULTS: The prototype colonoscope allowed cecal retroflexion, including clear visualization of the ileocecal valve and the cecal mucosa medial to the valve, in 95% of attempts. A standard pediatric colonoscope was successful in 50% and a standard adult colonoscope in 24.5%. The prototype was more successful than both the standard pediatric (p < 0.001) and the standard adult instrument (p < 0.001). The standard pediatric colonoscope was successful more often than the standard adult colonoscope (p = 0.02). CONCLUSIONS: Using the ability to retroflex in the cecum as a surrogate marker, a prototype pediatric colonoscope with a short bending section seems to facilitate retroflexion and visualization of the proximal aspects of difficult to see regions in the proximal colon.