Does one-man method better than two-man method for colonoscopy insertion in children

Quality improvement of pediatric colonoscopy by application of bundle and centralization: A single-center review

BACKGROUND

To assess the quality change of our single-center pediatric colonoscopy after applying bundle for bowel preparation and general anesthesia and centralize the procedure using terminal ileum (TI) intubation rate as the main indicator.

METHODS

All elective colonoscopies performed for patients younger than 18 years old in MacKay Memorial Hospital from July 2015 through June 2020 (assigned to group 1, before bundle) and from August 2020 through July 2021 (assigned to group 2, after bundle) were retrospectively reviewed for demographic characteristics, indications, bowel preparation agent and cleansing level, diagnostic and therapeutic procedures, maximum intestinal level reached, and cecal intubation and total procedure time. Statistical analysis was done using P value < 0.05 considered to be significant.

RESULTS

Analysis included 45 and 32 colonoscopies in group 1 and 2, respectively. Bloody stool was the most frequent indication in both groups. Both TI intubation rate (42.2 % vs. 75.0 %, P = 0.004) and biopsy rate (45.0 % vs. 75.9 %, P = 0.01) increased significantly from group 1 to group 2. The narrower standard deviation of bowel preparation score (1.93 vs. 1.15) and total procedure time (37.71 vs. 22.29) in group 2 indicated a more stable quality, although the mean showed no difference. There was no statistical difference in age, gender, body weight, cecal intubation rate, or cecal intubation time.

CONCLUSION

A higher TI intubation rate and biopsy rate indicated an improved quality of pediatric colonoscopy after applying bundle including bowel preparation and general anesthesia, with additional centralization.

Effects of Different Intervention Methods on Intestinal Cleanliness in Children Undergoing Colonoscopy

Objective

To explore the effects of different intervention methods on intestinal cleanliness in children undergoing colonoscopy.

Methods

61 children who underwent colonoscopy in our hospital from May 2020 to May 2021 were randomly divided into group A (n = 21), group B (n = 30), and group C (n = 10). The children in the three groups were intervened in different ways before the colonoscopy. Group A received a long-handled Kaiselu +1 cathartic intervention, while group B received a long-handled Kaiselu +2 cathartic intervention, and group C received an enema plus one cathartic intervention. The patients in the three groups were given the same diet before the examination until the examination was completed. The time-related indexes, cleanliness, adverse reactions, tolerance, and adaptability of the three groups under different dietary interventions and cleaning methods were evaluated.

Results

The first defecation time in group C was lower than that in group A and group B, the hospital stay was longer than that in group A and group B (p > 0.05), and the colonoscopy time in group C was shorter than that in group A and group B (p < 0.05). The BBPS score of group C was (2.10 ± 0.32), which was significantly higher than that of group A (1.16 ± 0.19) and group B (1.77 ± 0.18) (p < 0.05). The BBPS scores of children with liquid food in the three groups were significantly higher than those of common food, and the BBPS scores of liquid food and common food in group C were significantly higher than those in group A and group B (p < 0.05). The incidence of adverse reactions in group C was 20.00%, which was significantly lower than 33.33% in group A and 23.33% in group B (p < 0.05). The proportion of grade I in group C was 50.00%, which was significantly higher than 38.10% in group A and 43.33% in group B (p < 0.05).

Conclusion

Children undergoing colonoscopy take preintestinal preparation under different diets and intervention methods. The cleanliness of liquid food and enema + one-time laxative one day before colonoscopy is the best, which can significantly reduce adverse reactions and increase the acceptability and adaptability of children. It is worthy of clinical application.

One- or two-operator techniques for oesophago-gastro-duodenoscopy in unsedated patients: A comparative prospective randomized study

BACKGROUND

The standard oesophago-gastro-duodenoscopy procedure is performed with a single endoscopist (SE). Nurse-assisted (NA) oesophago-gastro-duodenoscopies have not yet been studied. We aimed to evaluate the efficacy of an NA endoscopy compared to an SE endoscopy.

METHODS

A prospective, single-center, randomized trial, in which 500 adult patients were divided into two groups. In the first group, patients underwent an endoscopy with an SE. In the second group, the endoscopy was performed with an NA. The ease of the procedure (scores 1-4; 1 difficult, 2 satisfactory, 3 easy, 4 veryeasy), evaluation of patient satisfaction (scores 1-4; 1 uncomfortable, 2 satisfactory, 3 comfortable, 4 verycomfortable), total time of the procedure and vocal cord observation were determined as quality indicators.

RESULTS

Mean patient satisfaction scores in groups 1 and 2 were 2.98±0.79 and 3.11±0.78, respectively (p=0.043), with uncomfortable ratings in 5.2% vs 4%, satisfactory in 16.8% vs 13.2%, comfortable in 53.2% vs 50.4%, and very comfortable in 24.8% vs 32.4% of patients in groups 1 and 2, respectively. Retching rates during the procedure were 54.4% and 45.2% (p=0.040) in groups 1 and 2, respectively. No differences were seen in vocal cord observation (54.4% vs 56.0%), total procedure time (2.35±1.56 vs 2.41±1.48min) and easy score (3.26±0.603 vs 3.25±0.64) in groups 1 and 2 for the procedures. Very easy, easy, satisfactory, and difficult ratings were given by 33.6% vs 34.8%, 60.4% vs 56.4%, 4.8% vs 7.6% and 1.2% vs 1.2% of groups 1 and 2, respectively.

CONCLUSIONS

Compared with the conventional method, the assisted endoscopic technique provides more comfort and less gag reflex without increasing the processing time or difficulty of performing the procedure.