Clinical Endoscopy

Enhanced adenoma detection with Endocuff Vision: a GRADE assessed systematic review and meta-analysis: Ahmed Ali Khan, Fariha Hasan, Mohammed Dheyaa Marsool Marsool, Muhammad Uzair, Kanz Ul Eman Maryam, Muhammad Usman Babar, Mutahhar Talha, Haider Imran, Rayyan Mohammad Makki Bakhsh, Kalsoom Zulfiqar, Fatima Wahid, Amal Shahzad Khan, Daniel Ashraf Guirguis, Christina Tofani, Anthony Infantolino; Clin Endosc 2026;59(3):371-385. Published online February 2, 2026; DOI: https://doi.org/10.5946/ce.2025.163

Graphical Abstract Abstract PDF Supplementary Material PubReader ePub: Background
/Aims: Colorectal cancer (CRC) is the second leading cause of cancer-related deaths and the third most common cancer worldwide. Detecting adenomas during colonoscopy reduces the CRC risk, with higher adenoma detection rates (ADRs) correlating with lower CRC incidence and mortality. Endocuff Vision (EV) enhances mucosal visualization and may improve ADRs.
Methods
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, PubMed, Embase, and Cochrane databases were searched through April 2025 for studies comparing EV-assisted and standard colonoscopy. The primary outcomes of interest were the ADRs, polyp detection rates (PDRs), and adverse events (AEs). Outcomes were pooled using a random-effects meta-analysis model and are presented as risk ratios (RRs) and mean differences. Heterogeneity in the pooled outcomes was assessed using the Higgins I².
Results
Thirty-four studies (43,702 participants) were included. EV significantly improved ADRs (RR, 1.15; 95% confidence interval [CI],1.07–1.25) and PDRs (RR, 1.16; 95% CI, 1.10–1.23). EV also improved lesion detection in the left colon (RR, 1.23; 95% CI, 1.11–1.35) and right colon (RR, 1.19; 95% CI, 1.09–1.29). No significant improvement was observed in advanced ADRs or cecal intubation. EV use was associated with more AEs.
Conclusions
EV-assisted colonoscopy improved ADRs and PDRs in both colonic regions and enhanced CRC screening despite increased AEs.

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A large and pedunculated inflammatory pseudotumor with pseudosarcomatous change of the cecum mimicking a malignant polyp: a case report and literature review: Jong Suk Oh, Hyung Wook Kim, Su Bum Park, Dae Hwan Kang, Cheol Woong Choi, Su Jin Kim, Hyeong Seok Nam, Dae Gon Ryu; Clin Endosc 2023;56(1):119-124. Published online July 19, 2021; DOI: https://doi.org/10.5946/ce.2021.081

Abstract PDF PubReader ePub: Inflammatory pseudotumor (IPT) is a rare benign tumor of unknown etiology that can occur in almost any organ system. It has neoplastic features such as local recurrence, invasive growth, and vascular invasion, leading to the possibility of malignant sarcomatous changes. The clinical presentations of colonic IPT may include abdominal pain, anemia, a palpable mass, and intestinal obstruction. A few cases of colonic IPT have been reported, but colonic IPT with pedunculated morphology is very rare. Furthermore, since it can mimic malignant polyps, understanding the endoscopic findings of colonic IPT is important for proper treatment. Herein, we present a case of colonic IPT with pseudosarcomatous changes, presenting as a large polyp, mimicking a malignant polyp in the cecum, along with a literature review.

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Double-Balloon Endoscopy after Incomplete Colonoscopy and Its Comparison with Computed Tomography Colonography: Carlijn Hermans, Dennis van der Zee, Lennard Gilissen; Clin Endosc 2018;51(1):66-71. Published online January 10, 2018; DOI: https://doi.org/10.5946/ce.2017.011

Abstract PDF PubReader ePub

Background
/Aims: Because of the national screening program for colorectal carcinoma in The Netherlands, the number of colonoscopies has increased. In case of incomplete colonoscopy, computed tomography colonography (CTC) and double-balloon colonoscopy (DBc) are alternative options. This study evaluated cecal intubation rate and pathology detection rate in the previously unexplored part of the colon, complication rate of DBc, and CTC results after incomplete colonoscopy.
Methods
Retrospective observational study in a tertiary referral hospital regarding DBc and CTC reports from cases with incomplete colonoscopy.
Results
Sixty-three DBcs were performed after incomplete colonoscopy. Cecal intubation rate was 95%. Detection rate was 58% (5% carcinoma and 3% high-grade dysplastic adenoma). CTC preceded 54% of DBcs and 62% of CTC findings were confirmed. In 16%, a biopsy was taken, and in 60%, an intervention (mostly polypectomy) was performed. One major complication (1.5%) occurred, i.e., arterial bleeding due to polypectomy necessitating right hemicolectomy. CTC (n=213) showed a possible lesion in 35%, and could be confirmed by follow-up endoscopy or surgery in 65%.
Conclusions
DBc is effective and safe for completion of colon inspection in incomplete colonoscopy. In patients with a high likelihood of pathology, DBc is preferred over CTC.

Citations

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Utility of repeat colonoscopy attempt after failed colonoscopy: a systematic review and pooled analysis
Aamir Saeed, Usama Qamar, Erin Tsambikos, Saira Yousuf, Faisal Kamal, Sultan Mahmood, Mohammad Madhoun, Muhammad Aziz, Ijlal Akbar Ali
Gastrointestinal Endoscopy.2026; 103(5): 890. CrossRef
A systematic review of the clinical effectiveness of a novel rigidizing overtube in completing difficult colonoscopies and for challenging colorectal polyp resection
Eleazar E. Montalvan-Sanchez, Dalton A. Norwood, Diego Izquierdo-Veraza, Renato Beas, Mirian Ramirez-Rojas, Sergio A. Sánchez-Luna, Shajan Peter, Douglas R. Morgan, Douglas K. Rex
iGIE.2025; 4(1): 68. CrossRef
When Experts Fail: Use of a Short Turning Radius Colonoscope Facilitates Successful Completion of Colonoscopy in Patients with Bowel Fixity
Mohit Girotra, Saurabh Sethi, Monique T. Barakat, Robert J. Huang, Shai Friedland, Uri Ladabaum, Subhas Banerjee
Digestive Diseases and Sciences.2020; 65(5): 1429. CrossRef
How I Approach Colonoscopy in Anatomically Difficult Colons
Douglas K. Rex
American Journal of Gastroenterology.2020; 115(2): 151. CrossRef
Diagnostic evaluation of a deep learning model for optical diagnosis of colorectal cancer
Dejun Zhou, Fei Tian, Xiangdong Tian, Lin Sun, Xianghui Huang, Feng Zhao, Nan Zhou, Zuoyu Chen, Qiang Zhang, Meng Yang, Yichen Yang, Xuexi Guo, Zhibin Li, Jia Liu, Jiefu Wang, Junfeng Wang, Bangmao Wang, Guoliang Zhang, Baocun Sun, Wei Zhang, Dalu Kong, K
Nature Communications.2020;[Epub] CrossRef
Performance of radiographic imaging after incomplete colonoscopy for nonmalignant causes in clinical practice
Nasim Parsa, Krishna C. Vemulapalli, Douglas K. Rex
Gastrointestinal Endoscopy.2020; 91(6): 1371. CrossRef
Computed Tomography Colonography Versus Standard Optical Colonoscopy for the Detection of Colorectal Polyp in Patients Who Faced Curative Surgery for Colorectal Cancer: A Diagnostic Performance Study
Lu He, Liang Guo, Chunhong Hu
Cancer Investigation.2020; 38(6): 339. CrossRef
Balloon-Assisted Colonoscopy after Incomplete Conventional Colonoscopy—Experience from Two European Centres with A Comprehensive Review of the Literature
Robertson Alexander R, Koulaouzidis Anastasios, Yung Diana E, Fraser Christopher, Nemeth Artur, Trimble Kenneth, Toth Ervin, Plevris John N, Wurm Johansson Gabriele
Journal of Clinical Medicine.2020; 9(9): 2981. CrossRef
Balloon-Assisted Endoscopy: A Powerful Tool for Complete Colonoscopy
Kyung Hwan Song, Beom Jae Lee
Clinical Endoscopy.2018; 51(1): 3. CrossRef

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Cecal Fecaloma Due to Intestinal Tuberculosis: Endoscopic Treatment: Sun Moon Kim, Ki Hyun Ryu, Young Suk Kim, Tae Hee Lee, Euyi Hyeog Im, Kyu Chan Huh, Young Woo Choi, Young Woo Kang; Clin Endosc 2012;45(2):174-176. Published online June 30, 2012; DOI: https://doi.org/10.5946/ce.2012.45.2.174

Abstract PDF PubReader ePub

Colorectal fecaloma is a mass of accumulated feces that is much harder in consistency than a fecal impactation. The rectosigmoid area is the common site for fecalomas and the cecum is the most unusual site. Diagnosis is usually made by distinctive radiographic findings of a mobile intraluminal mass with a smooth outline and no mucosal attachment. Most of the fecalomas are successfully treated by conservative methods such as laxatives, enemas and rectal evacuation. When conservative treatments have failed, endoscopic procedures or a surgical intervention may be needed. We report here that a cecal fecaloma caused by intestinal tuberculosis scar was successfully removed by endoscopic procedures.

Citations

Citations to this article as recorded by

Fecaloma: Classification, Treatment, and Outcomes
Diogo Henrique Saliba de Souza, Lucio Kenny Morais, Salustiano Gabriel Neto, Mauro Bafutto, Dayse Elisabeth Campos Oliveira, Camila Campos Oliveira, Jarbas Jabur Bittar Neto, Alejandro Luquetti Ostermayer, Ênio Chaves Oliveira
World Journal of Colorectal Surgery.2024; 13(4): 124. CrossRef
An Inahbitual Etiology of Acute Intestinal Obstruction: The Giant Fecalome
Leh Bi Kalou Ismaèl, Traoré Mamadou, N’Dri Ahou Bernadette, Ekra Amos Serge, Akowendo Ezéchiel, Kouakou Blaise Amos, Bamba Inza, Kouakou Kouamé Bernadin, Anzoua Kouakou Ibrahim, Lebeau Roger, Diané Bamourou
Surgical Science.2023; 14(03): 225. CrossRef
Obstructive Fecalomas in an Infant Treated with Successful Endoscopic Disimpaction
Risa Kanai, Kengo Nakaya, Koji Fukumoto, Masaya Yamoto, Hiromu Miyake, Akiyoshi Nomura, Susumu Yamada, Akihiro Makino, Hideto Iwafuchi, Naoto Urushihara, Georg Singer
Case Reports in Pediatrics.2021;[Epub] CrossRef
Cecal fecaloma: A rare cause of right lower quadrant pain
Brian T. Wang, Stefanie Y. Lee
European Journal of Radiology Open.2019; 6: 136. CrossRef
Gastrointestinal Tuberculosis
Eric H. Choi, Walter J. Coyle, David Schlossberg
Microbiology Spectrum.2016;[Epub] CrossRef
Successful Removal of Hard Sigmoid Fecaloma Using Endoscopic Cola Injection
Jong Jin Lee, Jeong Wook Kim
The Korean Journal of Gastroenterology.2015; 66(1): 46. CrossRef
Ileal Fecaloma Presenting with Small Bowel Obstruction
Ha Yeong Yoo, Hye Won Park, Seong-Hwan Chang, Sun Hwan Bae
Pediatric Gastroenterology, Hepatology & Nutrition.2015; 18(3): 193. CrossRef

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Mucocele of the Appendix Secondary to Obstruction by Cecal Endometriosis: Hyun-Min Lim, M.D. and Won-Choong Choi, M.D.; Korean J Gastrointest Endosc 2007;34(2):111-114. Published online March 2, 2007

Abstract PDF: The mucocele of the appendix is an uncommon abnormality caused by a dilatation of the appendiceal lumen caused by the abnormal accumulation of mucus. It can be associated with other colorectal tumors. Endometriosis of the gastrointestinal tract is also rare, particularly in the cecum. An appendiceal mucocele is usually diagnosed by a radiological study or surgery, however, recently, a colonoscopy is becoming an important diagnostic tool for colon diseases. We report a case of appendiceal mucocele. It is believed that the condition developed as a result of an obstruction of the appendicecal lumen caused by endometriosis, and might have been the cause of the intermittent right lower quadrant pain experience by the patient, which was aggravated during the menstrual period.

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Two Cases of Colon Anisakiasis: Asymphtomatic Cecal Anisakiasis and Ascending Colon Anisakiasis Detected One Month Later after Infestation: Sang Jung Kim, M.D., Jeong Wook Kim, M.D., Kwang Jin Kim, M.D., Chae Heo, M.D., Suk Won Kim, M.D., Sang Pyo Han, M.D., Young Hwan Seo, M.D., Jae Hyuk Do, M.D., Jae Gyu Kim, M.D. and Sill Moo Park, M.D.; Korean J Gastrointest Endosc 2006;33(2):116-120. Published online August 30, 2006

Abstract PDF: Anisakiasis of the gastrointestinal tract is usually caused by the ingestion of raw marine fish infested with Anisakis larvae. A majority of cases present as gastric and intestinal anisakiasis. Anisakiasis of colon is rare and asymptomatic colon anisakiasis has a particularly low incidence. A 45- year-old man received colonoscopy that revealed a 1.0 cm sized whitish linear larva penetrating the mucosa of the cecum and it was removed by colonscopy. He had no complaint before the colonoscopy. A 52-year-old man complained of right upper quadrant abdominal pain with weight loss for one month. Colonoscopy revealed a 1.5 cm sized whitish linear larva penetrating the mucosa of the distal part of ascending colon. Abdominal pain and weight loss were improved by colonoscopic removal of larva. (Korean J Gastrointest Endosc 2006;33:116⁣120)

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A Case of Inflammatory Fibroid Polyp of the Cecum Causing Intussusception: Se Young Park, M.D., Hyon Goo Kang, M.D., Hyun Jai Lee, M.D., Gyoung Jun Na, M.D., Chae Yong Yi, M.D., Dong Hyeon Lee, M.D., Tae Yeong Lee, M.D., Sang Hyun Kim, M.D., Chul Soo Song, M.D., Min Seok Kim, M.D.* and Ji Young Seo, M.D.^†; Korean J Gastrointest Endosc 2005;30(5):281-285. Published online May 30, 2005

Abstract PDF: Inflammatory fibroid polyp is a polypoid lesion of the gastrointestinal tract, composed of fibrous tissue, blood vessels, and inflammatory infiltration often dominated by eosinophilic leukocytes. It is infrequent, localized, and non-neoplastic condition. It is most often formed in the gastric antrum and ileum, and rarely in the esophagus, small bowel or colon. The polyp in the stomach is mainly located in the submucosa of the antrum, and may cause intermittent epigastric pain, vomiting, antral obstructive symptoms or rarely bleeding. When present in small bowel, it is usually localized in the ileum and presents with obstructive symptoms but clincal manifestations are different according to the location. Intussusception resulting from the mass is not common. We report a case of inflammatory fibroid polyp of the cecum causing intussusception. A 42-year-old male patient was referred to the hospital for the evaluation of right lower quadrant abdominal pain and palpable mass. A contrast-enhanced CT scan of the whole abdomen and colonoscopic examination revealed intussusception with a cecal mass. Inflammatory fibroid polyp causing intussusception was histologically confirmed by surgical wedge resection. (Korean J Gastrointest Endosc 2005;30:281⁣285)

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A Case of Duodeno-cecal Fistula Developed due to Foreign Body: Woo Jin Chung, M.D., Hea Won Park, M.D., Jun Young Hwang, M.D., Kyung Sik Park, M.D., Kwang Bum Cho, M.D., Jae Seok Hwang, M.D., Sung Hoon Ahn, M.D. and Soong Kook Park, M.D.; Korean J Gastrointest Endosc 2003;27(1):42-45. Published online July 30, 2003

Abstract PDF: Gastrointestinal foreign bodies are a common problem. It can be managed by observation, endoscopic removal, and/or surgical intervention. Bowel perforation, obstruction, bleeding, fistularization and abscess formation are common significant complications associated with foreign bodies. A 38-year-old woman with a toothbrush in the duodenum was referred to our hospital due to abdominal pain. Three years ago, she ingested a tooth brush. Esophagogastroduodenoscopy showed a tooth brush placed in the second portion of the duodenum. We removed a tooth brush by a snare and found a fistula at the junction of the second and third portion of the duodenum. Upper gastrointestinal series revealed a fistula between the duodenum and cecum. We report a case of duodeno-cecal fistula developed due to a toothbrush ingested 3 years before. (Korean J Gastrointest Endosc 2003;27:42⁣45)

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38세 남자, 우하복부 통증: Korean J Gastrointest Endosc 2003;26(5):374-374. Published online May 30, 2003

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대장내시경 및 CT 검사에서 종양으로 오진도니 맹장 게실염 1예 ( A Case of Solitary Cecal Diverticulitis Misdiagnosed as a Cecal Tumor ): Korean J Gastrointest Endosc 2000;21(1):563-567. Published online November 30, 1999

Abstract PDF: Cecal diverticulitis is a rare entity and remains a difficult diagnostic problem. Most patients are presented with an acute pain in the abdomen, which is nearly indistinguishable from that of appendicitis. Preoperative diagnostic studies are not helpful. Even with an operation, the correct diagnosis may be difficult to predict with certainty. The differential diagnosis between a cecal malignant tumor and a mass caused by inflammation due to cecal diverticulitis is difficult. Suspicion of a neoplastic process continues to prompt colectomy in an emergency setting. If diagnosed preoperatively, it can be treated effectively with a broad spectruum of antibiotics without surgical intervention. The physician must be aware this condition and be prepared to choose the most apropriate treatmetn. A case was experienced involving of solitary cecal diverticulitis misdiagnosed as a cecal tumor in a 61-year-o0ld female. This unique form of diverticulitis is herein reported with literature review. (Korean J Gastrointest Endosc 2000; 21:563-567)

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