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Objective: Magnetic endoscope imaging (MEI) is a technique for the direct visualisation of endoscope configuration within the colon. This method may prevent loop formation by giving visual feedback of endoscope movement. This study aimed to evaluate the efficacy of MEI in improving colonoscopy performance., Methods: Overall 1000 consecutive patients who underwent a complete routine colonoscopy were randomized into two groups: in group A with MEI, while in group B without MEI. Sedation was performed according to local standards. In both groups time to reach the cecum, the number of positioning maneuvers and involvement of a second assistant nurse were recorded. Abdominal compression was graded from 1 to 4 according to the duration and intensity of compression was quantified using a scale from 1-3 according to compression form and patient reaction., Results: Patients were randomized (group A with MEI, n = 490; group B without MEI, n = 510) and a total colonoscopy was performed. Time to cecal intubation did not differ between the groups (507 s vs 538 s; NS). The duration of abdominal compression was significantly shorter in MEI guided colonoscopy. The intensity of abdominal compression was lower in group A and fewer turn maneuvers needed per patient. A trend towards a reduced need for assistance in MEI group was seen., Conclusion: Although MEI does not generally accelerate colonoscope advancement, it significantly reduces the force and the duration of abdominal compression by assistant personnel, thus minimizing patient discomfort and decreasing the need for additional staff., (© 2011 The Authors. Journal of Digestive Diseases © 2011 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and Blackwell Publishing Asia Pty Ltd.)