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Kato T, Sasaki K, Nagata K, Hirayama M, Endo S, Horita S. Acceptance and Preference of Computed Tomographic Colonography and Colonoscopy: Results of a Nationwide Multicenter Comparative Questionnaire Survey in Japan. J Anus Rectum Colon 2024; 8:84-95. [PMID: 38689783 PMCID: PMC11056531 DOI: 10.23922/jarc.2023-025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 12/10/2023] [Indexed: 05/02/2024] Open
Abstract
Objectives To investigate patient acceptance and preference for computed tomographic colonography (CTC) over colonoscopy. Methods Participants were recruited from a nationwide multicenter trial in Japan to assess the accuracy of CTC detection. They were scheduled to undergo colonoscopy after CTC with common bowel preparation on the same day. Some were administered sedative drugs during colonoscopy, depending on the referring clinician and participant's preferences. The participants were requested to complete a questionnaire to evaluate the acceptability of bowel preparation, examinations, and preference for future examinations. Results Of the 1,257 enrolled participants, 1,180 (mean age: 60.6 years; women: 43.3%) completed the questionnaire. Sedative drugs were not administered in 687 participants (unsedated colonoscopy group) and were administered intravenously during colonoscopy in 493 participants (sedated colonoscopy group). Before propensity score matching, the mean participants' age, percentages of asymptomatic participants, insufflation of gas during colonoscopy, and number of participants with a history of abdominal/pelvic operation significantly differed between the groups. After propensity score matching, 912 participants from each group were included in the analysis. In the unsedated colonoscopy group, CTC was answered as significantly easier than colonoscopy (p<0.001). Conversely, CTC was significantly more difficult than colonoscopy in the sedated colonoscopy group (p<0.001). In the unsedated colonoscopy group, 48% preferred CTC and 22% preferred colonoscopy for future examinations, whereas in the sedated colonoscopy group, 26% preferred CTC and 38% preferred colonoscopy (p<0.001). Conclusions CTC has superior participant acceptability compared with unsedated colonoscopy. However, our study did not observe the advantages of CTC acceptance over sedative colonoscopy.
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Affiliation(s)
- Takashi Kato
- Department of Gastroenterology, Tomakomai City Hospital, Tomakomai, Japan
| | - Kiyotaka Sasaki
- Department of Internal Medicine, Hokkaido Gastroenterological Hospital, Sapporo, Japan
| | - Koichi Nagata
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
- Cancer Screening Center, National Cancer Center Hospital, Tokyo, Japan
| | | | - Shungo Endo
- Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
| | - Shoichi Horita
- Department of Internal Medicine, Hokkaido Gastroenterological Hospital, Sapporo, Japan
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Liu P, Wu J, He C, Wang W. ENDOANGEL versus water exchange for the detection of colorectal adenomas. Therap Adv Gastroenterol 2023; 16:17562848231218570. [PMID: 38116388 PMCID: PMC10729641 DOI: 10.1177/17562848231218570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 11/10/2023] [Indexed: 12/21/2023] Open
Abstract
Background Recently, the ENDOANGEL (EN) system, a computer-assisted detection technique, and water exchange (WE) assisted colonoscopy have both been shown to increase the colorectal adenoma detection rate (ADR). Objectives The aim of this study was to compare the ADR between EN- and WE-assisted colonoscopy. Design This was a retrospective study. Methods Data from patients who underwent either EN- or WE-assisted colonoscopy between October 2021 and August 2022 were analysed consecutively. The primary outcome measure was the ADR. Results The ADR was found to be similar between the EN and WE groups, with 80 out of 199 (40.2%) patients in the EN group compared to 78 out of 174 (44.8%) patients in the WE group [1.21; 95% confidence interval (CI), 0.80-1.83]. In the analysis using stabilized inverse probability treatment weighting after adjustment for confounding factors, both colonoscopy methods had similar performance in terms of ADR (1.41; 95% CI, 0.88-2.27). Conclusion EN was found to be comparable to WE in terms of ADR during colonoscopy, and both methods may be effectively used in clinical practice.
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Affiliation(s)
- Pengwei Liu
- Department of Gastroenterology, Yijishan Hospital of Wannan Medical College, Wuhu, China
| | - Jie Wu
- Department of Gastroenterology, Yijishan Hospital of Wannan Medical College, Wuhu, China
| | - Chiyi He
- Department of Gastroenterology, Yijishan Hospital of Wannan Medical College, No. 2 Zheshan West Road, Wuhu 241001, China
| | - Wei Wang
- Department of Gastroenterology, Yijishan Hospital of Wannan Medical College, No. 2 Zheshan West Road, Wuhu 241001, China
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Liu C, Zheng S, Gao H, Yuan X, Zhang Z, Xie J, Yu C, Xu L. Minimal water exchange by the air-water valve versus left colon water exchange in unsedated colonoscopy: a randomized controlled trial. Endoscopy 2022; 55:324-331. [PMID: 35998673 DOI: 10.1055/a-1929-4552] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Water exchange colonoscopy is the least painful method for unsedated colonoscopies. Simplified left colon water exchange (LWE) reduces the cecal intubation time but it is difficult to avoid the use of an additional pump. Minimal water exchange (MWE) is an improved novel method that eliminates the need for pumps, but it is not clear whether MWE has the same efficiency as LWE. METHODS This was a prospective, randomized, controlled, noninferiority trial conducted in a tertiary hospital. Enrolled patients were randomized 1:1 to the LWE group or MWE group. The primary outcome was recalled insertion pain measured by a 4-point verbal rating scale. Secondary outcomes included adenoma detection rate (ADR), cecal intubation time, volume of water used, and patient willingness to repeat unsedated colonoscopy. RESULTS 226 patients were included (LWE n = 113, MWE n = 113). The MWE method showed noninferior moderate/severe pain rates compared with the LWE method (10.6 % vs. 9.7 %), with a difference of 0.9 percentage points (99 % confidence interval [CI] -9.5 to 11.3; threshold, 15 %). ADR, cecal intubation time, and willingness to repeat unsedated colonoscopy were not significantly different between the two groups, but the mean volume of water used was significantly less with MWE than with LWE (163.7 mL vs. 407.2 mL; 99 %CI -298.28 to -188.69). CONCLUSION Compared with LWE, MWE demonstrated a noninferior outcome for insertion pain, and comparable cecal intubation time and ADR, but reduced the volume of water used and eliminated the need for a water pump.
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Affiliation(s)
- Cenqin Liu
- Department of Gastroenterology, Ningbo Hospital, Zhejiang University, Ningbo, China.,Department of Gastroenterology, Ningbo First Hospital, Ningbo, China
| | - Shuhao Zheng
- Department of Gastroenterology, Ningbo First Hospital, Ningbo, China.,School of Medicine, Ningbo University, Ningbo, China
| | - Hui Gao
- Department of Gastroenterology, Ningbo First Hospital, Ningbo, China.,School of Medicine, Ningbo University, Ningbo, China
| | - Xin Yuan
- Department of Gastroenterology, Ningbo First Hospital, Ningbo, China.,School of Medicine, Ningbo University, Ningbo, China
| | - Zhixin Zhang
- Department of Gastroenterology, Ningbo First Hospital, Ningbo, China.,School of Medicine, Ningbo University, Ningbo, China
| | - Jiarong Xie
- Department of Gastroenterology, Ningbo First Hospital, Ningbo, China
| | - Chaohui Yu
- Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,Zhejiang Provincial Clinical Research Center for Digestive Diseases, Hangzhou, China
| | - Lei Xu
- Department of Gastroenterology, Ningbo Hospital, Zhejiang University, Ningbo, China.,Department of Gastroenterology, Ningbo First Hospital, Ningbo, China.,Zhejiang Provincial Clinical Research Center for Digestive Diseases, Hangzhou, China
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Leung FW, Cadoni S, Koo M, Yen AW, Siau K, Hsieh YH, Ishaq S, Cheng CL, Ramirez FC, Bak AW, Karnes W, Bayupurnama P, Leung JW, de Groen PC. A survey of colonoscopists with and without in-depth knowledge of water-aided colonoscopy. J Gastroenterol Hepatol 2022; 37:1785-1791. [PMID: 35613903 DOI: 10.1111/jgh.15896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/10/2022] [Accepted: 05/14/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM Endoscopy featured water-aided colonoscopy (WAC) as novel in the Innovation Forum in 2011. Gastrointestinal Endoscopy published a modified Delphi consensus review (MDCR) that supports WAC for clinical practice in 2021. We tested the hypothesis that experience was an important predictor of WAC use, either as water immersion (WI), water exchange (WE), or a combination of WI and WE. METHODS A questionnaire was sent by email to the MDCR authors with an in-depth knowledge of WAC. They responded and also invited colleagues and trainees without in-depth knowledge to respond. Logistic regression analysis was used with the reasons for WAC use treated as the primary outcome. Reports related to WAC post MDCR were identified. RESULTS Of 100 respondents, > 80% indicated willingness to adopt and modify practice to accommodate WAC. Higher adenoma detection rate (ADR) incentivized WE use. Procedure time slots ≤ 30 and > 30 min significantly predicted WI and WE use, respectively. Co-authors of the MDCR were significantly more likely to perform WAC (odds ratio [OR] = 7.5, P = 0.037). Unfamiliarity with (OR = 0.11, P = 0.02) and absence of good experience (OR = 0.019, P = 0.002) were associated with colonoscopists less likely to perform WAC. Reports related to WAC post MDCR revealed overall and right colon WE outcomes continued to improve. Network meta-analyses showed that WE was superior to Cap and Endocuff. On-demand sedation with WE shortened nursing recovery time. CONCLUSIONS An important predictor of WAC use was experience. Superior outcomes continued to be reported with WE.
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Affiliation(s)
- Felix W Leung
- Sepulveda Ambulatory Care Center, VAGLAHS; David Geffen School of Medicine at UCLA, Medicine, North Hills, California, USA
| | - Sergio Cadoni
- Digestive Endoscopy Unit, CTO Hospital, Iglesias, Italy
| | - Malcolm Koo
- Graduate Institution of Long-term Care, Tzu Chi University of Science and Technology, Hualien, Taiwan
| | - Andrew W Yen
- Sacramento Veterans Affairs Medical Center, VANCHCS, Division of Gastroenterology, University of California Davis School of Medicine, Sacramento, California, USA
| | - Keith Siau
- Department of Gastroenterology, Dudley Group Hospitals NHS Foundation Trust, Dudley, UK
| | - Yu-Hsi Hsieh
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Sauid Ishaq
- The Dudley Group of Hospitals NHS Trust, Visiting Professor of Medicine and Gastroenterology, Birmingham City University, Birmingham, UK
| | - Chi-Liang Cheng
- Division of Gastroenterology, Department of Internal Medicine, Evergreen General Hospital, Taoyuan, Taiwan
| | - Francisco C Ramirez
- Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Adrian W Bak
- Division of Gastroenterology, Department of Medicine, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - William Karnes
- Digestive Health Institute, University of California Irvine Medical Center, Irvine, California, USA
| | - Putut Bayupurnama
- Division of Gastroenterology and Hepatology, Internal Medicine Department, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Joseph W Leung
- Sacramento Veterans Affairs Medical Center, VANCHCS, Division of Gastroenterology, University of California Davis School of Medicine, Sacramento, California, USA
| | - Piet C de Groen
- Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA
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Ang TL, Seet E, Goh YC, Ng WK, Koh CJ, Lui HF, Li JW, Oo AM, Lim KBL, Ho KS, Chew MH, Quan WL, Tan DMY, Ng KH, Goh HS, Cheong WK, Tseng P, Ling KL. Academy of Medicine, Singapore clinical guideline on the use of sedation by non-anaesthesiologists during gastrointestinal endoscopy in the hospital setting. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2022; 51:24-39. [PMID: 35091728 DOI: 10.47102/annals-acadmedsg.2021306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION In Singapore, non-anaesthesiologists generally administer sedation during gastrointestinal endoscopy. The drugs used for sedation in hospital endoscopy centres now include propofol in addition to benzodiazepines and opiates. The requirements for peri-procedural monitoring and discharge protocols have also evolved. There is a need to develop an evidence-based clinical guideline on the safe and effective use of sedation by non-anaesthesiologists during gastrointestinal endoscopy in the hospital setting. METHODS The Academy of Medicine, Singapore appointed an expert workgroup comprising 18 gastroenterologists, general surgeons and anaesthesiologists to develop guidelines on the use of sedation during gastrointestinal endoscopy. The workgroup formulated clinical questions related to different aspects of endoscopic sedation, conducted a relevant literature search, adopted Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology and developed recommendations by consensus using a modified Delphi process. RESULTS The workgroup made 16 recommendations encompassing 7 areas: (1) purpose of sedation, benefits and disadvantages of sedation during gastrointestinal endoscopy; (2) pre-procedural assessment, preparation and consent taking for sedation; (3) Efficacy and safety of drugs used in sedation; (4) the role of anaesthesiologist administered sedation during gastrointestinal endoscopy; (5) performance of sedation; (6) post-sedation care and discharge after sedation; and (7) training in sedation for gastrointestinal endoscopy for non-anaesthesiologists. CONCLUSION These recommendations serve to guide clinical practice during sedation for gastrointestinal endoscopy by non-anaesthesiologists in the hospital setting.
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Affiliation(s)
- Tiing Leong Ang
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
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Tseng CW, Hsieh YH. Use of water immersion instead of water exchange underlay the unfavourable outcomes in the water-assisted sigmoidoscopy (WAS) study. Gut 2021; 70:1803-1804. [PMID: 33148553 DOI: 10.1136/gutjnl-2020-323362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 10/19/2020] [Accepted: 10/21/2020] [Indexed: 12/08/2022]
Affiliation(s)
- Chih-Wei Tseng
- Department of Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.,School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan, Taiwan
| | - Yu-Hsi Hsieh
- Department of Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan .,School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan, Taiwan
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7
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Leng F, Ye CG, Dai HM, Hu N, Zhu XJ, Fang J, Xiang Y, Yang L. Clinical effects of left-colon water exchange colonoscopy vs conventional air-insufflation colonoscopy. Shijie Huaren Xiaohua Zazhi 2021; 29:972-976. [DOI: 10.11569/wcjd.v29.i16.972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The left colon is difficult to detect via conventional air-injection colonoscopy, and patients may have obvious discomfort during intubation. Studies have reported that water exchange technology can significantly reduce the pain and discomfort of patients during endoscopy. However, there are still few studies comparing the clinical effects of left-colon water exchange (WE) colonoscopy with conventional air-insufflation (AI) colonoscopy.
AIM To compare the clinical effects of left-colon WE colonoscopy and conventional AI colonoscopy.
METHODS Consecutive patients who underwent colonoscopy at our hospital from June 2020 to December 2020 were collected and randomly divided into either a left-colon WE colonoscopy group or a conventional AI colonoscopy group at a ratio of 1:1. The success rate of ileocecal insertion, time to cecal insertion, time to colonoscope withdrawal, adenoma detection rate (ADR), visual analogue scale (VAS) score of pain, and rate of complications were recorded in the two groups.
RESULTS A total of 276 patients were included according to the inclusion and exclusion criteria, including 139 cases in the left-colon WE colonoscopy group and 137 cases in the conventional AI colonoscopy group. There were no statistical differences in the success rate of ileocecal insertion, time to colonoscope withdrawal, or adenoma detection rate between the two groups (P > 0.05). However, time to cecal insertion was significantly shorter (4.6 min vs 5.3 min, P < 0.05) and VAS score was significantly lower (2.7 vs 3.1, P < 0.05) in the left-colon WE colonoscopy group than in the conventional AI colonoscopy group. No examination-related complications such as perforation occurred in either group.
CONCLUSION Compared with conventional AI colonoscopy, left-colon WE colonoscopy significantly shortens the time to ileocecal insertion and reduces the pain and discomfort of the patients.
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Affiliation(s)
- Fang Leng
- Department of Gastroenterology, Third People's Hospital of Jingdezhen, Jingdezhen 333000, Jiangxi Province, China
| | - Chang-Gen Ye
- Department of Gastroenterology, Third People's Hospital of Jingdezhen, Jingdezhen 333000, Jiangxi Province, China
| | - Hua-Mei Dai
- Department of Gastroenterology, Third People's Hospital of Jingdezhen, Jingdezhen 333000, Jiangxi Province, China
| | - Na Hu
- Department of Gastroenterology, Third People's Hospital of Jingdezhen, Jingdezhen 333000, Jiangxi Province, China
| | - Xiao-Jia Zhu
- Department of Gastroenterology, Third People's Hospital of Jingdezhen, Jingdezhen 333000, Jiangxi Province, China
| | - Jun Fang
- Department of Gastroenterology, Third People's Hospital of Jingdezhen, Jingdezhen 333000, Jiangxi Province, China
| | - Yang Xiang
- Department of Gastroenterology, Third People's Hospital of Jingdezhen, Jingdezhen 333000, Jiangxi Province, China
| | - Li Yang
- Department of Gastroenterology, Third People's Hospital of Jingdezhen, Jingdezhen 333000, Jiangxi Province, China
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Cadoni S, Ishaq S, Hassan C, Falt P, Fuccio L, Siau K, Leung JW, Anderson J, Binmoeller KF, Radaelli F, Rutter MD, Sugimoto S, Muhammad H, Bhandari P, Draganov PV, de Groen P, Wang AY, Yen AW, Hamerski C, Thorlacius H, Neumann H, Ramirez F, Mulder CJJ, Albéniz E, Amato A, Arai M, Bak A, Barret M, Bayupurnama P, Cheung R, Ching HL, Cohen H, Dolwani S, Friedland S, Harada H, Hsieh YH, Hayee B, Kuwai T, Lorenzo-Zúñiga V, Liggi M, Mizukami T, Mura D, Nylander D, Olafsson S, Paggi S, Pan Y, Parra-Blanco A, Ransford R, Rodriguez-Sanchez J, Senturk H, Suzuki N, Tseng CW, Uchima H, Uedo N, Leung FW. Water-assisted colonoscopy: an international modified Delphi review on definitions and practice recommendations. Gastrointest Endosc 2021; 93:1411-1420.e18. [PMID: 33069706 DOI: 10.1016/j.gie.2020.10.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/08/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Since 2008, a plethora of research studies has compared the efficacy of water-assisted (aided) colonoscopy (WAC) and underwater resection (UWR) of colorectal lesions with standard colonoscopy. We reviewed and graded the research evidence with potential clinical application. We conducted a modified Delphi consensus among experienced colonoscopists on definitions and practice of water immersion (WI), water exchange (WE), and UWR. METHODS Major databases were searched to obtain research reports that could potentially shape clinical practice related to WAC and UWR. Pertinent references were graded (Grading of Recommendations, Assessment, Development and Evaluation). Extracted data supporting evidence-based statements were tabulated and provided to respondents. We received responses from 55 (85% surveyed) experienced colonoscopists (37 experts and 18 nonexperts in WAC) from 16 countries in 3 rounds. Voting was conducted anonymously in the second and third round, with ≥80% agreement defined as consensus. We aimed to obtain consensus in all statements. RESULTS In the first and the second modified Delphi rounds, 20 proposed statements were decreased to 14 and then 11 statements. After the third round, the combined responses from all respondents depicted the consensus in 11 statements (S): definitions of WI (S1) and WE (S2), procedural features (S3-S5), impact on bowel cleanliness (S6), adenoma detection (S7), pain score (S8), and UWR (S9-S11). CONCLUSIONS The most important consensus statements are that WI and WE are not the same in implementation and outcomes. Because studies that could potentially shape clinical practice of WAC and UWR were chosen for review, this modified Delphi consensus supports recommendations for the use of WAC in clinical practice.
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Affiliation(s)
- Sergio Cadoni
- CTO Hospital, Digestive Endoscopy Unit, Iglesias, Italy
| | - Sauid Ishaq
- Russell Hall, Dept. of Gastroenterology, Birmingham, United Kingdom; Birmingham City University, Birmingham, United Kingdom
| | - Cesare Hassan
- Nuovo Regina Margherita Hospital, Digestive Endoscopy Unit, Rome, Italy
| | - Přemysl Falt
- University Hospital and Faculty of Medicine, Palacky University, Olomouc, Czech Republic; Faculty of Medicine, Charles University, Hradec Králové, Czech Republic
| | - Lorenzo Fuccio
- S. Orsola-Malpighi University Hospital, Department of Medical and Surgical Sciences, Bologna, Italy
| | - Keith Siau
- JAG Clinical Fellow, JAG, Royal College of Physicians, London, United Kingdom
| | - Joseph W Leung
- Division of Gastroenterology and Hepatology, Sacramento VA Medical Center and University of California Davis School of Medicine, Sacramento, California, USA
| | - John Anderson
- Gloucestershire Hospitals NHS Foundation Trust, Gloucestershire, United Kingdom
| | - Kenneth F Binmoeller
- California Pacific Medical Center, Interventional Endoscopy Services, San Francisco, California, United States
| | | | - Matt D Rutter
- University Hospital North Tees NHS, Department of Gastroenterology, Stockton-on-Tees, United Kingdom; Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom
| | - Shinya Sugimoto
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | | | - Pradeep Bhandari
- Portsmouth University Hospital, Dept. of Gastroenterology, Portsmouth, United Kingdom
| | | | - Piet de Groen
- University of Minnesota, Division of Gastroenterology, Minneapolis, Minnesota, United States
| | - Andrew Y Wang
- Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, Virginia, United States
| | - Andrew W Yen
- Division of Gastroenterology and Hepatology, Sacramento VA Medical Center and University of California Davis School of Medicine, Sacramento, California, USA
| | - Chris Hamerski
- California Pacific Medical Center, Interventional Endoscopy Services, San Francisco, California, United States
| | - Henrik Thorlacius
- Lund University Surgery, Department of Gastrointestinal Surgery, Malmö, Sweden
| | - Helmut Neumann
- University Medical Center, Interventional Endoscopy Center, Medizinische Klinik und Poliklinik, Mainz, Germany
| | | | - Chris J J Mulder
- VU University Medical Center, Department of Gastroenterology, Amsterdam, The Netherlands
| | - Eduardo Albéniz
- Gastroenterology Department, Endoscopy Unit, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Arnaldo Amato
- Ospedale Valduce, Gastroenterology Unit, Como, Italy
| | - Makoto Arai
- Chiba University, Gastroenterology Department, Chiba, Japan
| | - Adrian Bak
- University of British Columbia, Department of Medicine, Kelowna, Canada
| | | | - Putut Bayupurnama
- Division of Gastroenterology and Hepatology, Internal Medicine Department, Faculty of Medicine, Gadjah Mada University, Sardjito General Hospital, Yogyakarta, Indonesia
| | - Ramsey Cheung
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, VA Palo Alto, California, United States
| | - Hey-Long Ching
- Sheffield Teaching Hospitals, Gastroenterology Department, Sheffield, United Kingdom
| | - Hartley Cohen
- Department of Medicine, VA Greater Los Angeles Health Care System, Los Angeles, United States; David Geffen School of Medicine at UCLA, Department of Medicine, Los Angeles, California, United States
| | - Sunil Dolwani
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Shai Friedland
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, VA Palo Alto, California, United States
| | - Hideaki Harada
- Department of Gastroenterology, New Tokyo Hospital, Gastroenterology, Matsudo, Chiba, Japan
| | - Yu-Hsi Hsieh
- Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin Township, Taiwan
| | - Bu Hayee
- King's College Hospital NHS foundation Trust, Gastroenterology Department, London, United Kingdom
| | - Toshio Kuwai
- NHO Kure Medical Center and Chugoku Cancer Center, Gastroenterology Department, Kure, Japan
| | | | - Mauro Liggi
- ASSL Carbonia, Sirai Hospital, Digestive Endoscopy Unit, Carbonia, Italy
| | - Takeshi Mizukami
- NHO Kurihama Medical and Addiction Center, Endoscopy Center, Yokosuka, Japan
| | - Donatella Mura
- ASSL Carbonia, Sirai Hospital, Digestive Endoscopy Unit, Carbonia, Italy
| | - David Nylander
- Newcastle Upon Tyne NHS Foundation Trust, Gastroenterology Department, Newcastle Upon Tyne, United Kingdom
| | - Snorri Olafsson
- Telemark Hospital, Gastroenterology Department, Skien, Norway
| | - Silvia Paggi
- Ospedale Valduce, Gastroenterology Unit, Como, Italy
| | - Yanglin Pan
- Xijing Hospital, Department of Gastroenterology, Xian, Republic of China
| | - Adolfo Parra-Blanco
- NIHR Nottingham Biomedical Research Centre, Department of Gastroenterology, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, United Kingdom
| | - Rupert Ransford
- Endoscopy Department Hereford County Hospital, Hereford, United Kingdom
| | | | - Hakan Senturk
- Bezmialem Vakif University Medicine Faculty, Department of Medicine, Istanbul, Turkey
| | - Noriko Suzuki
- Wolfson Unit for Endoscopy, St Mark's Hospital, London, United Kingdom
| | - Chih-Wei Tseng
- Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin Township, Taiwan
| | - Hugo Uchima
- Hospital Germans Triasi i Pujol, Teknon Medical Center, Gastroenterology, Barcelona, Spain
| | - Noriya Uedo
- Osaka International Cancer Institute, Department of Gastrointestinal Oncology, Osaka, Japan
| | - Felix W Leung
- Department of Medicine, VA Greater Los Angeles Health Care System, Los Angeles, United States; David Geffen School of Medicine at UCLA, Department of Medicine, Los Angeles, California, United States
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Naveed M, Jamil L, Wani S, Qumseya BJ. Response. Gastrointest Endosc 2020; 92:1145-1146. [PMID: 33160503 DOI: 10.1016/j.gie.2020.07.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 07/26/2020] [Indexed: 02/08/2023]
Affiliation(s)
- Mariam Naveed
- Advent Health Medical Group, Department of Gastroenterology/Hepatology, Advent Health Hospital Altamonte Springs, Altamonte Springs, Florida, USA; Section of Gastroenterology and Hepatology, Beaumont Health-Royal Oak, Royal Oak, Michigan, USA; Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA; Division of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, Florida, USA
| | - Laith Jamil
- Advent Health Medical Group, Department of Gastroenterology/Hepatology, Advent Health Hospital Altamonte Springs, Altamonte Springs, Florida, USA; Section of Gastroenterology and Hepatology, Beaumont Health-Royal Oak, Royal Oak, Michigan, USA; Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA; Division of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, Florida, USA
| | - Sachin Wani
- Advent Health Medical Group, Department of Gastroenterology/Hepatology, Advent Health Hospital Altamonte Springs, Altamonte Springs, Florida, USA; Section of Gastroenterology and Hepatology, Beaumont Health-Royal Oak, Royal Oak, Michigan, USA; Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA; Division of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, Florida, USA
| | - Bashar J Qumseya
- Advent Health Medical Group, Department of Gastroenterology/Hepatology, Advent Health Hospital Altamonte Springs, Altamonte Springs, Florida, USA; Section of Gastroenterology and Hepatology, Beaumont Health-Royal Oak, Royal Oak, Michigan, USA; Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA; Division of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, Florida, USA
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- Advent Health Medical Group, Department of Gastroenterology/Hepatology, Advent Health Hospital Altamonte Springs, Altamonte Springs, Florida, USA; Section of Gastroenterology and Hepatology, Beaumont Health-Royal Oak, Royal Oak, Michigan, USA; Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA; Division of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, Florida, USA
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10
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Khan F, Hur C, Lebwohl B, Krigel A. Unsedated Colonoscopy: Impact on Quality Indicators. Dig Dis Sci 2020; 65:3116-3122. [PMID: 32696236 DOI: 10.1007/s10620-020-06491-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 07/11/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND In the USA, sedation is commonly used for colonoscopies; though colonoscopy can be successfully performed without sedation, outcomes data in this setting are scarce. AIMS To determine patient characteristics associated with undergoing unsedated colonoscopy and whether adenoma detection rate (ADR) and cecal intubation rate (CIR) differ between sedated and unsedated colonoscopy. METHODS Using a single-center electronic endoscopy database, we identified patients who underwent outpatient colonoscopy between 2011 and 2018 with or without sedation. We used multivariable logistic regression to determine factors associated with unsedated colonoscopy, CIR, and ADR. RESULTS We identified 24,795 patients who underwent colonoscopy during the study period. Of these, 179 patients (0.7%) underwent unsedated colonoscopy. ADR was 27.4% in sedated and 21.2% in unsedated colonoscopies (p = 0.06); CIR was 95.8% in sedated and 85.5% in unsedated patients (p < 0.01). On multivariable analysis, male sex (OR 2.06, CI 1.52-2.79) and suboptimal bowel preparation (OR 1.75, CI 1.24-2.45) were associated with undergoing unsedated colonoscopy, while higher BMI was inversely associated with unsedated colonoscopy (BMI 25-29.9: OR 0.44, CI 0.25-0.77). On multivariable analysis, colonoscopy with sedation was associated with CIR (OR 3.79, CI 2.39-6.00) and ADR (OR 1.45, OR 1.00-2.10). CONCLUSION We found that undergoing outpatient colonoscopy with sedation as opposed to no sedation was significantly associated with a higher CIR and ADR. Our findings suggest sedation is necessary to meet current CIR and ADR guidelines; however, given the potential cost and safety benefits of unsedated colonoscopy, further investigation into methods to improve patient selection and colonoscopy quality indicators is warranted.
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Affiliation(s)
- Fatima Khan
- Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, 177 Fort Washington Avenue, New York, NY, 10032, USA.
| | - Chin Hur
- Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, 177 Fort Washington Avenue, New York, NY, 10032, USA
| | - Benjamin Lebwohl
- Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, 177 Fort Washington Avenue, New York, NY, 10032, USA.,Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Anna Krigel
- Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, 177 Fort Washington Avenue, New York, NY, 10032, USA
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11
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McCain JD, Stancampiano FF, Bouras EP, DeVault KR, Gilbert EL, Ryan T, Maillis A, Heckman MG, Diehl NN, Palmer WC. Creation of a score to predict risk of high conscious sedation requirements in patients undergoing endoscopy. Gastrointest Endosc 2020; 91:595-605.e3. [PMID: 31756314 DOI: 10.1016/j.gie.2019.11.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 11/03/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS The administration of intravenous conscious sedation to patients undergoing GI endoscopy carries a risk of cardiopulmonary adverse events. Our study aim was to create a score that stratifies the risk of occurrence of either high-dose conscious sedation requirements or a failed procedure. METHODS Patients receiving endoscopy via endoscopist-directed conscious sedation were included. The primary outcome was occurrence of sedation failure, which was defined as one of the following: (1) high-dose sedation, (2) the need for benzodiazepine/narcotic reversal agents, (3) nurse-documented poor patient tolerance to the procedure, or (4) aborted procedure. High-dose sedation was defined as >10 mg of midazolam and/or >200 μg of fentanyl or the meperidine equivalent. Patients with sedation failure (n = 488) were matched to controls (n = 976) without a sedation failure by endoscopist and endoscopy date. RESULTS Significant associations with sedation failure were identified for age, sex, nonclonazepam benzodiazepine use, opioid use, and procedure type (EGD, colonoscopy, or both). Based on these 5 variables, we created the high conscious sedation requirements (HCSR) score, which predicted the risk of sedation failure with an area under the curve of 0.70. Compared with the patients with a risk score of 0, risk of a sedation failure was highest for patients with a score ≥3.5 (odds ratio, 17.31; P = 2 × 10-14). Estimated area under the curve of the HCSR score was 0.68 (95% confidence interval, 0.63-0.72) in a validation series of 250 cases and 250 controls. CONCLUSIONS The HCSR risk score, based on 5 key patient and procedure characteristics, can function as a useful tool for physicians when discussing sedation options with patients before endoscopy.
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Affiliation(s)
- Josiah D McCain
- Division of Community Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Ernest P Bouras
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Kenneth R DeVault
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Emily L Gilbert
- Division of Community Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Taylor Ryan
- CRISP Student Program, Mayo Clinic, Jacksonville, Florida, USA
| | - Alex Maillis
- CRISP Student Program, Mayo Clinic, Jacksonville, Florida, USA
| | - Michael G Heckman
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, Florida, USA
| | - Nancy N Diehl
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, Florida, USA
| | - William C Palmer
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
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12
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Hsieh YH, Tseng CW, Koo M, Leung FW. Feasibility of sedation on demand in Taiwan using water exchange and air insufflation: A randomized controlled trial. J Gastroenterol Hepatol 2020; 35:256-262. [PMID: 31420895 DOI: 10.1111/jgh.14839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 08/08/2019] [Accepted: 08/12/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM Completion of colonoscopy without sedation eliminates sedation cost and complications. Reported in the United States and Europe, on-demand sedation is not routine practice in Taiwan. Water exchange (WE), characterized by infusion and nearly complete removal of infused water during insertion, reduces insertion pain compared to air insufflation (AI) during colonoscopy. We evaluated the feasibility of on-demand sedation in Taiwan. In a randomized controlled trial of WE vs AI colonoscopy, we also aimed to determine if WE augmented the implementation by reducing insertion pain and decreasing sedation requirement. METHODS This prospective patient-blinded study randomized patients to AI or WE (75 patients/group) to aid insertion. The primary outcome was the proportion of patients completing without sedation. RESULTS In the AI and WE groups, 76.0% and 93.3% (P = 0.006) completed without need for sedation, respectively. The WE group had lower insertion pain score (mean [SD]) (4.0 [2.9] vs 2.1 [2.6], P < 0.001), lower doses of propofol (25.7 [52.7] mg vs 9.1 [35.6] mg, P = 0.012), and less time in the recovery room (3.4 [7.4] vs 1.5 [5.5], P = 0.027) than the AI group. Patient satisfaction scores and willingness to repeat if needed in the future were similar. CONCLUSION On-demand sedation was feasible in Taiwan. The completion rate without sedation was high in patients (76.0% with standard AI) open to the option (no prior intent to receive the standard of full or minimal sedation). WE augmented the implementation by reducing insertion pain and decreasing sedation requirement without adversely affecting patient satisfaction or willingness to repeat.
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Affiliation(s)
- Yu-Hsi Hsieh
- Division of Gastroenterology, Department of Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.,School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
| | - Chih-Wei Tseng
- Division of Gastroenterology, Department of Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.,School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
| | - Malcolm Koo
- Graduate Institute of Long-term Care, Tzu Chi University of Science and Technology, Hualien, Taiwan.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Felix W Leung
- Veterans Affairs Greater Los Angeles Healthcare System, Sepulveda Ambulatory Care Center, North Hill, California, USA.,David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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13
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Barclay RL, Percy DB. Underwater endoscopic mucosal resection without submucosal injection (UEMR) for large colorectal polyps: A community-based series. Am J Surg 2020; 220:693-696. [PMID: 32061399 DOI: 10.1016/j.amjsurg.2020.01.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 01/14/2020] [Accepted: 01/14/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Underwater endoscopic mucosal resection without submucosal injection (UEMR) is an appealing therapy for large colorectal polyps. However, this technique is not practiced widely and there are limited data evaluating UEMR in community settings. METHODS The study comprised patients undergoing UEMR of large (≥20 mm) sessile colorectal lesions at a community-based center. Residual neoplasia was assessed via follow-up colonoscopy. RESULTS Among 264 lesions (diameter 38 ± 18 mm; range 20-110 mm) 99% were successfully resected with UEMR. Two lesions involving the cecum/IC valve required multiple sessions. There were no cases of perforation or post-polypectomy syndrome. Delayed bleeding occurred in 1.6%, all managed conservatively. Residual neoplasia was present in 5.7% and was amenable to UEMR. CONCLUSION This large community-based series demonstrated high efficacy and safety of UEMR for large sessile colorectal lesions. The results support UEMR as first-line therapy for these lesions. SUMMARY Underwater endoscopic mucosal resection without submucosal injection (UEMR) is a recently developed method that has advantages over conventional EMR for treatment of large colorectal lesions. However, UEMR is not practiced widely and there are limited data evaluating this technique in everyday practice. This large community-based series demonstrated high efficacy and safety of UEMR for large sessile colorectal lesions.
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Affiliation(s)
- Robert L Barclay
- Vancouver General Hospital, 899 W.12th Avenue, Vancouver, BC, V5Z 1M9, Canada; Pacific Digestive Health, 1590 Cedar Hill Cross Road, Suite 230, Victoria, BC, V8P 2P5, Canada.
| | - Dean B Percy
- Vancouver General Hospital, 899 W.12th Avenue, Vancouver, BC, V5Z 1M9, Canada
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14
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Neilson LJ, Patterson J, von Wagner C, Hewitson P, McGregor LM, Sharp L, Rees CJ. Patient experience of gastrointestinal endoscopy: informing the development of the Newcastle ENDOPREM™. Frontline Gastroenterol 2020; 11:209-217. [PMID: 32419912 PMCID: PMC7223270 DOI: 10.1136/flgastro-2019-101321] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 11/12/2019] [Accepted: 12/13/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Measuring patient experience is important for evaluating the quality of patient care, identifying aspects requiring improvement and optimising patient outcomes. Patient Reported Experience Measures (PREMs) should, ideally, be patient derived, however no such PREMs for gastrointestinal (GI) endoscopy exist. This study explored the experiences of patients undergoing GI endoscopy and CT colonography (CTC) in order to: identify aspects of care important to them; determine whether the same themes are relevant across investigative modalities; develop the framework for a GI endoscopy PREM. METHODS Patients aged ≥18 years who had undergone oesophagogastroduodenoscopy (OGD), colonoscopy or CTC for symptoms or surveillance (but not within the national bowel cancer screening programme) in one hospital were invited to participate in semi-structured interviews. Recruitment continued until data saturation. Inductive thematic analysis was undertaken. RESULTS 35 patients were interviewed (15 OGD, 10 colonoscopy, 10 CTC). Most patients described their experience chronologically, and five 'procedural stages' were evident: before attending for the test; preparing for the test; at the hospital, before the test; during the test; after the test. Six themes were identified: anxiety; expectations; choice & control; communication & information; comfort; embarrassment & dignity. These were present for all three procedures but not all procedure stages. Some themes were inter-related (eg, expectations & anxiety; communication & anxiety). CONCLUSION We identified six key themes encapsulating patient experience of GI procedures and these themes were evident for all procedures and across multiple procedure stages. These findings will be used to inform the development of the Newcastle ENDOPREM™.
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Affiliation(s)
- Laura J Neilson
- Department of Gastroenterology, South Tyneside District Hospital, South Tyneside and Sunderland NHS Foundation Trust, South Shields, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Joanne Patterson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
- Speech and Language Therapy Department, Sunderland Royal Hospital, Sunderland, UK
| | - Christian von Wagner
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Paul Hewitson
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Linda Sharp
- Population Health Sciences Institute & Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Colin J Rees
- Department of Gastroenterology, South Tyneside District Hospital, South Tyneside and Sunderland NHS Foundation Trust, South Shields, UK
- Population Health Sciences Institute & Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
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15
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Beintaris I, Esmaily S, Saunders BP, Rees CJ, Von Wagner C, Tsiamoulos Z, Hoare Z, Evans R, Yeo ST, Edwards RT, Larkin T, Veitch A, Chilton A, Bramble MG, Deane J, Rutter MD. The WASh Trial: water-assisted sigmoidoscopy in the English Bowel Scope Screening Programme: study protocol for a randomized multicenter trial. Endosc Int Open 2019; 7:E1574-E1582. [PMID: 31723580 PMCID: PMC6847695 DOI: 10.1055/a-0953-1468] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 04/23/2019] [Indexed: 02/06/2023] Open
Abstract
Background and study aims The English National Bowel Scope Screening Programme (BSSP) invites 55-year-olds for a one-off, unsedated flexible sigmoidoscopy (FSIG). Data from BSSP participant-reported experience studies shows 1 in 3 participants report moderate or severe discomfort. Water-assisted colonoscopy (WAS) may improve participants' comfort. The primary objective of this study is to ascertain if post-procedural participant-assessed pain is reduced in WAS compared with carbon dioxide (CO 2 ) insufflation, in invitees undergoing FSIG in BSSP. Patients and methods This is a multicenter, prospective, randomized, two-arm, single-blinded trial designed to evaluate the performance of WAS versus CO 2 insufflation in BSSP. Participants will be randomized to either CO 2 or WAS and will be asked to rate pain post-procedure. Key procedure-related data will be analyzed, including adenoma detection rates (ADR) and degree of sigmoid looping. A cost-effectiveness analysis of WAS versus CO 2 and a discrete choice experiment exploring preferences of participants for attributes of sigmoidoscopy will also be performed. Discussion This is the first trial in the United Kingdom (UK) to investigate the effects of WAS in a screening setting. If the trial shows WAS either reduces pain or increases ADR, this may result in a practice change to implement WAS in screening and non-screening endoscopic practice directly impacting on 256,000 people a year who will undergo BSSP FSIG by 2020. Trial funding came from National Institute for Health Research (NIHR) Research for Patient Benefit (RfPB) supported by the NIHR Clinical Research Network. The trial is actively recruiting. ID: 35866 ISRCTN: 81466870.
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Affiliation(s)
- Iosif Beintaris
- Department of Gastroenterology, University Hospital of North Tees, Stockton-On-Tees, UK
| | - Shiran Esmaily
- Department of Gastroenterology, University Hospital of North Tees, Stockton-On-Tees, UK
| | | | - Colin J Rees
- Department of Gastroenterology, South Tyneside NHS Trust, South Shields UK
| | - Christian Von Wagner
- Research Department of Epidemiology and Public Health, University College London, UK
| | | | - Zoe Hoare
- North Wales Organisation for Randomised Trials in Health, UK
| | - Rachel Evans
- North Wales Organisation for Randomised Trials in Health, UK
| | - Seow Tien Yeo
- Centre for Health Economics and Medicines Evaluation, Bangor University, UK
| | - R T Edwards
- Centre for Health Economics and Medicines Evaluation, Bangor University, UK
| | | | - Andrew Veitch
- Department of Gastroenterology, New Cross Hospital, Wolverhampton, UK
| | - Andrew Chilton
- Department of Gastroenterology, Kettering General Hospital NHS Foundation Trust, UK
| | - Michael G Bramble
- Department of Gastroenterology, James Cook University Hospital, Middlesbrough, UK
| | - Jill Deane
- Department of Gastroenterology, University Hospital of North Tees, Stockton-On-Tees, UK
| | - Matthew D Rutter
- Department of Gastroenterology, University Hospital of North Tees, Stockton-On-Tees, UK
- School of Medicine Pharmacy and Health, Durham University, UK
- Northern Institute for Cancer Research, Newcastle University, UK
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16
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Abstract
Although an established standard, conventional endoscopic mucosal resection (EMR) has disseminated despite an absence of studies demonstrating the value of submucosal injection. Several consequences of poorly executed submucosal injection may increase the difficulty and risk of EMR. Underwater EMR (UEMR), an alternative resection method for colonic neoplasms, avoids the need for submucosal injections. In comparison with reported outcomes of EMR, UEMR achieves similar rates of complete resection with comparable safety, with lower rates of recurrence and fewer repeat procedures. UEMR also compares favorably with endoscopic submucosal dissection in terms of procedure time and rates of complete resection, recurrence, and complications.
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Affiliation(s)
- Andrew Nett
- Interventional Endoscopy Services, California Pacific Medical Center, 1101 Van Ness Ave. Floor 3, San Francisco, CA 94109, USA.
| | - Kenneth Binmoeller
- Interventional Endoscopy Services, California Pacific Medical Center, 1101 Van Ness Ave. Floor 3, San Francisco, CA 94109, USA
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17
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Siau K, Beintaris I. My approach to water-assisted colonoscopy. Frontline Gastroenterol 2019; 10:194-197. [PMID: 31205663 PMCID: PMC6540304 DOI: 10.1136/flgastro-2018-101143] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 12/03/2018] [Accepted: 12/09/2018] [Indexed: 02/04/2023] Open
Abstract
The goal of diagnostic colonoscopy is to achieve procedural completion while maximising effectiveness, patient acceptance and safety. In recent years, international interest in water-assisted colonoscopy (WAC) has been steadily gathering pace. A plethora of high-quality randomised controlled trials and meta-analyses now offer incontrovertible evidence into the benefits of WAC, both for the endoscopist and the patient. Despite this, uptake of WAC within the UK has been limited, with the lack of educational resources representing a significant barrier. This practical step-by-step guide is aimed at both existing practitioners and trainees, with a view to promoting familiarity with WAC and potentially for incorporation into daily practice which may ultimately have a positive effect on quality of colonoscopy and patient experience.
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Affiliation(s)
- Keith Siau
- Department of Gastroenterology, Dudley Group Hospitals NHS Foundation Trust, Dudley, UK
- Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Iosif Beintaris
- Department of Gastroenterology, North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, UK
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18
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Xu X, Ni D, Lu Y, Huang X. Diagnostic application of water exchange colonoscopy: A meta-analysis of randomized controlled trials. J Int Med Res 2019; 47:515-527. [PMID: 30632431 PMCID: PMC6381515 DOI: 10.1177/0300060518819626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Few well-designed studies have investigated water exchange colonoscopy (WE). We performed a meta-analysis to comprehensively evaluate the clinical utility of WE based on high-quality randomized controlled trials (RCTs) and to compare the impacts of WE, water immersion colonoscopy (WI), and gas-insufflation colonoscopy. Methods We searched the Cochrane Library, MEDLINE, Embase, PubMed, Elsevier, CNKI, VIP, and Wan Fang Data for RCTs on WE. We analyzed the results using fixed- or random-effect models according to the presence of heterogeneity. Publication bias was assessed by funnel plots. Results Thirteen studies were eligible for this meta-analysis. The colonoscopic techniques included WE as the study group, and WI and air- or CO2-insufflation colonoscopy as control groups. WE was significantly superior to the control procedures in terms of adenoma detection rate, proportion of painless unsedated colonoscopy procedures, and cecal intubation rate according to odds ratios. WE was also significantly better in terms of maximal pain score and patient satisfaction score according to mean difference. Conclusions WE can remarkably improve the adenoma detection rate, proportion of painless unsedated colonoscopy procedures, patient satisfaction, and cecal intubation rate, as well as reducing the maximal pain score in patients undergoing colonoscopy.
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Affiliation(s)
- Xiufang Xu
- The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Dongqiong Ni
- The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Yuping Lu
- The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Xuan Huang
- The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
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19
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Cadoni S, Hassan C, Frazzoni L, Ishaq S, Leung FW. Impact of water exchange colonoscopy on endoscopy room efficiency: a systematic review and meta-analysis. Gastrointest Endosc 2019; 89:159-167.e13. [PMID: 30048649 DOI: 10.1016/j.gie.2018.07.020] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 07/14/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Separate randomized controlled trials (RCTs) showed water exchange (WE) colonoscopy outperformed other techniques in minimizing insertion pain and optimizing adenoma detection rate. Longer insertion time required for removal of infused water, residual air, and feces might have hampered its wider adoption. We evaluate the impact of WE compared with air or carbon dioxide insufflation (GAS) on room turnaround efficiency measured by cecal intubation, withdrawal, and total procedure times. METHODS With a systematic search in PubMed, Embase, and Cochrane Library, we identified RCTs (published before March 18, 2018) that compared WE with GAS. We focused on parameters of turnaround efficiency and patient-centered outcomes. RESULTS We analyzed 8371 subjects from 17 studies. Demographics and indications were comparable. Mean cecal intubation time (± standard deviation) was WE 12.5 ± 6.1 minutes versus GAS 11.1 ± 7.0 minutes, with a mean difference of 1.4 ± 3.4 minutes. Six studies showed significant differences in insertion time, with mean cecal intubation times of 11.6 ± 5.1 minutes for WE versus 7.7 ± 5.2 minutes for GAS, with a mean difference of 3.9 ± 1.1 minutes. Mean withdrawal time was similar. Mean total procedure time was WE 26.0 ± 9.7 versus GAS 24.2 ± 9.6, with a mean difference of 1.8 ± 6.2 minutes. All mean procedure times were significantly different. Patient-centered outcomes revealed that patients examined with WE had significantly lower real-time insertion pain score, less need for sedation, and higher willingness to repeat the procedure. CONCLUSIONS Based on parameters of procedural time, the impact of WE colonoscopy on endoscopy room turnaround yields an increase in total procedure time of about 2 minutes and is associated with significant improvement in specific patient-centered outcomes.
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Affiliation(s)
- Sergio Cadoni
- Digestive Endoscopy Unit, CTO Hospital, Iglesias, Italy
| | - Cesare Hassan
- Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Leonardo Frazzoni
- Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Sauid Ishaq
- Department of Gastroenterology, Dudley Group Hospitals NHS Foundation Trust, Dudley, United Kingdom; Department of Health and Sciences, Birmingham City University, Birmingham, United Kingdom
| | - Felix W Leung
- Sepulveda Ambulatory Care Center, Veterans Affairs Greater Los Angeles Healthcare System, North Hills, California, USA; David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California, USA
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20
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Hsieh YH, Koo M, Tseng CW, Yang HW, Leung FW. Reduction of multitasking distractions underlies the higher adenoma detection rate of water exchange compared to air insufflation - blinded analysis of withdrawal phase videos. United European Gastroenterol J 2018; 7:230-238. [PMID: 31080608 DOI: 10.1177/2050640618817105] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 11/09/2018] [Indexed: 01/15/2023] Open
Abstract
Background Experts have hypothesized that a reduction of multitasking distractions and improved bowel cleanliness can explain why insertion water exchange enhances adenoma detection rate. Objective The purpose of this study was to test the role of both distractions during withdrawal and bowel cleanliness in enhancing adenoma detection rate using coded video records of colonoscopy. Methods The withdrawal phase of videos of 299 consecutive colonoscopies from two randomized controlled trials comparing water exchange versus air insufflation at a regional hospital in Taiwan were coded. The primary outcome was distractions; activities that preclude full attention being paid to inspection of the mucosa for polyps. A single blinded reviewer collected the data. Results There were significant agreements in inter-rater reliability indexes. Compared to air insufflation, water exchange had significantly fewer distractions; higher diagnostic yield (intervention time and number), adenoma detection rate, and Boston Bowel Preparation Scale score. Water exchange had a higher withdrawal technique score (predominantly adequacy of cleaning). The association between increased adenoma detection rate and water exchange was mediated by the number of distractions and withdrawal time, but not the Boston Bowel Preparation Scale score. Conclusion The speculation by experts that a reduction of multitasking distractions underlies the significantly higher adenoma detection rate of water exchange is supported by the current study. Increased bowel cleanliness did not contribute to the increased adenoma detection rate by use of water exchange.
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Affiliation(s)
- Yu-Hsi Hsieh
- Division of Gastroenterology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.,School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
| | - Malcolm Koo
- Graduate Institute of Long-term Care, Tzu Chi University of Science and Technology, Hualien, Taiwan.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Chih-Wei Tseng
- Division of Gastroenterology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.,School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
| | - Hsiu-Wen Yang
- Division of Gastroenterology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Felix W Leung
- Sepulveda Ambulatory Care Center, Veterans Affairs Greater Los Angeles Healthcare System, North Hill, USA.,David Geffen School of Medicine at UCLA, Los Angeles, USA
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21
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Abstract
BACKGROUND/AIMS To compare water exchange (WE) method with conventional air insufflation (AI) method for colonoscopy, evaluating the technical quality, screening efficacy, and patients' acceptance. MATERIALS AND METHODS Electronic databases were systematically searched for randomized controlled trials comparing WE colonoscopy with AI colonoscopy. The pooled data of procedure-associated and patient-related outcomes were assessed, using the weighted mean difference (WMD) with 95% confidence interval (CI) for continuous variables and relative risk (RR) with 95% CI for dichotomous variables, respectively. RESULTS A total of 13 studies involving 7056 patients were included. The cecum intubation rate was similar between WE and AI methods (RR = 1.01, 95% CI = 0.99-1.02,P = 0.37); however, a significantly longer cecum intubation time was shown in WE group (WMD = 1.56, 95% CI = 0.75-2.37,P = 0.002). Compared with AI, WE was associated with a higher risk of adenoma detection rate (ADR) (RR = 1.28, 95% CI = 1.18-1.38,P < 0.00001) and polyp detection rate (PDR) (RR = 1.30, 95% CI = 1.21-1.39,P < 0.00001). Patients in WE group experienced significantly less maximum pain score (WMD = -1.99, 95% CI = -2.68 to -1.30,P < 0.00001) and less requested on-demand sedation (RR = 0.58, 95% CI = 0.44-0.77,P = 0.0002). Likewise, they also experienced less abdominal compression (RR = 0.62, 95% CI = 0.51-0.74,P < 0.00001) and reposition (RR = 0.74, 95% CI = 0.63-0.86,P = 0.0001). Moreover, patients' willingness to repeat colonoscopy was significantly greater for WE (RR = 1.14, 95% CI = 1.07-1.21,P < 0.0001). CONCLUSION This meta-analysis confirmed that WE method could significantly increase ADR/PDR and improve patients' acceptance of colonoscopy, while reducing the degree of pain and minimize the need for on-demand sedation and adjunct maneuvers, despite requiring more cecal intubation time.
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Affiliation(s)
- Yang Liu
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Qing-Ke Huang
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Xiu-Li Dong
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Piao-Piao Jin
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
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Fuccio L, Frazzoni L, Hassan C, La Marca M, Paci V, Smania V, De Bortoli N, Bazzoli F, Repici A, Rex D, Cadoni S. Water exchange colonoscopy increases adenoma detection rate: a systematic review with network meta-analysis of randomized controlled studies. Gastrointest Endosc 2018; 88:589-597.e11. [PMID: 29981753 DOI: 10.1016/j.gie.2018.06.028] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 06/21/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Water-aided colonoscopy techniques, such as water immersion (WI) and water exchange (WE), have shown different results regarding adenoma detection rate (ADR). We determined the impact of WI and WE on ADR and other procedural outcomes versus gas (air, AI; CO2) insufflation colonoscopy. METHODS A systematic search of multiple databases for randomized controlled trials comparing WI and/or WE with AI and/or CO2 and reporting ADR was conducted. A network meta-analysis with mixed comparisons was performed. Primary outcome was ADR (overall, in the right side of the colon and by colonoscopy indication). RESULTS Seventeen randomized controlled trials (10,350 patients) were included. WE showed a significantly higher overall ADR versus WI (odds ratio [OR], 1.31; 95% credible interval [CrI], 1.12-1.55) versus AI (OR, 1.40; CrI, 1.22-1.62) versus CO2 (OR, 1.48; 95% CrI, 1.15-1.86). WE achieved the highest ADR also in the right side of the colon and in colorectal cancer screening cases (both significant vs AI and WI) as well as in patients taking a split-dose preparation (significant vs all the other techniques). The Boston Bowel Preparation Scale cleanliness score (vs AI and WI) was significantly higher for WE. Both WI and WE showed increased proportion of unsedated examinations and decreased real-time insertion pain, with WE being the least-painful insertion technique. Withdrawal time was comparable across techniques, but WE showed the longest insertion time (3-5 additional minutes). CONCLUSIONS WE significantly increases overall ADR, ADR in screening cases, and in the right side of the colon; it also improves colon cleanliness but requires a longer insertion time.
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Affiliation(s)
- Lorenzo Fuccio
- Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Leonardo Frazzoni
- Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Cesare Hassan
- Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Marina La Marca
- Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Valentina Paci
- Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Veronica Smania
- Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Nicola De Bortoli
- Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Franco Bazzoli
- Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Alessandro Repici
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research and University Hospital, Rozzano (MI), Italy
| | - Douglas Rex
- Division of Gastroenterology/Hepatology, Indiana University Hospital, Indianapolis, Indiana, USA
| | - Sergio Cadoni
- Digestive Endoscopy Unit, CTO Hospital, Iglesias, Italy
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23
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Chen Z, Li Z, Yu X, Wang G. Is water exchange superior to water immersion for colonoscopy? A systematic review and meta-analysis. Saudi J Gastroenterol 2018; 24:259-267. [PMID: 29873319 PMCID: PMC6151995 DOI: 10.4103/sjg.sjg_52_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background/Aims Recently, water exchange (WE) instead of water immersion (WI) for colonoscopy has been proposed to decrease pain and improve adenoma detection rate (ADR). This systematic review and meta-analysis is conducted to assess whether WE is superior to WI based on the published randomized controlled trials (RCTs). Materials and Methods We searched studies from PubMed, Cochrane Central Register of Controlled Trials, EMBASE, and MEDLINE. Only RCTs were eligible for our study. The pooled risk ratios (RRs), pooled mean difference (MD), and pooled 95% confidence intervals (CIs) were calculated by using the fixed-effects model or random-effects model based on heterogeneity. Results Five RCTs consisting of 2229 colonoscopies were included in this study. WE was associated with a significantly higher ADR than WI (RR = 1.18; CI = 1.05-1.32; P = 0.004), especially in right colon (RR = 1.31; CI = 1.07-1.61; P = 0.01). Compared with WI, WE was confirmed with lower pain score, higher Boston Bowel Preparation Scale score, but more infused water during insertion. There was no statistical difference between WE and WI in cecal intubation rate and the number of patients who had willingness to repeat the examination. Furthermore, both total procedure time and cecal intubation time in WE were significantly longer than that in WI (MD = 2.66; CI = 1.42-3.90; P < 0.0001; vs MD = 4.58; CI = 4.01-5.15; P < 0.0001). Conclusions This meta-analysis supports the hypothesis that WE is superior to WI in improving ADR, attenuating insertion pain and providing better bowel cleansing, but inferior in time and consumption of infused water consumption during insertion.
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Affiliation(s)
- Zhihao Chen
- Department of Endoscopy, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China
| | - Zhengqi Li
- Department of Endoscopy, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China
| | - Xinying Yu
- Department of Endoscopy, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China
| | - Guiqi Wang
- Department of Endoscopy, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China
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24
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Katzarov AK, Dunkov ZI, Popadiin I, Katzarov KS. How to measure quality in endoscopic retrograde cholangiopancreatography (ERCP). ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:265. [PMID: 30094251 DOI: 10.21037/atm.2018.05.01] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) is invasive therapeutic procedure demanding specific individual approach for learning and mastering. It is associated with greater morbidity and mortality than any other procedure in gastroenterology. The risk for complications and harm for patient inevitably require strict guidelines to be followed regarding training, certification and proficiency. In an attempt to reduce the risk of complications, various endoscopic societies worldwide have established so called "Quality measures" which proved to be the back bone for safety and quality in ERCP. Recently developed ERCP quality network allowing data comparison between endoscopist is the key of reducing complications and creating a state of the art teaching program for beginner endoscopist. Further research is required regarding quality measures improvement and information exchange in the global ERCP quality network.
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Affiliation(s)
| | - Zdravko Ivanov Dunkov
- Clinic of Gastroenterology and Hepatology, Military Medical Academy, Sofia, Bulgaria
| | - Ivan Popadiin
- Clinic of Gastroenterology and Hepatology, Military Medical Academy, Sofia, Bulgaria
| | - Krum Sotirov Katzarov
- Clinic of Gastroenterology and Hepatology, Military Medical Academy, Sofia, Bulgaria
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25
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Shi X, Tian D, Ye X, Wu Q, Pan Y, Yang Z, Fan D. Is water exchange superior to water immersion in detecting adenomas during colonoscopies? Results from a Bayesian network meta-analysis. Oncotarget 2018; 9:30679-30693. [PMID: 30093978 PMCID: PMC6078142 DOI: 10.18632/oncotarget.25504] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 05/08/2018] [Indexed: 12/13/2022] Open
Abstract
AIM Water-assisted colonoscopy (water exchange [WE] and water immersion [WI]) has been shown to improve the adenoma detection rate. However, few studies have compared these two methods head-to-head. Thus, we conducted a network meta-analysis to integrate both direct and indirect evidence comparing the effectiveness of these two procedures. METHOD We searched PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials for original papers and abstracts published up to March 2018. Randomized controlled trials (RCTs) reporting data in accordance with the eligibility criteria were included in this study. We performed a Bayesian random effects network meta-analysis with mixed comparisons. RESULTS Twenty-nine studies (n = 11464 patients) including 6 direct and 23 indirect comparisons were included in this network meta-analysis. There was a statistically significant difference in the efficacy of adenoma detection when WE was compared with WI (risk ratio [RR]: 1.2, 95% credible interval [CrI]: 1.1-1.3), air insufflation (AI; RR: 1.3, 95% CrI: 1.1-1.4), and carbon dioxide (CO2) insufflation (RR: 1.2, 95% CrI: 1.1-1.5). The different methods were ranked in order from the most to least effective in adenoma detection as follows: WE, WI, AI, and CO2. Moreover, although there were no significant differences in pain scores, willingness to repeat, caecal intubation rate, or total procedure time between WI and WE colonoscopy, WE required a longer caecal intubation time than WI. CONCLUSION This network meta-analysis supposes that WE may be superior to WI in detecting adenomas during colonoscopies without affecting other technical features or patient acceptance.
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Affiliation(s)
- Xin Shi
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, China
| | - Dan Tian
- Office of Educational Administration, Fourth Military Medical University, Xi’an, China
| | - Xiaofei Ye
- Department of Health Statistics, Second Military Medical University, Shanghai, China
| | - Qiong Wu
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, China
| | - Yanglin Pan
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, China
| | - Zhiping Yang
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, China
| | - Daiming Fan
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, China
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26
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Siau K, Cadoni S. Colonoscope Insertion: Is the Future Underwater. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2018; 25:163-165. [PMID: 29998160 PMCID: PMC6029225 DOI: 10.1159/000485038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 10/27/2017] [Indexed: 12/31/2022]
Affiliation(s)
- Keith Siau
- JAG Research Fellow, Royal College of Physicians, London
- Dudley Group Hospitals NHS Foundation Trust, Dudley, UK
| | - Sergio Cadoni
- Digestive Endoscopy Unit, CTO Hospital, Iglesias, Italy
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27
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The impact of water-aided methods on pain reduction and adenoma detection rate during colonoscopy. ADVANCES IN DIGESTIVE MEDICINE 2018. [DOI: 10.1002/aid2.13067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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28
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Zhang Z, Wu Y, Sun G, Zhang J, Li J, Qiu C, Zheng X, Wang B, Yang L, Wang X. Bayesian network meta-analysis: Efficacy of air insufflation, CO 2 insufflation, water exchange, and water immersion in colonoscopy. Dig Endosc 2018; 30:321-331. [PMID: 29334136 DOI: 10.1111/den.13012] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 01/08/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIM Colonoscopy is an excellent screening tool for colorectal cancer. There are four colonoscopy techniques: air insufflation, CO2 insufflation, water exchange, and water immersion. Some studies reported that the latter three methods are better than the criterion standard (air insufflation), whereas some studies did not. In order to evaluate the efficacy of the four colonoscopy techniques, a network meta-analysis was carried out. METHODS We searched randomized controlled trials (RCT) published up to September 2017 from PubMed, Embase, Cochrane library, and Web of Science. Studies referencing the comparison between at least two of air insufflation, CO2 insufflation, water exchange, and water immersion were selected. Primary outcomes included pain score during insertion, polyp detection rate, and adenoma detection rate, and secondary outcomes included cecal intubation time and cecal intubation rate. Mean differences or odds ratios and their corresponding 95% credible intervals were pooled with Bayesian modeling. RESULTS Forty RCT with 13 734 patients were included in this network meta-analysis. Our analysis showed that air insufflation had the highest pain score (surface under the cumulative ranking curve [SUCRA]: 98.8%) and the lowest detection rate of adenoma (SUCRA: 21.3%) and polyp (SUCRA: 16.8%). Water exchange had the lowest pain score (SUCRA: 1.1%) and highest detection rate of adenoma (SUCRA: 96.0%) and polyp (SUCRA: 98.9%), although it led to the longest cecal intubation time (SUCRA: 86.9%). CONCLUSIONS Air insufflation might be the most unsatisfactory colonoscopy. Meanwhile, water exchange might be the most efficient colonoscopy.
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Affiliation(s)
- Zhen Zhang
- Graduate School of Tianjin Medical University, Tianjin, China.,Tianjin Hospital of Integrated Traditional Chinese and Western Medicine, Tianjin, China
| | - Yifeng Wu
- Tianjin People's Hospital Tianjin Union Medical Center, Tianjin, China
| | - Guangge Sun
- Tianjin People's Hospital Tianjin Union Medical Center, Tianjin, China
| | - Jing Zhang
- Graduate School of Tianjin Medical University, Tianjin, China.,Tianjin Hospital of Integrated Traditional Chinese and Western Medicine, Tianjin, China
| | - Jiaxin Li
- Graduate School of Tianjin Medical University, Tianjin, China.,Tianjin Hospital of Integrated Traditional Chinese and Western Medicine, Tianjin, China
| | - Chongyang Qiu
- Graduate School of Tianjin Medical University, Tianjin, China.,Tianjin Hospital of Integrated Traditional Chinese and Western Medicine, Tianjin, China
| | - Xin Zheng
- Graduate School of Tianjin Medical University, Tianjin, China.,Tianjin Hospital of Integrated Traditional Chinese and Western Medicine, Tianjin, China
| | - Botao Wang
- Graduate School of Tianjin Medical University, Tianjin, China.,Tianjin Hospital of Integrated Traditional Chinese and Western Medicine, Tianjin, China
| | - Lei Yang
- Tianjin Institute of Acute Abdominal Disease of Integrated Traditional Chinese and Western Medicine, Tianjin, China
| | - Ximo Wang
- Tianjin Hospital of Integrated Traditional Chinese and Western Medicine, Tianjin, China
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Wada Y, Fukuda M, Ohtsuka K, Watanabe M, Fukuma Y, Wada Y, Wada M. Efficacy of Endocuff-assisted colonoscopy in the detection of colorectal polyps. Endosc Int Open 2018; 6:E425-E431. [PMID: 29607395 PMCID: PMC5876019 DOI: 10.1055/s-0044-101142] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 12/18/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Colonoscopy is the gold standard for detecting colorectal adenomas and cancers. Endoscopic surveillance has been shown to be effective for preventing colorectal cancer. Although detection of colorectal polyps at an early stage is important, endoscopic visualization of early neoplasia can be difficult. The Endocuff is a new device that can be attached to the tip of the colonoscope to hold the colonic folds away from the field of view during withdrawal. The aim of this study was to compare the adenoma detection rate (ADR) and the mean number of adenomas detected per patient (MAP) achieved using Endocuff-assisted colonoscopy (EAC) and standard colonoscopy (SC). PATIENTS AND METHODS This randomized prospective study was conducted at two academic endoscopy departments in Japan. A total of 447 patients underwent a complete colonoscopic examination between April 2015 and September 2015. The EAC group included 239 patients. The cecal intubation rate, insertion time, withdrawal time, pain score, complications, polyp detection rate (PDR), ADR, the mean number of polyps detected per patient (MPP), and the MAP were assessed. RESULTS There were no differences between the EAC and SC groups in terms of cecal intubation rate, insertion time, withdrawal time, or pain scores. The PDR in patients increased by about 12 % (61.9 % vs. 49.2 %, P = 0.013) and ADR increased by 15 % (52.5 % vs. 39.2 %, P = 0.001) with the use of the Endocuff. The advanced ADR was higher in the EAC group but no statistically significant difference was found (7.7 % vs. 4.6 %, P = 0.17). Both MPP and MAP were also higher in the EAC group (mean ± SD: 1.33 ± 1.43 vs. 0.83 ± 0.99 per patient; P < 0.01, 1.11 ± 1.41 vs. 0.66 ± 0.99 per patient; P < 0.01, respectively). No major complications occurred. CONCLUSIONS EAC not only enabled a higher ADR but also significantly increased the mean number of adenomas identified per patient, as compared with SC.
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Affiliation(s)
- Yoshiki Wada
- Wada Clinic – Endoscopic Department, Wakayama, Japan,Medical Hospital of Tokyo Medical and Dental University – Endoscopic Department, Tokyo, Japan,Corresponding author Yoshiki Wada Wada Clinic – Endoscopic Department1-4-21, Oda, WakayamaWakayama 640-8323Japan+81-73-473-5759
| | - Masayoshi Fukuda
- Medical Hospital of Tokyo Medical and Dental University – Endoscopic Department, Tokyo, Japan
| | - Kazuo Ohtsuka
- Medical Hospital of Tokyo Medical and Dental University – Endoscopic Department, Tokyo, Japan
| | - Mamoru Watanabe
- Medical Hospital of Tokyo Medical and Dental University – Department of Gastroenterology and Hepatology, Tokyo, Japan
| | - Yumiko Fukuma
- Wada Clinic – Endoscopic Department, Wakayama, Japan
| | - Yoko Wada
- Wada Clinic – Endoscopic Department, Wakayama, Japan
| | - Masahiro Wada
- Wada Clinic – Endoscopic Department, Wakayama, Japan
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30
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Cadoni S, Ishaq S. How to perform water-aided colonoscopy, with differences between water immersion and water exchange: a teaching video demonstration. VideoGIE 2018; 3:169-170. [PMID: 29916455 PMCID: PMC6004423 DOI: 10.1016/j.vgie.2018.02.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Sergio Cadoni
- Digestive Endoscopy Unit, Centro Traumatologico-Ortopedico Hospital, Iglesias, Italy
| | - Sauid Ishaq
- Department of Gastroenterology, Dudley Group Hospitals NHS Foundation Trust, Dudley, United Kingdom.,Birmingham City University, Birmingham, United Kingdom
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31
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Early DS, Lightdale JR, Vargo JJ, Acosta RD, Chandrasekhara V, Chathadi KV, Evans JA, Fisher DA, Fonkalsrud L, Hwang JH, Khashab MA, Muthusamy VR, Pasha SF, Saltzman JR, Shergill AK, Cash BD, DeWitt JM. Guidelines for sedation and anesthesia in GI endoscopy. Gastrointest Endosc 2018; 87:327-337. [PMID: 29306520 DOI: 10.1016/j.gie.2017.07.018] [Citation(s) in RCA: 290] [Impact Index Per Article: 48.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 07/13/2017] [Indexed: 02/08/2023]
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32
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Azevedo R, Leitão C, Pinto J, Ribeiro H, Pereira F, Caldeira A, Banhudo A. Can Water Exchange Improve Patient Tolerance in Unsedated Colonoscopy A Prospective Comparative Study. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2017; 25:166-174. [PMID: 29998161 DOI: 10.1159/000484093] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/09/2017] [Indexed: 12/20/2022]
Abstract
Background & Aims Unsedated colonoscopy can be painful, poorly tolerated by patients, and associated with unsatisfactory technical performance. Previous studies report an advantage of water exchange over conventional air insufflation in reducing pain during unsedated colonoscopy. Our goal was to analyze the impact of water exchange colonoscopy on the level of maximum pain reported by patients submitted to unsedated colonoscopy, compared to conventional air insufflation. Methods We performed a single-center, patient-blinded, prospective randomized comparative study, where patients were either allocated to the water group, in which the method of colonoscopy used was water exchange, or the standard air group, in which the examination was accomplished with air insufflation. Results A total of 141 patients were randomized, 70 to the water and 71 to the air group. The maximum level of pain reported by patients during unsedated colonoscopy, measured by a numeric scale of pain (0-10), was significantly lower in the water group (3.39 ± 2.32), compared to the air group (4.94 ± 2.10), p < 0.001. The rate of painless colonoscopy was significantly higher in the water group (12.9 vs. 1.4%, p = 0.009). There were no significant differences between the two groups regarding indications for the procedure, quality of bowel preparation, cecal intubation time, withdrawal time, number of position changes, adenoma detection rate, and postprocedural complications. Only the number of abdominal compressions was significantly different, showing that water exchange decreases the number of compressions needed during colonoscopy. Conclusions Water exchange was a safe and equally effective alternative to conventional unsedated colonoscopy, associated with less intraprocedural pain without impairing key performance measures.
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Affiliation(s)
- Richard Azevedo
- Department of Gastroenterology, Amato Lusitano Hospital, Castelo Branco, Portugal
| | - Cátia Leitão
- Department of Gastroenterology, Amato Lusitano Hospital, Castelo Branco, Portugal
| | - João Pinto
- Department of Gastroenterology, Amato Lusitano Hospital, Castelo Branco, Portugal
| | - Helena Ribeiro
- Department of Gastroenterology, Amato Lusitano Hospital, Castelo Branco, Portugal
| | - Flávio Pereira
- Department of Gastroenterology, Amato Lusitano Hospital, Castelo Branco, Portugal
| | - Ana Caldeira
- Department of Gastroenterology, Amato Lusitano Hospital, Castelo Branco, Portugal
| | - António Banhudo
- Department of Gastroenterology, Amato Lusitano Hospital, Castelo Branco, Portugal
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Cecal intubation time between cap-assisted water exchange and water exchange colonoscopy: a randomized-controlled trial. Eur J Gastroenterol Hepatol 2017; 29:1296-1302. [PMID: 28857895 DOI: 10.1097/meg.0000000000000954] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM The water exchange (WE) method can decrease the discomfort of the patients undergoing colonoscopy. It also provides salvage cleansing and improves adenoma detection, but a longer intubation time is required. Cap-assisted colonoscopy leads to a significant reduction in cecal intubation time compared with traditional colonoscopy with air insufflation. The aim of this study was to investigate whether combined cap-assisted colonoscopy and water exchange (CWE) could decrease the cecal intubation time compared with WE. PATIENTS AND METHODS A total of 120 patients undergoing fully sedated colonoscopy at a regional hospital in southern Taiwan were randomized to colonoscopy with either CWE (n=59) or WE (n=61). The primary endpoint was cecal intubation time. RESULTS The mean cecal intubation time was significantly shorter in CWE (12.0 min) compared with WE (14.8 min) (P=0.004). The volume of infused water during insertion was lower in CWE (840 ml) compared with WE (1044 ml) (P=0.003). The adenoma detection rate was 50.8 and 47.5% for CWE and WE, respectively (P=0.472). The Boston Bowel Preparation Scale scores were comparable in the two groups. Results from the multiple linear regression analysis indicated that WE with a cap, a higher degree of endoscopist's experience, a higher Boston Bowel Preparation Scale score, and a lower volume of water infused during insertion, without abdominal compression, without change of position, and without chronic laxative use, were significantly associated with a shorter cecal intubation time. CONCLUSION In comparison with WE, CWE could shorten the cecal intubation time and required lower volume of water infusion during insertion without compromising the cleansing effect of WE.
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Patel AM, Green J, Jowhari F, Hookey L. Use of warm carbon dioxide insufflators does not affect intra-colonic gas temperature and has no effect on polyp detection rate during colonoscopy - a randomized controlled trial. Endosc Int Open 2017; 5:E683-E689. [PMID: 28691054 PMCID: PMC5500117 DOI: 10.1055/s-0043-107779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 03/02/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Methods to improve polyp detection during colonoscopy have been investigated, with conflicting results for warm water irrigation. Carbon Dioxide (CO 2) warmed to 37 °C may have similar or more pronounced effects on bowel motility. This study aimed to assess whether warmed CO 2 would improve polyp detection compared to room temperature air insufflation. PATIENTS AND METHODS This was a double-blind, randomized controlled trial that enrolled 204 patients undergoing screening or surveillance outpatient colonoscopy. The primary outcome was polyp per patient detection rate. Secondary outcomes included adenoma per patient detection rates, bowel spasm, and patient comfort. RESULTS The trial was terminated after an interim analysis determined futility. Between the warmed CO 2 and room air groups, no significant differences were found in the per-colonoscopy polyp detection rate ( P = 0.57); overall polyp detection rate ( P = 0.69); or adenoma detection rates ( P = 0.74). More patients in the room temperature group had lower spasm scores (p = 0.02); however, there was a trend towards greater patient comfort in the warmed CO 2 group ( P = 0.054). An ex-vivo study showed a significant difference between exiting CO 2 temperature at the insufflator end vs. delivered CO 2 temperature at the colonoscope tip end. The temperature of insufflation at the tip of the colonoscope was not different when using warmed vs. unwarmed insufflation ( P = 0.62). CONCLUSION When compared with room air insufflation, warmed CO 2 insufflation did not affect polyp detection rates.
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Affiliation(s)
- Akash M. Patel
- Gastrointestinal Diseases Research Unit, Department of Medicine, Queen’s University, Kingston, Ontario
| | - Jordan Green
- Gastrointestinal Diseases Research Unit, Department of Medicine, Queen’s University, Kingston, Ontario
| | - Fahd Jowhari
- Gastrointestinal Diseases Research Unit, Department of Medicine, Queen’s University, Kingston, Ontario
| | - Lawrence Hookey
- Gastrointestinal Diseases Research Unit, Department of Medicine, Queen’s University, Kingston, Ontario,Corresponding author Lawrence Hookey Division of GastroenterologyHotel Dieu Hospital166 Brock StreetKingston, Ontario, CanadaK7L 5G2+613 544 3400, ext 2292+614 544 3114
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Hsieh YH, Tseng CW, Hu CT, Koo M, Leung FW. Prospective multicenter randomized controlled trial comparing adenoma detection rate in colonoscopy using water exchange, water immersion, and air insufflation. Gastrointest Endosc 2017; 86:192-201. [PMID: 27988288 DOI: 10.1016/j.gie.2016.12.005] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 12/04/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Adenoma detection rate (ADR), defined as the proportion of patients with at least one adenoma of any size, is a quality indicator. We tested the hypothesis that water exchange (WE) improves ADR but water immersion (WI) has no adverse effect on ADR compared with air insufflation (AI). METHODS A prospective study was conducted at the Dalin Tzu Chi Hospital in southern Taiwan and the Hualien Tzu Chi Hospital in eastern Taiwan on patients randomly assigned to WE, WI, or AI with stratification by the 3 study colonoscopists. The primary outcome was ADR. RESULTS From July 2013 to December 2015, 651 patients were recruited and randomized into 3 groups with a 1:1:1 ratio (217 patients per group). Overall, ADR met quality standards: WE 49.8% (95% CI, 43.2%-56.4%), AI 37.8% (95% CI, 31.6%-44.4%), and WI 40.6% (95% CI, 34.2%-47.2%). Compared with AI, WE significantly increased ADR (P = .016). There was no difference between WI and WE. ADRs of WI and AI were comparable. Compared with AI, WE confirmed a longer insertion time, higher cleanliness score, but similar adenoma per positive colonoscopy (APPC) and withdrawal time with polypectomy. Subgroup analysis found WE significantly increased ADR in propofol-sedated patients. Multivariate generalized linear mixed model analysis revealed that age ≥50 years, WE (vs AI), colonoscopy indication, no previous history of colonoscopy, and withdrawal time >8 minutes were significant predictors of increased ADR. CONCLUSIONS Confirmation of prior reports showing WE, but not WI, increased ADR further strengthened the validity of our observations. WE significantly increased ADR in propofol-sedated patients. The outcome differences justify assessment of the role of WE in colorectal cancer prevention. Similar APPC and withdrawal times suggest that adequate inspection was performed on colonoscope withdrawal in each of the study arms. (Clinical trial registration number: NCT01894191.).
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Affiliation(s)
- Yu-Hsi Hsieh
- Division of Gastroenterology, Department of Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan; School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
| | - Chih-Wei Tseng
- Division of Gastroenterology, Department of Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan; School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
| | - Chi-Tan Hu
- School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan; Department of Gastroenterology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Malcolm Koo
- Department of Medical Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan; Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Felix W Leung
- Sepulveda Ambulatory Care Center, Veterans Affairs Greater Los Angeles Healthcare System, North Hill, California, USA; David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Brown S, Whitlow CB. Patient comfort during colonoscopy. SEMINARS IN COLON AND RECTAL SURGERY 2017. [DOI: 10.1053/j.scrs.2016.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Carbon dioxide insufflation during colonoscopy in inflammatory bowel disease patients: a double-blind, randomized, single-center trial. Eur J Gastroenterol Hepatol 2017; 29:355-359. [PMID: 27845950 DOI: 10.1097/meg.0000000000000791] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Bowel distension by insufflated air causes abdominal discomfort after colonoscopy. Carbon dioxide (CO2) instead of air insufflation during colonoscopy can reduce postprocedural discomfort in diagnostic and screening cases. Discomfort after colonoscopy and CO2 insufflation have never been studied in inflammatory bowel disease (IBD) patients, characterized by younger age, structural changes of the colon, and need for repeated and frequently uncomfortable colonoscopies. Our trial was designed to evaluate postprocedural discomfort associated with CO2 compared with air insufflation in unsedated or minimally sedated patients with known IBD. METHODS In a double-blind, randomized, single-center study, 64 patients were randomized to either CO2 insufflation (CO2) or air insufflation colonoscopy (Air). Abdominal pain, bloating, and flatulence scores during 24 h after colonoscopy were recorded using a continuous scale of 0-10 (0=none, 10=maximum discomfort). The primary endpoint used for power calculation was bloating score at 1 h after colonoscopy. RESULTS Pain, bloating, and flatulence scores at end, 1, and 3 h after colonoscopy were significantly lower in CO2 than in Air arm (P<0.001). Scores at 6, 12, and 24 h were comparable. Procedural parameters such as cecal and terminal ileum intubation rate, intubation and total time, pain during insertion, need for repositioning, and abdominal compression were not different between arms. No complications were recorded in the study. CONCLUSION Compared with air, CO2 insufflation significantly reduces abdominal pain, bloating, and flatulence scores during at least 3 h after colonoscopy in IBD patients, achieving comparable intraprocedural outcomes.
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Affiliation(s)
- Amit Rastogi
- University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Sachin Wani
- University of Colorado, Aurora, Colorado, USA
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Cadoni S, Falt P, Gallittu P, Liggi M, Smajstrla V, Leung FW. Impact of carbon dioxide insufflation and water exchange on postcolonoscopy outcomes in patients receiving on-demand sedation: a randomized controlled trial. Gastrointest Endosc 2017; 85:210-218.e1. [PMID: 27207825 DOI: 10.1016/j.gie.2016.05.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 05/04/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Water exchange (WE) is the least painful insertion method during colonoscopy. Its impact on postcolonoscopy discomfort has not been well-described. Carbon dioxide (CO2) insufflation consistently reduced postcolonoscopy discomfort. We compared postcolonoscopy outcomes of various combinations of insertion and withdrawal techniques (insertion-withdrawal modality): WE-CO2, WE-air insufflation (WE-AI), and CO2-CO2. METHODS A total of 240 patients undergoing on-demand sedation diagnostic colonoscopy were randomized to WE-CO2 (n = 79), WE-AI (n = 80), CO2-CO2 (n = 81), with postprocedural data collected up to 24 hours. The primary outcome was postcolonoscopy bloating. Other postcolonoscopy outcomes included pain scores, flatus and incontinence episodes, toilet use, interference with normal activities, patient satisfaction, and patient willingness to repeat the procedure. RESULTS Demographic and procedural data were comparable. Compared with WE-AI, WE-CO2 and CO2-CO2 resulted in significantly less bloating (all P < .0005) and lower pain scores (P values ranged from .008 to < .0005) up to 3 hours and fewer flatus episodes up to 6 hours (P values ranged from .003 to < .0005). WE-CO2 resulted in less interference with same-day activities compared with WE-AI (P = .043). The differences in postprocedural outcomes were significant, but the magnitude was small. Patient satisfaction and willingness to repeat the procedure were high and comparable among groups. WE was the least painful insertion technique (P < .0005). CONCLUSIONS The combination WE-CO2 appears to be the optimal choice to decrease pain during the examination and to reduce bloating and other undesired procedural outcomes afterward. If a CO2 insufflator is already available, it seems advisable to adopt the combination WE-CO2. In the absence of a CO2 insufflator, the cost effectiveness of the addition of withdrawal CO2 to WE in diagnostic and nondiagnostic settings needs to be critically assessed. (Clinical trial registration number: NCT02409979.).
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Affiliation(s)
- Sergio Cadoni
- Digestive Endoscopy Unit, St. Barbara Hospital, Iglesias, Italy
| | - Přemysl Falt
- Digestive Diseases Center, Vitkovice Hospital, Ostrava, Czech Republic
| | - Paolo Gallittu
- Digestive Endoscopy Unit, St. Barbara Hospital, Iglesias, Italy
| | - Mauro Liggi
- Digestive Endoscopy Unit, St. Barbara Hospital, Iglesias, Italy
| | - Vit Smajstrla
- Digestive Diseases Center, Vitkovice Hospital, Ostrava, Czech Republic
| | - Felix W Leung
- Sepulveda Ambulatory Care Center, Veterans Affairs Greater Los Angeles Healthcare System, North Hills, California, USA; David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles, California, USA
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Suchanek S, Grega T, Zavoral M. The role of equipment in endoscopic complications. Best Pract Res Clin Gastroenterol 2016; 30:667-678. [PMID: 27931628 DOI: 10.1016/j.bpg.2016.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 08/17/2016] [Accepted: 09/06/2016] [Indexed: 01/31/2023]
Abstract
The role of the surrounding equipment in endoscopic complications has not been published widely. However, an adequate understanding of the advantages and disadvantages of such devices might be helpful to avoid unnecessary problems during endoscopy. This is an overview of the basic principles, benefits and possible harms of electrical power units, medical gases and vital sign monitoring equipment. The aim of this review is to summarize current knowledge about the approach to the electrosurgical unit settings; periprocedural precautions, minimizing the risk of interference between endoscopic equipment and other electrical devices; the appropriate selection of instruments regarding the electrosurgical outcome and the role of carbon dioxide, argon plasma coagulation, pulse oximetry and capnography.
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Affiliation(s)
- Stepan Suchanek
- Department of Internal Medicine, 1st Faculty of Medicine, Charles University, Military University Hospital, U Vojenske nemocnice 1200, Prague 6, 169 02, Czech Republic.
| | - Tomas Grega
- Department of Internal Medicine, 1st Faculty of Medicine, Charles University, Military University Hospital, U Vojenske nemocnice 1200, Prague 6, 169 02, Czech Republic.
| | - Miroslav Zavoral
- Department of Internal Medicine, 1st Faculty of Medicine, Charles University, Military University Hospital, U Vojenske nemocnice 1200, Prague 6, 169 02, Czech Republic.
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Kim HG. Painless Colonoscopy: Available Techniques and Instruments. Clin Endosc 2016; 49:444-448. [PMID: 27744665 PMCID: PMC5066405 DOI: 10.5946/ce.2016.132] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 09/19/2016] [Accepted: 09/19/2016] [Indexed: 12/21/2022] Open
Abstract
During colonoscopy, air insufflation to distend the lumen and facilitate careful inspection and scope insertion can induce pain and cause discomfort. Carbon dioxide (CO2) insufflation can decrease abdominal pain and discomfort during and after colonoscopy. The advantage of CO2 insufflation is the rapid absorption of the gas across the intestine. Another painless option is water-assisted colonoscopy. Two methods for water-assisted colonoscopy are available: water immersion and water exchange. In a recent direct comparison, the water exchange method was superior to water immersion, CO2 insufflation, and air insufflation with respect to pain during colonoscopy, although it still had the disadvantage of being a time-consuming procedure. Cap-assisted colonoscopy is a simple technique involving the use of a small transparent cap attached to the tip of the scope. Three studies showed an advantage of this technique in terms of reduced patient discomfort compared with the conventional method. Three robotic colonoscopy systems (Endotics System [Era Endoscopy], NeoGuide [NeoGuide Systems Inc.], and Invendoscope [Invendo Medical]) have been introduced to evaluate pain reduction during colonoscopy, but none has been widely adopted and used in practice. In this review, clinical trials of several techniques and new devices for painless colonoscopy are described and summarized.
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Affiliation(s)
- Hyun Gun Kim
- Institute for Digestive Research, Soon Chun Hyang University College of Medicine, Seoul, Korea
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Cadoni S, Falt P, Sanna S, Argiolas M, Fanari V, Gallittu P, Liggi M, Mura D, Porcedda ML, Smajstrla V, Erriu M, Leung FW. Impact of Colonoscopy Insertion Techniques on Adenoma Detection. Dig Dis Sci 2016; 61:2068-75. [PMID: 26846118 DOI: 10.1007/s10620-016-4053-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 01/21/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND Low adenoma detection rate (ADR) predicts development of interval cancers, found mainly in the right (cecum-ascending) colon, where poor bowel preparation is an associated factor. Single-site studies reported increased detection of adenomas in the proximal colon segments by water exchange (WE). Data about colon cleansing revealed that WE had the greatest impact in the right colon. AIMS To test the hypothesis that WE had the greatest impact on ADR in colon segments with the most favorable bowel cleanliness scores, namely the right colon. METHODS We pooled right colon and overall ADR data of three similarly designed colonoscopy trials that compared WE, water immersion (WI) and insufflation of air or carbon dioxide (AICD) in a mixed gender European population. RESULTS In this study, 1200 (704 males) subjects and were included. 288 were screening cases. Demographic and procedural data were comparable. Water exchange achieved significantly higher right colon <10 mm ADR (11.9 %, vs WI 6.9 %, p = 0.016; vs AICD 7.2 %, p = 0.025). Water exchange achieved the lowest proportions of poor bowel preparation and the highest right colon and overall Boston bowel preparation scale scores (p range 0.003, <0.0005). In patients with right colon excellent bowel cleanliness, water exchange was the only method significantly associated with right colon adenoma detection. One of the limitations is unblinded colonoscopists. CONCLUSIONS In a mixed gender European population, water exchange is confirmed to be a superior insertion technique showing a significant increase in <10 mm right colon adenoma detection, achieving the cleanest colon and lowest proportions of poor bowel preparation requiring repeat procedures. CLINICALTRIALS. GOV NO NCT01781650, 01954862, 01780818.
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Affiliation(s)
- Sergio Cadoni
- Digestive Endoscopy Unit, St. Barbara Hospital, Via S. Leonardo, 1, 09016, Iglesias, CI, Italy.
| | - Přemysl Falt
- Digestive Diseases Center, Vìtkovice Hospital, Zálužanského 1192/15, 703 84, Ostrava, Czech Republic
| | - Stefano Sanna
- Digestive Endoscopy Unit, N. S. di Bonaria Hospital, 09037, San Gavino Monreale, VS, Italy
| | - Mariangela Argiolas
- Digestive Endoscopy Unit, N. S. di Bonaria Hospital, 09037, San Gavino Monreale, VS, Italy
| | - Viviana Fanari
- Digestive Endoscopy Unit, N. S. di Bonaria Hospital, 09037, San Gavino Monreale, VS, Italy
| | - Paolo Gallittu
- Digestive Endoscopy Unit, St. Barbara Hospital, Via S. Leonardo, 1, 09016, Iglesias, CI, Italy
| | - Mauro Liggi
- Digestive Endoscopy Unit, St. Barbara Hospital, Via S. Leonardo, 1, 09016, Iglesias, CI, Italy
| | - Donatella Mura
- Digestive Endoscopy Unit, St. Barbara Hospital, Via S. Leonardo, 1, 09016, Iglesias, CI, Italy
| | - Maria L Porcedda
- Digestive Endoscopy Unit, N. S. di Bonaria Hospital, 09037, San Gavino Monreale, VS, Italy
| | - Vit Smajstrla
- Digestive Diseases Center, Vìtkovice Hospital, Zálužanského 1192/15, 703 84, Ostrava, Czech Republic
| | - Matteo Erriu
- Department of Surgical Sciences, University of Cagliari, 09121, Cagliari, Italy
| | - Felix W Leung
- Sepulveda Ambulatory Care Center, Veterans Affairs Greater Los Angeles Healthcare System, North Hills, CA, 91343, USA.,David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, 90024, USA
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Cadoni S, Falt P, Sanna S, Argiolas M, Fanari V, Gallittu P, Liggi M, Mura D, Porcedda ML, Smajstrla V, Erriu M, Leung FW. Insertion water exchange increases right colon adenoma and hyperplastic polyp detection rates during withdrawal. Dig Liver Dis 2016; 48:638-43. [PMID: 27017108 DOI: 10.1016/j.dld.2016.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 02/09/2016] [Accepted: 03/04/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Single site studies in male Veterans in the U.S. reported increased detection of presumptive cancer precursors (adenomas, hyperplastic polyps) in the proximal colon (cecum-splenic flexure) by water exchange. AIMS Assess the reproducibility of the observation. METHODS Analysis of secondary outcomes collected prospectively in 3 similarly designed randomized controlled trials using water exchange, water immersion and insufflation (air or carbon dioxide). MAIN OUTCOME detection rates of adenomas and hyperplastic polyps in proximal, transverse and right colon (cecum-ascending). RESULTS 704 males (173 screening) were evaluated. In the proximal colon, WE showed increased detection of small adenomas (p=0.009) and adenomas plus hyperplastic polyps (p=0.015) (vs insufflation); increased detection of adenomas plus hyperplastic polyps of any size (p=0.045) and of small size (p=0.04) (vs water immersion). In the right colon water exchange increased detection of small adenomas (19% vs 12.1%, p=0.04) (vs insufflation); small adenomas (19% vs 12%, p=0.038), adenomas plus hyperplastic polyps of any size (25% vs 16.7%, p=0.028) and of small size (23.7% vs 14.6%, p=0.012) (vs water immersion). Water exchange significantly improved bowel cleanliness. Sedation had no impact on lesion detection. CONCLUSIONS Water exchange is a superior insertion technique for detection of adenomas and hyperplastic polyps primarily in the right colon, especially those of small size.
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Affiliation(s)
- Sergio Cadoni
- Digestive Endoscopy Unit, St. Barbara Hospital, Iglesias, CI, Italy.
| | - Přemysl Falt
- Digestive Diseases Center, Vìtkovice Hospital, Ostrava, Czech Republic
| | - Stefano Sanna
- Digestive Endoscopy Unit, N. S. di Bonaria Hospital, San Gavino Monreale, VS, Italy
| | - Mariangela Argiolas
- Digestive Endoscopy Unit, N. S. di Bonaria Hospital, San Gavino Monreale, VS, Italy
| | - Viviana Fanari
- Digestive Endoscopy Unit, N. S. di Bonaria Hospital, San Gavino Monreale, VS, Italy
| | - Paolo Gallittu
- Digestive Endoscopy Unit, St. Barbara Hospital, Iglesias, CI, Italy
| | - Mauro Liggi
- Digestive Endoscopy Unit, St. Barbara Hospital, Iglesias, CI, Italy
| | - Donatella Mura
- Digestive Endoscopy Unit, St. Barbara Hospital, Iglesias, CI, Italy
| | - Maria L Porcedda
- Digestive Endoscopy Unit, N. S. di Bonaria Hospital, San Gavino Monreale, VS, Italy
| | - Vit Smajstrla
- Digestive Diseases Center, Vìtkovice Hospital, Ostrava, Czech Republic
| | - Matteo Erriu
- Department of Surgical Sciences, University of Cagliari, Cagliari, CA, Italy
| | - Felix W Leung
- Sepulveda Ambulatory Care Center, Veterans Affairs Greater Los Angeles Healthcare System, North Hills, CA, USA; David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA, USA
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Abstract
Colonoscopy is an important and frequently performed procedure. It is effective in the prevention of colorectal cancer and is an important test in the investigation of many gastrointestinal symptoms. This review focuses on developments over the last 5 years that have led to changes in aspects of colonoscopy, including patient preparation, technical factors, therapeutic procedures, safety, and quality.
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Affiliation(s)
- Thomas J.W. Lee
- North Tyneside General Hospital, North Shields, UK
- Northern Region Endoscopy Group, North Shields, UK
| | - Shelley Nair
- North Tyneside General Hospital, North Shields, UK
| | | | - Matthew D. Rutter
- Northern Region Endoscopy Group, North Shields, UK
- University Hospital of North Tees, Stockton on Tees, UK
- School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees, UK
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Sugimoto S, Mizukami T. Discrepancy in the classification of water immersion from water exchange colonoscopy. Gastrointest Endosc 2016; 83:676-7. [PMID: 26897056 DOI: 10.1016/j.gie.2015.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 10/14/2015] [Indexed: 12/11/2022]
Affiliation(s)
- Shinya Sugimoto
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Takeshi Mizukami
- Endoscopy Center, NHO Kurihama Medical and Addiction Center, Kanagawa, Japan
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Cadoni S, Liggi M, Falt P, Sanna S, Argiolas M, Fanari V, Gallittu P, Mura D, Porcedda ML, Smajstrla V, Erriu M, Leung FW. Evidence to suggest adoption of water exchange deserves broader consideration: Its pain alleviating impact occurs in 90% of investigators. World J Gastrointest Endosc 2016; 8:113-121. [PMID: 26839651 PMCID: PMC4724028 DOI: 10.4253/wjge.v8.i2.113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 08/18/2015] [Accepted: 12/15/2015] [Indexed: 02/05/2023] Open
Abstract
AIM: To determine whether observations were reproducible among investigators.
METHODS: From March 2013 through June 2014, 18-85-year-old diagnostic and 50-70-year-old screening patients were enrolled at each center to on-demand sedation colonoscopy with water exchange (WE), water immersion (WI) and insufflation with air or CO2 for insertion and withdrawal [air or carbon dioxide (AICD)]. Data were aggregated for analysis. Primary outcome: Variations in real-time maximum insertion pain (0 = none, 1-2 = discomfort, 10 = worst).
RESULTS: One thousand and ninety-one cases analyzed: WE (n = 371); WI (n = 338); AICD (n = 382). Demographics and indications were comparable. The WE group had the lowest real-time maximum insertion pain score, mean (95%CI): WE 2.8 (2.6-3.0), WI 3.8 (3.5-4.1) and AICD 4.4 (4.1-4.7), P < 0.0005. Ninety percent of the colonoscopists were able to use water exchange to significantly decrease maximum insertion pain scores. One investigator had high insertion pain in all groups, nonetheless WE achieved the lowest real-time maximum insertion pain score. WE had the highest proportions of patients with painless unsedated colonoscopy (vs WI, P = 0.013; vs AICD, P < 0.0005); unsedated colonoscopy with only minor discomfort (vs AICD, P < 0.0005), and completion without sedation (vs AICD, P < 0.0005).
CONCLUSION: Aggregate data confirm superiority of WE in lowering colonoscopy real-time maximum insertion pain and need for sedation. Ninety percent of investigators were able to use water exchange to significantly decrease maximum insertion pain scores. Our results suggest that the technique deserves consideration in a broader scale.
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Rodríguez-García JL, Carmona-Sánchez R, Rosas-Vitorino C. Usefulness of oil lubrication during colonoscopy: A comparative study with the conventional technique. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2016; 81:28-34. [PMID: 26780984 DOI: 10.1016/j.rgmx.2015.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 12/02/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND The different forms of lubrication are among the most simple, accessible, and economic techniques that have been implemented for improving the diagnostic performance of colonoscopy. AIM To determine whether the use of oil improved the number of complete colonoscopies, facilitated the procedure, reduced pain, or improved the study's diagnostic performance, compared with the conventional lubrication technique. PATIENTS AND METHODS One hundred and seventy-five patients referred for colonoscopy were alternately allocated to receive treatment with the standard lubrication method with chlorhexidine gel (group 1) or lubrication with corn oil administered through the working channel (group II). The number of complete colonoscopies, the length of time needed to reach the cecum, the degree of difficulty estimated by the endoscopist and the assistant, the level of pain at the end of the study estimated by the patient, and the endoscopic findings were all determined. RESULTS Eighty-eight patients made up group I and 87 made up group II. No statistically significant differences were found between the two groups in relation to general characteristics, the number of complete colonoscopies (93 vs. 97%, respectively), the time needed to reach the cecum (8:00 vs. 8:41min, respectively), the level of pain at the end of the study, or the detection of polyps. The degree of difficulty was slightly lower in group II, but with no statistical significance. CONCLUSIONS Lubrication with oil during colonoscopy did not improve the number of complete colonoscopies, did not facilitate the study, nor did it reduce pain or increase the diagnostic performance of the study, when compared with the conventional technique.
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Affiliation(s)
| | | | - C Rosas-Vitorino
- Departamento de Enfermería, Hospital Ángeles-CMP, San Luis Potosí, México
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Xiaoling X, Haihang Z, Di C, Langui F, Ting L, Qin S, Chaowu C, Denghao D. Carbon dioxide insufflation or warm-water infusion for unsedated colonoscopy: A randomized controlled trial in patients with chronic constipation in China. Saudi J Gastroenterol 2016; 22:18-24. [PMID: 26831602 PMCID: PMC4763523 DOI: 10.4103/1319-3767.173754] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
AIMS The effect of carbon dioxide (CO2) insufflation and warm-water infusion during colonoscopy on patients with chronic constipation remains unknown. We evaluated CO 2 insufflation and warm-water irrigation versus air insufflation in unsedated patients with chronic constipation in China. PATIENTS AND METHODS This randomized, single-center, controlled trial enrolled 287 consecutive patients, from January 2014 to January 2015, who underwent colonoscopy for chronic constipation. Patients were randomized to CO2 insufflation, warm-water irrigation and air insufflation colonoscopy insertion phase groups. Pain scores were assessed by the visual analog scale (VAS). The primary outcome was real-time maximum insertion pain, recorded by an unblinded nurse assistant. At discharge, the recalled maximum insertion pain was recorded. Meanwhile, patients were requested to select the VAS at 0, 10, 30, and 60 min after the procedure. In addition, cecal intubation and withdrawal time, total procedure time, and adjunct measures were recorded. RESULTS A total of 287 patients were randomized. The correlation between real-time and recalled maximum insertion pain ((Pearson coefficient r = 0.929; P < 0.0001) confirmed internal validation of the primary outcome. The mean real-time maximum pain scores during insertion 2.9 ± 2.1 for CO2, 2.7 ± 1.9 for water achieved a significantly lower pain score compared with air (5.7 ± 2.5) group (air vs CO2 P < 0.001; air vs water P < 0.001). However, no significant pain score differences were found between the patients in the CO2 and water groups (CO2 vs water, P = 0.0535). P values in painless colonoscopy and only discomfort colonoscopy (pain 1-2) were, respectively, 6 (6.4%) and 8 (8.5%) for air; 17 (17.7%) and 29 (30.2%) for CO2; 16 (16.5%) and 31 (31.9%) for water. At 0, 10, 30, and 60 min postprocedure, pain scores showed in the CO2 and water groups had significantly reduced than in air group. Insertion time was significantly different between air (10.6 ± 2.5) and CO2 ( 7.2 ± 1.4) (air vs CO2 P < 0.001), air and water (6.9 ± 1.3) (air vs water P < 0.001). However, CO2 and was not significantly different in cecum-intubated time (CO2 vs water, P = 0.404). CO2 and water group in extubation time were significantly different, respectively, CO2 (7.9 ± 1.1) and water (8.0 ± 1.1) (CO2 vs water, P = 0.707). CO2 or water group required less implementation of adjunct measures and more willingness to repeat the procedure. CONCLUSIONS Compared with air, the CO2 or water-aided method reduced real-time maximum pain and cecum-intubated time for chronic constipated patients in unsedated colonoscopy. The CO2 insufflation or warm-water irrigation may be a simple and inexpensive way to reduce discomfort in unsedated patients with constipation. This study demonstrated an advantage of using CO2 insufflation and warm-water irrigation during colonoscopy in unsedated constipated patients in China.
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Affiliation(s)
- Xu Xiaoling
- Department of Gastroenterology, Subei People's Hospital, Clinical Medical School, Yangzhou University Affiliated Hospital, Jiangsu, China
| | - Zhu Haihang
- Department of Gastroenterology, Subei People's Hospital, Clinical Medical School, Yangzhou University Affiliated Hospital, Jiangsu, China
| | - Chen Di
- Department of Gastroenterology, Subei People's Hospital, Clinical Medical School, Yangzhou University Affiliated Hospital, Jiangsu, China
| | - Fan Langui
- Department of Gastroenterology, Subei People's Hospital, Clinical Medical School, Yangzhou University Affiliated Hospital, Jiangsu, China
| | - Lu Ting
- Department of Gastroenterology, Subei People's Hospital, Clinical Medical School, Yangzhou University Affiliated Hospital, Jiangsu, China
| | - Shen Qin
- Department of Gastroenterology, Subei People's Hospital, Clinical Medical School, Yangzhou University Affiliated Hospital, Jiangsu, China
| | - Chen Chaowu
- Department of Gastroenterology, Subei People's Hospital, Clinical Medical School, Yangzhou University Affiliated Hospital, Jiangsu, China
| | - Deng Denghao
- Department of Gastroenterology, Subei People's Hospital, Clinical Medical School, Yangzhou University Affiliated Hospital, Jiangsu, China,Address for correspondence: Prof. Deng Denghao, No. 98 West Nantong Road, Yangzhou, Jiangsu, China. E-mail:
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Rodríguez-García J, Carmona-Sánchez R, Rosas-Vitorino C. Usefulness of oil lubrication during colonoscopy: A comparative study with the conventional technique. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2016. [DOI: 10.1016/j.rgmxen.2015.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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