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Abstract
Colorectal cancer (CRC) continues to be the third leading cause of cancer-related deaths in the US. Colonoscopy remains the best preventative tool against the development of CRC. As a result, high-quality colonoscopy is becoming increasingly important. Specifically, recent guidelines have highlighted pre-procedural, peri-procedural, and post-procedural practices, which promise to improve patient outcomes and reduce the mortality and interval cancer rates in patients undergoing colonoscopies. Despite the guidelines and advances in modern endoscopy, the procedure remains provider-dependent, which results in differences in outcomes. As a result, incorporating high-quality colonoscopy approaches early in training is key to improving patient outcomes. Additionally, ensuring that high-quality colonoscopy is practiced widely by endoscopists can lead to the most cost-effective care.
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Nam JH, Lee JH, Kim JH, Kang HW, Jang DK, Lim YJ, Koh MS, Park HS, Park EC, Lee JK, Lee JH. Factors for cecal intubation time during colonoscopy in women: Impact of surgical history. Saudi J Gastroenterol 2019; 25:377-383. [PMID: 31044751 PMCID: PMC6941456 DOI: 10.4103/sjg.sjg_9_19] [Citation(s) in RCA: 5] [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] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND/AIM Cecal intubation during colonoscopy is prone to be prolonged in women, which may be related to frequent exposure to pelvic/abdominal surgery. We evaluated the association between Cecal Intubation Time (CIT) and prior episodes of pelvic/abdominal surgery in women. PATIENTS AND METHODS A cross-sectional study was conducted on screening participants who underwent colonoscopy. Multivariate regression with parameter estimates (β) was performed to determine the factors affecting CIT, including age, body mass index (BMI), bowel preparation, sedation, diverticulosis, experience of colonoscopists, and a surgical history. Also, subgroup analyses according to type of surgery were performed. RESULTS A total of 835 women were enrolled. The mean CIT was 5.82 ± 3.40 min. 323 females (38.7%) had episodes of surgery. The CIT was prolonged in cases performed by non-experienced trainees (β = 3.61, P< 0.001) and with a history of gynecological surgery (β = 0.97, P = 0.001). In the subgroup of non-experienced trainees, lower BMI, poor preparation, and a history of cesarean section significantly prolonged the CIT. Also, the risk for difficult colonoscopy (CIT ≥ 15 min) was increased with a history of cesarean section (odds ratio = 4.43, P= 0.024). CONCLUSION A prior episode of gynecological surgery prolonged CIT. Also, cesarean section history was associated with difficult colonoscopy in the examination by non-experienced trainees.
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Affiliation(s)
- Ji Hyung Nam
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea,Department of Medicine, Graduate School, Yonsei University, Seoul, Republic of Korea
| | - Jung Hyeon Lee
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Jae Hak Kim
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Hyoun Woo Kang
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Dong Kee Jang
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Yun Jeong Lim
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Moon-Soo Koh
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Hyun Soo Park
- Department of Obstetrics and Gynecology, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Eun-Cheol Park
- Department of Preventive Medicine and Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jun Kyu Lee
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea,Address for correspondence: Dr. Jun Kyu Lee, Department of Internal Medicine, Dongguk University College of Medicine, Ilsan Hospital, Dongguk-ro 27, Ilsandong-gu, Goyang-si, Gyeonggi-do - 10326, Republic of Korea. E-mail:
| | - Jin Ho Lee
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
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Baudet JS, Aguirre-Jaime A. Effect of conscious sedation with midazolam and fentanyl on the overall quality of colonoscopy: a prospective and randomized study. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2019; 111:507-513. [PMID: 31117800 DOI: 10.17235/reed.2019.5735/2018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION a prospective, randomized study was performed to assess the influence of conscious sedation on the overall quality of colonoscopy, simultaneously quantifying its effect on the scientific quality, perceived quality and patient safety. METHODS patients referred for a colonoscopy were included in the study and were randomized to receive or not receive sedation. Demographic data, indication for colonoscopy, cecal intubation, introduction and withdrawal time, resected adenomas and complications during the exploration were collected. Thirty days later, a satisfaction questionnaire was performed (GHAA 9-me) and patients were asked about complications after the examination. RESULTS a total of 5,328 patients were included, the average age was 62 ± 15.22 years, 47% were male, 3,734 were sedated and 1,594 were not sedated. The sedated patients had a shorter endoscope insertion time (7'20 ± 2'15 min vs 6'15 ± 3'12 min, p < 0.019), a higher rate of cecal intubations (96% vs 88%, p < 0.05), longer withdrawal time (7'20 ± 2'15 min vs 6'15 ± 3'12 min, p < 0.01) and higher adenoma detection rates (22% vs 17%, p < 0.05). The use of sedation reduced discomfort during and after the exploration, without increasing the complications. The satisfaction questionnaire score was higher (23.6 ± 1.5 vs 16.6 ± 4.8, p < 0.001) in the sedated patients. CONCLUSIONS superficial sedation not only reduces patient discomfort but also improves the overall quality of the colonoscopy. Therefore, we must consider the use of sedation as an essential part of colonoscopy.
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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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Fabrizio C, Nadia M, Alessandra A, Elisa G, Carmelo M. Factors influencing challenging colonoscopies during anesthesiologist-assisted deep sedation. Saudi J Gastroenterol 2016; 22:64-8. [PMID: 26831609 PMCID: PMC4763531 DOI: 10.4103/1319-3767.173761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND/AIM Increased demand for colon cancer screening procedures can significantly impact on routine colonoscopy management at dedicated facilities, prompting a review of the factors that can negatively affect workflow. Although potential adverse effects and impact on costs of deep sedation have been documented elsewhere, this study focuses on variables that can influence performance of colonoscopy in deep sedation and interfere with normal procedure scheduling in settings where the presence of an anesthesiologist is mandatory. PATIENTS AND METHODS We performed a cross-sectional study of the activities of a colonoscopy screening unit, applying Bayesian Network (BN) analysis, designed to assess interdependencies among variables that can affect a process in complex, multidimensional systems. The study was performed at a teaching hospital where endoscopists and anesthesiologists of varying work experience operate on a rota basis. During a six-month period, we analyzed 1485 consecutive colonoscopies performed under deep propofol sedation, administered by an anesthesiologist via hand-controlled syringe. The BN was constructed with the variables: Gender, age, ASA status, bowel preparation, baseline blood pressure, endoscopist's experience, anesthesiologist's experience, presence of polypectomy, and the target node, "challenging procedure." This previously undefined category refers to any events disrupting the scheduled rota. RESULT AND CONCLUSION Two distinct networks were identified. One deals mainly with relationships among the variables, patients' demographic and clinical characteristics (procedures with polypectomy, ASA and baseline blood pressure). The other explains relationships among the variables, "challenging procedure," bowel preparation, and endoscopist's experience. The factors associated with the anesthesiologist's activity do not influence challenging colonoscopies.
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Affiliation(s)
- Cardin Fabrizio
- Department of Surgical and Gastroenterological Science, Padova University Hospital, Padova, Italy,Address for correspondence: Dr. Cardin Fabrizio, Department of Geriatric Surgery, Geriatric Division, Ospedale Giustinianeo, Università di Padova, Via Giustiniani, 2, Padova 35100, Italy. E-mail:
| | - Minicuci Nadia
- Department of Internal Medicine, National Research Council, Institute of Neuroscience, Padova, Italy
| | - Andreotti Alessandra
- Department of Internal Medicine, National Research Council, Institute of Neuroscience, Padova, Italy
| | - Granziera Elisa
- Department of Anesthesia and Intensive Care, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - Militello Carmelo
- Department of Surgical and Gastroenterological Science, Padova University Hospital, Padova, Italy
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Martínez Ó, Ballesteros D, Estébanez B, Chana M, López B, Martín C, Algaba Á, Vigil L, Blancas R. [Characteristics of deep sedation in gastrointestinal endoscopic procedures performed by intensivists]. Med Intensiva 2014; 38:533-40. [PMID: 25438874 DOI: 10.1016/j.medin.2014.04.010] [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: 06/12/2012] [Revised: 02/06/2014] [Accepted: 04/19/2014] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To determine tolerance, pain intensity, percentage of tests completed successfully and complications of deep sedation controlled by intensivists during gastrointestinal endoscopic procedures. DESIGN A one-year, prospective observational study was carried out. SETTING Department of Intensive Care intervention in the Endoscopy Unit of Hospital Universitario del Tajo (Spain). PATIENTS Subjects over 15 years of age subjected to endoscopic procedures under deep sedation. RESULTS A total of 868 patients were sedated during the study period, with the conduction of 1010 endoscopic procedures. The degree of tolerance was considered adequate («Very good»/«Good») in 96.9% of the patients (95%CI: 95.7-98.1%), with a median score of 0 on the pain visual analog scale. A total of 988 endoscopic procedures were successfully completed (97.8%; 95%CI: 96.9-98.8%): 675 colonoscopies (97.1%) and 305 endoscopies (99.7%). Complications were recorded in 106 patients (12.2%; 95%CI: 10.0-14.5%). The most frequent being desaturation (6.1%), rhythm disturbances (5.1%) and hypotension (2.4%). CONCLUSION Gastrointestinal endoscopic procedures under sedation controlled by intensivists are well tolerated and satisfactory for the patient, and are successfully completed in a very large percentage of cases. The procedures are associated with frequent minor complications that are resolved successfully.
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Affiliation(s)
- Ó Martínez
- Servicio de Medicina Intensiva, Hospital Universitario del Tajo, Aranjuez, España.
| | - D Ballesteros
- Servicio de Medicina Intensiva, Hospital Universitario del Tajo, Aranjuez, España
| | - B Estébanez
- Servicio de Medicina Intensiva, Hospital Universitario del Tajo, Aranjuez, España
| | - M Chana
- Servicio de Medicina Intensiva, Hospital Universitario del Tajo, Aranjuez, España
| | - B López
- Servicio de Medicina Intensiva, Hospital Universitario del Tajo, Aranjuez, España
| | - C Martín
- Servicio de Medicina Intensiva, Hospital Universitario del Tajo, Aranjuez, España
| | - Á Algaba
- Servicio de Medicina Intensiva, Hospital Universitario del Tajo, Aranjuez, España
| | - L Vigil
- Servicio de Medicina Intensiva, Hospital Universitario del Tajo, Aranjuez, España
| | - R Blancas
- Unidad de Cuidados Intensivos, Hospital de Torrejón, Torrejón de Ardoz, España
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Korman LY, Haddad NG, Metz DC, Brandt LJ, Benjamin SB, Lazerow SK, Miller HL, Mete M, Patel M, Egorov V. Effect of propofol anesthesia on force application during colonoscopy. Gastrointest Endosc 2014; 79:657-62. [PMID: 24472761 DOI: 10.1016/j.gie.2013.12.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Accepted: 12/02/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND Sedation is frequently used during colonoscopy to control patient discomfort and pain. Propofol is associated with a deeper level of sedation than is a combination of a narcotic and sedative hypnotic and, therefore, may be associated with an increase in force applied to the colonoscope to advance and withdraw the instrument. OBJECTIVE To compare force application to the colonoscope insertion tube during propofol anesthesia and moderate sedation. DESIGN An observational cohort study of 13 expert and 12 trainee endoscopists performing colonoscopy in 114 patients. Forces were measured by using the colonoscopy force monitor, which is a wireless, handheld device that attaches to the insertion tube of the colonoscope. SETTING Community ambulatory surgery center and academic gastroenterology training programs. PATIENTS Patients undergoing routine screening or diagnostic colonoscopy with complete segment force recordings. MAIN OUTCOME MEASUREMENTS Axial and radial forces and examination time. RESULTS Axial and radial forces increase and examination time decreases significantly when propofol is used as the method of anesthesia. LIMITATIONS Small study, observational design, nonrandomized distribution of sedation type and experience level, different instrument type and effect of prototype device on insertion tube manipulation. CONCLUSIONS Propofol sedation is associated with a decrease in examination time and an increase in axial and radial forces used to advance the colonoscope.
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Affiliation(s)
- Louis Y Korman
- Chevy Chase Clinical Research, Chevy Chase, Maryland, USA
| | - Nadim G Haddad
- Division of Gastroenterology, Georgetown University Hospital, Georgetown University School of Medicine, Washington, DC, USA
| | - David C Metz
- Division of Gastroenterology, Hospital University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Lawrence J Brandt
- Division of Gastroenterology, Montefiore Medical Center, Albert Einstein School of Medicine, Bronx, New York, USA
| | - Stanley B Benjamin
- Division of Gastroenterology, Georgetown University Hospital, Georgetown University School of Medicine, Washington, DC, USA
| | - Susan K Lazerow
- Gastroenterology Division, Department of Veterans Affairs Medical Center, Washington, DC, USA
| | - Hannah L Miller
- Gastroenterology Division, Department of Veterans Affairs Medical Center, Washington, DC, USA
| | - Mihriye Mete
- Department of Biostatistics and Bioinformatics, MedStar Health Research Institute, Washington, DC, USA
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Chen Y, Duan YT, Xie Q, Qin XP, Chen B, Xia L, Zhou Y, Li NN, Wu XT. Magnetic endoscopic imaging vs standard colonoscopy: Meta-analysis of randomized controlled trials. World J Gastroenterol 2013; 19:7197-7204. [PMID: 24222966 PMCID: PMC3819558 DOI: 10.3748/wjg.v19.i41.7197] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 08/17/2013] [Accepted: 09/04/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the theoretical advantages of magnetic endoscope imaging (MEI) over standard colonoscopies (SCs) and to compare their efficacies.
METHODS: Electronic databases, including PubMed, EMBASE, the Cochrane library and the Science Citation Index, were searched to retrieve relevant trials. In addition, abstracts from papers presented at professional meetings and the reference lists of retrieved articles were reviewed to identify additional studies. The meta-analyses were performed using RevMan 5.1. A random effect model with the Mantel-Haenszel method was used for pooling dichotomous and continuous data. A sensitivity analysis was performed by excluding the trials with a small number of patients and by excluding the trials performed by inexperienced providers.
RESULTS: Eight randomized controlled trials (RCTs), including 2967 patients, were included in the meta-analysis to compare cecal intubation rates and times, sedation dose, abdominal pain scores and the use of ancillary maneuvers between MEI and SC. The overall OR was 1.92 (95%CI: 1.13-3.27, eight RCTs), as indicated by the cecal intubation rate of MEI compared with SC, but MEI did not have any distinct advantage over SC for cecal intubation time (MD = -0.07, 95%CI: -0.16-0.02; three RCTs). MEI did not generally result in lower pain scores. Outcomes were also analyzed for the two subgroups based on the endoscopists’ experience level to evaluate cecal intubation rates. MEI presented better outcomes for non-experienced colonoscopists than experienced colonoscopists.
CONCLUSION: The real-time magnetic imaging system is of benefit in training and educating inexperienced endoscopists and improves the cecal intubation rate for experienced and inexperienced endoscopists.
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Okholm C, Hadikhadem T, Andersen LT, Donatsky AM, Vilmann P, Achiam MP. No increased risk of perforation during colonoscopy in patients undergoing Nurse Administered Propofol Sedation. Scand J Gastroenterol 2013; 48:1333-8. [PMID: 24063514 DOI: 10.3109/00365521.2013.837951] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Nurse Administered Propofol Sedation (NAPS) contributes to a deeper sedation of the patients, making them unable to respond to pain and an increased incidence of perforations has been speculated. The objective of this study was to evaluate the risk of perforations during colonoscopies performed with either NAPS or conventional sedation regimes. MATERIAL AND METHODS Data were retrospectively retracted from medical journals from 1 January 2007 to 31 December 2011. All journals were examined and cross-referenced to reveal any perforations. We analyzed all colonoscopies in regard to nature of the procedure (diagnostic vs therapeutic), experience of the endoscopist and ASA-classification of the patients. RESULTS A total of 6371 colonoscopies were performed, of which 3155 were performed under propofol sedation. There were 16 perforations (0.25%); 10 of these performed during NAPS and 6 during conventional colonoscopy (p = 0.454, OR: 1.7 (95% CI: 0.6-5.7)). There were 4874 diagnostic and 1497 therapeutic colonoscopies, with a majority of the perforations (94%) occurring during a diagnostic procedure (p = 0.389). No statistically difference was found in the incidence of perforations caused by an experienced or less experienced endoscopist (p = 0.589). CONCLUSION The risk of colonic perforations during colonoscopy was not found to be significantly higher in patients undergoing NAPS compared to patients undergoing conventional sedation, although a tendency may exist. Furthermore, we found no correlation to neither experience of the endoscopist, nature of the procedure nor sex of the patients. Larger and prospective studies are needed to further evaluate on this subject.
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Affiliation(s)
- Cecilie Okholm
- Department of Surgery, Herlev Hospital, University of Copenhagen , Herlev , Denmark
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Qian JY, Gao JX, Qi YR, Wang WJ, Jia WJ. Application value of variable stiffness colonoscope in colonoscopy in elderly patients. Shijie Huaren Xiaohua Zazhi 2013; 21:3168-3172. [DOI: 10.11569/wcjd.v21.i29.3168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To explore the application value of variable stiffness colonoscope (VSC) in colonoscopy in elderly patients.
METHODS: From July 2012 to March 2013, 732 elderly patients (60-74 years) suspected to have colorectal cancer underwent colonoscopy at our hospital. They were randomly divided into two groups to receive colonoscopy using either VSC or standard adult colonoscope (SAC). Cecal intubation rate, cecal intubation time, abdominal pain score, position changes during colonoscopy, and additional use of sedation and/or analgesia were compared between the two groups.
RESULTS: VSC was associated with higher cecal intubation rate (95.9% vs 90.7%, P < 0.05) and fewer position changes or ancillary maneuvers during colonoscopy (12.6% vs 33.3%, P < 0.01) compared to SAC. Cecal intubation time was similar between the two groups (8.2 min ± 3.5 min vs 9.4 min ± 3.2 min, P > 0.05). Although VAS score was higher in the VSC group than in the SAC group (57.4 vs 44.1), additional use of sedation and/or analgesia showed no significant difference between the two groups (4.1% vs 3.8%, P > 0.05).
CONCLUSION: Use of VSC significantly improves cecal intubation rate and reduces position changes or ancillary maneuvers during the procedure. Cecal intubation time and additional use of sedation and/or analgesia are similar for the two types of colonoscope.
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Renewed attention for overtube-assisted colonoscopy to prevent incomplete endoscopic examination of the colon. Dis Colon Rectum 2013; 56:1013-8. [PMID: 23838871 DOI: 10.1097/dcr.0b013e3182962636] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Colonoscopy is the standard examination to detect mucosal pathology in the colon. However, failure to complete colonoscopy may reach more than 10% in population-based endoscopy practices. The reasons for incomplete conventional colonoscopy are diverse and result in missed diagnosis of colonic polyps and carcinoma. OBJECTIVE Recent endoscopic developments have shown that the use of specialized overtubes may help to reach the cecum in the case of a difficult colonoscopy, even with less discomfort. Several types of overtubes are currently available, whereas other types are being developed and clinically evaluated. The current review highlights the development of overtubes for colonoscopy and the available clinical data on overtube-assisted colonoscopy in the case of incomplete conventional colonoscopy. DATA SOURCES Data were derived from a PubMed search through November 2012. STUDY SELECTION Available clinical literature data on recent developments in overtube-assisted colonoscopy were studied. INTERVENTION A descriptive comparison was made of currently available endoscopy systems used for overtube-assisted colonoscopy. MAIN OUTCOME MEASURES The primary outcomes measured were the feasibility and safety of different endoscopy systems to perform overtube-assisted colonoscopy. RESULTS Several overtube-assisted colonoscopy systems have recently been developed to complete colonoscopy in the case of difficult conventional colonoscopy. Literature data show excellent feasibility to reach the cecum with very low complication rates and good patient tolerance for the different overtube systems. LIMITATIONS The majority of available studies are uncontrolled case series describing 7 to 110 patients undergoing overtube-assisted colonoscopy with only 1 direct comparison between 2 overtube systems. CONCLUSIONS Overtube-assisted colonoscopy has been shown to be useful in performing colonoscopy by increasing the cecal intubation rate and patient tolerance and by decreasing the need for sedation. There is no standardized superior overtube system at this moment.
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Bannert C, Reinhart K, Dunkler D, Trauner M, Renner F, Knoflach P, Ferlitsch A, Weiss W, Ferlitsch M. Sedation in screening colonoscopy: impact on quality indicators and complications. Am J Gastroenterol 2012; 107:1837-48. [PMID: 23147522 DOI: 10.1038/ajg.2012.347] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Quality indicators including cecal intubation rate (CIR) and adenoma detection rate (ADR) are established. Sex differences of quality indicators are observed, but the influence of sedation has not been investigated so far. The objective of this study is to assess the impact of sedation on quality indicators, including CIR and ADR, according to sex. METHODS We analyzed data of 52,506 screening colonoscopies performed by 196 endoscopists between November 2007 and April 2011 according to the Austrian "quality management for colon cancer prevention" program. RESULTS Sedation did not affect polyp detection rate (women P=0.7972, men P=0.3711) or ADR for both sexes (women P=0.2773, men P=0.8676). ADR was not significantly influenced by sedation (P=0.1272), but by age and sex (both P<0.0001), when the executing endoscopist was considered. Although women were more often sedated than men (90.70 vs. 81.83%; P<0.0001), CIR was slightly lower in women than in men (94.69 vs. 96.58%; P<0.0001). Sedation improved the CIR in women by 2.95% (94.96 vs. 92.01%; P<0.0001), whereas in men it was just by 1.28% (96.81 vs. 95.53%; P<0.0001). Sedated women only reached the CIR of unsedated men (94.96 vs. 95.53%; P=0.1005). Accounting for the intra-observer influence of the endoscopist, the overall CIR was influenced by the interaction of sex and age (P=0.0049), but not by sedation (P=0.1435). CONCLUSIONS Sedation does not increase adenoma or polyp detection, although it leads to an increase in CIR in men and women. This effect is more pronounced in women, yet CIR of men remains higher compared with women. Quality indicators are mainly influenced by the patient's age, sex, and the endoscopists' individual performance, rather than the endoscopists' subspeciality or procedural experience.
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Affiliation(s)
- Christina Bannert
- Quality Assurance Working Group of Austrian Society for Gastroenterology and Hepatology, Vienna, Austria
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13
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Xie Q, Chen B, Liu L, Gan H. Does the variable-stiffness colonoscope makes colonoscopy easier? A meta-analysis of the efficacy of the variable stiffness colonoscope compared with the standard adult colonoscope. BMC Gastroenterol 2012; 12:151. [PMID: 23095461 PMCID: PMC3503737 DOI: 10.1186/1471-230x-12-151] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Accepted: 09/20/2012] [Indexed: 02/05/2023] Open
Abstract
Background The variable-stiffness colonoscope (VSC) appears to have advantages over the standard adult colonoscope (SAC), although data are conflicting. To provide a comprehensive up-to-date review, we conducted a meta-analysis to compare the efficacies of the VSC and SAC. Methods Electronic databases, including PubMed, EMBASE, the Cochrane library and the Science Citation Index, were searched to retrieve relevant trials. In addition, meeting abstracts and the reference lists of retrieved articles were reviewed for further relevant studies. Results Eight randomized controlled trials (RCTs), enrolling a total of 2033 patients, were included in the meta-analysis. There was no significant heterogeneity among these studies. The cecal intubation rate was higher with the use of VSC (RR = 1.03, 95% CI 1.01 to 1.06, 8 RCTs). The VSC was also associated with fewer position changes made during colonoscopy. Time to cecal intubation was similar with VSC and SAC (WMD −0.54, 95% CI −1.40 to 0.32) but shorter in subgroup analysis with the use of VSC (WMD = −1.36, 95% CI −2.29 to −0.43). Sedation dose used with the two types of instruments showed no evidence of differences either. For all trials, only patients were blinded because of the nature of the interventions. Conclusion Use of the VSC significantly improved the cecal intubation rate and reduced ancillary maneuvers made during the procedure. Cecal intubation time was similar for the two colonoscope types over all trials, whereas a shortened time with the use of the adult VSC was seen in subgroup analysis.
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Affiliation(s)
- Qin Xie
- Department of Gastroenterology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
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Leung FW, Pan Y, Mann SK, Leung JW, Siao-Salera RM, Jackson G. The water exchange method and difficult colonoscopy. JOURNAL OF INTERVENTIONAL GASTROENTEROLOGY 2012; 2:103-105. [PMID: 23805386 PMCID: PMC3655360 DOI: 10.4161/jig.23727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 04/29/2012] [Accepted: 05/07/2012] [Indexed: 06/02/2023]
Affiliation(s)
- Felix W Leung
- Gastroenterology, Sepulveda ACC, VAGLAHS, North Hill ; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Aljarallah B, Alshammari B. Colonoscopy completion rates and reasons for incompletion. Int J Health Sci (Qassim) 2011; 5:102-107. [PMID: 23267287 PMCID: PMC3521826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
OBJECTIVES Colonoscopy is one of the major procedures in gastroenterology. Since the procedure is operator dependant, Quality of each procedure is the main element of reliable outcome. One of the elements is the completion rate. Completion rate of endoscopy unit is a reliable measure to improve the quality of the procedure. METHODOLOGY We here reviewed retrospectively our endoscopy database from the main tertiary hospital in Qassim province, central part of Saudi Arabia. The recommended completion based on several professional societies range from 90 - 95 % completion rate according to the indication. We retrospectively reviewed our endoscopy database over the period from 2005 to 2008 in King Fahad Specialist Hospital. RESULTS Our adjusted completion rate was 85.3 %. The main reason of incompletion was poor preparation. Our completion rate was comparable throughout the study period. CONCLUSION our completion rate is below recommended range. We think this result will stimulate the efforts to incorporate more quality measures in the endoscopy unit.
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Affiliation(s)
- Badr Aljarallah
- Correspondence: Dr. Badr M Aljarallah, Department of Medicine, Division of Gastroenterology, King Fahad Specialist Hospital, Faculty of Medicine, Qassim University, Saudi Arabia,
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