A Pressure Sensing Device to Assist in Colonoscopic Procedures to Prevent Perforation-A Case Study.

Colonoscopy has a limited field of view because it relies solely on a small camera attached to the end of the scope and a screen displayed on a monitor. Consequently, the quality and safety of diagnosis and treatment depend on the experience and skills of the gastroenterologist. When a novice attempts to insert the colonoscope during the procedure, excessive pressure can sometimes be applied to the colon wall. This pressure can cause a medical accident known as colonic perforation, which the physician should prevent. We propose an assisting device that senses the pressure applied to the colon wall, analyzes the risk of perforation, and warns the physician in real time. Flexible pressure sensors are attached to the surface of the colonoscope shaft. These sensors measure pressure signals during a colonoscopy procedure. A simple signal processor is used to collect and process the pressure signals. In the experiment, a colonoscope equipped with the proposed device was inserted into a simulated colon made from a colon extracted from a pig. The processed data were visually communicated to the gastroenterologist via displays and light-emitting diodes (LEDs). The device helps the physician continuously monitor and prevent excessive pressure on the colon wall. In this experiment, the device appropriately generated and delivered warnings to help the physicians prevent colonic perforation. In the future, the device is to be improved, and more experiments will be performed in live swine models or humans to confirm its efficacy and safety.

Endoscopic retrograde cholangiopancreatography using a pediatric colonoscope in patients with Roux­en­Y gastrectomy and an intact major duodenal papilla.

Endoscopic retrograde cholangiopancreatography (ERCP) in patients with Roux-en-Y gastrectomy and an intact major duodenal papilla is challenging and difficult, with unsatisfactory outcomes using various endoscopes. Limited data are available regarding the outcomes of ERCP using a pediatric colonoscope in such patients. To evaluate the efficacy of a pediatric colonoscope in patients with Roux-en-Y gastrectomy and an major duodenal intact papilla, 93 consecutive patients with Roux-en-Y gastrectomy and an intact major duodenal papilla who underwent ERCP using a pediatric colonoscope at the Medical Center for Digestive Diseases, The Second Affiliated Hospital of Nanjing Medical University, (Nanjing, China) between January 2018 and December 2022 were retrospectively reviewed. Following the failure of bile duct cannulation, a double-guidewire or precut technique was utilized for advanced cannulation. Interventions were performed using standard ERCP therapeutic accessories. The results indicated that distal gastrectomy with Roux-en-Y reconstruction was performed in 38 out of 93 patients, while 55 patients underwent total gastrectomy with Roux-en-Y reconstruction. The success rates associated with endoscope insertion, endoscopic cannulation and therapeutic ERCP were 88.17% (82/93), 85.37% (70/82) and 95.71% (67/70), respectively, while the clinical intervention success and complication rates were 72.04% (67/93) and 7.53% (7/93), respectively. The endoscope insertion time was 40.78±10.04 min, and the ERCP procedure time was 88.55±16.38 min. Student's t-test showed that the endoscope insertion time and the ERCP procedure time in patients undergoing distal gastrectomy were longer than those in patients undergoing total gastrectomy (P<0.05). Binary logistic regression analysis showed that age and number of previous abdominal surgeries were independent risk factors associated with endoscope insertion failure. In conclusion, the present study demonstrated that the use of a pediatric colonoscope is efficacious and safe for patients with Roux-en-Y gastrectomy and an intact major duodenal papilla undergoing ERCP.

Mucus Impaction Related to Postoperative Anastomosis Site Obstruction: A Rare Case.

Anastomotic stricture has an incidence rate of 6-10% and typically manifests three to six months after colorectal surgery. Immediate postoperative stricture is exceedingly rare and underreported in the literature. The possible etiology includes poor circulation, leakage, local inflammation, or infection. We report a rare case of a patient with total obstruction by mucus on the anastomosis site on postoperation day two. We used a sigmoidoscope to remove mucus material, following which the patient recovered well.

A Case Study: Incidental Finding of Human Intestinal Spirochetosis in Screening Colonoscopy.

Human intestinal spirochetosis (HIS) is a rare occurrence. We present an interesting case study on an asymptomatic over-60-year-old male who was incidentally discovered to have HIS following a colonoscopy that was conducted for his positive fecal occult blood test (FOBT). Histopathology of the colonic biopsy proved the presence of human intestinal spirochetosis; however, as he was asymptomatic, treatment was not initiated in his case. We discuss here the prevalence, presentation, diagnostic methods, and treatment of colonic HIS.

Fluid retention in endoscopes: A real-world study on drying effectiveness.

BACKGROUND: Outbreaks linked to inadequate endoscope drying have infected numerous patients, and current standards and guidelines recommend at least 10 minutes of forced air for drying channels. This study evaluated a new forced-air drying system (FADS) for endoscopes. METHODS: Drying was assessed using droplet detection cards; visual inspection of air/water connectors, suction connectors, and distal ends; and borescope examinations of endoscope interiors. Assessments were performed after automated endoscope reprocessor (AER) alcohol flush and air purge cycles and after 10-minute FADS cycles. RESULTS: Researchers evaluated drying during encounters with 22 gastroscopes and 20 colonoscopes. After default AER alcohol and air purge cycles, 100% (42/42) of endoscopes were still wet. Substantial fluid emerged from distal ends during the first 15 seconds of the FADS cycle, and droplets also emerged from air/water and suction connectors. Following FADS cycle completion, 100% (42/42) were dry, with no retained fluid detected by any of the assessment methods. CONCLUSIONS: Multiple endoscope ports and channels remained wet after AER cycles intended to aid in drying but were dry after the FADS cycle. This study reinforced the need to evaluate the effectiveness of current drying practices and illustrated the use of practical tools in a real-world setting.

Comparison of the characteristics of the CF-H290I and PCF-Q260JI colonoscopes in non-sedated patients with a history of abdominal or pelvic surgery: a randomized controlled study.

BACKGROUND AND AIM: The purpose of this randomized controlled study was to compare the characteristics of the CF-H290I (high-definition) colonoscope with those of the PCF-Q260JI (high-resolution) colonoscope in non-sedated patients with a history of abdominal or pelvic surgery in an effort to help endoscopists to select more effectively and objectively between the various colonoscopes. METHODS: A total of 397 patients who underwent colonoscopy at the Affiliated Wuxi People's Hospital of Nanjing Medical University, between August 2022 and October 2022 were randomized to a CF-H290I group (n = 198) or a PCF-Q260JI group (n = 199) using a computer-generated allocation method. We compared the adenoma detection rate (ADR), patient satisfaction with the examination, discomfort associated with colonoscopy including abdominal distension and pain, cecal intubation time, and patient willingness to undergo colonoscopy in the future between the CF-H290I and PCF-Q260JI groups. RESULTS: There was no statistically significant difference in the overall ADR between the CF-H290I and PCF-Q260JI groups (81 [40.9%] vs 63 [31.7%], Z = 3.674, P = 0.055). However, the ADRs in the transverse colon and left colon were significantly higher in the CF-H290I group (22 [11.1%] vs 6 [3.0%], Z = 9.588, P = 0.002 and 57 [28.8%] vs 37 [18.6%], Z = 5.212, P = 0.017, respectively). More sessile serrated lesions were detected in the CF-H290I group (52 [26.3] vs 30 [15.1%], Z = 7.579, P = 0.006). Patient satisfaction with colonoscopy was better in the PCF-Q260JI group (8.91 ± 1.09 vs 8.51 ± 1.44, t = -3.158, P < 0.01) with less likelihood of discomfort (23 [11.6%] vs 41 [20.7%], Z = 6.144, P = 0.013), The number of patients willing to undergo colonoscopy in the future was significantly greater in the PCF-Q260JI group (168 [84.4%] vs 149 [75.3%], Z = 5.186, P = 0.023). The cecal intubation time was significantly shorter in the CF-H290I group (256.09 ± 155.70 s vs 315.64 ± 171.64 s, P = 0.004). There were no complications such as perforation or bleeding in either group. CONCLUSION: The CF-H290I and PCF-Q260JI colonoscopes each have advantages when used in patients with a history of abdominal or pelvic surgery. The CF-H290I has higher ADRs in the transverse and left colon whereas the PCF-Q260JI is less painful and better accepted by patients. This study was approved by the Clinical Research Ethics Committee of Wuxi People's Hospital and was registered in the Chinese Clinical Trial Registry (ChiCTR2200063092).

Utility of a Passive Bending Colonoscope for Endoscopic Retrograde Cholangiopancreatography in Patients with Surgically Altered Anatomy.

BACKGROUND AND AIM: The utility of a passive bending colonoscope (PBCS) in ERCP for patients with surgically altered anatomy has not been established. This study compared the outcome of PBCS-ERCP and balloon-assisted enteroscope (BAE)-ERCP. METHODS: This multicenter observational study included 343 patients with surgically altered anatomy who underwent ERCP. Among these, 110 underwent PBCS-ERCP and 233 underwent BAE-ERCP. Propensity score matching was applied, and a final cohort of 210 (105 in each group) with well-balanced backgrounds was analyzed. The primary outcome was the success rate of reaching anastomosis or ampulla of Vater. Secondary endpoints included the cannulation success rate, completion rate, procedure time (to reach, cannulate, complete), and adverse events. RESULTS: The success rate for reaching the target was 91.4% (96/105) with PBCS and 90.5% (95/105) with BAE (odds ratio [95% CI] 1.12, [0.44-2.89], P = 0.809). The mean time required to reach the target was significantly shorter in PBCS: 10.04 min (SD, 9.62) with PBCS versus 18.77 min (SD, 13.21) with BAE (P < 0.001). There were no differences in the success of cannulation or procedure completion, although the required times for cannulation and procedure completion were significantly shorter in PBCS. The incidence of adverse events was significantly higher in BAE (19.0%) than in PBCS (4.8%; P < 0.001). CONCLUSIONS: In patients with surgically altered anatomy, PBCS-ERCP showed promising results with shorter time to reach, cannulate, and a lower incidence of adverse events compared with BAE-ERCP. The success rate of reaching was favorable through PBCS compared with BAE. CLINICAL TRIAL REGISTRATION: UMIN000045546.

Erratum: Colonoscopic titanium clipping to address appendiceal stump leakage: a case report.

[This corrects the article DOI: 10.3389/fsurg.2023.1171875.].

Comparison of LED and LASER Colonoscopy About Linked Color Imaging and Blue Laser/Light Imaging of Colorectal Tumors in a Multinational Study.

INTRODUCTION: In light-emitting diode (LED) and LASER colonoscopy, linked color imaging (LCI) and blue light/laser imaging (BLI) are used for lesion detection and characterization worldwide. We analyzed the difference of LCI and BLI images of colorectal lesions between LED and LASER in a multinational study. METHODS: We prospectively observed lesions with white light imaging (WLI), LCI, and BLI using both LED and LASER colonoscopies from January 2020 to August 2021. Images were graded by 27 endoscopists from nine countries using the polyp visibility score: 4 (excellent), 3 (good), 2 (fair), and 1 (poor) and the comparison score (LED better/similar/LASER better) for WLI/LCI/BLI images of each lesion. RESULTS: Finally, 32 lesions (polyp size: 20.0 ± 15.2 mm) including 9 serrated lesions, 13 adenomas, and 10 T1 cancers were evaluated. The polyp visibility scores of LCI/WLI for international and Japan-expert endoscopists were 3.17 ± 0.73/3.17 ± 0.79 (p = 0.92) and 3.34 ± 0.78/2.84 ± 1.22 (p < 0.01) for LED and 3.30 ± 0.71/3.12 ± 0.77 (p < 0.01) and 3.31 ± 0.82/2.78 ± 1.23 (p < 0.01) for LASER. Regarding the comparison of lesion visibility about between LED and LASER colonoscopy in international endoscopists, a significant difference was achieved not for WLI, but for LCI. The rates of LED better/similar/LASER better for brightness under WLI were 54.5%/31.6%/13.9% (International) and 75.0%/21.9%/3.1% (Japan expert). Those under LCI were 39.2%/35.4%/25.3% (International) and 31.3%/53.1%/15.6% (Japan expert). There were no significant differences in the diagnostic accuracy and the comparison score of BLI images between LED and LASER. CONCLUSIONS: The differences of lesion visibility for WLI/LCI/BLI between LED and LASER in international endoscopists could be compared to those in Japanese endoscopists.

Colonoscopic titanium clipping to Maddress appendiceal stump leakage: a case report.

The incidence of appendiceal stump leakage (ASL) is extremely low and heterogeneous, which has been reported to be approximately 0.5%-1.0%. It is a catastrophic complication with high mortality rate despite its low morbidity. Once it occurs, it will put the doctor in a passive position because dealing with the leakage is much more cumbersome than appendectomy. We extensively reviewed the literature on ASL, focusing on the management and prognosis. Unsurprisingly, all of the physicians advocated extended resection, which apparently gave them sufficient confidence. However, partial cecum resection, cecostomy, or terminal ileectomy is extremely invasive and destructive. So, the patients had to experience great mental and physical trauma, longer hospital stays, higher rates of wound infection, more costs, and even a third surgery. Therefore, are there any better approaches for ASL? In this article, we report a case of ASL who successfully underwent endoscopic treatment. A 70-year-old male was admitted with gangrenous perforated appendicitis with a large iliopsoas abscess. Appendectomy, iliopsoas abscess debridement and sufficient drainage, appendicular stump repair and closure, and terminal ileostomy were performed. Three months later, the patient was readmitted and the stoma reversal was performed as scheduled. Seven days later, ASL was found when a liquid diet was applied routinely due to right lower quadrant pain and low fever. Finally, with the periappendiceal abscess completely drained, we clamped the appendiceal orifice with five titanium clips under an electronic colonoscope, which eventually sealed the leakage and avoided extended resection.

Laparoscopic repair of an incarcerated inguinal hernia containing the sigmoid colon with a colonoscope.

Here, we report the first case of laparoscopic surgery to repair an incarcerated colonoscope in an inguinal hernia containing the sigmoid colon. After colonoscopy was performed on a 74-year-old man with positive fecal occult blood test results, the colonoscope could not be withdrawn. A bulge consistent with an incarcerated colonoscope was found on examination of the patient's left inguinal area. Computed tomography revealed and led to the diagnosis of an incarcerated colonoscope in the sigmoid colon within the inguinal hernia. After confirmation during emergency laparoscopic surgery, the incarcerated sigmoid colon was reduced, and the colonoscope was removed under radiographic and laparoscopic guidance. No ischemic changes or serosal injuries were observed, averting the need for resection. A transabdominal preperitoneal approach with a mesh was then used to repair the inguinal hernia laparoscopically. The patient's postoperative recovery was uneventful, and no recurrence was observed at the 1-year follow-up.

A water-soluble alternative to simethicone for gastrointestinal endoscopy: Results of a clinical trial.

During endoscopy, simethicone defoaming agents are commonly used to improve visualization, but they leave residues and impact drying. This clinical trial involved patients undergoing colonoscopy procedures with substantial bubbles that impeded mucosal wall visibility. As an alternative to simethicone, investigators evaluated a water-soluble, ginger-based gastrointestinal supplement (GI-Ease) that did not contain sugars, thickeners, or binding agents. In 112/114 cases (98%), the bubbles were reduced sufficiently to allow visualization of the gastrointestinal tract, with no adverse events.

Successful Intubation Using a Cap-Assisted Colonoscope for Endoscopic Retrograde Cholangiopancreatography in Patients Undergoing Roux-en-Y Reconstruction.

Endoscopic retrograde cholangiopancreatography (ERCP) is challenging in patients undergoing Roux-en-Y (REY) reconstruction; although balloon-assisted enteroscopy is the first-line treatment, it is not always available considering equipment and expertise. We aimed to evaluate the feasibility of using a cap-assisted colonoscope as the primary approach for ERCP in REY reconstruction. We included 47 patients with REY who underwent ERCP using a cap-assisted colonoscope between January 2017 and February 2022. The primary outcome was intubation success for ERCP using a cap-assisted colonoscope during REY reconstruction. The secondary outcomes were cannulation success, procedure-related adverse events, and variables affecting successful intubation. Comparing side-to-side jejunojejunostomy (SS-JJ) and side-to-end jejunojejunostomy (SE-JJ) groups, the intubation success rate using a cap-assisted colonoscope in the SS-JJ group was higher than that in the SE-JJ group (34 of 38 (89.5%) vs. 1 of 9 (11.1%), p < 0.001). Successful intubation was achieved in 37 (97.4%) and 8 (88.9%) patients in the SS-JJ and SE-JJ groups, respectively, after applying the rescue technique using a balloon-assisted enteroscope for failed ERCP using only a colonoscope. No perforation occurred. Multivariable analysis showed that SS-JJ was a predictive factor for successful intubation (odds ratio [95% confidence interval] = 37.06 [3.91-925.56], p = 0.005). Usage of a cap-assisted colonoscope can be crucial for ERCP in patients undergoing REY reconstruction. Anatomically, SS-JJ can facilitate easy and accurate identification of the afferent limb and a highly successful ERCP using a cap-assisted colonoscope.

Incarceration of a colonoscope in an inguinal hernia: A report of two cases.

We report two cases of the rare complication of a colonoscope incarcerated in an inguinal hernia. The first patient was a 73-year-old man in whom a colonoscope was incarcerated in a left inguinal hernia on attempted withdrawal. The incarcerated colonoscope was successfully reduced manually under fluoroscopic guidance. The hernia was subsequently repaired using an extraperitoneal approach followed by a successful colonoscopy. The second patient was a 74-year-old man in whom the colonoscope became incarcerated in a left inguinal hernia on insertion. Similar to the first case, the colonoscope was manually reduced under fluoroscopy and the entire colonoscopy was then uneventfully performed. An advanced sigmoid cancer was identified and treated with sigmoidectomy. The hernia resolved after this operation. When a colonoscope becomes incarcerated in an inguinal hernia, the manual reduction should be attempted. Subsequent colonoscopy can be safely performed under certain circumstances.

Low-cost colonoscopic simulator and colonoscope to train basic skills in colonoscopy during undergraduate studies

Objective: To develop a low-cost simulator model and a colonoscope with materials that are easily accessible to offer training on colonoscopy skills during undergraduate studies. Since this is the procedure of choice for colorectal cancer screening, the general practitioner must be able to recognize its main indications, preparation, and complications. Methods: Using materials such as a mannequin, a vehicle inspection camera, a conduit, polyvinyl chloride (PVC) pipe, acrylic, wood, and red paint, we built a simulator and a 150-cm long and 20-to-25-mm thick colonoscope. The colonoscope's handle and handhold were made of acrylic, the colonoscope's mobile end was made with articulated PVC rings, and the up and down movements were performed according to the traction of the steel cables. The camera attached to its distal end enables connection to a smartphone to view the image. In the simulator, the conduit was inserted into the mannequin to simulate the curvatures of the colon. Red spray paint was used to simulate the staining of the colonic mucosa in the inner region of the mannequin and the adventitial layer in the outer region. Results: We were able to build a simulator and a colonoscope with a total amount of R $ 182.82 (roughly US$ 36.50). Both were tested and proved to be useful in the acquisition of psychomotor and cognitive skills in colonoscopy. Conclusion The simulator and colonoscope developed by us are cost-effective, useful in the acquisition of psychomotor and cognitive skills in colonoscopy, and can facilitate the structuring of a training program for undergraduate students. (AU)

Prospective comparison of an adult, an intermediate pediatric and a long pediatric colonoscope in the training process of gastrointestinal fellows to achieve high-quality practice in colonoscopy.

Background: Few data are available on the influence of colonoscope type on the training process and quality of colonoscopy. We conducted this prospective observational cohort study to investigate scope suitability for starting colonoscopy training, in relation to technical competence, quality indicators, and the patient's comfort during diagnostic colonoscopy. Methods: A total of 126 consecutive patients were enrolled in the study and assigned to one of 3 groups: adult colonoscope ([AC], n=41); intermediate pediatric colonoscope ([IPC], n=43); and long pediatric colonoscope ([LPC], n=42). Primary outcomes were completeness of the examination and minutes to the cecum. Secondary outcomes included patient tolerance, position change, use of abdominal compression, loop formation, kind of loop, and overall difficulty of the procedure. Results: Cecal intubation rates were not statistically different between the groups: AC/87.8%; IPC/81.4%; and LPC/92.8%. Terminal ileal intubation rate differed significantly among the 3 groups (P=0.015) with LPC having the higher rate (66.7% vs. 60.9%/AC and 37.2%/IPC). There were significant differences in positional changes (fewer with LPC/1.36 vs. AC/2.15 and IPC/2.09, P=0.027) and midazolam administered doses (lower with LPC/0.52 vs. AC/1.07 and IPC/0.93, P=0.032). Loop formation with subsequent resolution was significantly associated with more pain for the patient with all of the 3 colonoscope types. Conclusions: The LPC performs better in trainee hands than AC and IPC in terms of reaching competency, and quality indicators show less discomfort for the patients during colonoscopic procedures (lower midazolam dose and fewer positional changes). It could be considered the most suitable scope for starting high-quality colonoscopy training.

Impact of pediatric versus adult colonoscope on terminal ileum intubation: a retrospective study.

Background: Various possible predictors of successful terminal ileal intubation (TII) have been explored but the role of the type of colonoscope is unclear. Methods: We carried out a retrospective review of a prospectively collected database of all colonoscopies performed at a single endoscopy unit between May 2015 and July 2020. The primary outcome measure was successful TII in patients with specific indications for ileal examination. The primary predictor was the type of endoscope, pediatric or adult, used during the procedure. Univariate and multivariate analyses were performed. Results: In 5845 colonoscopies fulfilling the study criteria, the overall TII rate was 67.8%. In univariate analysis, the use of a pediatric colonoscope was associated with a higher TII rate (72.1% vs. 58.8%, P<0.001). Other variables associated with successful TII based on univariate analysis included the patient's age, male sex, body mass index, endoscopists' specialty, place of training, shorter colonoscope insertion time, shorter duration of the procedure, longer withdrawal time, procedures performed in the afternoon, type of sedation administered during colonoscopy, and cleanliness of the colon. Multivariate analysis yielded an adjusted odds ratio (OR) of 1.40 (95% confidence interval [CI] 1.21-1.62) for the use of a pediatric colonoscope. Propensity score-matching analysis also showed superiority of the pediatric colonoscope in achieving TII compared to an adult colonoscope, OR 1.35 (95%CI 1.17-1.57). Conclusions: Pediatric colonoscope increases the success of TII during colonoscopy. For endoscopists performing colonoscopy with intent to examine the terminal ileum, it is recommended to choose a pediatric colonoscope to maximize the success rate.

Clinical Yield of Ileal Intubation During Screening Colonoscopy.

Objectives Ileal intubation during screening colonoscopy can serve as supportive evidence of complete examination. However, most studies conducted in Western countries showed a limited value of ileal inspection in asymptomatic patients undergoing colonoscopy. Therefore, our aim is to determine the clinical yield of routine ileal examination during the performance of screening colonoscopy in a cohort of patients in the Middle East and identify factors associated with successful ileal intubation in this setting. Methods A retrospective review of a prospectively collected database of all screening colonoscopies was performed at a single endoscopy unit. The patients were divided into two groups; group A included patients in whom the extent of examination was the cecum and group B comprised of those who underwent ileal intubation as well. We summarized the endoscopic and pathological findings of the ileoscopic examinations and their clinical impact. Univariate and multivariate analyses were used to compare both groups and to identify factors predictive of ileal intubation in the setting of screening colonoscopy.  Results Two thousand four hundred seventy-three unique completed screening colonoscopies were analyzed (group A=1465 patients, group B=1008 patients). Overall Ileal intubation rate was 40.8%. Of the patients in group B, 3.7% were noted to have findings on ileoscopy, which were deemed to be clinically significant in almost half (1.8% overall). Univariate analysis identified the following factors as being predictive of ileal intubation during screening colonoscopy: patients' age (51.7 vs. 53.5 years, p<0.001), short cecal insertion time, endoscopists' specialty (gastroenterology 42.3% vs. surgery 24.3%, p<0.001), type of colonoscope (pediatric 47.1% vs. adult 33.5% colonoscope, p<0.001), and quality of preparation in the right colon (poor vs. adequate/good : (25.6% vs. 42.5%, p<0.001). Mixed-effects logistic regression identified patients' age, endoscopist specialty, quality of right colon preparation, and cases with short insertion time as independent variables predicting ileal intubation during SC Conclusion The clinical yield of routine ileal intubation during screening colonoscopy is low. Ileal intubation during screening colonoscopy in our cohort was more likely in younger patients with adequate/good right colon preparation and when the exam is performed by a gastroenterologist, in cases with short insertion time. Prospective studies are needed to assess our research findings and to determine the clinical value of routinely intubating terminal ileum during screening colonoscopy in the population of the Middle East.

Management of Biliopancreatic Limb Bleeding after Roux-en-Y Gastric Bypass: A Case Report.

The Roux-en-Y gastric bypass is one of the most extensive surgical treatments for obesity. The treatment of upper gastrointestinal bleeding after Roux-en-Y gastric bypass is complex due to the difficulty of accessing the excluded gastric antrum and duodenal bulb. There is no consensus regarding the management of this complication. While various techniques have been described to access the biliopancreatic limb, double-balloon enteroscopy is the most commonly used. If double-balloon enteroscopy is unavailable, a pediatric colonoscope may be used as an alternative; however, its use in such cases has not been described. We report the case of a 50-year-old male patient who underwent gastric bypass 13 years ago and was admitted for a second episode of upper gastrointestinal bleeding. The initial approach using upper endoscopy, colonoscopy, and abdominal computed tomography angiography did not reveal the cause of gastrointestinal hemorrhage; therefore, an endoscopic study of the biliopancreatic limb was performed using a pediatric colonoscope. A Forrest Ib ulcer was found in the duodenal bulb, and endoscopic therapy was administered. The evolution was found to be satisfactory.