Fluoroscopy - A valuable ally during difficult colonoscopy

Background: This study determines the pattern of fluoroscopy use during colonoscopy among a group of gastroenterologists and colon and rectal surgeons who have it readily available for each patient. Methods: One thousand three hundred fifty-seven consecutive patients undergoing colonoscopic examination were studied over a 16-month period. Results: Fluoroscopy was used during 34% of colonoscopic examinations. The frequency of fluoroscopy use was significantly higher for women (41% vs 28%, p < 0.001). Fluoroscopy was most commonly used to precisely locate the colonoscope tip (45%) or during manipulation of troublesome loops of colon (42%), thus accounting for 87% of 677 fluoroscopic checks. The most common location of the colonoscope tip during these fluoroscopic checks was the hepatic flexure (23%) followed by the cecum (20%); 51% involved the right colon. The selective use of fluoroscopy during the more difficult cases was substantiated by the longer procedure time (36 vs 26 min) and significantly lower cecal intubation rate (74% vs 96%, p < 0.002) when fluoroscopy was required. Fluoroscopy also proved to be valuable when precisely locating pathology and teaching colonoscope intubation techniques. Conclusions: Endoscopists who have fluoroscopy readily available often use it during difficult colonoscopic examinations. Fluoroscopy is most commonly used to maneuver troublesome loops of colon or to precisely locate colonoscope tip position, especially when negotiating the right colon. Although this technology is more frequently required for women, fluoroscopic capability for all colonoscopic examinations is advantageous.