Usefulness and safety of new ultrasmall-diameter colonoscope for cases with difficult insertion: A retrospective study

Usefulness and safety of new ultrasmall-diameter colonoscope for cases with difficult insertion: A retrospective study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Usefulness and safety of new ultrasmall-diameter colonoscope for cases with difficult insertion: A retrospective study Rie Terada, Ryoji Ichijima, Aya Iwao, Hiroshi Kinebuchi, Yuta Okada, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3856333/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 14 Sep, 2024 Read the published version in Scientific Reports → Version 1 posted 10 You are reading this latest preprint version Abstract Colonoscopies are widely available, but there are cases where insertion can be difficult, even for experienced endoscopists. EC-760XP/L, a new ultrasmall-diameter long scope, may be useful in such cases. This single-center retrospective study included 39 cases where colonoscope insertion was difficult even when previously conducted by an experienced endoscopist. The primary outcome was the cecal intubation time using EC-760XP/L compared to a previous examination with a standard scope. The secondary outcomes were the cecum intubation rate, intestinal cleanliness level, adenoma detection rate, polyp detection rate, sedative use rate, occurrence of adverse events, and pain experience. A comparison of cecal intubation times between EC-760XP/L and the standard scope showed that insertion times were significantly reduced with EC-760XP/L (9.5 minutes) compared to the standard scope (19 minutes) (p < 0.01). The standard scope achieved cecal intubation in 30 cases (76.9%), whereas EC-760XP/L reached the cecum in all cases (p < 0.01). Pain was observed in 3 cases (8.3%) with the EC-760XP/L, significantly lower than the 22 cases (56.4%) with the standard scope (p < 0.01). In conclusion, EC-760XP/L proved to be useful in cases where colonoscope insertion was difficult. Health sciences/Gastroenterology/Colonoscopy Health sciences/Gastroenterology/Gastrointestinal system Figures Figure 1 Introduction Colorectal cancer is ranked third in terms of morbidity and second in terms of mortality rate worldwide [ 1 ] . It has been suggested that the removal of adenomatous colonic polyps using a colonoscope is an effective means of preventing colorectal cancer [ 2 – 4 ] . Therefore, colonoscopies are an essential examination method for preventing and treating colorectal cancer. However, cases with pronounced inflammation, a history of abdominal surgery, and poor pretreatment may result in longer cecal intubation times, inability to intubate the cecum, or increased pain [ 5 ] . Patients who experience extended cecal intubation times or significant pain may be less inclined to consent to future examinations. Additionally, there is a concern in cases where cecal intubation is unsuccessful that colorectal cancer may develop in the regions not examined. Quality indicators of colonoscopy include the adenoma detection rate (ADR) and cecal intubation rate, and cases where intubation is difficult may decrease these indicators [ 6 – 10 ] . Even skilled endoscopists occasionally encounter difficult insertions. While sedation during endoscopy can alleviate pain, it must be administered with caution in elderly patients and those with underlying conditions due to potential adverse events, including respiratory depression and hypotension [ 11 , 12 ] . Various insertion methods and pretreatment methods have been previously reported, but some patients still experience pain during insertion. The use of ultrathin endoscopes has been reported to improve the ileocecal region intubation rate and reduce patient pain [ 5 ] . EC-760XP/L (FUJIFILM Corporation, Tokyo, Japan), a new ultra-small-diameter long scope with a flexible outer diameter of 9.3 mm and an effective length of 1690 mm, appears highly effective in cases with insertion difficulties. Unlike conventional small-diameter endoscopes with limited sub-water supply functions, EC-760XP/L is equipped with a sub-water supply function, enhancing its utility in inadequate pretreatment cases and managing post-procedural bleeding. It also supports image-enhanced observation techniques such as Linked Color Imaging (LCI) and Blue Laser Imaging (BLI), along with the CAD EYE system incorporating artificial intelligence technology, raising expectations for improved ADR and diagnostic accuracy [ 13 – 16 ] . As no prior reports have been on EC-760XP/L, this study aims to evaluate its usefulness and safety in cases with insertion difficulties encountered by endoscopists. Methods ・ Study design This was a single-center, retrospective study. The study was registered with the University Hospital Medical Information Network (UMIN 000052830) and conducted in accordance with the Helsinki Convention. Written informed consent was obtained from all patients before colonoscopy. This study received approval from the review board of Nihon University School of Medicine. ・ Inclusion and exclusion criteria Figure 1 presents the flow chart of this study. The participants were cases where colonoscope insertion was difficult despite a previous examination by an experienced endoscopist. Of the 3,071 patients who underwent colonoscopies between June 2022 and October 2023, 174 were examined using EC-760XP/L scope. From this group, exclusions were made as follows: 56 cases without a history of colonoscopy at our hospital, 58 cases where the previous endoscope insertion was not difficult, and 21 cases where the previous or current endoscopist was considered inexperienced. Consequently, a total of 39 subjects were included in the analysis. ・ Endoscopic procedure All patients undergoing colonoscopies had not eaten since 21:00 the day prior. Before the examination, patients orally administered sodium picosulfate (provided by Tsuruhara Pharmaceutical Co. Ltd., Osaka, Japan) before bed the night before. On the day of the examination, they used MoviPrep (EA Pharma Co., Tokyo, Japan) or Niflec (EA Pharma Co.) as a laxative. EC-760XP/L was used in the examination for all cases, with CO 2 insufflation. The operator used butylscopolamine or glucagon as an antispasmodic, depending on the patient's underlying disease and preference. Midazolam was used as a sedative. Before initiating the examination, the physician confirmed the patient's preferences. Medications were administered before the examination or upon the patient expressing pain. Definition Endoscope insertion difficulties were defined as cases where cecal intubation could not be achieved in the endoscopy conducted at our hospital or where the cecal intubation time was 15 minutes or longer despite an experienced endoscopist having examined with a standard endoscope during the previous endoscopy. An experienced endoscopist was defined as an endoscopist with experience in colonoscopy and who was certified by the Japan Gastroenterological Endoscopy Society. Evaluations regarding the presence of pain were determined based on the descriptions of the endoscopist who conducted the examination. The removal time was defined as the time from cecal intubation until the scope was removed and the examination was completed. SD endoscope was defined as one of the following: CF-H290I, CF-HQ290I, PCF-H290I, PCF-H290ZI, PCF-Q260AI, PCF-Q260AZI, PCF-Q260JI, PCF-Q240ZI (Olympus, Tokyo, Japan), and EC-760ZP-V/M (FUJIFILM Corporation, Tokyo, Japan). Evaluations of intestinal cleanliness levels involved the use of the Boston Bowel Preparation Scale (BBPS) [ 17 ] . A score of ≥ 6 out of 9 was considered good in terms of pretreatment. Adverse events included postexamination abdominal pain, nausea, vomiting, and intestinal perforation. ・ Outcomes The primary outcome was the cecal intubation time using EC-760XP/L compared to a previous examination with a standard scope. The secondary outcomes were the cecum intubation rate, intestinal cleanliness level, ADR, polyp detection rate (PDR), sedative use rate, occurrence of adverse events, and pain experience. ・ Statistical analysis Descriptive data are expressed as median and interquartile range. Comparisons between groups were conducted using the Wilcoxon signed rank test. The χ-squared test or Fisher's exact test was used for categorical variables. A p-value of < 0.05 was considered statistically significant. JMP Pro was used for all statistical analyses (version 13.0; JMP Statistical Discovery LLC, Cary, NC, USA). Result Baseline characteristics Table 1 shows the participant's characteristics. The median participant age was 64 years (IQR: 46.5–75 years), 15 were male, median height was 161.1 cm (154.0–165.0 cm), median weight was 55.6 kg (50.0–64.0 kg), and median BMI was 21.4 kg/m 2 (19.4–24.6 kg/m 2 ). Table 1 Baseline characteristics of this study N = 39 Age (IQR) 67 (57.5–74.3) Sex, (male / female) 15 (38.5%)/ 24 (61.5%) Height, cm (IQR) 161.1 (154.0-165.0) Weight, kg (IQR) 55.6 (50.0–64.0) BMI, kg/m 2 21.4 (19.4–24.6) ASA, n (%) I / II / III 0 (0%) / 37 (94.9%) / 2 (5.1%) Past History that may make insertion difficult, n (%) Abdominal surgery Diverticulitis 9 (23.0%) 11 (28.2%) IQR, interquartile range; BMI, body mass index; ASA, American Society of Anesthesiologists physical status grade Endoscopic results Table 2 shows the therapeutic results of endoscopy. A comparison between EC-760XP/L and a previous standard scope revealed a significant reduction in intubation times: 9.5 minutes (range 5.3–12 minutes) for EC-760XP/L versus 19 minutes (range 15.9–25 minutes) for the standard scope (p < 0.01). While the conventional scope achieved a cecal intubation rate in 30 cases (76.9%), EC-760XP/L successfully reached the cecum in all cases (p < 0.01). There was no significant difference in sedative use between the two groups. Notably, pain was reported in only 3 cases (8.3%) with EC-760XP/L, compared to 22 cases (56.4%) with the conventional scope, representing a significant improvement (p < 0.01). No statistically significant difference was observed in ADR and PDR. No adverse events associated with the examination were also observed in either group. The median BBPS values were 9 (6.8–9) for EC-760XP/L and 9 (8–9) for the standard scope, with no significant difference observed. Table 2 Endoscopic outcomes of last time and this time Ultrathin colonoscopy n = 39 Previous colonoscopy n = 39 *P-value Cecal intubation time, min (range) 9.5 (5.3–12.0) 19 (15.8–25.0) < 0.01 Cecal intubation rate, n 39 (100%) 30 (76.9%) < 0.01 Observational time, n 10.0 (8.0-14.8) 12.0 (9.0–19.0) 0.42 Adenoma Detection, n (%) 23 (59.0%) 17 (43.6%) 0.18 Polyp Detection, n (%) 26 (66.7%) 20 (51.3%) 0.24 Boston Bowel preparation Scale, n (IQR) 9 (6.8-9) 9 (8–9) 0.68 Pain, n (%) 3 (8.3%) 22 (56.4%) < 0.01 Use of sedatives, n (%) 13 (33.3%) 10 (25.6%) 0.62 Antispasmodic, n (%) 33 (84.6%) 27 (69.2%) 0.17 Adverse events, n (%) 0 0 - * P-value was calculated using the χ 2 test or Fisher's exact test for categorical data P-value was calculated using a t test or the Mann–Whitney U test for continuous data Discussion This study is a single-center, retrospective analysis that evaluates the use of the EC-760XP/L in patients who experienced difficulties with colonoscope insertion. Results showed that using this endoscope improved the cecal intubation rate, reduced cecal intubation time, and significantly reduced pain. To our knowledge, this is the first report that has demonstrated the usefulness of EC-760XP/L for patients with difficult colonoscope insertion. There have been several previous reports regarding colonoscopy using PCF-PQ260L (PQL), which is another small-diameter endoscope. Sato et al. used PQL as a rescue device in patients where the colonoscope could not be inserted during regular examination, and results showed that cecal intubation was achieved in 97.7% (42/43) of cases. They also showed that the mean pain score during the colonoscopy was significantly lower after the second PQL colonoscopy than during the first regular colonoscopy [ 18 ] . According to a report by Inoki et al. [ 5 ] , there were no significant differences in the cecal intubation rate, cecal intubation time, and ADR between the PQL and standard colonoscope use groups. However, a comparison between PQL examinations and standard colonoscopies in the same patient showed that PQL use resulted in a reduced mean cecal intubation time (7 minutes vs. 10 minutes, p < 0.01), as well as a significantly higher number of patients with less pain (66% vs. 20%, p < 0.01) and less use of sedation (48% vs. 25%, p < 0.01). Hamada et al. conducted a study in which female patients undergoing colonoscopy without sedatives were randomly assigned to either a group using PQL or a standard colonoscopy group. Their analysis revealed that the group using PQL experienced significantly less pain and demonstrated a higher willingness to undergo the next examination without sedatives compared to the standard colonoscopy group [ 19 ] . These results also indicate the usefulness of small-diameter long scopes in cases with insertion difficulties. Similar to the present study, the report by Inoki et al. [ 5 ] compared standard colonoscopy and PQL in the same patient; however, PQL was conducted by a specialist in a significantly higher number of cases, suggesting that the results may have been affected by differences in endoscopy techniques. In our study, the inclusion criteria were specifically limited to cases where insertion was difficult during the previous examination, even when performed by an experienced endoscopist. Additionally, we focused on the same patients as those from the previous examination. We defined insertion difficulty as instances where the previous intubation time was ≥ 15 minutes or longer, providing a more objective basis for analysis. EC-760XP/L offers significant advantages, including LCI and a water jet function (sub-water supply function). A challenge in conventional narrow-band imaging and BLI is that water appears red, potentially impacting image clarity. In cases with insertion difficulties, inadequate pretreatment, insufficient suction of water, or residual feces are frequent, which may reduce the ADR of the enhanced image. Meanwhile, with LCI, the ADR can be expected to increase regardless of water influence, and the water jet function also enables the cleaning of mucous membranes. Although our study did not demonstrate an additional effect on ADR or PDR compared to previous endoscopies, we observed encouraging results with an ADR of 59.0% and a PDR of 66.7%. Furthermore, although there is a high risk of adverse events (such as adhesions) in cases with insertion difficulties, no adverse events, such as gastrointestinal perforation or abdominal pain, were confirmed in this study. Meanwhile, EC-760XP/L has a narrow forceps channel and long scope, so there is still room for improvement in terms of treatment. Future studies will need to consider ways to improve treatment. The present study had several limitations. Firstly, it was a single-center, retrospective study with a small sample size. Secondly, direct comparisons were not performed by conducting examinations with a standard scope following those with the EC-760XP/L. Furthermore, each examination was conducted by different operators. Thirdly, the role of sedatives warrants consideration. Although there were no significant differences in sedative use, their administration could potentially enhance the cecal intubation rate, reduce intubation times, and reduce pain. In the future, conducting a multicenter, prospective, comparative study of EC-760XP/L in cases with insertion difficulties and accumulating cases is necessary. Conclusion In the present study, we demonstrated the usefulness of EC-760XP/L in cases with difficult colonoscope insertion. Further research is required to validate our findings. Declarations Acknowledgements (not compulsory) We sincerely thank all medical staff from the Nihon University School of Medicine. We thank Editage (www.editage.com) for English language editing. Author contributions statement R.T., A.I and R.I. planned and designed the study. R.T. and R.I. analyzed and interpreted the data. R.T. and R.I. wrote the manuscript. R.T., R.I., A.I., H.K., Y.O., T.S., K.O., A.H., and H.K. were involved in critical revision of the article for important intellectual content. All authors approved the final manuscript. Additional information There are no external funding sources for this study. All authors had no conflict of interest in this study. Additional information There are no external funding sources for this study. All authors had no conflict of interest in this study. Author Contribution R.T., A.I and R.I. planned and designed the study. R.T. and R.I. analyzed and interpreted the data. R.T. and R.I. wrote the manuscript. R.T., R.I., A.I., H.K., Y.O., T.S., K.O., A.H., and H.K. were involved in critical revision of the article for important intellectual content. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3856333","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":267113013,"identity":"d9c2a451-df15-473b-82a7-21e16083dc57","order_by":0,"name":"Rie Terada","email":"","orcid":"","institution":"Nihon University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Rie","middleName":"","lastName":"Terada","suffix":""},{"id":267113014,"identity":"92b26d13-a159-4b87-9094-89a4d2c8f36d","order_by":1,"name":"Ryoji 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16:11:09","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":403493,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3856333/v1/3dc945ac-cdfc-4816-8ed0-6b5b4dd2e478.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Usefulness and safety of new ultrasmall-diameter colonoscope for cases with difficult insertion: A retrospective study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eColorectal cancer is ranked third in terms of morbidity and second in terms of mortality rate worldwide\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. It has been suggested that the removal of adenomatous colonic polyps using a colonoscope is an effective means of preventing colorectal cancer\u003csup\u003e[\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. Therefore, colonoscopies are an essential examination method for preventing and treating colorectal cancer. However, cases with pronounced inflammation, a history of abdominal surgery, and poor pretreatment may result in longer cecal intubation times, inability to intubate the cecum, or increased pain\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. Patients who experience extended cecal intubation times or significant pain may be less inclined to consent to future examinations. Additionally, there is a concern in cases where cecal intubation is unsuccessful that colorectal cancer may develop in the regions not examined. Quality indicators of colonoscopy include the adenoma detection rate (ADR) and cecal intubation rate, and cases where intubation is difficult may decrease these indicators\u003csup\u003e[\u003cspan additionalcitationids=\"CR7 CR8 CR9\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e. Even skilled endoscopists occasionally encounter difficult insertions. While sedation during endoscopy can alleviate pain, it must be administered with caution in elderly patients and those with underlying conditions due to potential adverse events, including respiratory depression and hypotension\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e. Various insertion methods and pretreatment methods have been previously reported, but some patients still experience pain during insertion. The use of ultrathin endoscopes has been reported to improve the ileocecal region intubation rate and reduce patient pain\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eEC-760XP/L (FUJIFILM Corporation, Tokyo, Japan), a new ultra-small-diameter long scope with a flexible outer diameter of 9.3 mm and an effective length of 1690 mm, appears highly effective in cases with insertion difficulties. Unlike conventional small-diameter endoscopes with limited sub-water supply functions, EC-760XP/L is equipped with a sub-water supply function, enhancing its utility in inadequate pretreatment cases and managing post-procedural bleeding. It also supports image-enhanced observation techniques such as Linked Color Imaging (LCI) and Blue Laser Imaging (BLI), along with the CAD EYE system incorporating artificial intelligence technology, raising expectations for improved ADR and diagnostic accuracy\u003csup\u003e[\u003cspan additionalcitationids=\"CR14 CR15\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e. As no prior reports have been on EC-760XP/L, this study aims to evaluate its usefulness and safety in cases with insertion difficulties encountered by endoscopists.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e・\u003cb\u003eStudy design\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThis was a single-center, retrospective study. The study was registered with the University Hospital Medical Information Network (UMIN 000052830) and conducted in accordance with the Helsinki Convention.\u003c/p\u003e \u003cp\u003eWritten informed consent was obtained from all patients before colonoscopy. This study received approval from the review board of Nihon University School of Medicine.\u003c/p\u003e \u003cp\u003e・\u003cb\u003eInclusion and exclusion criteria\u003c/b\u003e\u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents the flow chart of this study. The participants were cases where colonoscope insertion was difficult despite a previous examination by an experienced endoscopist. Of the 3,071 patients who underwent colonoscopies between June 2022 and October 2023, 174 were examined using EC-760XP/L scope. From this group, exclusions were made as follows: 56 cases without a history of colonoscopy at our hospital, 58 cases where the previous endoscope insertion was not difficult, and 21 cases where the previous or current endoscopist was considered inexperienced. Consequently, a total of 39 subjects were included in the analysis.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003e・\u003c/b\u003e \u003cb\u003eEndoscopic procedure\u003c/b\u003e \u003c/p\u003e \u003cp\u003eAll patients undergoing colonoscopies had not eaten since 21:00 the day prior. Before the examination, patients orally administered sodium picosulfate (provided by Tsuruhara Pharmaceutical Co. Ltd., Osaka, Japan) before bed the night before. On the day of the examination, they used MoviPrep (EA Pharma Co., Tokyo, Japan) or Niflec (EA Pharma Co.) as a laxative. EC-760XP/L was used in the examination for all cases, with CO\u003csub\u003e2\u003c/sub\u003e insufflation. The operator used butylscopolamine or glucagon as an antispasmodic, depending on the patient's underlying disease and preference. Midazolam was used as a sedative. Before initiating the examination, the physician confirmed the patient's preferences. Medications were administered before the examination or upon the patient expressing pain.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eDefinition\u003c/h2\u003e \u003cp\u003eEndoscope insertion difficulties were defined as cases where cecal intubation could not be achieved in the endoscopy conducted at our hospital or where the cecal intubation time was 15 minutes or longer despite an experienced endoscopist having examined with a standard endoscope during the previous endoscopy. An experienced endoscopist was defined as an endoscopist with experience in colonoscopy and who was certified by the Japan Gastroenterological Endoscopy Society. Evaluations regarding the presence of pain were determined based on the descriptions of the endoscopist who conducted the examination. The removal time was defined as the time from cecal intubation until the scope was removed and the examination was completed. SD endoscope was defined as one of the following: CF-H290I, CF-HQ290I, PCF-H290I, PCF-H290ZI, PCF-Q260AI, PCF-Q260AZI, PCF-Q260JI, PCF-Q240ZI (Olympus, Tokyo, Japan), and EC-760ZP-V/M (FUJIFILM Corporation, Tokyo, Japan). Evaluations of intestinal cleanliness levels involved the use of the Boston Bowel Preparation Scale (BBPS)\u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e. A score of \u0026ge;\u0026thinsp;6 out of 9 was considered good in terms of pretreatment. Adverse events included postexamination abdominal pain, nausea, vomiting, and intestinal perforation.\u003c/p\u003e \u003cp\u003e \u003cb\u003e・\u003c/b\u003e \u003cb\u003eOutcomes\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe primary outcome was the cecal intubation time using EC-760XP/L compared to a previous examination with a standard scope. The secondary outcomes were the cecum intubation rate, intestinal cleanliness level, ADR, polyp detection rate (PDR), sedative use rate, occurrence of adverse events, and pain experience.\u003c/p\u003e \u003cp\u003e \u003cb\u003e・\u003c/b\u003e \u003cb\u003eStatistical analysis\u003c/b\u003e \u003c/p\u003e \u003cp\u003eDescriptive data are expressed as median and interquartile range. Comparisons between groups were conducted using the Wilcoxon signed rank test. The χ-squared test or Fisher's exact test was used for categorical variables. A p-value of \u0026lt;\u0026thinsp;0.05 was considered statistically significant. JMP Pro was used for all statistical analyses (version 13.0; JMP Statistical Discovery LLC, Cary, NC, USA).\u003c/p\u003e \u003c/div\u003e"},{"header":"Result","content":"\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eBaseline characteristics\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the participant's characteristics. The median participant age was 64 years (IQR: 46.5\u0026ndash;75 years), 15 were male, median height was 161.1 cm (154.0\u0026ndash;165.0 cm), median weight was 55.6 kg (50.0\u0026ndash;64.0 kg), and median BMI was 21.4 kg/m\u003csup\u003e2\u003c/sup\u003e (19.4\u0026ndash;24.6 kg/m\u003csup\u003e2\u003c/sup\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline characteristics of this study\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;39\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e67 (57.5\u0026ndash;74.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex, (male / female)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15 (38.5%)/ 24 (61.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeight, cm (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e161.1 (154.0-165.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeight, kg (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e55.6 (50.0\u0026ndash;64.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI, kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21.4 (19.4\u0026ndash;24.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eASA, n (%) I / II / III\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0 (0%) / 37 (94.9%) / 2 (5.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePast History that may make insertion difficult, n (%)\u003c/p\u003e \u003cp\u003eAbdominal surgery\u003c/p\u003e \u003cp\u003eDiverticulitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (23.0%)\u003c/p\u003e \u003cp\u003e11 (28.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003eIQR, interquartile range; BMI, body mass index; ASA, American Society of Anesthesiologists physical status grade\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eEndoscopic results\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the therapeutic results of endoscopy. A comparison between EC-760XP/L and a previous standard scope revealed a significant reduction in intubation times: 9.5 minutes (range 5.3\u0026ndash;12 minutes) for EC-760XP/L versus 19 minutes (range 15.9\u0026ndash;25 minutes) for the standard scope (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). While the conventional scope achieved a cecal intubation rate in 30 cases (76.9%), EC-760XP/L successfully reached the cecum in all cases (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). There was no significant difference in sedative use between the two groups. Notably, pain was reported in only 3 cases (8.3%) with EC-760XP/L, compared to 22 cases (56.4%) with the conventional scope, representing a significant improvement (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). No statistically significant difference was observed in ADR and PDR. No adverse events associated with the examination were also observed in either group. The median BBPS values were 9 (6.8\u0026ndash;9) for EC-760XP/L and 9 (8\u0026ndash;9) for the standard scope, with no significant difference observed.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEndoscopic outcomes of last time and this time\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUltrathin colonoscopy\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;39\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePrevious colonoscopy\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;39\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e*P-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCecal intubation time, min (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.5 (5.3\u0026ndash;12.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (15.8\u0026ndash;25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCecal intubation rate, n\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30 (76.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObservational time, n\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.0 (8.0-14.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.0 (9.0\u0026ndash;19.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.42\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdenoma Detection, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23 (59.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (43.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePolyp Detection, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26 (66.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (51.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBoston Bowel preparation Scale, n (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (6.8-9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (8\u0026ndash;9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.68\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePain, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (8.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (56.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUse of sedatives, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (33.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (25.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.62\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAntispasmodic, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33 (84.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27 (69.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdverse events, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003e*\u003c/sup\u003eP-value was calculated using the χ\u003csup\u003e2\u003c/sup\u003e test or Fisher's exact test for categorical data\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eP-value was calculated using a t test or the Mann\u0026ndash;Whitney U test for continuous data\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study is a single-center, retrospective analysis that evaluates the use of the EC-760XP/L in patients who experienced difficulties with colonoscope insertion. Results showed that using this endoscope improved the cecal intubation rate, reduced cecal intubation time, and significantly reduced pain. To our knowledge, this is the first report that has demonstrated the usefulness of EC-760XP/L for patients with difficult colonoscope insertion. There have been several previous reports regarding colonoscopy using PCF-PQ260L (PQL), which is another small-diameter endoscope. Sato et al. used PQL as a rescue device in patients where the colonoscope could not be inserted during regular examination, and results showed that cecal intubation was achieved in 97.7% (42/43) of cases. They also showed that the mean pain score during the colonoscopy was significantly lower after the second PQL colonoscopy than during the first regular colonoscopy\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e. According to a report by Inoki et al.\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e, there were no significant differences in the cecal intubation rate, cecal intubation time, and ADR between the PQL and standard colonoscope use groups. However, a comparison between PQL examinations and standard colonoscopies in the same patient showed that PQL use resulted in a reduced mean cecal intubation time (7 minutes vs. 10 minutes, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), as well as a significantly higher number of patients with less pain (66% vs. 20%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and less use of sedation (48% vs. 25%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Hamada et al. conducted a study in which female patients undergoing colonoscopy without sedatives were randomly assigned to either a group using PQL or a standard colonoscopy group. Their analysis revealed that the group using PQL experienced significantly less pain and demonstrated a higher willingness to undergo the next examination without sedatives compared to the standard colonoscopy group\u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e. These results also indicate the usefulness of small-diameter long scopes in cases with insertion difficulties.\u003c/p\u003e \u003cp\u003eSimilar to the present study, the report by Inoki et al.\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e compared standard colonoscopy and PQL in the same patient; however, PQL was conducted by a specialist in a significantly higher number of cases, suggesting that the results may have been affected by differences in endoscopy techniques.\u003c/p\u003e \u003cp\u003eIn our study, the inclusion criteria were specifically limited to cases where insertion was difficult during the previous examination, even when performed by an experienced endoscopist. Additionally, we focused on the same patients as those from the previous examination. We defined insertion difficulty as instances where the previous intubation time was \u0026ge;\u0026thinsp;15 minutes or longer, providing a more objective basis for analysis.\u003c/p\u003e \u003cp\u003eEC-760XP/L offers significant advantages, including LCI and a water jet function (sub-water supply function). A challenge in conventional narrow-band imaging and BLI is that water appears red, potentially impacting image clarity. In cases with insertion difficulties, inadequate pretreatment, insufficient suction of water, or residual feces are frequent, which may reduce the ADR of the enhanced image. Meanwhile, with LCI, the ADR can be expected to increase regardless of water influence, and the water jet function also enables the cleaning of mucous membranes. Although our study did not demonstrate an additional effect on ADR or PDR compared to previous endoscopies, we observed encouraging results with an ADR of 59.0% and a PDR of 66.7%.\u003c/p\u003e \u003cp\u003eFurthermore, although there is a high risk of adverse events (such as adhesions) in cases with insertion difficulties, no adverse events, such as gastrointestinal perforation or abdominal pain, were confirmed in this study. Meanwhile, EC-760XP/L has a narrow forceps channel and long scope, so there is still room for improvement in terms of treatment. Future studies will need to consider ways to improve treatment.\u003c/p\u003e \u003cp\u003eThe present study had several limitations. Firstly, it was a single-center, retrospective study with a small sample size. Secondly, direct comparisons were not performed by conducting examinations with a standard scope following those with the EC-760XP/L. Furthermore, each examination was conducted by different operators. Thirdly, the role of sedatives warrants consideration. Although there were no significant differences in sedative use, their administration could potentially enhance the cecal intubation rate, reduce intubation times, and reduce pain. In the future, conducting a multicenter, prospective, comparative study of EC-760XP/L in cases with insertion difficulties and accumulating cases is necessary.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn the present study, we demonstrated the usefulness of EC-760XP/L in cases with difficult colonoscope insertion. Further research is required to validate our findings.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements (not compulsory)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe sincerely thank all medical staff from the Nihon University School of Medicine. We thank Editage (www.editage.com) for English language editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions statement\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eR.T., A.I and R.I. planned and designed the study. R.T. and R.I. analyzed and interpreted the data. R.T. and R.I. wrote the manuscript. R.T., R.I., A.I., H.K., Y.O., T.S., K.O., A.H., and H.K. were involved in critical revision of the article for important intellectual content. All authors approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAdditional information\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere are no external funding sources for this study. All authors had no conflict of interest in this study.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eAdditional information\u003c/strong\u003e \u003cp\u003eThere are no external funding sources for this study. All authors had no conflict of interest in this study.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eR.T., A.I and R.I. planned and designed the study. R.T. and R.I. analyzed and interpreted the data. R.T. and R.I. wrote the manuscript. R.T., R.I., A.I., H.K., Y.O., T.S., K.O., A.H., and H.K. were involved in critical revision of the article for important intellectual content. All authors approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eTudor, C., Sova, R. A. Mining Google Trends data for nowcasting and forecasting colorectal cancer (CRC) prevalence. \u003cem\u003ePeerJ\u003c/em\u003e Comput. Sci. 9, e1518 (2023). DOI: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.7717/peerj-cs.1518\u003c/span\u003e\u003cspan address=\"10.7717/peerj-cs.1518\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. 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PMID: 34222630; PMCID: PMC8211489.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-3856333/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3856333/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eColonoscopies are widely available, but there are cases where insertion can be difficult, even for experienced endoscopists. EC-760XP/L, a new ultrasmall-diameter long scope, may be useful in such cases.\u003c/p\u003e\n\u003cp\u003eThis single-center retrospective study included 39 cases where colonoscope insertion was difficult even when previously conducted by an experienced endoscopist. The primary outcome was the cecal intubation time using EC-760XP/L compared to a previous examination with a standard scope. The secondary outcomes were the cecum intubation rate, intestinal cleanliness level, adenoma detection rate, polyp detection rate, sedative use rate, occurrence of adverse events, and pain experience.\u003c/p\u003e\n\u003cp\u003eA comparison of cecal intubation times between EC-760XP/L and the standard scope showed that insertion times were significantly reduced with EC-760XP/L (9.5 minutes) compared to the standard scope (19 minutes) (p \u0026lt; 0.01). The standard scope achieved cecal intubation in 30 cases (76.9%), whereas EC-760XP/L reached the cecum in all cases (p \u0026lt; 0.01). Pain was observed in 3 cases (8.3%) with the EC-760XP/L, significantly lower than the 22 cases (56.4%) with the standard scope (p \u0026lt; 0.01).\u003c/p\u003e\n\u003cp\u003eIn conclusion, EC-760XP/L proved to be useful in cases where colonoscope insertion was difficult.\u003c/p\u003e","manuscriptTitle":"Usefulness and safety of new ultrasmall-diameter colonoscope for cases with difficult insertion: A retrospective study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-01-16 19:39:26","doi":"10.21203/rs.3.rs-3856333/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-06-19T07:21:15+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-06-19T04:27:33+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-05-18T04:17:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"a36f20e7-f991-4c49-87e0-3d596c32eb56","date":"2024-05-08T14:46:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"6ade6565-d453-4912-a99d-f79c45781523","date":"2024-05-08T03:20:21+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-02-27T04:05:48+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-02-22T06:32:28+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-01-13T20:21:02+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-01-13T20:18:00+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2024-01-12T08:48:21+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c9ab17e6-ee1c-45df-ab5c-345b4ece241a","owner":[],"postedDate":"January 16th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":28135727,"name":"Health sciences/Gastroenterology/Colonoscopy"},{"id":28135728,"name":"Health sciences/Gastroenterology/Gastrointestinal system"}],"tags":[],"updatedAt":"2024-09-16T16:01:30+00:00","versionOfRecord":{"articleIdentity":"rs-3856333","link":"https://doi.org/10.1038/s41598-024-72689-1","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2024-09-14 15:56:55","publishedOnDateReadable":"September 14th, 2024"},"versionCreatedAt":"2024-01-16 19:39:26","video":"","vorDoi":"10.1038/s41598-024-72689-1","vorDoiUrl":"https://doi.org/10.1038/s41598-024-72689-1","workflowStages":[]},"version":"v1","identity":"rs-3856333","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3856333","identity":"rs-3856333","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}