జీర్ణకోశ & జీర్ణ వ్యవస్థ

నైరూప్య

Retrograde Device Assisted Enteroscopy as a Salvage Procedure for Failed Colonoscopy: The Experience of a large Australian Centre

Mathew Keegan, Keval Pandya, Sanjivan Mudaliar, Payal Saxena, Arthur J Kaffes and Judith E Baars

Aim: Failed caecal intubation occurs in 4-25% of colonoscopies. The primary objective was to assess the technical success of retrograde Device Assisted Enteroscopy (rDAE) after failed colonoscopy. Secondary aims were to describe the diagnoses and interventions, and to identify factors affecting technical success.
Methods: Retrospective review of consecutive patients undergoing retrograde DAE at our institution between November 2004 and May 2016. Data were collected on: demographics, technical success, bowel preparation, diagnoses, interventions and adverse events.
Results: In total, 277 patients underwent retrograde DAE. Of these, 86 procedures were performed on 82 patients for incomplete colonoscopy, primarily in redundant colons. Cecal intubation was achieved in 80 procedures (93%). Incomplete procedures were caused by unsatisfactory preparation in 5 cases (6%) and by colonic herniation in 1 case (1%). Of the 80 completed procedures, 2 were non-diagnostic due to poor bowel preparation and 20 showed no abnormalities. In the remaining 58 procedures, 66 diagnoses were made: adenomatous polyps (n=25), inflammatory bowel disease (n=14), angioectasias (n=7), colonic diverticulosis (n=6), strictures (n=5), laterally spreading tumours (n=3), adenocarcinomas (n=3), and ileal ulcers (n=2). Interventions performed were: snare polypectomy (n=29), biopsy (n=17), argon plasma coagulation (n=8), endoscopic mucosal resections (n=3), dilatation (n=3) and endoscopic clipping (n=4). No reported adverse events.
Conclusion: Salvage retrograde DAE has a high technical success in redundant colons and important diagnostic findings. DAE should be recommended in preference to repeat standard colonoscopy or CT colonography. There should be a strong focus on optimising bowel preparation, as it was the major factor influencing technical success and diagnostic yield.