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Costello B, James T, Hall C, Shergill A, Schlossberg N. Does Manual Abdominal Pressure During Colonoscopy Put Endoscopy Staff and Patients at Risk? Experiences of Endoscopy Nurses and Technicians. Gastroenterol Nurs 2023; 46:386-392. [PMID: 37289853 PMCID: PMC10549874 DOI: 10.1097/sga.0000000000000756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 04/21/2023] [Indexed: 06/10/2023] Open
Abstract
Endoscopy staff suffer work-related musculoskeletal disorders at a rate greater than or comparable to nurses and technicians in other subspecialities, which may be attributable to the widespread use of manual pressure and repositioning during colonoscopy. In addition to negatively impacting staff health and job performance, colonoscopy-related musculoskeletal disorder injuries may also signal potential risks to patient safety. To assess the prevalence of staff injury and perceived patient harm relating to the use of manual pressure and repositioning techniques during colonoscopy, 185 attendees of a recent national meeting of the Society of Gastroenterology Nurses and Associates were asked to recall experiencing injuries to themselves or observing injuries to other staff or patients during colonoscopy. A majority of respondents (84.9%, n = 157) reported either experiencing or observing staff injury, whereas 25.9% ( n = 48) reported observing patient complications. Among respondents who perform manual repositioning and apply manual pressure during colonoscopy (57.3%, n = 106), 85.8% ( n = 91) reported experiencing musculoskeletal disorders from performing these tasks; 81.1% ( n = 150) reported no awareness of colonoscopy-specific ergonomics policies at their facility. Results highlight the relationship between the physical job requirements of endoscopy nurses and technicians, staff musculoskeletal disorders, and patient complications, and suggest that implementation of staff safety protocols may benefit patients as well as endoscopy staff.
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Affiliation(s)
- Bridget Costello
- Correspondence to: Bridget Costello, PhD, CIP, King's College, 133 N. River St., Wilkes-Barre, PA 18711 ()
| | - Tamara James
- Bridget Costello, PhD, CIP, is Associate Professor of Sociology, King's College, Wilkes-Barre, Pennsylvania
- Tamara James, MA, is Assistant Consulting Professor, Duke Family Medicine and Community Health, Clarksville, Virginia
- Connie Hall, BSN, RN, CGRN, CER, is Patient Care Manager, Endoscopy, Barnes West County Hospital, St. Louis, Missouri
- Amandeep Shergill, MD, MS, is Professor of Clinical Medicine, University of California at San Francisco, San Francisco
- Nancy Schlossberg, BSN, RN, CGRN, CER, is Program Director, Digestive Health Services, Walnut Creek, California
| | - Connie Hall
- Bridget Costello, PhD, CIP, is Associate Professor of Sociology, King's College, Wilkes-Barre, Pennsylvania
- Tamara James, MA, is Assistant Consulting Professor, Duke Family Medicine and Community Health, Clarksville, Virginia
- Connie Hall, BSN, RN, CGRN, CER, is Patient Care Manager, Endoscopy, Barnes West County Hospital, St. Louis, Missouri
- Amandeep Shergill, MD, MS, is Professor of Clinical Medicine, University of California at San Francisco, San Francisco
- Nancy Schlossberg, BSN, RN, CGRN, CER, is Program Director, Digestive Health Services, Walnut Creek, California
| | - Amandeep Shergill
- Bridget Costello, PhD, CIP, is Associate Professor of Sociology, King's College, Wilkes-Barre, Pennsylvania
- Tamara James, MA, is Assistant Consulting Professor, Duke Family Medicine and Community Health, Clarksville, Virginia
- Connie Hall, BSN, RN, CGRN, CER, is Patient Care Manager, Endoscopy, Barnes West County Hospital, St. Louis, Missouri
- Amandeep Shergill, MD, MS, is Professor of Clinical Medicine, University of California at San Francisco, San Francisco
- Nancy Schlossberg, BSN, RN, CGRN, CER, is Program Director, Digestive Health Services, Walnut Creek, California
| | - Nancy Schlossberg
- Bridget Costello, PhD, CIP, is Associate Professor of Sociology, King's College, Wilkes-Barre, Pennsylvania
- Tamara James, MA, is Assistant Consulting Professor, Duke Family Medicine and Community Health, Clarksville, Virginia
- Connie Hall, BSN, RN, CGRN, CER, is Patient Care Manager, Endoscopy, Barnes West County Hospital, St. Louis, Missouri
- Amandeep Shergill, MD, MS, is Professor of Clinical Medicine, University of California at San Francisco, San Francisco
- Nancy Schlossberg, BSN, RN, CGRN, CER, is Program Director, Digestive Health Services, Walnut Creek, California
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Goksoy B, Kiyak M. The effectiveness of using an abdominal binder during colonoscopy: a randomized, double-blind, sham-controlled trial. Scand J Gastroenterol 2021; 56:990-997. [PMID: 34154490 DOI: 10.1080/00365521.2021.1941238] [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: 02/04/2023]
Abstract
BACKGROUND Prolongation of cecal intubation time (CIT) directly affects the comfort of the patient and the colonoscopist. In this study, the effectiveness of using an abdominal binder (AB) during colonoscopy on procedure time and colonoscopy outcomes was investigated. METHODS We conducted a parallel randomized double-blind sham-device-controlled study of patients who underwent elective outpatient colonoscopy between 1 May 2020, and 31 August 2020. Participants were randomly assigned to AB (n = 173) and sham binder (SB) (n = 173) groups. The primary outcome was CIT. Secondary outcomes were the need for auxiliary maneuvers, the cecum intubation length (CIL) of the colonoscope, visual analog scale (VAS) score, narcotic analgesic dose, and colonoscopy results. Moreover, subgroup analysis was performed in terms of age and obesity indices. RESULTS A total of 346 patients were enrolled in the study. The mean CIT was similar between groups (AB group 240 secs, control group 250 secs, p > .05). Manual pressure requirement was less in the AB group (27 vs. 36%, p = .069). VAS score and the need for extra narcotic analgesic drugs were prominently lower in the AB group (p < .001, p = .016, respectively). In the subgroup analyses, in participants at the age of <60 and waist-to-height ratio (WHtR) ≥0.5, manual pressure requirements were significantly shorter in the AB group (p = .017, p = .032, respectively). CONCLUSION AB use in selected patients may be advantageous during colonoscopy because it reduces the need for analgesics and post-procedure pain, and reduces the need for auxiliary maneuvers in relatively young and obese patients.
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Affiliation(s)
- Beslen Goksoy
- Department of General Surgery, Sancaktepe Şehit Prof Dr Ilhan Varank Training and Research Hospital, Istanbul, Turkey
| | - Mevlut Kiyak
- Department of Gastroenterology, Sancaktepe Şehit Prof Dr Ilhan Varank Training and Research Hospital, Istanbul, Turkey
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Prone or Left for Colonoscopy? A Randomized Controlled Trial of Prone Versus Left-sided Starting Position for Colonoscopy. J Clin Gastroenterol 2018. [PMID: 28644314 DOI: 10.1097/mcg.0000000000000871] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND AIMS Data have emerged supporting the right-lateral starting position in reducing time to cecum and improving patient comfort for minimally sedated colonoscopy. We aimed to test whether prone starting position results in similar advantages in procedure time and patient tolerability in comparison to traditional left-sided starting position. MATERIALS AND METHODS We conducted a randomized controlled trial in which patients were randomized to begin in either the prone or left-lateral (LL) position. A total of 181 adult patients undergoing scheduled colonoscopy were stratified by age, gender, body mass index, and experience of the endoscopist. Patients were then randomized 1:1 in permuted blocks. The primary outcome measure was time to cecal intubation and secondary outcome measures included patient comfort that was measured by visual analog scale. RESULTS There was no benefit from prone starting positioning over conventional left-sided starting positioning. Further, prone starting position led to an increase in time to reach cecum (701 vs. 511 s; P=0.01). This could be in part explained by an increased time to reach transverse colon in patients positioned prone (332 vs. 258 s; P=0.06). Comfort levels were similar between patients positioned prone and LL (4 vs. 4 visual analog scale; P=0.6) although endoscopists found colonoscopies in which patients started prone more technically challenging than if started LL (5 vs. 4; P=0.002). CONCLUSIONS Prone starting position did not improve time to reach cecum or patient comfort for minimally sedated patients undergoing colonoscopy. The ClinicalTrials.gov identifier is NCT02305706.
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Baltes P, Bota M, Albert J, Philipper M, Hörster HG, Hagenmüller F, Steinbrück I, Jakobs R, Bechtler M, Hartmann D, Neuhaus H, Charton JP, Mayershofer R, Hohn H, Rösch T, Groth S, Nowak T, Wohlmuth P, Keuchel M. PillCamColon2 after incomplete colonoscopy - A prospective multicenter study. World J Gastroenterol 2018; 24:3556-3566. [PMID: 30131662 PMCID: PMC6102503 DOI: 10.3748/wjg.v24.i31.3556] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 07/18/2018] [Accepted: 07/21/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the ability of PillCamColon2 to visualize colonic segments missed by incomplete optical colonoscopy (OC) and to assess the diagnostic yield.
METHODS This prospective multicentre study included 81 patients from nine centres who underwent second-generation colon capsule endoscopy (CCE) following incomplete OC performed by an experienced gastroenterologist (> 1000 colonoscopies). Patients with stenosis were excluded. According to patient preferences, CCE was performed the following day (protocol A) after staying on clear liquids and 0.75 L Moviprep in the morning or within 30 d after new split-dose Moviprep (protocol B). Boosts consisted of 0.75 L and 0.25 L Moviprep, and phospho-soda was given as a rescue if the capsule was not excreted after seven hours.
RESULTS Seventy-four patients were analysed (51% of them in group A; 49% in group B). Bowel cleansing was adequate in 67% of cases, and CCE could visualize colonic segments missed by incomplete colonoscopy in 90% of patients under protocol A and 97% of patients under protocol B (P = 0.35, n.s.). Significant polyps including adenocarcinoma were detected in 24% of cases. Detection rates for all polyps and significant polyps per patient were similar in both protocols. Polyps were found predominantly in the right colon (86%) in segments that were not reached by OC. Extracolonic findings - such as reflux esophagitis, suspected Barrett esophagus, upper GI-bleeding, gastric polyps, gastric erosions and angiectasia - were detected in eight patients. PillCamColon2 capsule was retained in the ileum of one patient (1.4%) without symptoms and removed during an uneventful resection for unknown Crohn’s disease that was diagnosed as the cause of anemia, which was the indication for colonoscopy. CCE was well tolerated. One patient suffered from self-limiting vomiting after consuming the phospho-soda.
CONCLUSION Second-generation CCE using a low-volume preparation is useful after incomplete OC, and it allows for the detection of additional relevant findings, but cleansing efficiency could be improved.
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Affiliation(s)
- Peter Baltes
- Clinic for Internal Medicine, Bethesda Krankenhaus Bergedorf, Hamburg 21029, Germany
| | - Marc Bota
- Clinic for Internal Medicine, Bethesda Krankenhaus Bergedorf, Hamburg 21029, Germany
| | - Jörg Albert
- Department of Internal Medicine I, Klinikum der JW. Goethe Universität, Frankfurt 60590, Germany
| | | | | | | | - Ingo Steinbrück
- 1st Medical Department, Asklepios Klinikum Altona, Hamburg 22763, Germany
| | - Ralf Jakobs
- Medical Clinic C, Klinikum der Stadt Ludwigshafen, Ludwigshafen 67063, Germany
| | - Matthias Bechtler
- Medical Clinic C, Klinikum der Stadt Ludwigshafen, Ludwigshafen 67063, Germany
| | - Dirk Hartmann
- Clinic for Internal Medicine, Sana Klinikum Lichtenberg, Berlin 10365, Germany
| | - Horst Neuhaus
- Clinic for Internal Medicine, Evangelisches Krankenhaus, Düsseldorf 40217, Germany
| | - Jean-Pierre Charton
- Clinic for Internal Medicine, Evangelisches Krankenhaus, Düsseldorf 40217, Germany
| | | | - Horst Hohn
- Schwerpunktpraxis Gastroenterologie, Koblenz 56068, Germany
| | - Thomas Rösch
- Clinic for Interdisciplinary Endoscopy, University Hospital Eppendorf, Hamburg 20251, Germany
| | - Stefan Groth
- Clinic for Interdisciplinary Endoscopy, University Hospital Eppendorf, Hamburg 20251, Germany
| | - Tanja Nowak
- CorporateHealth International, Hamburg 20149, Germany
| | - Peter Wohlmuth
- Biometry and Data Management, Asklepios Proresearch, Hamburg 20099, Germany
| | - Martin Keuchel
- Clinic for Internal Medicine, Bethesda Krankenhaus Bergedorf, Hamburg 21029, Germany
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Yu GQ, Huang XM, Li HY, Tang W, Hu DM, Lü MH, Fu KI. Use of an abdominal obstetric binder in colonoscopy: A randomized, prospective trial. J Gastroenterol Hepatol 2018; 33:1365-1369. [PMID: 29292858 DOI: 10.1111/jgh.14077] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 11/25/2017] [Accepted: 12/19/2017] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIMS Various methods have been reported as aids to cecal intubation. This study aimed to prospectively investigate whether an abdominal obstetric binder (AOB) used during pregnancy and attached to the patients' abdomen during colonoscopy could facilitate effective colonoscopic insertion. METHODS This was a prospective study of 451 consecutive outpatient colonoscopies performed by a single experienced endoscopist. The recruited patients were randomly separated into two groups that received colonoscopy either with (Group A) or without an AOB attached (Group B). The cecal intubation time, cecal intubation length of the colonoscope, use of manual pressure, position change of each patient, and the number of patients with abdominal distension were collected for comparison. RESULTS A total of 451 patients (224 in Group A and 227 in Group B) were ultimately included in this study. In Group A, cecal intubation time and cecal intubation length of colonoscope (CIL) were significantly reduced (P < 0.001). The patients had significantly fewer position changes and manual pressure in Group A (P < 0.001). Significantly less abdominal distension was reported by patients in Group A (P < 0.001). CONCLUSIONS During colonoscopy, the application of an AOB provided a significantly faster and more effective colonoscope insertion.
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Affiliation(s)
- Guang Qiu Yu
- Department of Gastroenterology, The Second Affiliated Hospital of Suzhou University, Jiangsu Province, Suzhou, China
| | - Xiao Mei Huang
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Sichuan Province, Luzhou, China
| | - Hai Yan Li
- Department of Gastroenterology, The Second Affiliated Hospital of Suzhou University, Jiangsu Province, Suzhou, China
| | - Wen Tang
- Department of Gastroenterology, The Second Affiliated Hospital of Suzhou University, Jiangsu Province, Suzhou, China
| | - Duan Min Hu
- Department of Gastroenterology, The Second Affiliated Hospital of Suzhou University, Jiangsu Province, Suzhou, China
| | - Mu Han Lü
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Sichuan Province, Luzhou, China
| | - Kuang-I Fu
- Department of Endoscopy, Kanma Memorial Hospital, Nasushiobara, Japan
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Crockett SD, Cirri HO, Kelapure R, Galanko JA, Martin CF, Dellon ES. Use of an Abdominal Compression Device in Colonoscopy: A Randomized, Sham-Controlled Trial. Clin Gastroenterol Hepatol 2016; 14:850-857.e3. [PMID: 26767313 PMCID: PMC4875866 DOI: 10.1016/j.cgh.2015.12.039] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 12/21/2015] [Accepted: 12/21/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Looping is a common problem during colonoscopy that prolongs procedure time. We aimed to determine the efficacy and safety of ColoWrap, an external abdominal compression device, with respect to insertion time and other procedural outcomes. METHODS We performed a prospective study of outpatients undergoing elective colonoscopy (40-80 years old; mean age, 60.5 years) at endoscopy facilities in the University of North Carolina Hospitals from April 2013 through March 2014. Subjects were randomly assigned to groups that received either ColoWrap (n = 175) or a sham device (control, n = 175) during colonoscopy. Colonoscopists and staff were blinded to the application. The primary outcome was cecal intubation time (CIT). Secondary outcomes included use of manual pressure and position change. RESULTS The mean CIT was similar for the control and ColoWrap groups (6.69 vs 6.67 minutes; P = .98). There were no statistical differences in the frequency of manual pressure (45% for controls vs 37% for ColoWrap group, P = .13) or position changes (4% for controls vs 2% for ColoWrap group, P = .36). Among patients with body mass index between 30 and 40 kg/m(2) (n = 78), CIT was significantly lower for patients in the ColoWrap group (4.69 minutes) than controls (6.10 minutes) (P = .03). Adverse events were similar between groups. CONCLUSIONS In patients undergoing elective colonoscopy, application of an external abdominal compression device did not improve CIT or affect the frequency of ancillary maneuvers. A possible benefit was observed in patients with body mass index between 30 and 40 kg/m(2), but further studies are needed. ClinicalTrials.gov number: NCT02025504.
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7
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Rozeboom ED, Bastiaansen BA, de Vries ES, Dekker E, Fockens PA, Broeders IAMJ. Robotic-assisted flexible colonoscopy: preliminary safety and efficiency in humans. Gastrointest Endosc 2016; 83:1267-71. [PMID: 26551732 DOI: 10.1016/j.gie.2015.10.046] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 10/25/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS The flexible endoscope is used as a platform for minimally invasive interventions. However, control of the conventional endoscope and multiple instruments is difficult. Robotic assistance could provide a solution and better control for a single operator. A novel platform should also enable interventions in areas that are currently difficult to reach. This study evaluates the safety and efficacy of a robotic platform that guides a conventional endoscope through the large bowel. METHODS Adult patients scheduled for routine diagnostic colonoscopy were included in this feasibility study. The endoscope was introduced using a robotic add-on to provide tip bending and air/water actuation. The endoscopist directly controlled the endoscope shaft. Upon cecal intubation, the add-on was detached and the procedure continued using conventional control. Primary evaluation parameters were the number of serious adverse events and the percentage of successful cecal intubations. RESULTS The procedure was performed on 22 consecutive patients who all gave informed consent. There were no serious adverse events. Cecal intubation was successful in 15 patients (68%) using the robotic add-on. Six cases were completed after conversion to conventional control: 3 cases were converted to pass sharp angulation in the flexures and 3 cases were converted after technical difficulties. One case was not successful with either technique because of severe diverticulosis. CONCLUSIONS The robotic add-on steering module allows safe endoscope intubation to reach intervention sites throughout the large bowel. The next step is to clinically evaluate complementary instrument and shaft-guiding modules in therapeutic procedures.
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Affiliation(s)
- Esther D Rozeboom
- Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands
| | - Barbara A Bastiaansen
- Department of Gastroenterology and Hepatology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Elsemieke S de Vries
- Department of Gastroenterology and Hepatology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Paul A Fockens
- Department of Gastroenterology and Hepatology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Ivo A M J Broeders
- Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands; Department of Surgery, Meander Medical Center, Amersfoort, The Netherlands
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Willcock H, Gold DM. Supine Colonoscopy: An Advantage over Left Lateral in Synchronous Proctological Surgery. J Laparoendosc Adv Surg Tech A 2016; 26:475-7. [PMID: 26982385 DOI: 10.1089/lap.2015.0609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Repositioning sedated or anesthetized patients between colonoscopy and further surgical procedures is potentially unsafe and time consuming. We aim to show that colonoscopy performed in the modified lithotomy position offers surgical, anesthetic, and patient advantage. METHODS Patients presenting for colonoscopy and a synchronous surgical procedure between May 2013 and August 2014 were prospectively included. Colonoscopy duration, cecal intubation rate (CIR), terminal ileum intubation rate, and patient characteristics were recorded. RESULTS Sixty-eight patients were included in this study. Of them, 24 (35%) were women and mean age was 42.3 years. Mean colonoscopy duration was 7 minutes (2-24 minutes). CIR was 100%. Terminal ileum intubation rate was 92%. Utilization of ancillary colonoscopic maneuvers was easier for the operator/assistant. Overall theatre time was reduced and there was no increase in length of stay. CONCLUSION The modified lithotomy position offers multiple surgical, anesthetic, theatre, and patient advantage in those undergoing a colonoscopy followed by a further proctological or surgical procedure.
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Affiliation(s)
- Helen Willcock
- 1 School of Medicine, University Notre Dame , Australia, Darlinghurst, New South Wales, Australia
| | - Darren Marc Gold
- 2 St. Vincent's Clinical School , UNSW Australia, Darlinghurst, New South Wales, Australia
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van der Stap N, Rozeboom ED, Pullens HJM, van der Heijden F, Broeders IAMJ. Feasibility of automated target centralization in colonoscopy. Int J Comput Assist Radiol Surg 2015; 11:457-65. [PMID: 26450108 PMCID: PMC4766207 DOI: 10.1007/s11548-015-1301-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 09/11/2015] [Indexed: 12/16/2022]
Abstract
Purpose Early detection of colorectal cancer is key to full recovery. This urged governments to start population screening programs for colorectal cancer, often using flexible endoscopes. Flexible endoscopy is difficult to learn and time-consuming. Automation of flexible endoscopes may increase the capacity for the screening programs. The goal of this pilot study is to investigate the clinical and technical feasibility of an assisting automated navigation algorithm for a colonoscopy procedure. Methods Automated navigation (lumen centralization) was implemented in a robotized system designed for conventional flexible endoscopes. Ten novice and eight expert users were asked to perform a diagnostic colonoscopy on a colon model twice: once using the conventional and once using the robotic system. Feasibility was evaluated using time and location data as measures of the system’s added value. Results Automated target centralization (ATC) was turned on by the novices for a median of 4.2 % of the time during insertion and 0.3 % during retraction. Experts turned ATC on for 4.0 % of the time during insertion and 11.6 % during retraction. Novices and experts showed comparable times to reach the cecum with the conventional or the robotic setup with ATC. Conclusion The ATC algorithm combined with the robotized endoscope setup works in an experimental setup that closely resembles the clinical environment and is considered feasible, although ATC use was lower than expected. For novices, it was unclear whether the low usage was due to unfamiliarity with the system or because they did not need ATC. Experts used ATC also during the retraction phase of the procedure. This was an unexpected finding and may indicate an added value of the system. Electronic supplementary material The online version of this article (doi:10.1007/s11548-015-1301-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- N van der Stap
- Department of Robotics and Mechatronics, MIRA Institute, University of Twente, Carré 3.625, P. O. Box 1502, 7500 AE, Enschede, The Netherlands.
| | - E D Rozeboom
- Department of Robotics and Mechatronics, MIRA Institute, University of Twente, Carré 3.625, P. O. Box 1502, 7500 AE, Enschede, The Netherlands
| | - H J M Pullens
- Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort, The Netherlands
| | - F van der Heijden
- Department of Robotics and Mechatronics, MIRA Institute, University of Twente, Carré 3.625, P. O. Box 1502, 7500 AE, Enschede, The Netherlands
| | - I A M J Broeders
- Department of Robotics and Mechatronics, MIRA Institute, University of Twente, Carré 3.625, P. O. Box 1502, 7500 AE, Enschede, The Netherlands.,Department of Surgery, Meander Medical Center, Amersfoort, The Netherlands
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Gan T, Yang JL, Wu JC, Wang YP, Yang L. When and why a colonoscopist should discontinue colonoscopy by himself? World J Gastroenterol 2015; 21:7834-7841. [PMID: 26167083 PMCID: PMC4491970 DOI: 10.3748/wjg.v21.i25.7834] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 04/03/2015] [Accepted: 05/21/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate when and why a colonoscopist should discontinue incomplete colonoscopy by himself.
METHODS: In this cross-sectional study, 517 difficult colonoscope insertions (Grade C, Kudo’s difficulty classification) screened from 37800 colonoscopy insertions were collected from April 2004 to June 2014 by three 4th-level (Kudo’s classification) colonoscopists. The following common factors for the incomplete insertion were excluded: structural obstruction of the colon or rectum, insufficient colon cleansing, discontinuation due to patient’s discomfort or pain, severe colon disease with a perforation risk (e.g., severe ischemic colonopathy). All the excluded patients were re-scheduled if permission was obtained from the patients whose intubation had failed. If the repeat intubations were still a failure because of the difficult operative techniques, those patients were also included in this study. The patient’s age, sex, anesthesia and colonoscope type were recorded before colonoscopy. During the colonoscopic examination, the influencing factors of fixation, tortuosity, laxity and redundancy of the colon were assessed, and the insertion time (> 10 min or ≤ 10 min) were registered. The insertion time was analyzed by t-test, and other factors were analyzed by univariate and multivariate logistic regression.
RESULTS: Three hundred and twenty-two (62.3%) of the 517 insertions were complete in the colonoscope insertion into the ileocecum, but 195 (37.7%) failed in the insertion. Fixation, tortuosity, laxity or redundancy occurred during the colonoscopic examination. Multivariate logistic regression analysis revealed that fixation (OR = 0.06, 95%CI: 0.03-0.16, P < 0.001) and tortuosity (OR = 0.04, 95%CI: 0.02-0.08, P < 0.001) were significantly related to the insertion into the ileocecum in the left hemicolon; multivariate logistic regression analysis also revealed that fixation (OR = 0.16, 95%CI: 0.06-0.39, P < 0.001), tortuosity (OR 0.23, 95%CI: 0.13-0.43, P < 0.001), redundancy (OR = 0.12, 95%CI: 0.05-0.26, P < 0.001) and sex (OR = 0.35, 95%CI: 0.20-0.63, P < 0.001) were significantly related to the insertion into the ileocecum in the right hemicolon. Prolonged insertion time (> 10 min) was an unfavorable factor for the insertion into the ileocecum.
CONCLUSION: Colonoscopy should be discontinued if freedom of the colonoscope body’s insertion and rotation is completely lost, and the insertion time is prolonged over 30 min.
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Uddin FS, Iqbal R, Harford WV, Dunbar KB, Cryer BL, Spechler SJ, Feagins LA. Prone positioning of obese patients for colonoscopy results in shortened cecal intubation times: a randomized trial. Dig Dis Sci 2013; 58:782-7. [PMID: 23143737 DOI: 10.1007/s10620-012-2468-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 10/12/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND Obesity is a risk factor for colorectal cancer, and colonoscopy can be technically challenging in obese patients. It has been proposed (with little supporting data) that prone positioning of obese patients might facilitate a difficult colonoscopy. AIM The aim of this study was to determine if starting colonoscopy in the prone position for obese patients decreases cecal intubation times. METHODS This was a prospective, randomized study conducted at the North Texas VA Medical Center. Patients with a body mass index of ≥30 kg/m(2) undergoing elective colonoscopy were randomized 1:1 to either initial prone positioning or standard, left-lateral positioning. The outcome measurements were cecal intubation time, frequency of repositioning, sedative medications used, reports of pain, complications, and procedure tolerability. RESULTS Fifty patients were randomized to have colonoscopy starting in the standard, left-lateral decubitus position, and 51 to the prone position. The average cecal intubation time for the standard group was 550 vs. 424 s in the prone group (p = 0.03). Patient repositioning was used in 28 % of patients in the standard group versus 8 % in the prone group (p = 0.009). There was no difference in subjective reports of pain between groups (p = 0.95) or in average pain scores (p = 0.79). Follow-up interviews were conducted in 93 % of patients, all of whom said that they would be willing to have repeat colonoscopy in the same position. CONCLUSIONS Performance of colonoscopy in the prone position for obese patients results in significantly shorter cecal intubation times and decreased need for patient repositioning. Prone positioning is well accepted and does not significantly increase procedure-related discomfort.
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Affiliation(s)
- Fatema S Uddin
- Division of Gastroenterology (111B1), Dallas VA Medical Center, 4500 S. Lancaster Road, Dallas, TX 75216, USA
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Endoscopic management of failed colonoscopy in clinical practice: to change endoscopist, instrument, or both? Int J Colorectal Dis 2011; 26:103-8. [PMID: 20686778 DOI: 10.1007/s00384-010-1016-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/14/2010] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Caecal intubation fails up to 20% of colonoscopy in clinical practice. We aimed to assess whether (1) in patients with a prior incomplete colonoscopy with a standard adult colonoscope, a subsequent caecal intubation may be achieved with the same instrument; (2) there are factors predicting a repeated unsuccessful colonoscopy; and (3) how frequently completion can be further achieved by shifting to a standard gastroscope. MATERIALS AND METHODS Data of patients with a previously failed bowel examination referred to our community hospital for a further colonoscopy were reviewed. When caecal intubation still failed with standard colonoscope, complete colonoscopy was usually attempted by shifting to a gastroscope. RESULTS Overall, 451 patients with a prior colonoscopy were considered. By using a standard colonoscope, caecal intubation rate was achieved in 285 out of 296 patients with prior complete examination and in 121 out of 155 patients with a prior failed colonoscopy (96.3% vs. 78.1%, p < .001). Caecum visualization was significantly lower when prior colonoscopy was stopped in the sigmoid tract as compared to any other proximal tract (65.1% vs. 86.9%, p < .001). After a second failed examination, colonoscopy was completed in 15 (51.7%) out of 29 cases by shifting to a standard gastroscope. No procedure-related complications were observed in the study. CONCLUSIONS After incomplete colonoscopy with a standard adult colonoscope, a further colonoscopy may be completed with same standard colonoscope or by using a gastroscope in the same session. A prior failed colonoscopy, particularly when stopped in the sigmoid tract, is significantly associated with a lower caecal intubation rate at second colonoscopy.
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