Post written by Aamir Saeed, MD, from the University of Tennessee Health Sciences Center, Memphis, Tenn, USA.

We aimed to conduct a systematic review and meta-analysis to assess the outcomes of repeat colonoscopy after a previous incomplete procedure. Colorectal cancer is the second leading cause of cancer-related mortality in the Western world. Colonoscopy plays a critical role in reducing the incidence and mortality of colorectal cancer by enabling both detection and removal of premalignant lesions and early-stage cancers.

In clinical practice, patients with incomplete colonoscopies may undergo alternative imaging modalities such as CT colonography, capsule endoscopy, or barium enema or may be referred for repeat colonoscopy using advanced techniques. Methods such as variable-stiffness scopes, balloon-assisted enteroscopy, and water-assisted insertion have been used to improve success rates. Importantly, repeat colonoscopy has been shown to detect advanced neoplasia in a notable proportion of patients.

A total of 26 studies involving 1647 patients (61% female) met the inclusion criteria. The pooled overall cecal intubation rate (CIR) on repeat attempt was 95.7% (95% CI, 94.2%-97.2%), P < .001, I² = 58%. With a standard colonoscope, the pooled CIR was 96.2% (95% CI, 94.1%-98.4%), P < .031, I² = 50%. With single-balloon enteroscopy, the pooled CIR was 96.8% (95% CI, 95%-98.7%), P = .80, I² = 0%. In addition, the pooled CIR with double-balloon enteroscopy was 93% (95% CI, 88.7%-97.3%), P < .001, I² = 77.59%.

Repeat colonoscopy offers a high likelihood of CIR approaching 95%. Because it enables both diagnostic and therapeutic interventions, including adenoma removal, it should be the preferred modality in case of failed cecal intubation. Our findings also suggest the need for further large-scale randomized controlled trials to evaluate device efficacy across different clinical scenarios.

Overall cecal intubation rate (CIR) on repeat attempt. Ev/Trt, Event/total in treatment g.

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