Gauze and washcloth insertion into the rectum during colonoscopy: An unrecognized complication

Practice habits regarding the materials that endoscopists use to hold the colonoscope during the procedure, type of lubricant utilized and the complications encountered involving the use of these materials are unknown. The purpose of this study was to determine the type of lubrication used during colonoscopy, the product utilized to hold the colonoscope during the procedure, and any complication resulting from use of these materials by surveying a group of non-randomly selected gastroenterologists. This survey was designed after a patient removed a piece of gauze from his rectum eleven days after a routine colonoscopy was performed. Methods: Survey questionnaires were sent to 200 gastroenterologists and 105 were returned (52.5% response rate). Eighty-seven percent of the respondents had > 10 years of colonoscopy experience. Results: 1) 54% of the respondents utilized gauze, 41% used a washcloth, 21% used nothing and 1% used other means to hold the colonoscope (more than one choice per recipient). 2) 98% of the respondents used water-soluble lubricants. 3) Four complications were reported: 3 involved the use of gauze and one involved a washcloth, ail of which were inadvertently left in the rectum after a colonoscopy. Conclusions: 1) Over 95% of gastroenterologists used either gauze or a washcloth to hold the colonoscope. 2) 98% of respondents used water-soluble lubricants. 3) A complication of colonoscopy may be the inadvertent introduction of gauze or a washcloth into the rectum. Summary: Gauze or washcloth counts should be instituted after completion of a colonoscopy to minimize the risk of this complication.