Does fluoroscopic imaging still have a role in colonoscopy?

Goal: To assess the use and value of fluoroscopic imaging in difficult colonoscopy. Background: Few endoscopy centers have easy access to fluoroscopy to facilitate difficult colonoscopy. Its benefits are therefore unclear. Although interest in colonoscope imaging has recently been stimulated by magnetic imaging techniques, these are expensive and unlikely to be widely available for some time. Study: During routine colonoscopy lists, a mobile fluoroscopy unit was used when colonoscopy could not be completed in the absence of stricturing despite changes in patient position and application of external pressure. This retrospective review assesses the percentage of procedures completed with and without fluoroscopy. Results: A series of 1551 procedures in adult patients without colon resection and with satisfactory bowel preparation was analyzed. The cecal intubation rate was 95.1% (1475/1551), rising to 96.5% (1475/1528) when impassable strictures were excluded. Fluoroscopy was used in 61 (4%) of the 1528 procedures without stricture, but allowed completion in only 13% (8/61). In the absence of stricture, fluoroscopy improved completion rate by only 0.5% (from 96.0% to 96.5%). Conclusions: Fluoroscopy is seldom required and even then contributes little to success. Magnetic imaging, which provides continuous 3-dimensional images, may be more likely to speed and facilitate completion.