How to complete colonoscopy for those who fail standard colonoscopy

Colonoscopy is the gold standard investigation in the lower gastrointestinal tract. However, 75% of patients can experience pain or discomfort with moderate sedation. The application of robotic technology promises to advance and overcome difficulties faced including better utilisation of rooms for advanced procedures and to achieve a complete colonoscopy in patients where pain and technical challenges inhibit progression.

This pilot study, the first at a UK NHS Hospital between January2023 to April2025 with an expert endoscopist performing the robotic colonoscopy with the Endotics system. This is a disposable soft robot which employs expand and contract movement to self-propel along the bowel. Patients with failed previous standard colonoscopy along with index diagnostic procedures deemed potentially difficult were recruited. Procedures were performed outside the endoscopy unit similar to an outpatient clinical room. 

126 patients were recruited (57M:69F), mean-age 55.5 years over 30 months. The commonest indications for robotic colonoscopy were rectal bleeding (35.7%), failed standard colonoscopy (22.6%) and change in bowel habit (19.1%). 23 patients had failed previous standard colonoscopy with 16 patients achieving completion with subsequent robotic colonoscopy (70% improvement). Average caecal intubation time 36.63 minutes with average total procedure time 48.74 minutes.

Robotic colonoscopy provides a safe and effective method in improving comfort and completion-rates, including previously failed colonoscopy. Direct visualisation, biopsy and polypectomy is still possible with robotic colonoscopy. This study has demonstrated a viable alternative to conventional colonoscopy. With no sedation it allows procedures to be conducted outside the traditional endoscopy unit such as outpatients. The study highlights a learning curve to reduce caecal intubation time.