Introduction: It is estimated that 14 percent of adults have fecal/flatal incontinence. It can be difficult or impossible to maintain pneumocolon during colonoscopy performed in patients (pts) with weak anal sphincters. In these pts, insufflated gas is quickly expelled transanally. Thus, before the colon is adequately expanded it collapses. In such pts only a poor quality diagnostic exam can be performed and, if polyps are found, it can be extremely difficult or impossible to remove them because of poor exposure. This case report proposes a solution for pts with incompetent sphincters undergoing colonoscopy. History: A 70 year old HIV + man underwent a screening colonoscopy to the terminal ileum. On withdrawal, about 45 cm from the anus, a 1 cm clinical adenoma was found. Attempts to remove the polyp were unsuccessful because every 20-30 seconds gas was expelled transanally which resulted in a loss of the endoscopic field. Attempts to resinsuflate ended in the rapid passage of more gas. The exam was terminated and a future exam done via a transanal platform recommended. At a later date the pt was brought to the operating room and a Gelpoint Path (Applied Medical Corporation, CA) anal platform was inserted. Because of the 4 cm diameter of the anal sleeve anesthesia is necessary (in this case general). The anal sleeve was inserted with an obturator and secured to the buttocks with 2 sutures. A pediatric colonoscope was passed through the Gel cap and the cap attached to the anal sleeve. A flexible sigmoidoscopy was then performed. The exposure obtained was excellent and there was no flatal incontinence. The index polyp was easily found and removed with a hot snare after a saline lift. An additional 7 small polyps were found and removed via hot and cold snare and biopsy forceps. Pathology revealed 4 adenomas and 3 hyperplastic polyps. At the end of the procedure the scope and the anal platform was removed. The pt went home after a brief recovery. Discussion: It is difficult to do a high quality exam in pts with incompetent anal sphincters; polyps and cancers can be missed The selective use of a transanal platform with airtight cap through which the scope is passed allows a thorough examination and intervention. In this case, the platform allowed an excellent exam and multiple polypectomies. Further study regarding anorectal platforms are warranted. A narrower channel would simplify insertion.