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Spinou M, Kyvelou E, Aggelopoulos G, Ziogas DΙ, Panagaki A, Manti M, Papaefthymiou A, Gkolfakis P, Facciorusso A, Mathou N, Giannakopoulos A, Triantafyllou K, Paraskeva KD, Vezakis A, Vlachogiannakos I, Karamanolis G, Tziatzios G. Safe outpatient discharge after gastrointestinal endoscopy with sedation and analgesia: a systematic literature review. Ann Gastroenterol 2024; 37:499-508. [PMID: 39238791 PMCID: PMC11372546 DOI: 10.20524/aog.2024.0899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 05/27/2024] [Indexed: 09/07/2024] Open
Abstract
Sedation and analgesia during gastrointestinal (GI) endoscopy increase procedural quality, contributing at the same time to greater patient satisfaction and willingness to undergo the procedure. Although sedation use has been optimized by the advent of efficacious and safe medications, data regarding the minimal criteria for discharge after outpatient endoscopy remain scant. Moreover, the time of discharge after endoscopy can be highly variable, depending not only on the type of procedure and anesthesia administered, but also on postprocedural complications and the patient's comorbidities. To make things even more conflicting, there is neither consensus among various endoscopic societies, concerning the most appropriate discharge strategy, nor a universally established tool that could be incorporated into everyday clinical practice, allowing patients' safe discharge as well as ability to drive. In this context, we conducted a systematic review, aiming to summarize the evidence regarding the available discharge scoring systems after outpatient GI endoscopy with sedation and analgesia administration.
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Affiliation(s)
- Marianna Spinou
- Department of Gastroenterology, "Konstantopoulio-Patision" General Hospital of Nea Ionia, Athens, Greece (Marianna Spinou, Eleni Kyvelou, Giorgos Aggelopoulos, Antonia Panagaki, Magdalini Manti, Paraskevas Gkolfakis, Nikoletta Mathou, Athanasios Giannakopoulos, Konstantina D. Paraskeva, Georgios Tziatzios)
| | - Eleni Kyvelou
- Department of Gastroenterology, "Konstantopoulio-Patision" General Hospital of Nea Ionia, Athens, Greece (Marianna Spinou, Eleni Kyvelou, Giorgos Aggelopoulos, Antonia Panagaki, Magdalini Manti, Paraskevas Gkolfakis, Nikoletta Mathou, Athanasios Giannakopoulos, Konstantina D. Paraskeva, Georgios Tziatzios)
| | - Giorgos Aggelopoulos
- Department of Gastroenterology, "Konstantopoulio-Patision" General Hospital of Nea Ionia, Athens, Greece (Marianna Spinou, Eleni Kyvelou, Giorgos Aggelopoulos, Antonia Panagaki, Magdalini Manti, Paraskevas Gkolfakis, Nikoletta Mathou, Athanasios Giannakopoulos, Konstantina D. Paraskeva, Georgios Tziatzios)
| | - Dimitrios Ι Ziogas
- 1 Department of Internal Medicine, 251 Hellenic Air Force & VA General Hospital, Athens, Greece (Dimitrios Ι. Ziogas)
| | - Antonia Panagaki
- Department of Gastroenterology, "Konstantopoulio-Patision" General Hospital of Nea Ionia, Athens, Greece (Marianna Spinou, Eleni Kyvelou, Giorgos Aggelopoulos, Antonia Panagaki, Magdalini Manti, Paraskevas Gkolfakis, Nikoletta Mathou, Athanasios Giannakopoulos, Konstantina D. Paraskeva, Georgios Tziatzios)
| | - Magdalini Manti
- Department of Gastroenterology, "Konstantopoulio-Patision" General Hospital of Nea Ionia, Athens, Greece (Marianna Spinou, Eleni Kyvelou, Giorgos Aggelopoulos, Antonia Panagaki, Magdalini Manti, Paraskevas Gkolfakis, Nikoletta Mathou, Athanasios Giannakopoulos, Konstantina D. Paraskeva, Georgios Tziatzios)
| | - Apostolis Papaefthymiou
- Endoscopy Unit, Cleveland Clinic London, London, United Kingdom (Apostolis Papaefthymiou)
- Department of Gastroenterology, General University Hospital of Larissa, Greece (Apostolis Papaefthymiou)
| | - Paraskevas Gkolfakis
- Department of Gastroenterology, "Konstantopoulio-Patision" General Hospital of Nea Ionia, Athens, Greece (Marianna Spinou, Eleni Kyvelou, Giorgos Aggelopoulos, Antonia Panagaki, Magdalini Manti, Paraskevas Gkolfakis, Nikoletta Mathou, Athanasios Giannakopoulos, Konstantina D. Paraskeva, Georgios Tziatzios)
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Medical Sciences, University of Foggia, Italy (Antonio Facciorusso)
| | - Nikoletta Mathou
- Department of Gastroenterology, "Konstantopoulio-Patision" General Hospital of Nea Ionia, Athens, Greece (Marianna Spinou, Eleni Kyvelou, Giorgos Aggelopoulos, Antonia Panagaki, Magdalini Manti, Paraskevas Gkolfakis, Nikoletta Mathou, Athanasios Giannakopoulos, Konstantina D. Paraskeva, Georgios Tziatzios)
| | - Athanasios Giannakopoulos
- Department of Gastroenterology, "Konstantopoulio-Patision" General Hospital of Nea Ionia, Athens, Greece (Marianna Spinou, Eleni Kyvelou, Giorgos Aggelopoulos, Antonia Panagaki, Magdalini Manti, Paraskevas Gkolfakis, Nikoletta Mathou, Athanasios Giannakopoulos, Konstantina D. Paraskeva, Georgios Tziatzios)
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, Second Department of Internal Medicine - Propaedeutic, Medical School, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece (Konstantinos Triantafyllou)
| | - Konstantina D Paraskeva
- Department of Gastroenterology, "Konstantopoulio-Patision" General Hospital of Nea Ionia, Athens, Greece (Marianna Spinou, Eleni Kyvelou, Giorgos Aggelopoulos, Antonia Panagaki, Magdalini Manti, Paraskevas Gkolfakis, Nikoletta Mathou, Athanasios Giannakopoulos, Konstantina D. Paraskeva, Georgios Tziatzios)
| | - Antonios Vezakis
- Department of Surgery, Aretaieion University Hospital, National and Kapodistrian University of Athens, Greece (Antonios Vezakis)
| | - Ioannis Vlachogiannakos
- Academic Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, "Laiko" General Hospital of Athens, Athens, Greece (Ioannis Vlachogiannakos)
| | - George Karamanolis
- Gastroenterology Unit, Second Department of Surgery, Aretaieion University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece (George Karamanolis)
| | - Georgios Tziatzios
- Department of Gastroenterology, "Konstantopoulio-Patision" General Hospital of Nea Ionia, Athens, Greece (Marianna Spinou, Eleni Kyvelou, Giorgos Aggelopoulos, Antonia Panagaki, Magdalini Manti, Paraskevas Gkolfakis, Nikoletta Mathou, Athanasios Giannakopoulos, Konstantina D. Paraskeva, Georgios Tziatzios)
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Cukierman DS, Perez M, Guerra-Londono JJ, Carlson R, Hagan K, Ghebremichael S, Hagberg C, Ge PS, Raju GS, Rhim A, Cata JP. Nasal continuous positive pressure versus simple face mask oxygenation for adult obese and obstructive sleep apnea patients undergoing colonoscopy under propofol-based general anesthesia without tracheal intubation: A randomized controlled trial. J Clin Anesth 2023; 89:111196. [PMID: 37406462 DOI: 10.1016/j.jclinane.2023.111196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 06/21/2023] [Accepted: 06/27/2023] [Indexed: 07/07/2023]
Abstract
STUDY OBJECTIVE To determine if a nasal positive airway pressure (nasal CPAP) mask would decrease the number of hypoxemic events in obese and obstructive sleep apnea patients undergoing colonoscopy. DESIGN Single-center prospective randomized controlled trial. SETTING Tertiary academic center. PATIENTS We enrolled 109 patients with diagnosis of obesity and/or obstructive sleep apnea scheduled to undergo colonoscopy under propofol general anesthesia without planned tracheal intubation. INTERVENTION Patients were randomly allocated (1:1 ratio) to receive supplementary oxygen at a flow of 10 L/min, either through a nasal CPAP or a simple facemask. MEASUREMENTS The primary endpoint was the difference in the mean percentage of time spent with oxygen saturation below 90% between the two groups. Secondary outcomes included the need for airway maneuvers/interventions, average SpO2 during the case, duration and severity of oxygen desaturation, incidence and duration of procedural interruptions, and satisfaction and tolerance scores. MAIN RESULTS 54 were allocated to the simple face mask and 55 to the nasal CPAP mask arms, respectively. A total of 6 patients experienced a hypoxemic event. Among these patients, the difference in the percentage of time spent with oxygen saturation below 90% was not clinically relevant (p = 1.0). However, patients in the nasal CPAP group required less chin lift (20% vs. 42.6%; p = 0.01) and oral cannula insertion (12.7% vs.29.6%; p = 0.03). The percentage of patients with at least one airway maneuver was higher in the simple face mask arm (68.5% vs. 41.8%; p = 0.005). Patient tolerance to device score was lower in the nasal CPAP group (8.85 vs. 9.56; p = 0.003). CONCLUSIONS A nasal CPAP did not prevent hypoxemia and should not be used routinely for colonoscopy in obese or OSA patients if a simple face mask is an alternative therapy. However, potential advantages of its use include fewer airway maneuvers or interventions, which may be desirable in certain clinical settings. TRIAL REGISTRATION Clinicaltrials.gov, identifier: NCT05175573.
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Affiliation(s)
- Daniel S Cukierman
- Department of Anesthesiology, Hospital Bernardino Rivadavia, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Manuel Perez
- Department of Anesthesiology and Perioperative Medicine, The University of Texas - MD Anderson Cancer Center, Houston, TX, USA; Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas - MD Anderson Cancer Center, Houston, TX, USA
| | - Juan J Guerra-Londono
- Department of Anesthesiology and Perioperative Medicine, The University of Texas - MD Anderson Cancer Center, Houston, TX, USA; Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas - MD Anderson Cancer Center, Houston, TX, USA
| | - Richard Carlson
- Department of Anesthesiology and Perioperative Medicine, The University of Texas - MD Anderson Cancer Center, Houston, TX, USA
| | - Katherine Hagan
- Department of Anesthesiology and Perioperative Medicine, The University of Texas - MD Anderson Cancer Center, Houston, TX, USA
| | - Semhar Ghebremichael
- Department of Anesthesiology and Perioperative Medicine, The University of Texas - MD Anderson Cancer Center, Houston, TX, USA
| | - Carin Hagberg
- Department of Anesthesiology, Hospital Bernardino Rivadavia, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Phillip S Ge
- Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas - MD Anderson Cancer Center, Houston, TX, USA
| | - Gottumukkala S Raju
- Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas - MD Anderson Cancer Center, Houston, TX, USA
| | - Andrew Rhim
- Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas - MD Anderson Cancer Center, Houston, TX, USA
| | - Juan P Cata
- Department of Anesthesiology and Perioperative Medicine, The University of Texas - MD Anderson Cancer Center, Houston, TX, USA; Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas - MD Anderson Cancer Center, Houston, TX, USA; Anesthesiology and Surgical Oncology Research Group, Houston, TX, USA.
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Sui Y, Zheng Y, Wang Q, Lv J, Wang H, Wen Q, Wang Z, Wang G, Jia H, Cao F, Wang N, Hao J, Zhang Y, Wu X, Chen H, Lu J, Chen X. Comparison of missed adenomas in deep-sedated and unsedated colonoscopy: A multicenter retrospective study. Eur J Intern Med 2023; 110:48-53. [PMID: 36710136 DOI: 10.1016/j.ejim.2023.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/17/2023] [Accepted: 01/23/2023] [Indexed: 01/29/2023]
Abstract
BACKGROUND Deep-sedated colonoscopy with propofol is widely used in China. However, its impact on quality metrics remains controversial. We aimed to investigate the effects of deep-sedated colonoscopy on missed adenomas, specifically in each colorectal segment. METHODS Data of 3710 individuals from seven hospitals in China who underwent an initial colonoscopy with or without propofol sedation and a second colonoscopy without sedation within six months for surveillance or polypectomy by endoscopist of the same level between October 2020 and September 2021 were retrospectively analyzed. RESULTS A total of 1113 missed adenomas in 3710 patients were evaluated. The adenoma miss rate (AMR) was significantly higher in deep-sedated colonoscopy than in unsedated colonoscop [19.14% (578/3020) vs. 16.15% (535/3313), P < 0.05]. The risk of missing adenomas in deep-sedated colonoscopy was 1.229 times higher than in unsedated colonoscopy (OR, 1.229; 95% CI: 1.080-1.399). AMRs of the splenic flexure (26.02% [96/369] vs. 16.04% [47/293], P < 0.05) and descending colon (20.86% [102/489] vs. 13.37% [54/404], P < 0.05) were significantly higher in deep-sedated colonoscopy than in unsedated colonoscopy when performed by middle-level endoscopists rather than high-level endoscopists (P < 0.05). CONCLUSIONS AMR was higher in deep-sedated colonoscopy than in unsedated colonoscopy. Furthermore, adenomas in the splenic flexure and descending colon were more frequently missed in deep-sedated colonoscopy than in unsedated colonoscopy, particularly when performed by less experienced endoscopists.
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Affiliation(s)
- Yue Sui
- Shanxi Medical University, 030000, China
| | | | - Qing Wang
- Shanxi Medical University, 030000, China.
| | - Jieping Lv
- The First Hospital of Shanxi Medical University, 03000, China.
| | - Hongjin Wang
- The Second People's Hospital of Datong, 037000, China
| | - Qing Wen
- The Second People's Hospital of Datong, 037000, China.
| | - Zhenzhen Wang
- The Second People's Hospital of Datong, 037000, China
| | - Guanfeng Wang
- The Second People's Hospital of Datong, 037000, China.
| | - Hui Jia
- Ordos Mongolian Medical Hospital, 017000, China.
| | - Fengzhen Cao
- Kangning Physical Examination Center, 017000, China
| | - Naping Wang
- The First Hospital of Shanxi Medical University, Yanhu District Branch, 044000, China
| | - Junlian Hao
- Xiaoyi Traditional Chinese Medicine Hospital, 033000, China.
| | - Yiping Zhang
- Datong Shoujia Digestive Disease Hospital, 037000, China.
| | - Xiaopeng Wu
- Lvliang Traditional Chinese Medicine Hospital, 033000, China.
| | - Haihua Chen
- The First Hospital of Shanxi Medical University, 03000, China.
| | - Junhui Lu
- Shanxi Medical University, 030000, China
| | - Xing Chen
- The First Hospital of Shanxi Medical University, 03000, China.
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Sedation Is Associated with Higher Polyp and Adenoma Detection Rates during Colonoscopy: A Retrospective Cohort Study. Gastroenterol Res Pract 2023; 2023:1172478. [PMID: 36852194 PMCID: PMC9966568 DOI: 10.1155/2023/1172478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 11/13/2022] [Accepted: 01/31/2023] [Indexed: 03/01/2023] Open
Abstract
Background and Aims Currently sedation is a common practice in colonoscopy to reduce pain of patients and improve the operator satisfaction, whereas its impact on examination quality, especially adenoma detection rate (ADR) is still controversial. Thus, we aimed to investigate the association of sedation with ADR. Methods Consecutive patients receiving colonoscopy between January 2017 and January 2020 at the Nanjing Drum Tower Hospital, Nanjing, China, were collected. Univariate and multivariate logistic regression models were performed to investigate the association between sedation and ADR. Subgroup analysis and propensity score matching (PSM) analysis, as sensitivity analysis, were performed to validate the independent effect. Results The ADR was significantly higher in cases with sedation (ADR: 36.9% vs. 29.1%, odds ratio [OR]: 1.42, 95% confidence interval [CI]: 1.31-1.55, P < 0.001). Multivariate analysis showed that the sedation was an independent factor associated with ADR (OR: 1.49, 95% CI: 1.35-1.65, P < 0.001). The effect was consistent in subgroup analyses (P > 0.05) and PSM analysis (ADR: 37.6% vs. 29.1%, OR: 1.47, 95% CI: 1.33-1.63, P < 0.001). Conclusion Sedation was associated with a higher polyp and ADR s during colonoscopy, which can promote the quality of colonoscopy.
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Comparison of adenoma detection in different colorectal segments between deep-sedated and unsedated colonoscopy. Sci Rep 2022; 12:15356. [PMID: 36097050 PMCID: PMC9468171 DOI: 10.1038/s41598-022-19468-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 08/30/2022] [Indexed: 11/08/2022] Open
Abstract
To investigate if deep-sedated colonoscopy affects adenoma detection in certain colorectal segment. Review of colonoscopy reports, electronic images and medical records of individuals underwent screening colonoscopy with or without propofol sedation between October 2020 and March 2021 from seven hospitals in China. A total of 4500 individuals were analyzed. There was no significant difference in ADR between deep-sedated colonoscopy and unsedated colonoscopy [45.4% vs. 46.3%, P > 0.05]. The APP of deep-sedated colonoscopy was lower than unsedated colonoscopy (1.76 ± 0.81 vs. 2.00 ± 1.30, P < 0.05). Both average number of adenomas and luminal distention score of splenic flexure and descending colon were lower in deep-sedated colonoscopy (P < 0.05), and average number of adenomas was positively correlated with an improved distension score in splenic flexure and descending colon (splenic flexure r = 0.031, P < 0.05; descending colon r = 0.312, P < 0.05). Linear regression model showed deep-sedated colonoscopy significantly affected luminal distention of splenic flexure and descending colon as well as average number of adenomas detected in splenic flexure (P < 0.05). Deep-sedated colonoscopy decreased adenoma detection in splenic flexure and the luminal distention of splenic flexure and descending colon compared with unsedated colonoscopy.
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Sui Y, Chen X, Ma T, Lu J, Xiao T, Wang Z, Wen Q, Wang G, Jia H, Cao F, Wu X, Zhang Y, Hao J, Wang N. Comparison of three sedation models for same-day painless bidirectional endoscopy: A multicenter randomized controlled trial. J Gastroenterol Hepatol 2022; 37:1603-1609. [PMID: 35618650 PMCID: PMC9543240 DOI: 10.1111/jgh.15901] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/12/2022] [Accepted: 05/24/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM We investigated the most beneficial propofol sedation model for same-day painless bidirectional endoscopy (BDE). METHODS Asymptomatic participants scheduled for same-day painless BDE examination from October 2020 to September 2021 were randomized to three groups: sedated esophagogastroduodenoscopy followed by unsedated colonoscopy (Group A); sedated esophagogastroduodenoscopy followed by sedated colonoscopy (Group B); and sedated esophagogastroduodenoscopy followed by sedated insertion colonoscopy (Group C). Patient discomfort, colonoscopy performance, doses of propofol, cardiovascular stress, anesthesia resuscitation, and sedation-related adverse events were evaluated. RESULTS A total of 3200 participants were analyzed. Baseline demographics, patient discomfort, cecal intubation rate, adenoma detection rate and sedation-related adverse events were similar in the three groups. Propofol dose was the lowest in Group A (137.65 ± 36.865 mg) compared with Group B (177.71 ± 40.112 mg, P < 0.05) and Group C (161.63 ± 31.789 mg, P < 0.05). Decline in vital signs was most obvious in Group B during the procedure (P < 0.05). Recovery time was the shortest in Group A (5.01 ± 1.404 min) compared with Group B (9.51 ± 2.870 min, P < 0.05) and Group C (5.83 ± 2.594 min, P < 0.05); discharge time was the shortest in Group A (3.53 ± 1.685 min) compared with Group B (11.29 ± 5.172 min, P < 0.05) and Group C (6.47 ± 2.338 min, P < 0.05). Adenomas per positive patient of Group A (2.29 ± 1.055) and Group C (2.28 ± 0.931) were more than that in Group B (2.11 ± 0.946, P < 0.05). CONCLUSIONS Sedated esophagogastroduodenoscopy followed by unsedated colonoscopy is the superior model for same-day painless BDE with the benefits of satisfactory patient comfort, reduced sedation dose, less cardiovascular stress, faster recovery, shorter discharge time and high colonoscopy quality.
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Affiliation(s)
- Yue Sui
- Shanxi Medical UniversityTaiyuanChina
| | - Xing Chen
- Shanxi Medical UniversityTaiyuanChina,The First Hospital of Shanxi Medical UniversityTaiyuanChina
| | - Ting Ma
- Shanxi Medical UniversityTaiyuanChina
| | - Junhui Lu
- Shanxi Medical UniversityTaiyuanChina
| | - Tao Xiao
- Shanxi Cancer HospitalTaiyuanChina
| | | | - Qing Wen
- The Second People's Hospital of DatongDatongChina
| | | | - Hui Jia
- Erdos Kangning Physical Examination CenterErdosChina
| | - Fengzhen Cao
- Erdos Kangning Physical Examination CenterErdosChina
| | - Xiaopeng Wu
- Lvliang Traditional Chinese Medicine HospitalLvliangChina
| | - Yiping Zhang
- Datong Shoujia Digestive Disease HospitalDatongChina
| | - Junlian Hao
- Xiaoyi Traditional Chinese Medicine HospitalXiaoyiChina
| | - Naping Wang
- The First Hospital of Shanxi Medical UniversityYunchengChina
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Sedation/Analgesia Administration Practice Varies according to Endoscopy Facility (Hospital- or Office-Based) Setting: Results from a Nationwide Survey in Greece. Gastroenterol Res Pract 2020; 2020:8701791. [PMID: 33082781 PMCID: PMC7556063 DOI: 10.1155/2020/8701791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 06/30/2020] [Indexed: 11/21/2022] Open
Abstract
Objectives To examine the impact of endoscopy setting (hospital-based vs. office-based) on sedation/analgesia administration and to provide nationwide data on monitoring practices among Greek gastroenterologists in real-world settings. Material and Methods. A web-based survey regarding sedation/analgesia rates and monitoring practices during endoscopy either in a hospital-based or in an office-based setting was disseminated to the members of the Hellenic Society of Gastroenterology and Professional Association of Gastroenterologists. Participants were asked to complete a questionnaire, which consisted of 35 items, stratified into 4 sections: demographics, preprocedure (informed consent, initial patient evaluation), intraprocedure (monitoring practices, sedative agents' administration rate), and postprocedure practices (recovery). Results 211 individuals responded (response rate: 40.3%). Propofol use was significantly higher in the private hospital compared to the public hospital and the office-based setting for esophagogastroduodenoscopy (EGD) (85.8% vs. 19.5% vs. 10.5%, p < 0.0001) and colonoscopy (88.2% vs. 20.1% vs. 9.4%, p < 0.0001). This effect was not detected for midazolam, pethidine, and fentanyl use. Endoscopists themselves administered the medications in most cases. However, a significant contribution of anesthesiology sedation/analgesia provision was detected in private hospitals (14.7% vs. 2.8% vs. 2.4%, p < 0.001) compared to the other settings. Only 35.2% of the private offices have a separate recovery room, compared to 80.4% and 58.7% of the private hospital- and public hospital-based facilities, respectively, while the nursing personnel monitored patients' recovery in most of the cases. Participants were familiar with airway management techniques (83.9% with bag valve mask and 23.2% with endotracheal intubation), while 49.7% and 21.8% had received Basic Life Support (BLS) and Advanced Life Support (ALS) training, respectively. Conclusion The private hospital-based setting is associated with higher propofol sedation administration both for EGD and for colonoscopy. Greek endoscopists are adequately trained in airway management techniques.
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Predictors of Failed Conscious Sedation in Patients Undergoing an Outpatient Colonoscopy and Implications for the Adenoma Detection Rate. Sci Rep 2020; 10:2167. [PMID: 32034266 PMCID: PMC7005773 DOI: 10.1038/s41598-020-59189-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 01/15/2020] [Indexed: 01/10/2023] Open
Abstract
Guidelines to triage patients to conscious sedation (CS) or monitored anaesthesia care (MAC) for colonoscopy do not exist. We aimed to identify the CS failure rate, predictors of failure, and its impact on the adenoma detection rate (ADR). Strict (based on patient experience) and expanded (based on doses of sedative medications) definitions of CS failure were used. Patient and procedure-related variables were extracted. Multivariable logistic regression identified predictors for CS failure and the ADR. Among 766 patients, 29 (3.8%) and 175 (22.8%) patients failed CS by strict and expanded definitions, respectively. Female gender (OR 3.50; 95% CI: 1.37–8.94) and fellow involvement (OR 4.15; 95% CI: 1.79–9.58) were associated with failed CS by the strict definition. Younger age (OR 1.27, 95% CI: 1.07–1.49), outpatient opiate use (OR 1.71; 95% CI 1.03–2.84), use of an adjunct medication (OR 3.34; 95% CI: 1.94–5.73), and fellow involvement (OR 2.20; 95% CI: 1.31–3.71) were associated with failed CS by the expanded definition. Patients meeting strict failure criteria had a lower ADR (OR 0.30; 95% CI: 0.12–0.77). Several clinical factors may be useful for triaging to MAC. The ADR is lower in patients meeting strict criteria for failed CS.
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Affiliation(s)
- Ethna McFerran
- Centre for Cancer Research and Cell Biology, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast BT9 7AE, UK
| | - James F O'Mahony
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Edward Goodall
- Northern Ireland Cancer Research Consumer Forum, Belfast City Hospital, Belfast, UK
| | - Mark Lawler
- Centre for Cancer Research and Cell Biology, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast BT9 7AE, UK
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Lim S, Lee OH, Yoon IJ, Choi GJ, Kang H. Moderate versus deep sedation in adults undergoing colonoscopy: systematic review and meta-analysis. Curr Med Res Opin 2019; 35:879-885. [PMID: 30479163 DOI: 10.1080/03007995.2018.1552040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To perform a systematic review and meta-analysis comparing effectiveness and safety of moderate and deep sedation during colonoscopy. RESEARCH DESIGN AND METHODS We searched Medline, Embase, Central and Google scholar in May 2017 and updated in March 2018 to identify all randomized controlled trials that compared the effectiveness and safety of moderate and deep sedation during colonoscopy. The quality of studies was assessed using the "Risk of bias" tool. The primary endpoints were defined as patient satisfaction, physician satisfaction, incidence of recall and incidence of desaturation. Recovery time was also evaluated. Review Manager and Comprehensive Meta-Analysis software were used for statistical analysis. RESULTS A total of 919 patients from three studies were included in the final analysis. The combined analysis did not reveal any differences in patient satisfaction between moderate and deep sedation (RR = 0.94; 95% CI: 0.86 to 1.04; Pchi2 = 0.06; I2 = 65%; number needed to treat to harm [NNTH] = 15.6; 95% CI: NNTH 7.8 to ∞ to number needed to treat to benefit [NNTB] = 3078.0), physician satisfaction (RR = 0.35; 95% CI: 0.02 to 6.95; Pchi2 < 0.001; I2 = 100%; NNTB = 1.6; 95% CI: 1.5 to 1.8), incidence of recall (RR = 5.82; 95% CI: 0.51 to 66.48; Pchi2 = 0.11; I2 = 60%; NNTH = 11.0; 95% CI: 7.5 to 20.5) or recovery time (mean difference = -6.77; 95% CI: -16.21 to 2.67; Pchi2 < 0.001; I2 = 99%). However, incidence of desaturation was higher in the deep group than in the moderate group (RR = 0.18; 95% CI: 0.01 to 0.99; Pchi2 = 0.48; I2 = 0%; NNTB = 56.7; 95% CI: 31.6 to 273.1). CONCLUSIONS Moderate sedation showed comparable safety and effectiveness to deep sedation with respect to patient satisfaction, physician satisfaction, incidence of recall and recovery time.
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Affiliation(s)
- Seho Lim
- a Department of Anesthesiology and Pain Medicine , Chung-Ang University College of Medicine , Seoul , Republic of Korea
| | - Oh Haeng Lee
- a Department of Anesthesiology and Pain Medicine , Chung-Ang University College of Medicine , Seoul , Republic of Korea
| | - Il Jae Yoon
- a Department of Anesthesiology and Pain Medicine , Chung-Ang University College of Medicine , Seoul , Republic of Korea
| | - Geun Joo Choi
- a Department of Anesthesiology and Pain Medicine , Chung-Ang University College of Medicine , Seoul , Republic of Korea
| | - Hyun Kang
- a Department of Anesthesiology and Pain Medicine , Chung-Ang University College of Medicine , Seoul , Republic of Korea
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Karamaroudis S, Stamou A, Vorri SC, Gkolfakis P, Papadopoulos V, Tziatzios G, Karagouni A, Katsouli P, Dimitriadis GD, Triantafyllou K. Monitoring of colonoscopy quality indicators in an academic endoscopy facility reveals adherence to international recommendations. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:263. [PMID: 30094249 DOI: 10.21037/atm.2018.03.34] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background We monitor colonoscopy service quality biannually, by measuring sedation administration, colonoscopy completion, adenoma detection and early complications rates (CR). We herein present our audit results for the years 2013 and 2015. Methods In our endoscopy facility, five rotating senior gastroenterologists perform colonoscopies, on a daily basis. We measured the quality indicators in three cohorts: A, intention for total colonoscopy cases; B, cohort A excluding bowel obstruction cases; C, colorectal cancer (CRC) screening cases. Results In 2015, overall sedation administration rate (SAR) was 93.0% (91.6-94.4%), achieving our target to give conscious sedation to >90% of patients undergoing colonoscopy in all three cohorts. Colonoscopy completion rate (CCR) increased significantly (P<0.0001) from 94.8% (93.4-96.2%) to 98.1% (97.3-98.9%) in cohort B and numerically from 96.6% (94.4-98.8%) to 98.6% (97.4-99.7%) in cohort C, at the same periods. In cohort C, adenoma detection rates (ADR) were similar-27.1% (21.7-32.5%) and 27% (22.7-31.3%)-in the two periods. There were only two serious early complications: one cardiorespiratory event and one perforation in 2013 and 2015, respectively. While significant variability regarding SAR (ranging from 80% to 100%) was detected among the participating endoscopists, all but one of them constantly achieved [judged by the lower confidence interval (CI) of the quality indicator] CCRs higher than the recommended by international guidelines. On the contrary ADR was variable among endoscopists during the studied periods. Conclusions Although there is certain variability in endoscopists' performance, the overall colonoscopy quality indicators meet or exceed the internationally recommended standards, in our endoscopy facility.
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Affiliation(s)
- Stefanos Karamaroudis
- Hepatogastroenterology Unit, Second Department of Internal Medicine Research Institute and Diabetes Center, Attikon University General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Aliki Stamou
- Hepatogastroenterology Unit, Second Department of Internal Medicine Research Institute and Diabetes Center, Attikon University General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Stamatia C Vorri
- Hepatogastroenterology Unit, Second Department of Internal Medicine Research Institute and Diabetes Center, Attikon University General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Paraskevas Gkolfakis
- Hepatogastroenterology Unit, Second Department of Internal Medicine Research Institute and Diabetes Center, Attikon University General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasilios Papadopoulos
- Hepatogastroenterology Unit, Second Department of Internal Medicine Research Institute and Diabetes Center, Attikon University General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Tziatzios
- Hepatogastroenterology Unit, Second Department of Internal Medicine Research Institute and Diabetes Center, Attikon University General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Aikaterini Karagouni
- Hepatogastroenterology Unit, Second Department of Internal Medicine Research Institute and Diabetes Center, Attikon University General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiota Katsouli
- Hepatogastroenterology Unit, Second Department of Internal Medicine Research Institute and Diabetes Center, Attikon University General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - George D Dimitriadis
- Hepatogastroenterology Unit, Second Department of Internal Medicine Research Institute and Diabetes Center, Attikon University General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, Second Department of Internal Medicine Research Institute and Diabetes Center, Attikon University General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Zhang K, Yuan Q, Zhu S, Xu D, An Z. Is Unsedated Colonoscopy Gaining Ground Over Sedated Colonoscopy? J Natl Med Assoc 2017; 110:143-148. [PMID: 29580447 DOI: 10.1016/j.jnma.2016.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 12/10/2016] [Accepted: 12/19/2016] [Indexed: 02/08/2023]
Abstract
Colorectal cancer (CRC) is a prevalent cancer with high global incidence and a leading cause of cancer death worldwide. CRC screening is important for early cancer detection and prevention. Most premalignant adenomas can be identified and removed before they become malignant. Colonoscopy plays a vital role in reducing the risk for developing CRC. Although screening programs with colonoscopy have been implemented in many countries and considered beneficial for a number of people, this technique is generally associated with anxiety, embarrassment, pain, and discomfort, resulting in lack of adherence to the recommended screening guidelines. In the US, colonoscopy is mostly performed under sedation, thereby causing amnesia and analgesia. In contrast to sedated colonoscopy, which has been associated with some disadvantages, unsedated colonoscopy exhibits advantages and has been preferred over sedated colonoscopy in numerous cancer centers worldwide. This review enumerates the features of sedated and unsedated colonoscopy with the use of the current relevant evidence-based literature. Unsedated colonoscopy can be a reasonable option for routine and unscheduled CRC screening.
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Affiliation(s)
- Kaixian Zhang
- Department of Oncology, Tengzhou Central People's Hospital, Tengzhou 277599, China
| | - Qianqian Yuan
- Department of Oncology, Tengzhou Central People's Hospital, Tengzhou 277599, China
| | - Shuguang Zhu
- Department of Gastroenterology, Tengzhou Central People's Hospital, Tengzhou 277599, China
| | - Daheng Xu
- Department of Gastroenterology, Tengzhou Central People's Hospital, Tengzhou 277599, China
| | - Zhe An
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun 130033, China.
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Rees CJ, Bevan R, Zimmermann-Fraedrich K, Rutter MD, Rex D, Dekker E, Ponchon T, Bretthauer M, Regula J, Saunders B, Hassan C, Bourke MJ, Rösch T. Expert opinions and scientific evidence for colonoscopy key performance indicators. Gut 2016; 65:2045-2060. [PMID: 27802153 PMCID: PMC5136701 DOI: 10.1136/gutjnl-2016-312043] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 09/08/2016] [Accepted: 09/11/2016] [Indexed: 12/12/2022]
Abstract
Colonoscopy is a widely performed procedure with procedural volumes increasing annually throughout the world. Many procedures are now performed as part of colorectal cancer screening programmes. Colonoscopy should be of high quality and measures of this quality should be evidence based. New UK key performance indicators and quality assurance standards have been developed by a working group with consensus agreement on each standard reached. This paper reviews the scientific basis for each of the quality measures published in the UK standards.
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Affiliation(s)
- Colin J Rees
- Department of Gastroenterology, South Tyneside District Hospital, South Shields, UK
| | - Roisin Bevan
- Department of Gastroenterology, North Tees University Hospital, Stockton-on-Tees, UK
| | | | - Matthew D Rutter
- Department of Gastroenterology, North Tees University Hospital, Stockton-on-Tees, UK
| | - Douglas Rex
- Department of Gastroenterology, Indiana University, Indianapolis, USA
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Thierry Ponchon
- Department of Gastroenterology and Hepatology, Edouard Herriot Hospital, Lyon University, Lyon, France
| | - Michael Bretthauer
- Department of Health Management and Health Economics and KG Jebsen Center for Colorectal Cancer Research, University of Oslo, Oslo, Norway
| | - Jaroslaw Regula
- Department of Gastroenterology, Medical Center for Postgraduate Education and the Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - Brian Saunders
- Department of Gastroenterology, St Mark's Hospital and Academic Institute, Harrow, UK
| | - Cesare Hassan
- Digestive Endoscopy Unit, Catholic University, Rome, Italy
| | - Michael J Bourke
- Department of Gastroenterology, Westmead Hospital, Sydney, Australia
| | - Thomas Rösch
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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New-Generation High-Definition Colonoscopes Increase Adenoma Detection when Screening a Moderate-Risk Population for Colorectal Cancer. Clin Colorectal Cancer 2016; 16:44-50. [PMID: 27528514 DOI: 10.1016/j.clcc.2016.07.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 07/07/2016] [Accepted: 07/12/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIM Adenoma detection rate (ADR) is the most important quality indicator for screening colonoscopy, due to its association with colorectal cancer outcomes. As a result, a number of techniques and technologies have been proposed that have the potential to improve ADR. The aim of this study was to assess the potential impact of new-generation high-definition (HD) colonoscopy on ADR within the Bowel Cancer Screening Programme (BCSP). METHOD This was a retrospective single-center observational study in patients undergoing an index screening colonoscopy. The examination was performed with either standard-definition colonoscopes (Olympus Q240/Q260 series) or HD colonoscopes (Olympus HQ290 EVIS LUCERA ELITE system) with the primary outcome measures of ADR and mean adenoma per procedure (MAP) between the 2 groups. RESULTS A total of 395 patients (60.5% male, mean age 66.8 years) underwent screening colonoscopy with 45% performed with HD colonoscopes. The cecal intubation rate was 97.5% on an intention-to-treat basis and ADR was 68.6%. ADR with standard-definition was 63.13%, compared with 75.71% with HD (P = .007). The MAP in the HD group was 2.1 (± 2.0), whereas in the standard-definition group it was 1.6 (± 1.8) (P = .01). There was no significant difference in withdrawal time between the 2 groups. In the multivariate regression model, only HD scopes (P = .03) and male sex (P = .04) independently influenced ADR. CONCLUSION Olympus H290 LUCERA ELITE HD colonoscopes improved adenoma detection within the moderate-risk population. A 12% improvement in ADR might be expected to increase significantly the protection afforded by colonoscopy against subsequent colorectal cancer mortality.
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Triantafyllou K, Gkolfakis P, Triantafyllou M, Ndini X, Melissaratou A, Moustafa GA, Xanthopoulou E, Tziatzios G, Vlachonikolou G, Papadopoulos V, Pantelakis E, Malli C, Dimitriadis GD. Long-term patient satisfaction of gastrointestinal endoscopic procedures. Ann Gastroenterol 2016; 29:188-95. [PMID: 27065732 PMCID: PMC4805739 DOI: 10.20524/aog.2016.0011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Background We prospectively assessed patient satisfaction in a Greek Academic endoscopy facility. Methods Consecutive outpatients filled a satisfaction questionnaire right after their endoscopy (D1), 3 days (D3) and 3 months (M3) later. Overall patient satisfaction was measured by their willingness to repeat endoscopy in our facility and to further recommend it. Participant satisfaction regarding pre-procedural, procedural and post-procedural issues was measured using a five-step Likert scale in 19 items with 4 and 5 scores indicating favorable responses. Pareto analysis was used to determine service issues requiring improvement. Late adverse events were recorded at D3 and M3 assessments. Results Over six months, 501 patients participated (89.4% and 87.8% response rate at D3 and M3 assessments, respectively). More than 97% of the participants would repeat the procedure in our facility and would recommend our endoscopy service, at all three assessments. Pareto analysis identified waiting time until the appointment and on the day of the examination, discomfort during and after the endoscopy, time to obtain the pathology report and overall management of the patient problems as the issues requiring improvement. No predictor of high satisfaction score has been identified. No serious late adverse events were reported. Conclusion Despite the overall high levels of patient satisfaction, management of patient discomfort and organizational issues need improvement.
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Affiliation(s)
- Konstantinos Triantafyllou
- Hepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, Attikon University General Hospital, Medical School, Athens University, Athens, Greece
| | - Paraskevas Gkolfakis
- Hepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, Attikon University General Hospital, Medical School, Athens University, Athens, Greece
| | - Maria Triantafyllou
- Hepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, Attikon University General Hospital, Medical School, Athens University, Athens, Greece
| | - Xhoela Ndini
- Hepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, Attikon University General Hospital, Medical School, Athens University, Athens, Greece
| | - Anastasia Melissaratou
- Hepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, Attikon University General Hospital, Medical School, Athens University, Athens, Greece
| | - Giannis-Aimant Moustafa
- Hepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, Attikon University General Hospital, Medical School, Athens University, Athens, Greece
| | - Eleni Xanthopoulou
- Hepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, Attikon University General Hospital, Medical School, Athens University, Athens, Greece
| | - Georgios Tziatzios
- Hepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, Attikon University General Hospital, Medical School, Athens University, Athens, Greece
| | - Georgia Vlachonikolou
- Hepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, Attikon University General Hospital, Medical School, Athens University, Athens, Greece
| | - Vasilios Papadopoulos
- Hepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, Attikon University General Hospital, Medical School, Athens University, Athens, Greece
| | - Evdoxos Pantelakis
- Hepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, Attikon University General Hospital, Medical School, Athens University, Athens, Greece
| | - Chrysoula Malli
- Hepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, Attikon University General Hospital, Medical School, Athens University, Athens, Greece
| | - George D Dimitriadis
- Hepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, Attikon University General Hospital, Medical School, Athens University, Athens, Greece
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Diagnostic yield of scope retroflexion in the right colon: A prospective cohort study. Dig Liver Dis 2016; 48:176-81. [PMID: 26748425 DOI: 10.1016/j.dld.2015.11.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 11/21/2015] [Accepted: 11/24/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Techniques have been implemented to improve colonoscopy adenoma detection rate (ADR) in the right colon. AIMS & METHODS We prospectively examined the additional diagnostic yield of right colon examination with colonoscope retroflexion in consecutive, symptomatic and screening-surveillance patients. Right colon was examined in forward-view first and thereafter, retroflexion was performed to re-inspect it. RESULTS Right colon examination in retroflexion was achieved in 620 (92%) patients. Increased inserted scope length to the cecum (OR: 0.48 [95% CI: 0.27-0.84]) and elderly status (OR: 0.53 [95% CI: 0.430-0.94]) predicted retrofexion failure. Forward-view colonoscopy detected 134 polyps and 112 adenomas in 105 and 85 patients, respectively. Scope retroflexion revealed 7 missed (6 adenomas--2 advanced) polyps in 7 patients; indicating 4.96 (95% CI: 1.37-8.55) % and 5.1 (95% CI: 1.12-9.05) % per-polyp and per-adenoma miss rates, respectively. In ITT analysis, per-patient polyp and adenoma miss rates were 1.041% and 0.89%, respectively. Among screening-surveillance patients, retroflexion detected 3 missed adenomas (2 advanced) in 3 patients, resulting in changed surveillance schedule in 2 of them (5.12 per 1000 screening-surveillance patients). Early study termination was favored by low right colon ADR improvement and lacking substantial surveillance interval change. CONCLUSION The additional diagnostic yield of scope retroflexion in the right colon is questionable.
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Wang JF, Li B, Yang YG, Fan XH, Li JB, Deng XM. Target-Controlled Infusion of Propofol in Training Anesthesiology Residents in Colonoscopy Sedation: A Prospective Randomized Crossover Trial. Med Sci Monit 2016; 22:206-10. [PMID: 26787637 PMCID: PMC4727496 DOI: 10.12659/msm.895295] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Propofol is widely used in sedation for colonoscopy, but its adverse effects on cardiovascular and respiratory systems are still concerning. The present study investigated whether target controlled infusion (TCI) of propofol could provide a better sedation quality than manually controlled infusion (MCI) in training inexperienced anesthesiology residents. MATERIAL/METHODS Eighteen training residents were allocated into 2 groups receiving TCI and MCI training in their first month in the endoscopy center, while receiving MCI and TCI training instead in their second month. The last 2 patients at the end of each month were included to analyze the sedation quality of TCI and MCI techniques by comparing satisfaction of endoscopist and patients based on the visual analogue scale (VAS). Heart rate (HR), mean blood pressure (MAP), SpO2, and recovery time were also compared as the secondary outcomes. RESULTS The demographic data were similarly distributed among the TCI and MCI patients. Endoscopist's satisfaction score in the TCI group was significantly higher than in the MCI group, 81.3±7.2 versus 74.2±9.5 (P=0.003), but the patients' satisfaction score was similar between the 2 groups. More stable hemodynamic status was obtained in the TCI group, manifested as higher lowest MAP and lower highest MAP than in the MCI group. Lowest SpO2 in the TCI group was significantly higher than in the MCI group. Patients in the TCI group recovered earlier than in the MCI group. CONCLUSIONS TCI is a more effective and safer technique for anesthesiology residents in sedation for colonoscopy.
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Affiliation(s)
- Jia-feng Wang
- Department of Anesthesiology and Intensive Care, Changhai Hospital, The Second Military Medical University, Shanghai, China (mainland)
| | - Bo Li
- Department of Anesthesiology and Intensive Care, Changhai Hospital, The Second Military Medical University, Shanghai, China (mainland)
| | - Yu-guang Yang
- Department of Anesthesiology and Intensive Care, Changhai Hospital, The Second Military Medical University, Shanghai, China (mainland)
| | - Xiao-hua Fan
- Department of Anesthesiology and Intensive Care, Changhai Hospital, The Second Military Medical University, Shanghai, China (mainland)
| | - Jin-bao Li
- Department of Anesthesiology and Intensive Care, Changhai Hospital, The Second Military Medical University, Shanghai, China (mainland)
| | - Xiao-ming Deng
- Department of Anesthesiology and Intensive Care, Changhai Hospital, The Second Military Medical University, Shanghai, China (mainland)
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Bond A, Sarkar S. New technologies and techniques to improve adenoma detection in colonoscopy. World J Gastrointest Endosc 2015; 7:969-980. [PMID: 26265990 PMCID: PMC4530330 DOI: 10.4253/wjge.v7.i10.969] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 06/17/2015] [Accepted: 07/08/2015] [Indexed: 02/05/2023] Open
Abstract
Adenoma detection rate (ADR) is a key component of colonoscopy quality assessment, with a direct link between itself and future mortality from colorectal cancer. There are a number of potential factors, both modifiable and non-modifiable that can impact upon ADR. As methods, understanding and technologies advance, so should our ability to improve ADRs, and thus, reduce colorectal cancer mortality. This article will review new technologies and techniques that improve ADR, both in terms of the endoscopes themselves and adjuncts to current systems. In particular it focuses on effective techniques and behaviours, developments in image enhancement, advancement in endoscope design and developments in accessories that may improve ADR. It also highlights the key role that continued medical education plays in improving the quality of colonoscopy and thus ADR. The review aims to present a balanced summary of the evidence currently available and does not propose to serve as a guideline.
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