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Bernth JE, Zhang G, Malas D, Abrahams G, Hayee B, Liu H. MorphGI: A Self-Propelling Soft Robotic Endoscope Through Morphing Shape. Soft Robot 2024. [PMID: 38484296 DOI: 10.1089/soro.2023.0096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
Colonoscopy is currently the best method for detecting bowel cancer, but fundamental design and construction have not changed significantly in decades. Conventional colonoscope (CC) is difficult to maneuver and can lead to pain with a risk of damaging the bowel due to its rigidity. We present the MorphGI, a robotic endoscope system that is self-propelling and made of soft material, thus easy to operate and inherently safe to patient. After verifying kinematic control of the distal bending segment, the system was evaluated in: a benchtop colon simulator, using multiple colon configurations; a colon simulator with force sensors; and surgically removed pig colon tissue. In the colon simulator, the MorphGI completed a colonoscopy in an average of 10.84 min. The MorphGI showed an average of 77% and 62% reduction in peak forces compared to a CC in high- and low-stiffness modes, respectively. Self-propulsion was demonstrated in the excised tissue test but not in the live pig test, due to anatomical differences between pig and human colons. This work demonstrates the core features of MorphGI.
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Affiliation(s)
- Julius E Bernth
- Department of Surgical and Interventional Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Guokai Zhang
- Department of Surgical and Interventional Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Dionysios Malas
- Department of Surgical and Interventional Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - George Abrahams
- Department of Surgical and Interventional Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Bu Hayee
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Hongbin Liu
- Department of Surgical and Interventional Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- Institute of Automation, Chinese Academy of Sciences (CAS), Beijing, China
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2
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Asgari M, Magerand L, Manfredi L. A review on model-based and model-free approaches to control soft actuators and their potentials in colonoscopy. Front Robot AI 2023; 10:1236706. [PMID: 38023589 PMCID: PMC10665478 DOI: 10.3389/frobt.2023.1236706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 09/22/2023] [Indexed: 12/01/2023] Open
Abstract
Colorectal cancer (CRC) is the third most common cancer worldwide and responsible for approximately 1 million deaths annually. Early screening is essential to increase the chances of survival, and it can also reduce the cost of treatments for healthcare centres. Colonoscopy is the gold standard for CRC screening and treatment, but it has several drawbacks, including difficulty in manoeuvring the device, patient discomfort, and high cost. Soft endorobots, small and compliant devices thatcan reduce the force exerted on the colonic wall, offer a potential solution to these issues. However, controlling these soft robots is challenging due to their deformable materials and the limitations of mathematical models. In this Review, we discuss model-free and model-based approaches for controlling soft robots that can potentially be applied to endorobots for colonoscopy. We highlight the importance of selecting appropriate control methods based on various parameters, such as sensor and actuator solutions. This review aims to contribute to the development of smart control strategies for soft endorobots that can enhance the effectiveness and safety of robotics in colonoscopy. These strategies can be defined based on the available information about the robot and surrounding environment, control demands, mechanical design impact and characterization data based on calibration.
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Affiliation(s)
- Motahareh Asgari
- Division of Imaging Science and Technology, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Ludovic Magerand
- Division of Computing, School of Science and Engineering, University of Dundee, Dundee, United Kingdom
| | - Luigi Manfredi
- Division of Imaging Science and Technology, School of Medicine, University of Dundee, Dundee, United Kingdom
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Hochstein D, Tejman-Yarden S, Saukhat O, Vazgovski O, Parmet Y, Nagar N, Ram E, Carter D. Three-dimensional reconstruction of computed tomography colonography
discloses anatomic features associated with colonoscopy failure. Therap Adv Gastroenterol 2023; 16:17562848231160625. [PMID: 36968619 PMCID: PMC10031618 DOI: 10.1177/17562848231160625] [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: 09/02/2022] [Accepted: 02/13/2023] [Indexed: 03/24/2023] Open
Abstract
Objectives: Three-dimensional virtual reality (3D VR) permits precise reconstruction of
computed tomography (CT) images, and these allow precise measurements of
colonic anatomical parameters. Colonoscopy proves challenging in a subset of
patients, and thus CT colonoscopy (CTC) is often required to visualize the
entire colon. The aim of the study was to determine whether 3D
reconstructions of the colon could help identify and quantify the key
anatomical features leading to colonoscopy failure. Design: Retrospective observational study. Methods: Using 3D VR technology, we reconstructed and compared the length of various
colonic segments and number of bends and colonic width in 10 cases of CTC in
technically failed prior colonoscopies to 10 cases of CTC performed for
non-technically failure indications. Results: We found significant elongation of the sigmoid colon (71 ± 23 cm
versus 35 ± 9; p = 0.01) and of
pancolonic length (216 ± 38 cm versus 158 ± 20 cm;
p = 0.001) in cases of technically failed colonoscopy.
There was also a significant increase in the number of colonic angles
(17.7 ± 3.2 versus 12.7 ± 2.4; p = 0.008)
in failed colonoscopy cases. Conclusion: Increased sigmoid and pancolonic length and more colonic bends are novel
factors associated with technical failure of colonoscopy.
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Affiliation(s)
- David Hochstein
- St. Goerge’s University of London, London,
UK
- Engineering Medical Laboratory, The Edmond J.
Safra International Congenital Heart Center, Chaim Sheba Medical Center,
Ramat Gan, Israel
| | - Shai Tejman-Yarden
- Engineering Medical Lab, The Edmond J. Safra
International Congenital Heart Center, Chaim Sheba Medical Center, Ramat
Gan, Israel
- Sackler faculty of medicine, Tel Aviv
University, Tel Aviv, Israel
| | - Olga Saukhat
- Sackler faculty of medicine, Tel Aviv
University, Tel Aviv, Israel
- Department of Radiology, Chaim Sheba Medical
Center, Ramat Gan, Israel
| | - Oliana Vazgovski
- Engineering Medical Lab, The Edmond J. Safra
International Congenital Heart Center, Chaim Sheba Medical Center, Ramat
Gan, Israel
| | - Yisrael Parmet
- Industrial Engineering and Management
Department, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Netanel Nagar
- Engineering Medical Lab, The Edmond J. Safra
International Congenital Heart Center, Chaim Sheba Medical Center, Ramat
Gan, Israel
| | - Edward Ram
- Surgery B, Chaim Sheba Medical Center, Ramat
Gan, Israel
- Sackler faculty of medicine, Tel Aviv
University, Tel Aviv, Israel
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4
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Dean HF, Britton E, Farrow E, Abdel-Khaleq S, Lakin N, Bradbury M, Cook T. Can endoscopic follow-up after acute diverticulitis be rationalised? Surg Endosc 2023:10.1007/s00464-023-09997-6. [PMID: 36932189 PMCID: PMC10023004 DOI: 10.1007/s00464-023-09997-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/27/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND Acute diverticulitis (AD) is a common cause of presentation to emergency surgical services. Follow-up with endoluminal investigation to exclude colorectal cancer (CRC) remains controversial. Guidelines are increasingly moving to a more restrictive follow-up based on severity of disease and age. The purpose of this observational study was to assess the prevalence of CRC in AD patients and the impact of follow-up on endoscopy services. METHODS Patients admitted with a diagnosis of AD over a 2-year period were reviewed. The proportion of patients undergoing endoscopic follow-up and the CRC detection rate were recorded. The potential impact of a more conservative approach to follow-up was evaluated. RESULTS There were 484 patients with AD presenting 546 times (M:F = 198:286; median age = 63 years). 80% of admissions were aged 50 or older. There were 43 emergency interventions in 39 patients (10 percutaneous drain; 33 surgery). The remainder were managed conservatively. 28 patients (5.1%) underwent colonic resection with cancer found in one specimen (3.6%). 287 patients underwent endoluminal follow-up with cancer diagnosed in 3 cases (1.0%). There was no significant difference in the prevalence of CRC between patients requiring emergency surgery and those managed conservatively, or between patients with complicated versus uncomplicated diverticulitis. CONCLUSION CRC masquerading as acute diverticulitis is rare. The incidence of neoplasia both at endoscopic follow-up and in patients requiring emergency intervention is low. Conservative follow-up strategies appear safe, but their effectiveness in reducing the burden on endoscopy services may be limited by current age-based recommendations. Restricting follow-up to those with complicated AD would reduce the number of patients requiring endoluminal investigation by 70%.
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Affiliation(s)
- Harry Frederick Dean
- Department of Colorectal Surgery, Gloucestershire Hospitals NHS Foundation Trust, Great Western Rd, Gloucester, GL1 3NN, UK.
| | - Emily Britton
- Department of Colorectal Surgery, Gloucestershire Hospitals NHS Foundation Trust, Great Western Rd, Gloucester, GL1 3NN, UK
| | - Emily Farrow
- Department of Colorectal Surgery, Gloucestershire Hospitals NHS Foundation Trust, Great Western Rd, Gloucester, GL1 3NN, UK
| | - Sameerah Abdel-Khaleq
- Department of Colorectal Surgery, Gloucestershire Hospitals NHS Foundation Trust, Great Western Rd, Gloucester, GL1 3NN, UK
| | - Natasha Lakin
- Department of Colorectal Surgery, Gloucestershire Hospitals NHS Foundation Trust, Great Western Rd, Gloucester, GL1 3NN, UK
| | - Molly Bradbury
- Department of Colorectal Surgery, Gloucestershire Hospitals NHS Foundation Trust, Great Western Rd, Gloucester, GL1 3NN, UK
| | - Tim Cook
- Department of Colorectal Surgery, Gloucestershire Hospitals NHS Foundation Trust, Great Western Rd, Gloucester, GL1 3NN, UK
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5
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Thomson M, Belsha D, Nedelkopoulou N, Sharma S, Campbell D, Narula P, Rao P, Urs A, D'Ambrosio A, Isoldi S. Colonoscope "Looping" During Ileo-Colonoscopy in Children is Significantly Different to that Observed in Adult Practice. J Pediatr Gastroenterol Nutr 2022; 74:651-656. [PMID: 35192574 DOI: 10.1097/mpg.0000000000003421] [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] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Ileo-colonoscopy (IC) can be technically challenging because of unpredictable colonoscope loop formation. Aims of this study were to assess the risk of loop formation and to attempt to understand which factors were likely to predispose to which subtype of loop. METHODS Prospective study conducted on children referred for an IC at Sheffield Children's Hospital. Presence and type of loop was objectively assessed using the magnetic endoscope imaging tool. RESULTS Three hundred procedures were prospectively evaluated. Only 9% of paediatric ICs were loop-free. Alpha loops were the most common loop in children older than 5, whereas reverse alpha loops and a wider variety of complex and repetitive loops were observed in younger patients. Once a specific type of loop has formed, the risk of re-looping in a different way or in a different position of the colon is reduced. Left lateral starting position was found to increase the risk of reverse alpha loops and re-looping. Challenging loops, such as reverse alpha, were more frequent in males. Higher body mass index (BMI) was associated with an increased risk of alpha and deep transverse loops formation, while lower BMI with a higher incidence of reverse alpha and N loop. Loop formation did not prevent 100% ileal intubation. CONCLUSIONS This study represents the first attempt to describe loop formation according to patient characteristics in a large paediatric series. Further studies are needed in order to establish if these findings could be helpful in simplifying the execution of IC procedures in children and facilitate the learning curve during endoscopy training programs.
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Affiliation(s)
- Mike Thomson
- Centre for Paediatric Gastroenterology, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | - Dalia Belsha
- Centre for Paediatric Gastroenterology, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | - Natalia Nedelkopoulou
- Centre for Paediatric Gastroenterology, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | - Shishu Sharma
- Centre for Paediatric Gastroenterology, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | - David Campbell
- Centre for Paediatric Gastroenterology, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | - Priya Narula
- Centre for Paediatric Gastroenterology, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | - Prithvi Rao
- Centre for Paediatric Gastroenterology, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | - Arun Urs
- Centre for Paediatric Gastroenterology, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | - Angelo D'Ambrosio
- The lnstitute for Infection Prevention and Hospital Epidemiology, Freiburg Medical center, Freiburg, Germany
| | - Sara Isoldi
- The Maternal and Child Health Department, Santa Maria Goretti Hospital, Sapienza-University of Rome, Latina, Italy
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6
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Syed S, Angel AJ, Syeda HB, Jennings CF, VanScoy J, Syed M, Greer M, Bhattacharyya S, Al-Shukri S, Zozus M, Prior F, Tharian B. TAX-Corpus: Taxonomy based Annotations for Colonoscopy Evaluation. BIOMEDICAL ENGINEERING SYSTEMS AND TECHNOLOGIES, INTERNATIONAL JOINT CONFERENCE, BIOSTEC ... REVISED SELECTED PAPERS. BIOSTEC (CONFERENCE) 2022; 2022:162-169. [PMID: 35300321 PMCID: PMC8926426 DOI: 10.5220/0010876100003123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Colonoscopy plays a critical role in screening of colorectal carcinomas (CC). Unfortunately, the data related to this procedure are stored in disparate documents, colonoscopy, pathology, and radiology reports respectively. The lack of integrated standardized documentation is impeding accurate reporting of quality metrics and clinical and translational research. Natural language processing (NLP) has been used as an alternative to manual data abstraction. Performance of Machine Learning (ML) based NLP solutions is heavily dependent on the accuracy of annotated corpora. Availability of large volume annotated corpora is limited due to data privacy laws and the cost and effort required. In addition, the manual annotation process is error-prone, making the lack of quality annotated corpora the largest bottleneck in deploying ML solutions. The objective of this study is to identify clinical entities critical to colonoscopy quality, and build a high-quality annotated corpus using domain specific taxonomies following standardized annotation guidelines. The annotated corpus can be used to train ML models for a variety of downstream tasks.
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Affiliation(s)
- Shorabuddin Syed
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, U.S.A
| | | | - Hafsa Bareen Syeda
- Department of Neurology, University of Arkansas for Medical Sciences, U.S.A
| | | | - Joseph VanScoy
- College of Medicine, University of Arkansas for Medical Sciences, U.S.A
| | - Mahanazuddin Syed
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, U.S.A
| | - Melody Greer
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, U.S.A
| | | | - Shaymaa Al-Shukri
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, U.S.A
| | - Meredith Zozus
- Department of Population Health Sciences, University of Texas Health Science Centre at San Antonio, U.S.A
| | - Fred Prior
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, U.S.A
| | - Benjamin Tharian
- Division of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, U.S.A
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7
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Manfredi L. Endorobots for Colonoscopy: Design Challenges and Available Technologies. Front Robot AI 2021; 8:705454. [PMID: 34336938 PMCID: PMC8317132 DOI: 10.3389/frobt.2021.705454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 06/22/2021] [Indexed: 12/12/2022] Open
Abstract
Colorectal cancer (CRC) is the second most common cause of cancer death worldwide, after lung cancer (Sung et al., 2021). Early stage detection is key to increase the survival rate. Colonoscopy remains to be the gold standard procedure due to its dual capability to optically inspect the entire colonic mucosa and to perform interventional procedures at the same time. However, this causes pain and discomfort, whereby it requires sedation or anaesthesia of the patient. It is a difficult procedure to perform that can cause damage to the colonic wall in some cases. Development of new technologies aims to overcome the current limitations on colonoscopy by using advancements in endorobotics research. The design of these advanced medical devices is challenging because of the limited space of the lumen, the contorted shape, and the long tract of the large bowel. The force applied to the colonic wall needs to be controlled to avoid collateral effects such as injuries to the colonic mucosa and pain during the procedure. This article discusses the current challenges in the colonoscopy procedure, the available locomotion technologies for endorobots used in colonoscopy at a prototype level and the commercial products available.
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Affiliation(s)
- Luigi Manfredi
- Division of Imaging Science and Technology, School of Medicine, University of Dundee, Dundee, United Kingdom
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8
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Wei MT, Hwang JH, Watson RR, Park W, Friedland S. Novel rigidizing overtube for colonoscope stabilization and loop prevention (with video). Gastrointest Endosc 2021; 93:740-749. [PMID: 32739483 DOI: 10.1016/j.gie.2020.07.054] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/24/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Loop formation can impede endoscope advancement, destabilize the tip, and cause pain. Strategies to mitigate looping include torque-based reduction maneuvers, variable stiffness shafts, and abdominal splinting. In some cases, these strategies are insufficient, and there is need for novel instruments. Loop formation is of particular concern in colonoscopy, but it can also impact performance of other endoscopic procedures such as enteroscopy and altered-anatomy ERCP. In this case series we demonstrate the utility of a novel rigidizing overtube (Pathfinder; Neptune Medical, Burlingame, Calif, USA) in colonoscopy and other endoscopic procedures where loop management is critical. METHODS We describe our initial experience with the Pathfinder overtube in 29 patients. The overtube is 85 cm long and can accommodate a pediatric colonoscope. In its native state, the overtube is extremely flexible. Once the overtube is advanced to the desired location, application of a vacuum to the device causes the device to become 15 times stiffer. The endoscope can then be advanced through the overtube without loop formation in the region that the overtube traverses. RESULTS The overtube was used in 29 patients to assist with difficult procedures. Patients were predominantly men (n = 18; 62.1%), with a median age of 66 years (interquartile range, 57-72). One patient received an upper endoscopy (3.4%), 24 received colonoscopy (82.8%), and 4 received enteroscopy (13.8%). The overtube was used in 12 procedures for incomplete colonoscopy (41.4%), 6 for depth (20.7%), and 11 for stability (37.9%). Colonoscopy was performed in the setting of screening (n = 3), surveillance given polyp history (n = 7), referrals for polyp removal (n = 10), workup of iron deficiency anemia (n = 2), and incomplete colonoscopy (n = 1). The lower endoscopy cases had a median cecal intubation time of 5 minutes (interquartile range, 4.25-7). Enteroscopy was performed in 4 patients: In one patient the distal 60 cm of the ileum was examined with a pediatric colonoscope to exclude ileitis, in another the overtube was used to stabilize a 6-mm endoscope to traverse a tight Crohn's ileocolonic stricture, in a third patient altered-anatomy ERCP was performed using an enteroscope through the overtube to reach a hepaticojejunostomy, and in the final patient upper enteroscopy was performed and the mid-jejunum was reached. We present 4 cases that demonstrate the use of the overtube. There were no adverse events. CONCLUSIONS Initial experience with a novel rigidizing overtube suggests that this tool can be useful in colonoscopy and other endoscopic procedures affected by looping.
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Affiliation(s)
- Mike Tzuhen Wei
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA; Department of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Joo Ha Hwang
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Rabindra R Watson
- Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, California, USA
| | - Walter Park
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Shai Friedland
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA; Department of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
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Affiliation(s)
- Mike T Wei
- Stanford University, Stanford, California
- Veterans Affairs Palo Alto, Palo Alto California
| | | | | | - Shai Friedland
- Stanford University, Stanford, California
- Veterans Affairs Palo Alto, Palo Alto California
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10
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Lin L, Huang P. Transparent cap‐assisted, water‐exchange colonoscopy in previous incomplete difficult colonoscopy patients: A retrospective study. ADVANCES IN DIGESTIVE MEDICINE 2020. [DOI: 10.1002/aid2.13175] [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: 11/08/2022]
Affiliation(s)
- Lien‐Fu Lin
- Division of Hepato‐Gastroenterology, Department of Internal Medicine Tungs' Taichung Metro‐Harbor Hospital Taichung Taiwan
| | - Pi‐Teh Huang
- Division of Hepato‐Gastroenterology, Department of Internal Medicine Tungs' Taichung Metro‐Harbor Hospital Taichung Taiwan
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11
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Ricci ZJ, Kobi M, Flusberg M, Yee J. CT Colonography in Review With Tips and Tricks to Improve Performance. Semin Roentgenol 2020; 56:140-151. [PMID: 33858640 DOI: 10.1053/j.ro.2020.07.007] [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]
Affiliation(s)
- Zina J Ricci
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY.
| | - Mariya Kobi
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Milana Flusberg
- Westchester Medical Center/New York Medical College, Valhalla, NY
| | - Judy Yee
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
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12
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Parsa N, Vemulapalli KC, Rex DK. Performance of radiographic imaging after incomplete colonoscopy for nonmalignant causes in clinical practice. Gastrointest Endosc 2020; 91:1371-1377. [PMID: 32032619 DOI: 10.1016/j.gie.2020.01.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 01/22/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS CT colonography (CTC) or barium enema are commonly ordered to complete colorectal imaging after an incomplete colonoscopy. We evaluated the sensitivity of radiographic studies performed for this purpose in clinical practice outside clinical trials. METHODS Adult patients referred to an expert endoscopist for incomplete colonoscopy because of a redundant colon or a difficult sigmoid and who underwent previous radiographic imaging between July 2001 and July 2019 were identified. None of the patients had a malignant obstruction as the cause of incomplete colonoscopy. Data on polyp size, location, and pathology were obtained from colonoscopy and radiology reports. Polyps identified on imaging and colonoscopy were matched based on polyp size and location. RESULTS Among 769 patients referred for incomplete colonoscopy, we identified 65 with a radiographic examination performed within 36 months of colonoscopy at our center. Per-patient sensitivity for CTC was suboptimal (70%) and was very low for barium enema (26.7%). Per-polyp sensitivity for both CTC and barium enema was poor (23.8% and 7.6%). Quality of the examination did not seem to affect procedure sensitivity. CONCLUSIONS Radiographic imaging after incomplete colonoscopy for reasons other than malignant obstruction had poor sensitivity for polyps. Patients with incomplete colonoscopies should be considered for repeat colonoscopy by an expert.
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Affiliation(s)
- Nasim Parsa
- Division of Gastroenterology and Hepatology, University of Missouri, Columbia, Missouri, USA
| | - Krishna C Vemulapalli
- Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Douglas K Rex
- Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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13
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Park SW, Shin SP, Hong JT. Efficacy and Tolerability of Prucalopride in Bowel Preparation for Colonoscopy: A Systematic Review and Meta-Analysis. Adv Ther 2020; 37:2507-2519. [PMID: 32323193 DOI: 10.1007/s12325-020-01333-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Adequate bowel preparation is a vital determinant for the success of colonoscopy. However, individuals who undergo bowel preparation for colonoscopy can experience major discomfort. To solve this problem, adding prucalopride to the prepared solution may reduce intake volume, decreasing discomfort and side effects. We performed meta-analyses and systematic review of available randomized controlled trials. METHODS Meta-analyses were conducted to evaluate the overall relative risk and 95% confidence intervals in the combined studies for the assessment of primary outcome, which is the efficacy of bowel preparation with the addition of prucalopride. RESULTS Four randomized controlled trials involving 581 patients were included. When data were pooled for all patients in two non-inferiority studies, no significant difference in the quality of bowel preparation was observed between patients receiving prucalopride plus bowel preparation solution at a lower volume and those receiving the existing solution (relative risk: 0.94; 95% confidence interval: 0.86-1.03). The effects of prucalopride on acceptability, adverse events, adenoma detection rate, and polyp detection rate did not significantly differ from those of traditional solutions. CONCLUSIONS The combination of prucalopride and bowel preparation solution at a lower volume has similar effects on bowel preparation, and its use did not increase the occurrence of adverse effects.
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Affiliation(s)
- Sung-Wook Park
- Department of Internal Medicine, Nasaret International Hospital, Incheon, Korea
| | - Seok-Pyo Shin
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Ji Taek Hong
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea.
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14
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Oey RC, van Tilburg L, Erler NS, Metselaar HJ, Spaander MC, van Buuren HR, de Man RA. The Yield and Safety of Screening Colonoscopy in Patients Evaluated for Liver Transplantation. Hepatology 2019; 69:2598-2607. [PMID: 30767249 PMCID: PMC6593716 DOI: 10.1002/hep.30562] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 02/10/2019] [Indexed: 12/12/2022]
Abstract
Colorectal cancer (CRC) screening with colonoscopy is commonly used in patients who are candidates for liver transplantation. We initiated this study to define the risk-benefit ratio of performing screening colonoscopy in this population. A retrospective observational study of all consecutive patients undergoing colonoscopy during pre-liver transplantation screening between 2004 and 2017 was conducted. Endoscopic and pathological findings and clinical events potentially related to the colonoscopy in the 30 days after the procedure were registered and compared with a 30-day inpatient control time frame. A total of 858 colonoscopies were performed in 808 patients (65% male; median age, 55 years [interquartile range (IQR), 47-62]; median model for end-stage liver disease (MELD) score, 15 [IQR, 11-18]). CRC was found in 2 patients (0.2%), and advanced adenomas were found in 44 patients (5.4%). The only independent risk factor for an advanced neoplasm was age (odds ratio, 1.072 per year; 95% confidence interval, 1.031-1.115; P < 0.001). During the 30-day postprocedure period, 178 clinical events occurred in 128 patients compared with 101 clinical events in 72 patients in the control time frames (P < 0.001). After colonoscopy, there was a significantly increased risk for renal failure (P = 0.001) and gastrointestinal (GI) bleeding (P = 0.023). Presence of ascites and MELD score were identified as independent risk factors for acute renal failure and GI bleeding. During the study observation period, 53.5% of the screened population actually underwent liver transplantation. Conclusion: CRC screening in pre-liver transplantation patients is associated with a relatively low prevalence of CRC and an increased risk of postcolonoscopy complications such as acute renal failure and GI bleeding, especially in patients with advanced liver disease. Because the risk-benefit ratio of standard performance of a screening colonoscopy in this population appears questionable, alternative screening strategies should be considered.
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Affiliation(s)
- Rosalie C. Oey
- Department of Gastroenterology and HepatologyErasmus Medical Center University HospitalRotterdamthe Netherlands
| | - Laurelle van Tilburg
- Department of Gastroenterology and HepatologyErasmus Medical Center University HospitalRotterdamthe Netherlands
| | - Nicole S. Erler
- Department of BiostatisticsErasmus Medical Center University HospitalRotterdamthe Netherlands
| | - Herold J. Metselaar
- Department of Gastroenterology and HepatologyErasmus Medical Center University HospitalRotterdamthe Netherlands
| | - Manon C.W. Spaander
- Department of Gastroenterology and HepatologyErasmus Medical Center University HospitalRotterdamthe Netherlands
| | - Henk R. van Buuren
- Department of Gastroenterology and HepatologyErasmus Medical Center University HospitalRotterdamthe Netherlands
| | - Robert A. de Man
- Department of Gastroenterology and HepatologyErasmus Medical Center University HospitalRotterdamthe Netherlands
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15
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Gado A, Ebeid B, Abdelmohsen A, Gado T, Axon A. Endoscopy audit over 10 years in a community hospital in Egypt. ALEXANDRIA JOURNAL OF MEDICINE 2019. [DOI: 10.1016/j.ajme.2017.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Ahmed Gado
- Department of Medicine, Bolak Eldakror Hospital, Giza, EgyptDepartment of Medicine, Bolak Eldakror Hospital, Giza, Egypt
| | - Basel Ebeid
- Department of Tropical Medicine and Infectious Diseases, Beny Suef University, Beny Suef, EgyptDepartment of Tropical Medicine and Infectious Diseases, Beny Suef University, Beny Suef, Egypt
| | - Aida Abdelmohsen
- Department of Community Medicine, National Research Center, Giza, EgyptDepartment of Community Medicine, National Research Center, Giza, Egypt
| | - Tarek Gado
- Department of Medicine, Cairo university, Giza, EgyptDepartment of Medicine, Cairo university, Giza, Egypt
| | - Anthony Axon
- Department of Gastroenterology, The General Infirmary at Leeds, Leeds, United KingdomDepartment of Gastroenterology, The General Infirmary at Leeds, Leeds, United Kingdom
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16
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Choi SJ, Kim ES, Choi BK, Min G, Kim W, Lee JM, Lee JM, Kim SH, Choi HS, Keum B, Jeen YT, Lee HS, Chun HJ, Kim CD. A randomized controlled trial comparing the efficacy of 1-L polyethylene glycol solution with ascorbic acid plus prucalopride versus 2-L polyethylene glycol solution with ascorbic acid for bowel preparation. Scand J Gastroenterol 2018; 53:1619-1624. [PMID: 30621479 DOI: 10.1080/00365521.2018.1543450] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Bowel cleansing is a major patient complaint during colonoscopy. Adding laxatives to the bowel preparation is effective in replacing a portion of bowel preparation solution and reducing its volume. Prucalopride is a serotonin receptor agonist that stimulates gastrointestinal motility and provides propulsive force for defecation. This study aimed to compare 1 L polyethylene glycol (PEG) with ascorbic acid (Asc) plus 2 mg prucalopride (1LP/AP) and 2 L PEG with Asc (2LP/A) for colonoscopy preparation with respect to bowel-cleansing quality and side effects. METHODS A single-center, randomized, prospective study was conducted with 260 outpatients administered either 1LP/AP or 2LP/A. The primary endpoint was bowel preparation quality, which was evaluated using the Boston Bowel Preparation Scale and Aronchick Bowel Preparation Scale, and the secondary endpoints were patient tolerability and acceptability, assessed by a questionnaire-based survey. RESULTS The adequate bowel preparation rates were 88.5% and 83.1% in the 2LP/A and 1LP/AP groups, respectively, and the efficacy of 1LP/AP was equivalent to the control regimen (p=.216). Other colonoscopic variables including adenoma detection rate were similar in both groups. Patient tolerability and acceptability were not significantly different, but patients in the 1LP/AP group were more willing to repeat the same regimen (p=.039). CONCLUSIONS Bowel preparation quality with 1LP/AP was equivalent to that with 2LP/A, which did not increase the occurrence of side effects, but it reduced the volume of the solution ingested, and increased patient satisfaction.
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Affiliation(s)
- Seong Ji Choi
- a Department of Internal Medicine, Division of Gastroenterology and Hepatology , Korea University College of Medicine , Seoul , South Korea
| | - Eun Sun Kim
- a Department of Internal Medicine, Division of Gastroenterology and Hepatology , Korea University College of Medicine , Seoul , South Korea
| | - Byeong Kwang Choi
- a Department of Internal Medicine, Division of Gastroenterology and Hepatology , Korea University College of Medicine , Seoul , South Korea
| | - Geeho Min
- a Department of Internal Medicine, Division of Gastroenterology and Hepatology , Korea University College of Medicine , Seoul , South Korea
| | - Woojung Kim
- a Department of Internal Medicine, Division of Gastroenterology and Hepatology , Korea University College of Medicine , Seoul , South Korea
| | - Jung Min Lee
- a Department of Internal Medicine, Division of Gastroenterology and Hepatology , Korea University College of Medicine , Seoul , South Korea
| | - Jae Min Lee
- a Department of Internal Medicine, Division of Gastroenterology and Hepatology , Korea University College of Medicine , Seoul , South Korea
| | - Seung Han Kim
- a Department of Internal Medicine, Division of Gastroenterology and Hepatology , Korea University College of Medicine , Seoul , South Korea
| | - Hyuk Soon Choi
- a Department of Internal Medicine, Division of Gastroenterology and Hepatology , Korea University College of Medicine , Seoul , South Korea
| | - Bora Keum
- a Department of Internal Medicine, Division of Gastroenterology and Hepatology , Korea University College of Medicine , Seoul , South Korea
| | - Yoon Tae Jeen
- a Department of Internal Medicine, Division of Gastroenterology and Hepatology , Korea University College of Medicine , Seoul , South Korea
| | - Hong Sik Lee
- a Department of Internal Medicine, Division of Gastroenterology and Hepatology , Korea University College of Medicine , Seoul , South Korea
| | - Hoon Jai Chun
- a Department of Internal Medicine, Division of Gastroenterology and Hepatology , Korea University College of Medicine , Seoul , South Korea
| | - Chang Duck Kim
- a Department of Internal Medicine, Division of Gastroenterology and Hepatology , Korea University College of Medicine , Seoul , South Korea
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17
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Nusrat S, Madhoun MF, Tierney WM. Use of diphenhydramine as an adjunctive sedative for colonoscopy in patients on chronic opioid therapy: a randomized controlled trial. Gastrointest Endosc 2018; 88:695-702. [PMID: 29689257 DOI: 10.1016/j.gie.2018.04.2342] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 04/14/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Chronic opioid use increases tolerance to sedatives. Diphenhydramine is recommended for difficult-to-sedate patients during endoscopic procedures. We hypothesized that the addition of diphenhydramine to midazolam and fentanyl would improve objective and subjective measures of procedural sedation. METHODS This randomized, double-blind, placebo-controlled trial included patients on chronic opioids undergoing colonoscopy. Patients were randomized to receive 50 mg of diphenhydramine intravenously (n = 61) or placebo (n = 58), in addition to fentanyl and midazolam. Baseline characteristics, amount of fentanyl and midazolam, procedure times, and adverse events were recorded. Quality of sedation was assessed by the physician and nurse. Patients rated pain and amnesia on a 10-point scale. RESULTS There was no difference in amounts of fentanyl (125.4 ± 56.2 μg vs 126.9 ± 53.5 μg, P = .88) and midazolam (4.9 ± 2.1 mg vs 5 ± 1.9 mg, P = .79) used. The mean sedation scores from the physician (6.2 ± 1.1 vs 5.3 ± 1.2, P =.0002) and nurses (5.6 ± 1.5 vs 5.1 ± 1.4, P =.04) were statistically significant in favor of the diphenhydramine arm. Patient scores for pain (2.05 ± 2.17 vs 3.09 ± 3.95, P =.047) and amnesia (7.8 ± 3.4 vs 6.5 ± 3.8, P =.047) favored the group that received diphenhydramine. Qualitative assessment showed no significant difference between the groups. There was no difference in induction time (P = .86), procedure duration (P = .98), or recovery time (P = .16). Hypotensive episodes were more common in the placebo group (P = .027). CONCLUSIONS In patients on chronic opioid therapy, administration of diphenhydramine does not allow for lower doses of procedural sedatives but improves quality of sedation without increasing the number of adverse events. (Clinical trial registration number: NCT T01967433.).
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Affiliation(s)
- Salman Nusrat
- Department of Medicine, Section of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA; Department of Medicine, Section of Digestive Diseases and Nutrition, Veterans Affairs Medical Center, Oklahoma City, Oklahoma, USA
| | - Mohammed F Madhoun
- Department of Medicine, Section of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA; Department of Medicine, Section of Digestive Diseases and Nutrition, Veterans Affairs Medical Center, Oklahoma City, Oklahoma, USA
| | - William M Tierney
- Department of Medicine, Section of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA; Department of Medicine, Section of Digestive Diseases and Nutrition, Veterans Affairs Medical Center, Oklahoma City, Oklahoma, USA
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18
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Oh JR, Han KS, Hong CW, Kim BC, Kim B, Park SC, Kim MJ, Lee SJ, Oh JH, Shin C, Sohn DK. Colonoscopy learning curves for colorectal surgery fellow trainees: experiences with the 15-year colonoscopy training program. Ann Surg Treat Res 2018; 95:169-174. [PMID: 30310799 PMCID: PMC6172355 DOI: 10.4174/astr.2018.95.4.169] [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: 01/26/2018] [Revised: 03/24/2018] [Accepted: 05/04/2018] [Indexed: 12/22/2022] Open
Abstract
Purpose This study aimed to analyze the learning curves for colorectal surgery fellows in a colonoscopy training program. Methods Between May 2003 and February 2017, 60 surgical fellows joined our 1-year colonoscopy training program as trainees and performed 43,784 cases of colonoscopy. All trainees recorded their colonoscopy experiences prospectively into the database. After excluding 6 trainees, who had experience with performing more than 50 colonoscopies before participating in our training program or who discontinued our training program with experience performing less than 300 colonoscopies, this study included 54 trainees who had performed 39,539 colonoscopy cases. We analyzed the cecal intubation rate (CIR) and cecal intubation time (CIT) using the cumulative sum (Cusum) technique and moving average method to assess the technical colonoscopy competence. Results Overall, the CIR by the trainees was 80.7%. The median number of cases of colonoscopy performed during the training period for each trainee was 696 (range, 322–1,669). The trainees were able to achieve a 90% CIR with 412 and 493 procedures when analyzed using the moving average and the Cusum, respectively. Using the moving average method, CIRs after 150, 300, and 400 procedures were 67.0%, 84.1%, and 89.2%, respectively. The CIT of trainees continuously decreased until 400 successful cases. Median CITs were 9.4, 8.3, and 7.4 minutes at 150, 300, and 400 successful cases, respectively. Conclusion We found that more than 400 cases of experience were needed for technical competence in colonoscopy. Continuous teaching and monitoring is required until trainees become sufficiently competent.
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Affiliation(s)
- Jung Ryul Oh
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Kyung Su Han
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Chang Won Hong
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Byung Chang Kim
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Bun Kim
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Sung Chan Park
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Min Jung Kim
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Sang Jae Lee
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Jae Hwan Oh
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Changha Shin
- Innovative Medical Engineering & Technology, Division of Convergence Technology, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Dae Kyung Sohn
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.,Innovative Medical Engineering & Technology, Division of Convergence Technology, Research Institute and Hospital, National Cancer Center, Goyang, Korea
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19
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Alatise OI, Ayandipo OO, Adeyeye A, Seier K, Komolafe AO, Bojuwoye MO, Afuwape OO, Zauber A, Omisore A, Olatoke S, Akere A, Famurewa O, Gonen M, Irabor DO, Kingham TP. A symptom-based model to predict colorectal cancer in low-resource countries: Results from a prospective study of patients at high risk for colorectal cancer. Cancer 2018; 124:2766-2773. [PMID: 29645077 DOI: 10.1002/cncr.31399] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 03/16/2018] [Accepted: 03/20/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Colorectal cancer (CRC) rates in low-resource countries, which typically lack CRC screening programs, are rising. This study determined whether a risk model for patients with rectal bleeding could identify patients with curable CRC. METHODS This prospective, cross-sectional study evaluated a model constructed from data from 1 hospital and validated at 2 other hospitals. The primary endpoint was the ability of the model to predict CRC, as diagnosed by colonoscopy, from clinical characteristics. The secondary endpoint was to determine the percentage of patients who had CRC. RESULTS Consecutive patients who were 45 years old or older and had self-reported rectal bleeding for more than 1 week were evaluated. From January 2014 to July 2016, 362 patients answered a questionnaire and underwent colonoscopy. In the validation cohort, 56% of patients with rectal bleeding, weight loss, and changes in bowel habits had CRC, whereas 2% of patients with bleeding alone did. Overall, 18.2% of the patients had CRC, and 8.6% had adenomas. The proportion of CRC patients with potentially curable stage II or III disease was 74%, whereas the historical rate was 36%. The combination of rectal bleeding with both symptoms significantly predicted CRC in the validation set (odds ratio, 12.8; 95% confidence interval, 4.6-35.4; P < .001). CONCLUSIONS In low-resource settings, patients with rectal bleeding, weight loss, and changes in bowel habits should be classified as high risk for CRC. Patients with a high risk score should be prioritized for colonoscopy to increase the number of patients diagnosed with potentially curable CRC. Cancer 2018;124:2766-2773. © 2018 American Cancer Society.
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Affiliation(s)
- Olusegun Isaac Alatise
- Faculty of Clinical Sciences, College of Health Sciences, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria.,Surgeons OverSeas, New York, New York
| | | | | | - Ken Seier
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Akinwunmi O Komolafe
- Faculty of Clinical Sciences, College of Health Sciences, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | | | | | - Ann Zauber
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Adeleye Omisore
- Faculty of Clinical Sciences, College of Health Sciences, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | | | | | - Olusola Famurewa
- Faculty of Clinical Sciences, College of Health Sciences, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Mithat Gonen
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - T Peter Kingham
- Surgeons OverSeas, New York, New York.,Memorial Sloan Kettering Cancer Center, New York, New York
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20
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Trindade AJ, Lichtenstein DR, Aslanian HR, Bhutani MS, Goodman A, Melson J, Navaneethan U, Pannala R, Parsi MA, Sethi A, Sullivan S, Thosani N, Trikudanathan G, Watson RR, Maple JT. Devices and methods to improve colonoscopy completion (with videos). Gastrointest Endosc 2018; 87:625-634. [PMID: 29454445 DOI: 10.1016/j.gie.2017.12.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 12/22/2017] [Indexed: 02/08/2023]
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21
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Shah-Khan SM, Cumberledge J, Reynolds GJ. Using the plan-do-study-act approach to improve inpatient colonoscopy preparation. BMJ Open Qual 2018; 6:e000230. [PMID: 29435514 PMCID: PMC5728268 DOI: 10.1136/bmjoq-2017-000230] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 11/21/2017] [Accepted: 11/21/2017] [Indexed: 02/07/2023] Open
Abstract
Poor inpatient colonoscopy preparations can provide multiple challenges to healthcare providers and patients alike. Poor preparations can make the colonoscopy difficult to perform, and can require the procedure to be repeated. This can in turn lead to greater costs, longer length of stays, less patient satisfaction and worse outcomes. The aim of this quality improvement project was to decrease the rate of poor inpatient colonoscopy preparations using the plan-do-study-act approach. Inpatient colonoscopies at our institution from a 3-month span (November 2016 to January 2017) were evaluated, and found to have a 19% rate of poor preparations. A multiphase intervention programme was then conducted to improve the quality of these preparations. This intervention programme was threefold, and involved (1) direct education to physicians and nursing staff on the preparation process and its importance; (2) the implementation of an electronic order set within our electronic medical record (EMR) to standardise and simplify the process of ordering colonoscopy preparations; and (3) patient education in the form of a handout explaining the steps and importance of a good preparation. Through these interventions, we were able to bring down our rate of poor preparations over a 3-month average from 19% to 4%. Specifically, the implementation of an electronic order set within our EMR resulted in the greatest impact. Our interventions can be replicated at other institutions in order to decrease the rate of poor preparations, and thus result in better outcomes for patients, providers and healthcare facilities.
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Affiliation(s)
| | - Jeremy Cumberledge
- Department of Digestive Diseases, West Virginia University, Morgantown, West Virginia, USA
| | - Gorman Joel Reynolds
- Department of Digestive Diseases, West Virginia University, Morgantown, West Virginia, USA
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22
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Enns RA, Hookey L, Armstrong D, Bernstein CN, Heitman SJ, Teshima C, Leontiadis GI, Tse F, Sadowski D. Clinical Practice Guidelines for the Use of Video Capsule Endoscopy. Gastroenterology 2017; 152:497-514. [PMID: 28063287 DOI: 10.1053/j.gastro.2016.12.032] [Citation(s) in RCA: 242] [Impact Index Per Article: 34.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Video capsule endoscopy (CE) provides a noninvasive option to assess the small intestine, but its use with respect to endoscopic procedures and cross-sectional imaging varies widely. The aim of this consensus was to provide guidance on the appropriate use of CE in clinical practice. METHODS A systematic literature search identified studies on the use of CE in patients with Crohn's disease, celiac disease, gastrointestinal bleeding, and anemia. The quality of evidence and strength of recommendations were rated using the Grading of Recommendation Assessment, Development, and Evaluation (GRADE) approach. RESULTS The consensus includes 21 statements focused on the use of small-bowel CE and colon capsule endoscopy. CE was recommended for patients with suspected, known, or relapsed Crohn's disease when ileocolonoscopy and imaging studies were negative if it was imperative to know whether active Crohn's disease was present in the small bowel. It was not recommended in patients with chronic abdominal pain or diarrhea, in whom there was no evidence of abnormal biomarkers typically associated with Crohn's disease. CE was recommended to assess patients with celiac disease who have unexplained symptoms despite appropriate treatment, but not to make the diagnosis. In patients with overt gastrointestinal bleeding, and negative findings on esophagogastroduodenoscopy and colonoscopy, CE should be performed as soon as possible. CE was recommended only in selected patients with unexplained, mild, chronic iron-deficiency anemia. CE was suggested for surveillance in patients with polyposis syndromes or other small-bowel cancers, who required small-bowel studies. Colon capsule endoscopy should not be substituted routinely for colonoscopy. Patients should be made aware of the potential risks of CE including a failed procedure, capsule retention, or a missed lesion. Finally, standardized criteria for training and reporting in CE should be defined. CONCLUSIONS CE generally should be considered a complementary test in patients with gastrointestinal bleeding, Crohn's disease, or celiac disease, who have had negative or inconclusive endoscopic or imaging studies.
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Affiliation(s)
- Robert A Enns
- Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Lawrence Hookey
- Division of Gastroenterology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - David Armstrong
- Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Charles N Bernstein
- Section of Gastroenterology, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Steven J Heitman
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Christopher Teshima
- Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Grigorios I Leontiadis
- Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Frances Tse
- Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Daniel Sadowski
- Division of Gastroenterology, Royal Alexandria Hospital, Edmonton, Alberta, Canada
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23
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Bick BL, Vemulapalli KC, Rex DK. Regional center for complex colonoscopy: yield of neoplasia in patients with prior incomplete colonoscopy. Gastrointest Endosc 2016; 83:1239-44. [PMID: 26584785 DOI: 10.1016/j.gie.2015.10.053] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 10/29/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Incomplete colonoscopy increases the risk of incident proximal colon cancer postcolonoscopy. Incomplete colonoscopy is often followed by barium enema or CT colonography. We sought to describe the yield of completion colonoscopy in a regional center for complex colonoscopy. METHODS This is a retrospective cohort study of 520 consecutive patients referred to a single colonoscopist over a 14-year period for completion colonoscopy after a previous incomplete examination. RESULTS Colonoscopy was completed to the cecum in 506 of 520 patients (97.3%). A total of 913 conventional adenomas was removed in 277 patients (adenoma detection rate 53.3%). There were 184 adenomas ≥ 1 cm in size or with advanced pathology. There were 525 serrated-class lesions removed in 175 patients, including 54 sessile serrated polyps in 26 patients and 41 hyperplastic polyps greater than 1 cm in 26 patients. Nine colorectal cancers were found. We estimated that approximately 57% of the conventional adenomas, 58% of the sessile serrated polyps, 27% of the hyperplastic polyps, and all 9 cancers detected by the completion colonoscopy were beyond the extent of the previous examination. CONCLUSIONS The yield of completion colonoscopy in a cohort of patients with previous failed cecal intubation was substantial. Regional centers for complex colonoscopy can provide high rates of cecal intubation in cases of incomplete colonoscopy and high yields of lesions in these cases. The regional center for complex colonoscopy is an important medical service.
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Affiliation(s)
- Benjamin L Bick
- Department of Medicine, Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Krishna C Vemulapalli
- Department of Medicine, Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Douglas K Rex
- Department of Medicine, Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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24
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赖 雪, 汤 小, 黄 思, 龚 伟, 智 发, 刘 思, 陈 烨. [Risk factors of pain during colonoscopic examination]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2016; 37:482-487. [PMID: 28446400 PMCID: PMC6744110 DOI: 10.3969/j.issn.1673-4254.2017.04.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To investigate the risk factorsthat predict pain during colonoscopy for decision of sedation or analgesia before the examination. METHODS A total of 283 consecutive patients undergoing colonoscopicexamination at Nanfang Hospital between July, 2016 and September, 2016were retrospectively analyzed. The clinical data and visual analogue scale after the examination were analyzed to identify the risk factors for pain during colonoscopy using univariate analysis and multivariate logistic regression. A risk stratification model for predicting pain in colonoscopy was established. RESULTS The completion rate of the procedure was significantly lower in patients with a visual analogue scale ≥5 (P<0.000). Univariate analysis showed that female patients, previous abdominal surgery, no previous experience with colonoscopy, complaint of abdominal pain before colonoscopy, insufficient experience of the endoscopists, patient's anticipation of high painlevelbefore examination, and a low body mass index (BMI) were all associated with the experience of pain in colonoscopy (P<0.05). Multivariate logistic regressionanalysis identified BMI index (X1), level of experience of the endoscopist (A1, A2, A3) and the patient's anticipation of painlevel (X2) as the risk factors of pain in colonoscopy(P<0.05), and the establishedmodel with the 3 variables was: P=eY/(1+eY),Y=0.049-0.124×X1-0.97×X2+1.713×A1+0.781×A2+0.147×A3, which showed a sensitivity of 70.3% and a specificity of 67.5%for predicting pain in colonoscopy. CONCLUSION The patient's anticipation of a high pain level in colonoscopy, insufficient experience of the endoscopist, and a low BMI are the independent risk factors for pain in colonoscopy, and evaluation of these factors can help in the decision-making concerning the use of sedation or analgesia before colonoscopy.
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Affiliation(s)
- 雪莹 赖
- />南方医科大学南方医院消化内科,广东 广州 510515Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 小伟 汤
- />南方医科大学南方医院消化内科,广东 广州 510515Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 思霖 黄
- />南方医科大学南方医院消化内科,广东 广州 510515Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 伟 龚
- />南方医科大学南方医院消化内科,广东 广州 510515Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 发朝 智
- />南方医科大学南方医院消化内科,广东 广州 510515Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 思德 刘
- />南方医科大学南方医院消化内科,广东 广州 510515Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 烨 陈
- />南方医科大学南方医院消化内科,广东 广州 510515Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
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Sulz MC, Frei R, Semadeni GM, Sawatzki M, Borovicka J, Meyenberger C. The role of single-balloon colonoscopy for patients with previous incomplete standard colonoscopy: Is it worth doing it? Surg Endosc 2015; 30:1876-82. [PMID: 26183958 DOI: 10.1007/s00464-015-4405-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Accepted: 07/02/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND The rate of cecal intubation is a well-recognized quality measure of successful colonoscopy. Infrequently, the standard colonoscopy techniques fail to achieve complete examination. The role of single-balloon overtube-assisted colonoscopy (SBC) in these situations has only been sparsely studied. This prospective single-center study aimed to investigate the technical success (rate of cecal intubation) and the diagnostic gain of SBC. METHODS The study recruited consecutive patients with previous incomplete standard colonoscopy who were admitted for SBC at our tertiary center in Eastern Switzerland between February 2008 and October 2014. The primary outcome was defined as successful cecal intubation. Data on patient characteristics, indication, technical details of procedure, and outcome were collected prospectively. The Olympus enteroscope SIF-Q180 was used. RESULTS The study included 100 consecutive patients (median age 70 years; range 38-87 years; 54 % female) who were examined using a single-balloon overtube-assisted technique. The cecal intubation rate was 98 % (98/100). The median time of total procedure was 54 min (range 15-119 min); the median time to reach the cecal pole was 27.5 min (range 4-92 min). Passage of the sigmoid colon was not possible in two cases with a fixed, angulated sigmoid colon. The diagnostic gain was 21 % regarding adenomatous polyps in the right colon. The complication rate was 2 % (2/100, minor) without need for surgery. CONCLUSIONS This prospective patient cohort study shows that single-balloon colonoscopy is a safe and effective procedure to achieve a complete endoscopic examination in patients with a previous failed standard colonoscopy. A significant diagnostic and therapeutic gain in the right colon justifies additional procedure time.
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Affiliation(s)
- Michael Christian Sulz
- Division of Gastroenterology and Hepatology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland.
| | - Remus Frei
- Division of Gastroenterology and Hepatology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
| | - Gian-Marco Semadeni
- Division of Gastroenterology and Hepatology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
| | - Mikael Sawatzki
- Division of Gastroenterology and Hepatology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
| | - Jan Borovicka
- Division of Gastroenterology and Hepatology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
| | - Christa Meyenberger
- Division of Gastroenterology and Hepatology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
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Heetun Z, Crowley R, Zeb F, Kearns D, Brennan MH, O'Connor C, Courtney G, Aftab AR. Comparison of polyethylene glycol vs sodium picosulphate vs sodium biphosphonate by efficacy in bowel cleansing and patients' tolerability: a randomised trial. Ir J Med Sci 2015; 185:629-633. [PMID: 26024926 DOI: 10.1007/s11845-015-1320-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 05/23/2015] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Adequate bowel preparation is necessary for a complete colonoscopy. Polyethylene glycol-electrolyte oral solution (PEG-EOS), sodium picosulphate (SS) and sodium biphosphonate (SP) are the three most commonly used purgative agents. We aimed to determine their efficacy and tolerability compared to each other in a randomised study. METHODS 313 patients were randomly assigned to receive either PEG-EOS, SS or SP. Patients completed a tolerability score pre-colonoscopy. A cleanliness score was used to document adequacy of bowel preparation. A separate group of patients completed taste scores for the three cathartic agents before and after addition of flavour. RESULTS PEG-EOS was the worst-tolerated regimen but achieved the highest rates of right colonic cleansing and the lowest rate of incomplete colonoscopies. There were no statistical differences in the rates of rectosigmoid and mid-gut cleansing among the three agents. SS was by far the preferred purgative in the taste assessment study. Addition of flavour increased significantly taste scores for PEG-EOS. CONCLUSION For adequate bowel cleansing PEG-EOS is the most effective but is the least tolerated and least preferred among patients. Addition of flavour increases significantly patients' acceptance of PEG-EOS.
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Affiliation(s)
- Z Heetun
- Department of Gastroenterology and Hepatology, St Luke's Hospital, Kilkenny, Ireland.
| | - R Crowley
- Department of Gastroenterology and Hepatology, St Luke's Hospital, Kilkenny, Ireland
| | - F Zeb
- Department of Gastroenterology and Hepatology, St Luke's Hospital, Kilkenny, Ireland
| | - D Kearns
- Department of Gastroenterology and Hepatology, St Luke's Hospital, Kilkenny, Ireland
| | - M H Brennan
- Department of Gastroenterology and Hepatology, St Luke's Hospital, Kilkenny, Ireland
| | - C O'Connor
- Department of Gastroenterology and Hepatology, St Luke's Hospital, Kilkenny, Ireland
| | - G Courtney
- Department of Gastroenterology and Hepatology, St Luke's Hospital, Kilkenny, Ireland
| | - A R Aftab
- Department of Gastroenterology and Hepatology, St Luke's Hospital, Kilkenny, Ireland
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Ward ST, Mohammed MA, Walt R, Valori R, Ismail T, Dunckley P. An analysis of the learning curve to achieve competency at colonoscopy using the JETS database. Gut 2014; 63:1746-54. [PMID: 24470280 PMCID: PMC4215302 DOI: 10.1136/gutjnl-2013-305973] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The number of colonoscopies required to reach competency is not well established. The primary aim of this study was to determine the number of colonoscopies trainees need to perform to attain competency, defined by a caecal intubation rate (CIR) ≥90%. As competency depends on completion, we also investigated trainee factors that were associated with colonoscopy completion. DESIGN The Joint Advisory Group on GI Endoscopy in the UK has developed a trainee e-portfolio from which colonoscopy data were retrieved. Inclusion criteria were all trainees who had performed a total of ≥20 colonoscopies and had performed ≤50 colonoscopies prior to submission of data to the e-portfolio. The primary outcome measure was colonoscopy completion. The number of colonoscopies required to achieve CIR ≥90% was calculated by the moving average method and learning curve cumulative summation (LC-Cusum) analysis. To determine factors which determine colonoscopy completion, a mixed effect logistic regression model was developed which allowed for nesting of patients within trainees and nesting of patients within hospitals, with various patient, trainee and training factors entered as fixed effects. RESULTS 297 trainees undertook 36 730 colonoscopies. By moving average analysis, the cohort of trainees reached a CIR of 90% at 233 procedures. By LC-Cusum analysis, 41% of trainees were competent after 200 procedures. Of the trainee factors, the number of colonoscopies, intensity of training and previous flexible sigmoidoscopy experience were significant factors associated with colonoscopy completion. CONCLUSIONS This is the largest study to date investigating the number of procedures required to achieve competency in colonoscopy. The current training certification benchmark in the UK of 200 procedures does not appear to be an inappropriate minimum requirement. The LC-Cusum chart provides real time feedback on individual learning curves for trainees. The association of training intensity and flexible sigmoidoscopy experience with colonoscopy completion could be exploited in training programmes.
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Affiliation(s)
- Stephen Thomas Ward
- Centre for Liver Research and NIHR Birmingham Biomedical Research Unit, Level 5 Institute for Biomedical Research, University of Birmingham, Birmingham, UK
| | | | - Robert Walt
- Department of Gastroenterology and GI Surgery, Queen Elizabeth Hospital, Birmingham, UK
| | - Roland Valori
- Department of Gastroenterology, Gloucestershire Royal Hospital, Gloucester, UK
| | - Tariq Ismail
- Department of Gastroenterology and GI Surgery, Queen Elizabeth Hospital, Birmingham, UK
| | - Paul Dunckley
- Department of Gastroenterology, Gloucestershire Royal Hospital, Gloucester, UK
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Gawron AJ, Veerappan A, Keswani RN. High success rate of repeat colonoscopy with standard endoscopes in patients referred for prior incomplete colonoscopy. BMC Gastroenterol 2014; 14:56. [PMID: 24679009 PMCID: PMC3986859 DOI: 10.1186/1471-230x-14-56] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 03/21/2014] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND In patients with incomplete colonoscopy, cecal intubation is sometimes unsuccessful due to a redundant or tortuous colon. Repeat colonoscopy may be successful with the use of alternate endoscopes or careful attention to technique but limited outcomes data is available. The aim of this study was to describe the technique, success rate and outcomes of consecutive patients referred for previous incomplete colonoscopy. METHODS We conducted a retrospective chart review of incomplete colonoscopy procedures in patients age 18-90 at an academic teaching hospital referred to an endoscopist specializing in difficult colonoscopy. RESULTS Cecal intubation was successful in 96 of 100 repeat colonoscopies and 83 procedures were completed with a standard endoscope (adult, pediatric, or gastroscope). The adenoma detection rate was 28% for successful repeat colonoscopies; a majority of these patients had no adenomas identified on incomplete exam. In 69.4% of cases, an endoscope was used to successfully complete colonoscopy that was not used in the incomplete colonoscopy. The median insertion time was significantly less for the complete colonoscopy (10.6 min) compared to the incomplete colonoscopy (18.8 min, P = 0.004). CONCLUSIONS Repeat colonoscopy has a high success rate and identified a significant number of new adenomas. Use of all available endoscopes should be considered prior to procedure termination in patients with a tortuous colon. Repeat colonoscopy can often be accomplished using a standard endoscope and is not attributed to increased endoscope insertion time.
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Affiliation(s)
| | | | - Rajesh N Keswani
- Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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Colon capsule endoscopy is feasible to perform after incomplete colonoscopy and guides further workup in clinical practice. Gastrointest Endosc 2014; 79:307-16. [PMID: 24060522 DOI: 10.1016/j.gie.2013.07.061] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 07/31/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND Colon capsule endoscopy (CCE) could be an option to examine the colon after incomplete colonoscopy. OBJECTIVE To investigate the extent that CCE complements incomplete colonoscopy and guides further workup. DESIGN Prospective, follow-up study. SETTING Three tertiary-care centers. PATIENTS Consecutive outpatients after colonoscopy failure; 1-year study period. INTERVENTION Patients underwent CCE either immediately after colonoscopy or were rescheduled. Further investigations were guided by the results of CCE. Patients were followed as long as 2 years. RESULTS We studied 75 outpatients; 39 had a screening colonoscopy. One third of the patients underwent CCE immediately after colonoscopy. Overall, CCE reached or went beyond the colon segment at which colonoscopy stopped in 68 patients (91%). CCE technically complemented difficult colonoscopy independently of whether same-day CCE was performed (24 [96%]) or was not performed (44 [88%]). CCE detected additional significant findings in 36% of the same-day CCE cases and in 48% of the rescheduled ones. Two patients in the same-day group and 13 in the rescheduled CCE group underwent further colon examination that revealed additional significant findings in 3 of them. Ten percent of the patients reported mild adverse events (AE). If needed, 63 participants (84%) were willing to repeat CCE. Follow-up has not identified symptomatic missed colon cancers. LIMITATIONS Selected patient population, first-generation colon capsule, old preparation scheme. CONCLUSION CCE performed immediately or at a scheduled date after colonoscopy failure is feasible and safe. CCE after incomplete colonoscopy appears to yield significant findings, guide further workup, and has high patient acceptance.
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Patient-controlled analgesia with inhaled methoxyflurane versus conventional endoscopist-provided sedation for colonoscopy: a randomized multicenter trial. Gastrointest Endosc 2013; 78:892-901. [PMID: 23810328 DOI: 10.1016/j.gie.2013.05.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 05/13/2013] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Inhaled methoxyflurane (Penthrox, Medical Device International, Melbourne, Australia) has been used extensively in Australasia (Australia and New Zealand) to manage trauma-related pain. The aim is to evaluate the efficacy, safety, and outcome of Penthrox for colonoscopy. DESIGN Prospective randomized study. SETTING Three tertiary endoscopic centers. PATIENTS Two hundred fifty-one patients were randomized to receive either Penthrox (n = 125, 70 men, 51.4 ± 1.1 years old) or intravenous midazolam and fentanyl (M&F; n = 126, 72 men, 54.9 ± 1.1 years old) during colonoscopy. MAIN OUTCOME MEASUREMENT Discomfort (visual analogue scale [VAS] pain score), anxiety (State-Trait Anxiety Inventory Form Y [STAI-Y] anxiety score), colonoscopy performance, adverse events, and recovery time. RESULTS Precolonoscopy VAS pain and STAI-Y scores were comparable between the 2 groups. There were no differences between groups in (1) pain VAS or STAI Y-1 anxiety scores during or immediately after colonoscopy, (2) procedural success rate (Penthrox: 121/125 vs M&F: 124/126), (3) hypotension during colonoscopy (7/125 vs 8/126), (4) tachycardia (5/125 vs 3/126), (5) cecal arrival time (8 ± 1 vs 8 ± 1 minutes), or (6) polyp detection rate (30/125 vs 43/126). Additional intravenous sedation was required in 10 patients (8%) who received Penthrox. Patients receiving Penthrox alone had no desaturation (oxygen saturation [SaO(2)] < 90%) events (0/115 vs 5/126; P = .03), awoke quicker (3 ± 0 vs 19 ± 1 minutes; P < .001) and were ready for discharge earlier (37 ± 1 vs 66 ± 2 minutes; P < .001) than those receiving intravenous M&F. LIMITATIONS Inhaled Penthrox is not yet available in the United States and Europe. CONCLUSIONS Patient-controlled analgesia with inhaled Penthrox is feasible and as effective as conventional sedation for colonoscopy with shorter recovery time, is not associated with respiratory depression, and does not influence the procedural success and polyp detection.
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Onyekwere CA, Odiagah JN, Ogunleye OO, Chibututu C, Lesi OA. Colonoscopy practice in lagos, Nigeria: a report of an audit. DIAGNOSTIC AND THERAPEUTIC ENDOSCOPY 2013; 2013:798651. [PMID: 23533321 PMCID: PMC3600188 DOI: 10.1155/2013/798651] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Accepted: 01/25/2013] [Indexed: 12/31/2022]
Abstract
Background. Colonoscopy effectiveness depends on the quality of the examination. Community-based report of quality of colonoscopy practice in a developing country will help in determining standard and also serve as a stimulus for improvement in service. Aim. To review the quality of colonoscopy practice and document pattern of colonic disease including polyp detection rate in Lagos, Nigeria. Method. A protocol that captured the patients' demographics, indication, and some quality indices of colonoscopy was developed and sent to all the identified colonoscopy units in Lagos to complete for all procedures performed between January 2011 and June 2012. All data were collated and analyzed. The quality indices studied were compared with guideline standard. Results. Twelve colonoscopy centers were identified but only nine centers responded. The gastroenterologist/endoscopists were physicians (3) and surgeons (5). Six hundred and seven colonoscopy procedures were performed during this period (M : F = 333 : 179) while the sex was not disclosed in 95 subjects. The examination indications were lower GI bleeding (24.2%), altered bowel habits (9.2%), lower abdominal pain (9.1%), screening for CRC (4.3%) and unspecified (46.8%). Conscious sedation was generally used while bowel preparation (good in 81.4%) was done with low residue diet and stimulant laxatives. Caecal intubation rate was 81.2%. Common endoscopic findings were haemorrhoids (43.2%), polyps/masses (13.4%), diverticulosis (11.1%), and no abnormality (23.4%). Polyp was detected in 6.8% of cases. Conclusion. Colonoscopy utilization is low, and the quality of practice is suboptimal; although limited resources could partly explain this, however it is not clear if the low rate of polyp detection is due to missed lesions or low population incidence.
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Affiliation(s)
- C. A. Onyekwere
- Gastroenterology Unit, Department of Medicine, Lagos State University College of Medicine/Teaching Hospital, P.O. Box 203 Satelitte Town, Lagos, Nigeria
| | - J. N. Odiagah
- Gastroenterology Unit, Department of Medicine, Lagos State University Teaching Hospital, PMB 21266, Ikeja, Lagos, Nigeria
| | - O. O. Ogunleye
- Clinical Pharmacology Unit, Department of Medicine, Lagos State University College of Medicine/Teaching Hospital, PMB 21266, Ikeja, Lagos, Nigeria
| | | | - O. A. Lesi
- Department of Medicine, University of Lagos College of Medicine/Teaching Hospital, Private Mail Bag 12003, Lagos, Nigeria
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