Pediatric vs Adult Colonoscopes' Effectiveness in Obese Patients: The PACE Randomized Clinical Trial.

INTRODUCTION

Obesity is highly prevalent among US adults and is linked to a higher risk of colorectal neoplasia, making it essential to optimize colonoscopy for this population. However, comparative data guiding colonoscope selection in obese individuals remain limited.

METHODS

A randomized equivalence clinical trial conducted at 2 Cleveland Clinic Florida locations included patients aged 18 years or older with a body mass index of ≥30 kg/m 2 , scheduled for screening or surveillance colonoscopy. The primary outcome was a composite of successful cecal intubation within 10 minutes without the need for scope exchange. Participants were randomly assigned in a 1:1 ratio to slim (pediatric) or adult colonoscopes.

RESULTS

A total of 245 participants entered the study protocol between January and September 2025. The primary endpoint was achieved in 94.3% of the slim colonoscope group and 92.6% of the adult colonoscope group, resulting in an unadjusted absolute risk difference of 1.7% (95% CI: -4.3% to 8.2%). This confirms equivalence within the predefined ±10% margin. After adjusting for sex, body mass index, bowel preparation quality, diverticulosis, and surgical history, the adjusted risk difference was 2.6% (95% CI: -4.3% to 8.6%). Secondary outcomes, including insertion time, withdrawal time, overall cecal intubation rate, terminal ileum intubation rate, adenoma detection rate, and use of ancillary maneuvers, were similar between the study groups.

DISCUSSION: Among expert endoscopists, slim and adult colonoscopes are equivalent in facilitating nondifficult colonoscopy in obese patients, with a trend toward improved performance using the slim colonoscope.