Effect of instrument diameter on the depth of penetration of fiberoptic sigmoidoscopes

Does flexible small-diameter colonoscope reduce insertion pain during colonoscopy?

AIM: It is well known that colonoscopy can be difficult due to abdominal pain induced during colonoscope insertion, if sedative agents are not given. Recently, an extra-flexible, small-diameter colonoscope (CF-SV, Olympus Inc., Japan) was developed in order to improve safety and comfort. The aim of this study was to access the usefulness of the CF-SV.

METHODS: One hundred patients undergoing sigmoidoscopy were recruited and colonoscopy was performed by one experienced colonoscopist. First, a routine-type colonoscope (CF-230I) was inserted into the colon without sedation. When the patient complained of abdominal pain (even if mild), the scope was not advanced further and was withdrawn after the anatomic location of its tip was determined fluoroscopically. Then, the CF-SV was inserted until it reached the cecun or the site where abdominal pain occurred. Previous abdominal surgery and a bdominal disease were considered as unfavorable factors (UF) and the relationship between abdominal pain and UF, age and gender were investigated. Furthermore, the colonic insertion pressures in 36 patients with abdominal pain were measured with a force gauge.

RESULTS: Thirty-four cases (34%) felt no pain with the CF-230I and successful pancolon-oscopies to the cecum were performed. Sixty-six cases (66%) complained of abdominal pain. The procedure was painless for 47% of men and 24% of women, respectively. The CF-230I scope failed to reach the sigmoid-descending colon junctions in 59 (89.4%) of the 66 patients complaining of abdominal pain. However, CF-SV reached proximal area in 94.9% of those who failed with CF-230I. The median pressure for pain-inducing was 700 g/cm².

CONCLUSION: Unsedated patients with UF were prone to complain of pain when the standard-type CF-230I scope was used. The newly developed extra-flexible CF-SV is useful for the aged and for those with UF or being prone to suffer from abdominal pain. Sedative agents may be unnecessary if this new type of colonoscope is used.

Flexible sigmoidoscopy by nurses: state of the art 1999

Although screening flexible sigmoidoscopy is associated with a significant decrease in colorectal cancer mortality, less than 50% of eligible Americans have had a sigmoidoscopy. As the United States population ages, over 50 million Americans will be eligible for colorectal cancer screening with flexible sigmoidoscopy. The projected increase in a population eligible for screening is expected to increase demand for this procedure and may result in overwhelming currently available endoscopic resources. Gastroenterology nurses should actively seek training to perform flexible sigmoidoscopy to accommodate this increased demand. Current barriers to nurse-performed sigmoidoscopy are prohibitions by state Boards of Nursing and lack of procedural reimbursement for nurse endoscopists performing flexible sigmoidoscopy. The lack of research about the effectiveness of this practice is a contributing factor to the hindrances in the development of this nursing role. This review outlines research about the effectiveness of flexible sigmoidoscopy by nurses, legal and reimbursement issues, and details the scope of training programs used by institutions with nurse endoscopists.

Flexible sigmoidoscopy by paramedical personnel

Screening sigmoidoscopy is associated with a 45% to 80% reduction in colorectal cancer mortality. Although less than 50% of eligible Americans have been screened with flexible sigmoidoscopy (FS), the use of this procedure is rising rapidly. By the year 2000, as many as 10 million screening FS per year could be performed. To accommodate the increased demand, many medical centers have trained paramedical personnel (i.e. physician assistants, nurses, and gastroenterology technicians) to perform FS. However, as a result of the paucity of research about this practice, only physicians receive a professional fee for performing screening FS. Many state Boards of Nursing explicitly prohibit registered nurses (RNs) from performing this procedure. This review outlines research about the effectiveness of paramedical endoscopists, medico-legal and reimbursement issues, and outlines a training program in FS for paramedical personnel.