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Ruan W, Narula P, Fishman DS. Upskilling Pediatric Ileocolonoscopy. Gastrointest Endosc Clin N Am 2023; 33:253-265. [PMID: 36948745 DOI: 10.1016/j.giec.2022.11.006] [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: 03/24/2023]
Abstract
Upskilling in ileocolonoscopy is an important aspect of pediatric endoscopic practice as it enables endoscopists to learn additional skills through education and training to improve outcomes. With the advent of technologies, endoscopy is continuously evolving. Many devices can be applied to improve endoscopy quality and ergonomics. In addition, techniques such as dynamic position change can be employed to increase procedural efficiency and completeness. Key to upskilling is enhancing endoscopists' cognitive, technical and nontechnical skills and the concept of "training the trainer" to ensure trainers have the requisite skills to teach endoscopy effectively. This chapter details aspects of upskilling pediatric ileocolonoscopy.
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Affiliation(s)
- Wenly Ruan
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA; Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Texas Children's Hospital, Houston, TX, USA
| | - Priya Narula
- Department of Paediatric Gastroenterology, Sheffield Children's NHS Foundation, TrustWestern Bank, Sheffield S10 2TH, United Kingdom
| | - Douglas S Fishman
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA; Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Texas Children's Hospital, Houston, TX, USA.
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Lussi J, Mattmann M, Sevim S, Grigis F, De Marco C, Chautems C, Pané S, Puigmartí‐Luis J, Boehler Q, Nelson BJ. A Submillimeter Continuous Variable Stiffness Catheter for Compliance Control. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2021; 8:e2101290. [PMID: 34272935 PMCID: PMC8456283 DOI: 10.1002/advs.202101290] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/10/2021] [Indexed: 05/02/2023]
Abstract
Minimally invasive robotic surgery often requires functional tools that can change their compliance to adapt to the environment and surgical needs. This paper proposes a submillimeter continuous variable stiffness catheter equipped with a phase-change alloy that has a high stiffness variation in its different states, allowing for rapid compliance control. Variable stiffness is achieved through a variable phase boundary in the alloy due to a controlled radial temperature gradient. This catheter can be safely navigated in its soft state and rigidified to the required stiffness during operation to apply a desired force at the tip. The maximal contact force that the catheter applies to tissue can be continuously modified by a factor of 400 (≈20 mN-8 N). The catheter is equipped with a magnet and a micro-gripper to perform a fully robotic ophthalmic minimally invasive surgery on an eye phantom by means of an electromagnetic navigation system.
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Affiliation(s)
- Jonas Lussi
- Institute of Robotics and Intelligent SystemsETH ZurichZurichCH‐8092Switzerland
| | - Michael Mattmann
- Institute of Robotics and Intelligent SystemsETH ZurichZurichCH‐8092Switzerland
| | - Semih Sevim
- Institute of Chemical and BioengineeringETH ZurichVladimir Prelog Weg 1ZurichCH‐8093Switzerland
| | - Fabian Grigis
- Institute of Robotics and Intelligent SystemsETH ZurichZurichCH‐8092Switzerland
| | - Carmela De Marco
- Institute of Robotics and Intelligent SystemsETH ZurichZurichCH‐8092Switzerland
| | - Christophe Chautems
- Institute of Robotics and Intelligent SystemsETH ZurichZurichCH‐8092Switzerland
| | - Salvador Pané
- Institute of Robotics and Intelligent SystemsETH ZurichZurichCH‐8092Switzerland
| | - Josep Puigmartí‐Luis
- Departament de Ciència dels Materials i Química FísicaInstitut de Química Teòrica i ComputacionalBarcelona08028Spain
- ICREACatalan Institution for Research and Advanced StudiesPg. Lluís Companys 23Barcelona08010Spain
| | - Quentin Boehler
- Institute of Robotics and Intelligent SystemsETH ZurichZurichCH‐8092Switzerland
| | - Bradley J. Nelson
- Institute of Robotics and Intelligent SystemsETH ZurichZurichCH‐8092Switzerland
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Gerges C, Neumann H, Ishaq S, Sivanathan V, Galle PR, Neuhaus H, Neumann H. Evaluation of a novel colonoscope offering flexibility adjuster - a retrospective observational study. Therap Adv Gastroenterol 2021; 14:17562848211013494. [PMID: 34104209 PMCID: PMC8170286 DOI: 10.1177/17562848211013494] [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: 01/17/2021] [Accepted: 04/07/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Although colonoscopy is the gold standard for colorectal cancer screening, colonic looping may make complete colonoscopy challenging. Commonly available stiffening device colonoscopy has been described as helpful but not effective enough to prevent looping. In this context the effect on cecal intubation time and rate was described differently in various studies and in some studies had no impact on cecal intubation time at all. The aim of this study was to evaluate whether a novel colonoscope with gradual stiffness (Fujifilm EC760R-V/I- flexibility adjuster, Tokyo, Japan) using four significantly different grades of stiffness can be an alternative to established devices in terms of loop prevention, cecal intubation rate and time, adverse events, and patient/examiner satisfaction. METHODS Consecutive patients without previous colorectal surgery were analyzed retrospectively. Colonoscopy was performed with the new colonoscope and performance characteristics, including time to cecum, withdrawal time, total examination time, and patient and endoscopist satisfaction were recorded. RESULTS Among 180 consecutive procedures, 98.3% of examinations were complete to the cecum. The endoscopic flexibility adjuster was used in 150 of 180 cases (83.3%). Overall, the device was scored by the examiner as helpful to prevent looping in 146 of the 150 cases (97.7%). Mean cecal intubation time was 6.5 min, with 35% of examination performed in under 5 min with a mean withdrawal time of 7 min. Mean total examination time was 18 min. Patient satisfaction was rated as high in all examinations performed. CONCLUSION The new flexibility adjuster colonoscope was shown to be helpful in loop prevention, allowed for fast and successful cecal intubation, and led to a high rate of patients satisfaction.
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Affiliation(s)
- Christian Gerges
- Department of Gastroenterology, Evangelisches
Krankenhaus Düsseldorf, Düsseldorf, Germany
| | | | - Sauid Ishaq
- Department of Gastroenterology, Dudley Group
NHS, Foundation Trust and Birmingham City University, Birmingham, UK
| | - Visvakanth Sivanathan
- Department of Interdisciplinary Endoscopy, I.
Medizinische Klinik und Poliklinik, University Hospital, Mainz,
Germany
| | - Peter R. Galle
- Department of Interdisciplinary Endoscopy, I.
Medizinische Klinik und Poliklinik, University Hospital, Mainz,
Germany
| | - Horst Neuhaus
- Department of Gastroenterology, Evangelisches
Krankenhaus Düsseldorf, Düsseldorf, Germany
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Choy MC, Matharoo M, Thomas-Gibson S. Diagnostic ileocolonoscopy: getting the basics right. Frontline Gastroenterol 2020; 11:484-490. [PMID: 33101627 PMCID: PMC7569527 DOI: 10.1136/flgastro-2019-101266] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 02/15/2020] [Accepted: 02/17/2020] [Indexed: 02/04/2023] Open
Abstract
Proficient colonoscopy technique that optimises patient comfort while simultaneously enhancing the timely detection of pathology and subsequent therapy is an aspirational and achievable goal for every endoscopist. This article aims to provide strategies to improve colonoscopy quality for both endoscopists and patients.
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Affiliation(s)
- Matthew C Choy
- Wolfson Endoscopy Unit, St Marks Hospital, Harrow, UK,Department of Medicine, Austin Academic Centre, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Siwan Thomas-Gibson
- Wolfson Endoscopy Unit, St Marks Hospital, Harrow, UK,Department of Surgery and Cancer, Imperial College London, London, UK
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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: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [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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Sato K, Ito S, Kitagawa T, Hirahata K, Hihara D, Tominaga K, Yasuda I, Maetani I. A prospective randomized study of the use of an ultrathin colonoscope versus a pediatric colonoscope in sedation-optional colonoscopy. Surg Endosc 2017; 31:5150-5158. [PMID: 28488178 DOI: 10.1007/s00464-017-5581-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 05/02/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Ultrathin colonoscopes (UTC) reportedly produce less pain during colonoscopy than standard colonoscopes. The aim of this study was to assess the tolerability of an UTC compared with that of a pediatric colonoscope. METHODS A total of 270 adult patients scheduled to undergo colonoscopy were randomized, with 134 allocated to the UTC group and 136 to the pediatric colonoscope group. Pain was assessed using a visual analog scale. For all procedures, sedation was administered only if requested. Overall pain, rate and time of cecal and terminal ileum intubation, number of patients requesting sedation, adenoma detection rates (ADR), and rate of complications were measured and analyzed. RESULTS Among all patients, the medians of maximum pain and overall pain were significantly lower in the UTC group than in the pediatric colonoscope group (23 vs. 38, P < 0.001; 12 vs. 22, P = 0.0003, respectively). Significantly fewer patients requested sedation in the UTC group than in the pediatric colonoscope group (1.4 vs. 6.6%; P = 0.0269). No significant differences were seen in either the rate and time of successful cecal and terminal ileum intubation, or in other procedure-related outcomes, including ADR. CONCLUSIONS Compared with a pediatric colonoscope, the UTC was associated with reduced overall and maximum pain during colonoscopy, with no difference in ADR.
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Affiliation(s)
- Koichiro Sato
- Department of Gastroenterology, Mizonokuchi Hospital, Teikyo University School of Medicine, 3-8-3 Mizonokuchi, Takatsu-ku, Kawasaki, Kanagawa, 213-8507, Japan.
| | - Sayo Ito
- Division of Gastroenterology, Department of Internal Medicine, Toho University Ohashi Medical Center, 2-17-6 Ohashi, Meguro-ku, Tokyo, 153-8515, Japan
| | - Tomoyuki Kitagawa
- Department of Gastroenterology, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minamikoshigaya, Koshigaya-Shi, Saitama Prefecture, Japan
| | | | - Daisuke Hihara
- Division of Gastroenterology, Department of Internal Medicine, Toho University Ohashi Medical Center, 2-17-6 Ohashi, Meguro-ku, Tokyo, 153-8515, Japan
| | - Kenji Tominaga
- Division of Gastroenterology, Department of Internal Medicine, Toho University Ohashi Medical Center, 2-17-6 Ohashi, Meguro-ku, Tokyo, 153-8515, Japan
| | - Ichiro Yasuda
- Department of Gastroenterology, Mizonokuchi Hospital, Teikyo University School of Medicine, 3-8-3 Mizonokuchi, Takatsu-ku, Kawasaki, Kanagawa, 213-8507, Japan
| | - Iruru Maetani
- Division of Gastroenterology, Department of Internal Medicine, Toho University Ohashi Medical Center, 2-17-6 Ohashi, Meguro-ku, Tokyo, 153-8515, Japan
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Pasternak A, Szura M, Solecki R, Matyja M, Szczepanik A, Matyja A. Impact of responsive insertion technology (RIT) on reducing discomfort during colonoscopy: randomized clinical trial. Surg Endosc 2016; 31:2247-2254. [PMID: 27631316 PMCID: PMC5411411 DOI: 10.1007/s00464-016-5226-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 08/25/2016] [Indexed: 12/12/2022]
Abstract
Background In many countries, colonoscopies for colorectal cancer screening are performed without sedation due to the cost. Changes in the structure of the endoscopes are designed to facilitate the colonoscopic examination, reduce the duration of the procedure, and improve the imaging of the intestinal lumen. The variable stiffness of the endoscope and the recently introduced responsive insertion technology (RIT) are features aimed at easing colonoscope insertion and reducing the discomfort and pain during the examination. The aim of the study is to analyze whether the new RIT system can improve the practice of colonoscopy under no anesthesia with respect to the widely available variable stiffness colonoscopes. Materials and methods This analysis included 647 patients who underwent complete colonoscopy in the screening program. All colonoscopies were performed without sedation. Olympus series 180 and 190 endoscopes equipped with a magnetic positioning system were used. Group I included patients who were examined using endoscopes equipped with responsive insertion technology (RIT), and group II included patients who were examined using conventional variable stiffness colonoscopies. The main objective was to evaluate the cecal intubation time, the number of loops, the requirement to apply manual pressure to different areas of the abdomen and the degree of discomfort and pain expressed on a visual analogue scale (VAS). ClinicalTrials.gov number, NCT01688557. Results Group I consisted of 329 patients, and group II included 318 patients. The mean age of the patients was 58.4 years (SD ± 4.21). Both groups were compared in terms of age, sex, and BMI. The mean cecal intubation time was 209 s in group I and 224 s in group II (p < 0.05). Increased loop formation was observed upon endoscope insertion in group II (1.7 vs. 1.35) (p < 0.05) and required more manual pressure to the abdomen (2.2 vs. 1.7) (p = 0.001). In group I, less discomfort and pain, as graded on a VAS (2.3 vs. 2.6), were noted. Conclusions The implementation of RIT reduced of the cecal intubation time. The modified structure of the endoscope rendered the colonoscopic examination easier by reducing loop formation upon insertion with a subsequently reduced rate of auxiliary maneuvers.
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Affiliation(s)
- Artur Pasternak
- First Chair of General, Oncological and Gastrointestinal Surgery, Jagiellonian University Medical College, 40th Kopernika St., 31-501, Krakow, Poland. .,Department of Anatomy, Jagiellonian University Medical College, 12th Kopernika St., 31-034, Krakow, Poland.
| | - Miroslaw Szura
- Department of Experimental and Clinical Surgery, Jagiellonian University Medical College, 12th Michalowskiego St., 31-126, Krakow, Poland
| | - Rafal Solecki
- Department of Experimental and Clinical Surgery, Jagiellonian University Medical College, 12th Michalowskiego St., 31-126, Krakow, Poland
| | - Maciej Matyja
- Second Chair of General Surgery, Jagiellonian University Medical College, 21st Kopernika St., 31-501, Krakow, Poland
| | - Antoni Szczepanik
- First Chair of General, Oncological and Gastrointestinal Surgery, Jagiellonian University Medical College, 40th Kopernika St., 31-501, Krakow, Poland
| | - Andrzej Matyja
- First Chair of General, Oncological and Gastrointestinal Surgery, Jagiellonian University Medical College, 40th Kopernika St., 31-501, Krakow, Poland
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Cuesta R, Sola-Vera J, Uceda F, García Sepulcre MF, Morillo E, Vázquez N. Does "responsive insertion technology" improve practice of colonoscopy? Results of a randomized study. Scand J Gastroenterol 2014; 49:355-61. [PMID: 24417584 DOI: 10.3109/00365521.2013.871576] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE. During colonoscopy, advancing the endoscope can sometimes be difficult due to the appearance of loops or bends in the insertion tube. Therefore, research continues toward improving colonoscope technology. The aim of this study is to compare the use of colonoscopes equipped with "responsive insertion technology" (RIT) versus regular non-RIT colonoscopes. MATERIALS AND METHODS. Prospective, comparative and randomized trials that included patients submitted to colonoscopy. In group I, RIT colonoscopes were used, while in group II, colonoscopies with variable stiffness but without the other components of the RIT technology were used. Demographic variables and variables related to colonoscopy, as well as the pain perceived by the patient and the difficulty in performing endoscopy were recorded. RESULTS. A total of 122 patients were included in group I and 120 patients in group II. The cecal intubation rate was similar in both groups. The use of the RIT colonoscopes was associated with a lower cecal intubation time (4.4 ± 2.0 vs. 5.4 ± 3.5, p = 0.005) and a lower difficulty in performing examinations for both the endoscopist (19.1 ± 20.0 vs. 27.7 ± 22.2, p = 0.002) and the nursing staff (20.8 ± 17.0 vs. 26.3 ± 19.6, p = 0.04). No significant differences were found between both groups in the need for ancillary maneuvers or in the pain perceived by the patient. CONCLUSIONS. RIT colonoscopes allow cecal intubation in a shorter time compared to variable stiffness colonoscopes, and are associated with a greater level of ease of the procedure.
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Affiliation(s)
- Rubén Cuesta
- Hospital General Universitario de Elche, Digestive Medicine , Elche , Spain
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Jun WU, Bing HU. Comparative effectiveness of water infusion vs air insufflation in colonoscopy: a meta-analysis. Colorectal Dis 2013; 15:404-9. [PMID: 22889295 DOI: 10.1111/j.1463-1318.2012.03194.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM Colonoscopy with air insufflation is known to result in abdominal pain and discomfort. We aimed to determine the effectiveness of water infusion during colonoscopy through a meta-analysis. METHOD Original papers and abstracts published up to October 2011 were searched in MEDLINE, EMBASE, Cochrane Library Database and important meeting abstracts. Clinical appraisal and data extraction were conducted by two reviewers independently. Statistical analysis was performed by meta-analysis using a fixed effects model or a random effects model. RESULTS Seven studies involving 872 patients were included. Meta-analysis showed that the water infusion group had fewer patients requiring abdominal compression or position change [risk ratio (RR) 0.73, 95% CI 0.59, 0.91], a lower mean pain score (RR -1.10, 95% CI -1.26, -0.95), lower maximum pain score (RR -2.34, 95% CI -2.92, -1.76) and fewer patients requiring on-demand sedation (RR 0.45, 95% CI 0.31, 0.66) than the air insufflation group during colonoscopy. There were no significant differences in caecal intubation rate, caecal intubation time, total procedure time and adenoma detection rate. CONCLUSION Water infusion significantly decreases patient discomfort and abdominal pain during colonoscopy without affecting operation time and intubation success rate.
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Affiliation(s)
- W U Jun
- Department of Endoscopy, Eastern Hepatobiliary Hospital, Second Military Medical University, Shanghai, China
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Kobayashi K, Mukae M, Ogawa T, Yokoyama K, Sada M, Koizumi W. Clinical usefulness of single-balloon endoscopy in patients with previously incomplete colonoscopy. World J Gastrointest Endosc 2013; 5:117-121. [PMID: 23515370 PMCID: PMC3600547 DOI: 10.4253/wjge.v5.i3.117] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 12/04/2012] [Accepted: 01/24/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the clinical usefulness of single-balloon endoscopy (SBE) in patients in whom a colonoscope was technically difficult to insert previously.
METHODS: The study group comprised 15 patients (8 men and 7 women) who underwent SBE for colonoscopy (30 sessions). The number of SBE sessions was 1 in 7 patients, 2 in 5 patients, 3 in 1 patient, 4 in 1 patient, and 6 in 1 patient. In all patients, total colonoscopy was previously unsuccessful. The reasons for difficulty in scope passage were an elongated colon in 6 patients, severe intestinal adhesions after open surgery in 4, an elongated colon and severe intestinal adhesions in 2, a left inguinal hernia in 2, and multiple diverticulosis of the sigmoid colon in 1. Three endoscopists were responsible for SBE. The technique for inserting SBE in the colon was basically similar to that in the small intestine. The effectiveness of SBE was assessed on the basis of the success rate of total colonoscopy and the presence or absence of complications. We also evaluated the diagnostic and treatment outcomes of colonoscopic examinations with SBE.
RESULTS: Total colonoscopy was successfully accomplished in all sessions. The mean insertion time to the cecum was 22.9 ± 8.9 min (range 9 to 40). Abnormalities were found during 21 sessions of SBE. The most common abnormality was colorectal polyps (20 sessions), followed by radiation colitis (3 sessions) and diverticular disease of the colon (3 sessions). Colorectal polyps were resected endoscopically in 15 sessions. A total of 42 polyps were resected endoscopically, using snare polypectomy in 32 lesions, hot biopsy in 7 lesions, and endoscopic mucosal resection in 3 lesions. Fifty-six colorectal polyps were newly diagnosed on colonoscopic examination with SBE. Histopathologically, these lesions included 2 intramucosal cancers, 42 tubular adenomas, and 2 tubulovillous adenomas. The mean examination time was 48.2 ± 20.0 min (range 25 to 90). Colonoscopic examination or endoscopic treatment with SBE was not associated with any serious complications.
CONCLUSION: SBE is a useful and safe procedure in patients in whom a colonoscope is technically difficult to insert.
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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: 1.2] [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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Koumi A, Kalaitzakis E, Forbes A, Panos MZ. Underutilisation of the gastroscope for total colonoscopy in adults: a survey of two European countries. Int J Colorectal Dis 2012; 27:959-65. [PMID: 22395658 DOI: 10.1007/s00384-012-1436-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/09/2012] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND STUDY AIMS High caecal intubation success rates have been reported with the gastroscope in adults. We surveyed the current use of the gastroscope for total colonoscopy in adults in the UK and Greece. METHODS A questionnaire was e-mailed to 952 members of the British Society of Gastroenterology (UK) and 478 members of the Hellenic Society of Gastroenterology (GR), enquiring as to access to a paediatric colonoscope, use of gastroscope for total colonoscopy and estimate of caecal intubation success rate. RESULTS Valid replies were 17.4% from UK and 19.7% from GR. The paediatric colonoscope was available to 106/138 (77%) UK and to only 18/86 (21%) GR respondents (p = 0.0002). Of all the UK and GR respondents, 109/138 (79%) and 68/86 (79%), respectively, did not use the gastroscope for total colonoscopy. For the use of the gastroscope for total colonoscopy, 26/29 (89%) UK and 9/18 (50%) GR users did so, while a paediatric colonoscope was also available (p = 0.001), and 3/29 (10.3%) UK and 9/18 (50%) GR users did so, whilst they had no access to a paediatric colonoscope (p = 0.001). Estimated gastroscope caecal intubation success rate was 69% (SD 0.26) UK and 46% (SD 0.36) GR, p = 0.008. Only 37% UK and 28% GR respondents used the gastroscope to examine the left colon. CONCLUSIONS The gastroscope is underutilised for total colonoscopy in both the UK and Greece. Use of the gastroscope does not appear to be related to lack of access to a paediatric colonoscope in the UK but may be in GR. Gastroscope caecal intubation success rate justifies its use where the colonoscope fails.
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Affiliation(s)
- Andriani Koumi
- Department of Gastroenterology, Euroclinic of Athens, 9 Athanasiadou Street, 11521 Athens, Greece
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Luo DJY, Hui AJ, Yan KKL, Ng SC, Wong VWS, Chan FKL, Cheong JPK, Lam PPY, Tse YK, Lau JYW. A randomized comparison of ultrathin and standard colonoscope in cecal intubation rate and patient tolerance. Gastrointest Endosc 2012; 75:484-90. [PMID: 21963069 DOI: 10.1016/j.gie.2011.07.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Accepted: 07/14/2011] [Indexed: 02/08/2023]
Abstract
BACKGROUND Complete colonoscopy examination cannot be performed in as many as 10% of cases. The new 9.2-mm ultrathin colonoscope (UTC) with an extra bending section may improve procedure tolerance and allow improvement in colonoscopy completion rate compared with a 12.9-mm standard colonoscope (SC). OBJECTIVE To compare the performance of the 9.2-mm UTC with that of the 12.9-mm SC. DESIGN Prospective, randomized, controlled trial. SETTING Academic endoscopic unit. PATIENTS Subjects 18 years and older undergoing their first colonoscopy. INTERVENTION Subjects were randomized to either the UTC or SC group. MAIN OUTCOME MEASUREMENTS First and rescue successful cecal intubation rates, subject satisfaction scores, and sedation requirements were compared. RESULTS A total of 1121 patients (56% women, mean age 53.6 years) were randomized to the UTC group (n = 551) or the SC group (n = 570). There was no statistically significant difference in the first successful cecal intubation rate between the UTC and SC groups (98.9% vs 97.4%, P = .057). The mean (standard deviation) dose of midazolam and pethidine used was significantly lower in the UTC group (2.65 [0.65] mg vs 2.82 [0.85] mg, P < .001 and 27.6 [7.4] mg vs 29.7 [9.6] mg, P < .001, respectively). The mean (standard deviation) patient satisfaction score was similar between groups (6.99 [2.89] vs 7.04 [3.06], P = .762). Of the 21 patients (1.9%) with an incomplete initial colonoscopy (6 in the UTC group and 15 in the SC group), all 6 in the UTC group had their procedure completed with an SC. Eleven of 15 patients in the SC group had their procedures completed with a UTC in the same session. LIMITATIONS Low failure rate may mask any difference between the 2 colonoscopes as a rescue instrument. CONCLUSIONS The 9.2-mm UTC has performance characteristics similar to those of an SC in Chinese subjects undergoing their first colonoscopy performed by experienced and trainee endoscopists. ( CLINICAL TRIAL REGISTRATION NUMBER NCT01142167.).
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Affiliation(s)
- Derek J Y Luo
- Institute of Digestive Disease, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR
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15
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Abstract
Although colonoscopy is a very commonly carried out procedure, it is not without its problems, including a risk of perforation and significant patient discomfort, especially associated with looping formation. Furthermore, looping formation may prevent a complete colonoscopy from being carried out in certain patients. The conventional colonoscope has not changed very much since its original introduction. We review promising technologies that are being promoted as a way to address the problems with current colonoscopy. There are some methods to prevent looping formation, including overtube, variable stiffness, computer-guided scopes, Aer-O-Scope, magnetic endoscopic imaging and the capsule endoscope. In recent years, with the progress of microelectromechanical and microelectronic technologies, many biomedical and robotic researchers are developing autonomous endoscopes with miniaturization of size and integration functionality that represent state of the art of the micro-robotic endoscope. The initial results by using aforementioned methods seem promising; however, there are some conflicting reports of clinical trials with the overtube colonoscope, the computer-guided scope and the variable stiffness colonoscope. There are also some limitations in the use of the Aer-o-scope and the capsule endoscope. The autonomous endoscope is based on a self-propelling property that is able to avoid looping completely. This novel technology could potentially become the next generation endoscope; however, there are still critical techniques to be approached in order to develop the effective and efficient novel endoscope.
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Affiliation(s)
- Wu Bin Cheng
- Division of Biomedical Engineering, University of Saskatchewan, Saskatoon, Canada
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Cheng WB, Moser M, Kanagaratnam S, Zhang WJ. Development of autonomous microrobotics in endoscopy. J Med Eng Technol 2011; 35:391-401. [DOI: 10.3109/03091902.2011.626839] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Adler DG. Initial report of a variable stiffness duodenoscope for use during endoscopic retrograde cholangiopancreatography. J Clin Gastroenterol 2011; 45:590-2. [PMID: 20921902 DOI: 10.1097/mcg.0b013e3181f42d85] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
GOALS To evaluate a new variable stiffness duodenoscope. BACKGROUND Variable stiffness colonoscopies have been in use for nearly a decade. We report the initial experience with a new, variable stiffness duodenoscope for use during endoscopic retrograde cholangiopancreatography (ERCP). STUDY Retrospective, single tertiary referral academic center. Among the first 50 patients to undergo ERCP with the variable stiffness cope, 3 patients in whom the variable stiffness duodenoscope was instrumental in procedural success are discussed in detail. RESULTS In the first 50 patients in whom the variable stiffness duodenoscope was used, the variable stiffness function was critical to procedural success in 3 patients (6%). One patient had a gastric bypass with Roux-en-Y anatomy, 1 patient had a large J-shaped stomach that could not be traversed by a routine duodenoscope, and 1 patient had a duodenal stenosis that could not be traversed by a routine duodenoscope. In these 3 patients, the variable stiffness function allowed for procedure success. CONCLUSIONS Although most ERCPs can be accomplished with standard duodenoscopes, in cases in which extra endoscope stiffness was felt to be required, the variable stiffness function was extremely helpful.
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Affiliation(s)
- Douglas G Adler
- Gastroenterology and Hepatology, Huntsman Cancer Center, University of Utah School of Medicine, Salt Lake City, UT, USA.
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18
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Does the use of a variable stiffness colonoscope offer advantages during colonoscopy under deep sedation? Results of a randomized trial. Eur J Gastroenterol Hepatol 2011; 23:593-7. [PMID: 21593674 DOI: 10.1097/meg.0b013e32834793d3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Variable stiffness colonoscope may be useful in performing colonoscopies in nonsedated patients or under endoscopist-controlled sedation. The objective of this study is to evaluate whether this instrument facilitates colonoscopy in patients under deep sedation monitored by an anaesthesiologist. METHODS Prospective and randomized study enroling consecutive patients referred for colonoscopy under deep sedation monitored by an anaesthesiologist. In group I, a variable stiffness colonoscope was used, whereas in group II, a standard colonoscope was used. The main variable was the need to change the position of the patient during the endoscopy. RESULTS Fifty-six patients were included in group I (variable stiffness colonoscope) and 54 in group II (standard colonoscope). The caecum was reached in 92.9% of patients in group I and in 90.7% of group II (P=0.7). The time required to reach the caecum was significantly less in group I (6.14±3.5 vs. 7.7±3.8; P=0.035). The variable stiffness colonoscope was effective in 66.7% of cases. Changing the position of the patient was necessary in 12.5% of cases in group I compared with 33.3% of cases in group II (P=0.01). CONCLUSION The variable stiffness colonoscope avoids the need to change the patient's position and reduces caecal intubation time in patients undergoing colonoscopy under deep sedation controlled by an anaesthesiologist.
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Coppola F, Gaia S, Cosimato M, Recchia S. Enteroscope without overtube for cecal intubation after an incomplete colonoscopy. Dig Liver Dis 2011; 43:475-7. [PMID: 21334994 DOI: 10.1016/j.dld.2011.01.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Revised: 01/03/2011] [Accepted: 01/17/2011] [Indexed: 12/11/2022]
Abstract
BACKGROUND Cecal intubation is one of the targets of colon endoscopic evaluation, however even under experienced hands 5-10% of colonoscopies are incomplete. AIMS The aim of the study is to evaluate the usefulness of single balloon enteroscope (SBE) without employing overtube-balloon equipment in patients with incomplete colonoscopy. METHODS Between January 2009 and July 2010, patients with an incomplete standard colonscopy were prospectively enrolled to perform a colonoscopy with a single balloon enteroscope. Examinations were performed by the same expert operator during the same session. RESULTS Enteroscopy was performed on 79 patients, cecal intubation were obtained in 93.6% of the cases (74/79). It provided a new diagnosis in 43% of cases (34/79). Procedure was safe and well tolerated. Overall the additional use of single balloon enteroscope allowed to obtain the cecal intubation in up to 99.2% cases (898/905). CONCLUSIONS The use of the enteroscope without overtube-balloon equipment may be an effective method to increase the cecal intubation rate after failure of a standard colonoscopy.
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Affiliation(s)
- Franco Coppola
- Department of Gastroenterology, San Giovanni Bosco Hospital, Torino, Italy.
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20
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Abstract
The colonoscopic insertion technique is still one of the most difficult endoscopic procedures to master and development of a new colonoscope that is easier to insert is much awaited especially into the cecum without patient discomfort. We focused on reducing patient pain and boosting the success rate of colonoscope insertion into the cecum in complicated cases. As a result, we have successfully developed two mechanisms: "Passive Bending" and use of a "High Force Transmission insertion tube." We believe these two mechanisms when combined together will contribute to a reduction in patient discomfort and an increase in the cecal intubation rate during many difficult colonoscopies, but further evaluation is required with respect to therapeutic endoscopy effectiveness and insertion for patients with long colons.
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Affiliation(s)
- Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
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Litten JD, Choi J, Drozek D. Development of a colonoscopy add-on device for improvement of the intubation process. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2011; 4:197-208. [PMID: 22915947 PMCID: PMC3417891 DOI: 10.2147/mder.s27728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A colonoscopy add-on device has been developed to reduce intubation time without modification of the current colonoscope and peripheral devices. One of the main purposes of the system is to minimize trauma caused by the distal tip of the colonoscope. The detachable sensory fixture at the end of the distal tip measures the distance between the distal tip and the colon wall in three directions, and the actuation system attached at the base of the colonoscope controls the distal tip by rotating two dial knobs. The device controls the distal tip to minimize contact between the distal tip and the colon wall, and the distal tip ideally points out the next possible lumen. A compatibility test of the infrared sensory system was carried out, and the design of the actuation system was accomplished. The system is integrated and controlled by a microprocessor. The device was tested in a silicon colon and porcine intestine. The results showed that a colonoscopist successfully reached the cecum with the aid of the colonoscopy add-on device without significant contact between the colon wall and the distal tip. The colonoscopy aid device was very helpful for the novice colonoscopist.
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Affiliation(s)
- Jonathan D Litten
- Department of Mechanical Engineering, Ohio University, Athens, OH, USA
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23
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Maximizing the general success of cecal intubation during propofol sedation in a multi-endoscopist academic centre. BMC Gastroenterol 2010; 10:123. [PMID: 20961451 PMCID: PMC2975653 DOI: 10.1186/1471-230x-10-123] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Accepted: 10/20/2010] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Achieving the target of 95% colonoscopy completion rate at centres conducting colorectal screening programs is an important issue. Large centres and teaching hospitals employing endoscopists with different levels of training and expertise risk achieving worse results. Deep sedation with propofol in routine colonoscopy could maximize the results of cecal intubation. METHODS The present study on the experience of a single centre focused on estimating the overall completion rate of colonoscopies performed under routine propofol sedation at a large teaching hospital with many operators involved, and on assessing the factors that influence the success rate of the procedure and how to improve this performance, analyzing the aspects relating to using of deep sedation. Twenty-one endoscopists, classified by their level of specialization in colonoscopic practice, performed 1381 colonoscopies under deep sedation. All actions needed for the anaesthesiologist to restore adequate oxygenation or hemodynamics, even for transient changes, were recorded. RESULTS The "crude" overall completion rate was 93.3%. This finding shows that with routine deep sedation, the colonoscopy completion rate nears, but still does not reach, the target performance for colonoscopic screening programs, at centers where colonoscopists of difference experience are employed in such programs.Factors interfering with cecal intubation were: inadequate colon cleansing, endoscopists' expertise in colonoscopic practice, patients' body weight under 60 kg or age over 71 years, and the need for active intervention by the anaesthesiologist. The most favourable situation--a patient less than 71 years old with a body weight over 60 kg, an adequate bowel preparation, a "highly experienced specialist" performing the test, and no need for active anaesthesiological intervention during the procedure--coincided with a 98.8% probability of the colonoscopy being completed. CONCLUSIONS With routine deep sedation, the colonoscopy completion rate nears the target performance for colonoscopic screening programs, at centers where colonoscopists of difference experience are employed in such programs. Organizing the daily workload to prevent negative factors affecting the success rate from occurring in combination may enable up to 85% of incomplete procedures to be converted into successful colonoscopies.
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Loeve AJ, Bosma JH, Breedveld P, Dodou D, Dankelman J. Polymer Rigidity Control for Endoscopic Shaft-Guide ‘Plastolock’ — A Feasibility Study. J Med Device 2010. [DOI: 10.1115/1.4002494] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Flexible endoscopes are used for diagnostic and therapeutic interventions in the human body for their ability to be advanced through tortuous trajectories. However, this very same property causes difficulties as well. For example, during surgery, a rigid shaft would be more beneficial since it provides more stability and it allows for better surgical accuracy. In order to keep the flexibility and to obtain the rigidity when needed, a shaft-guide with controllable rigidity could be used. In this article, we introduce the plastolock shaft-guide concept, which uses thermoplastics that are reversibly switched from rigid to compliant by changing their temperatures from 5°C to 43°C. These materials are used to make a shaft that can be rendered flexible to follow the flexible endoscope and rigid to guide it. To find polymers that are suitable for the plastolock concept, an extensive database and internet search was performed. The results suggest that many suitable materials are available or can be custom synthesized to meet the requirements. The thermoplastic polymer Purasorb® PLC 7015 was obtained and a dynamic mechanical analysis showed that it is suitable for the plastolock concept. A simple production test indicated that this material is suitable for prototyping by molding. Overall, the results in this article show that the plastolock concept can offer simple, scalable solutions for medical situations that desire stiffness at one instance and flexibility at another.
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Affiliation(s)
- Arjo J. Loeve
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, The Netherlands
| | - Johannes H. Bosma
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, The Netherlands
| | - Paul Breedveld
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, The Netherlands
| | - Dimitra Dodou
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, The Netherlands
| | - Jenny Dankelman
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, The Netherlands
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Hsieh YH, Tseng KC, Lin HJ, O'Brien MJ, Gottlieb LS, Sternberg SS, Waye JD, Schapiro M, Bond JH, Panish JF. Limited low-air insufflation is optimal for colonoscopy. Dig Dis Sci 2010; 55:2035-42. [PMID: 20411425 DOI: 10.1007/s10620-010-1210-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2009] [Accepted: 03/21/2010] [Indexed: 12/26/2022]
Abstract
BACKGROUND Air insufflation is essential in routine colonoscopy, but obtaining optimal insufflation levels has not been discussed in the literature. The aim of this study was to determine optimal air insufflation during colonoscopic examination. METHODS Consecutive patients who underwent colonoscopy were randomized to receive high-air insufflation (group A, n = 83), low-air insufflation (group B, n = 84), or low-air insufflation limited to the rectum and sigmoid colon (group C, n = 83). Completion rate, cecal intubation time, propofol dose, need for abdominal compression, and turning of patients, were evaluated. The post-procedure abdominal bloating was assessed with a 0-10 visual analog scale. RESULTS The completion rates were similar among the three groups. The cecal intubation time was significantly shorter in group C than in group B (4.1 +/- 1.7 min vs. 5.2 +/- 3.0 min, mean +/- SD, p = 0.005). The dose of propofol was significantly less in group C than in group A (11.7 +/- 3.2 mg vs. 12.7 +/- 3.6 mg, mean +/- SD, p = 0.045). Group C needed the least manual abdominal compression (group A, B, and C: 81.9, 69, and 59%, respectively, p = 0.005) and had the least post-procedure abdominal bloating (group A, B, and C: 2.2 +/- 2.4, 2.2 +/- 2.1, and 1.5 +/- 1.9, respectively, p = 0.04). CONCLUSIONS We found that limited use of low-air insufflation in the rectum and sigmoid is the procedure of choice for colonoscopic examination.
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Affiliation(s)
- Yu-Hsi Hsieh
- Division of Gastroenterology, Department of Medicine, Buddhist Dalin Tzu Chi General Hospital, Chia-Yi, Taiwan
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Hsieh YH, Tseng KC, Chou AL. Patient self-administered abdominal pressure to reduce loop formation during minimally sedated colonoscopy. Dig Dis Sci 2010; 55:1429-1433. [PMID: 19582577 DOI: 10.1007/s10620-009-0876-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2009] [Accepted: 06/08/2009] [Indexed: 12/09/2022]
Abstract
CONTEXT Assistant-administered abdominal pressure is usually required to reduce loop formation during a colonoscopy. The effect of patient self-administered abdominal pressure has not been evaluated. OBJECTIVE To compare the effectiveness of patient self-administered abdominal pressure with assistant-administered abdominal pressure to reduce loop formation during colonoscopy performed with minimal sedation. PATIENTS Consecutive patients who underwent colonoscopy were randomized to receive either patient self-administered abdominal pressure (patient group, n = 51) or assistant-administered abdominal pressure (assistant group, n = 52) when looping occurred during colonoscopy minimally sedated with meperidine. When patient-administered abdominal pressure failed to reduce the loop formation, an assistant took over and delivered the abdominal pressure. RESULTS No difference was found regarding cecal intubation rate, intubation time, mean pain scores, and overall satisfaction of patients between groups. However, fewer patients required assistant-administered pressure in the patient group than in the assistant group (18/51 vs. 41/52, P < 0.001). CONCLUSIONS Patient self-administered pressure is effective in reducing looping during minimally sedated colonoscopy.
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Affiliation(s)
- Yu-Hsi Hsieh
- Division of Gastroenterology, Department of Medicine, Buddhist Dalin Tzu Chi General Hospital, 2 Min-Sheng Road, Dalin, Chia-Yi 622, Taiwan.
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Eickhoff A, Pickhardt PJ, Hartmann D, Riemann JF. Colon anatomy based on CT colonography and fluoroscopy: impact on looping, straightening and ancillary manoeuvres in colonoscopy. Dig Liver Dis 2010; 42:291-6. [PMID: 19502116 DOI: 10.1016/j.dld.2009.04.022] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2008] [Revised: 04/23/2009] [Accepted: 04/29/2009] [Indexed: 12/11/2022]
Abstract
BACKGROUND Unsedated colonoscopy is an uncomfortable procedure for most patients. Discomfort during colonoscopy is largely related to looping of the colonoscope which displaces the colon from its native configuration. Therefore, complete intubation of the colon is considerably difficult in up to 10-20% of procedures. Aims of this study were to determine the "normal" colon anatomy in CT-colonoscopy with special focus on length, number of flexures and tortuosity and to assess frequency and type of looping as well as straightening manoeuvres based on fluoroscopic findings. METHODS 100 consecutive screening patients underwent CT colonography and another 100 cases traditional colonoscopy with fluoroscopic aid. Interactive 3D colon maps and 2D MPR images from virtual procedures were reviewed by two experienced GI-radiologists and GI-endoscopists. Colonoscopy was performed by three board-certified gastroenterologists. Fluoroscopic films of each case were recorded and retrospectively analysed. RESULTS There was a considerable difference in overall colonic length between CT colonography and conventional colonoscopy (167 cm vs. 93.5 cm). Number of acute angle flexures and degree of tortuosity was higher in CT colonography than previously assumed. The caecum was reached in 98/100 cases with conventional colonoscopy. Procedures were incomplete due to an obstructing sigmoid cancer and a floppy redundant colon. Looping occurred in 73/100 cases and straightening manoeuvres with fluoroscopy were highly effective in 95%. Looping was more common in older and smaller women. CONCLUSIONS Predictive anatomical factors for potentially difficult endoscopic colonoscopy can be defined by CT colonography. Looping occurs frequently during routine colonoscopy but hindered caecal intubation in only one case. Short-term fluoroscopy is extremely helpful to guide straightening and ancillary manoeuvres and should be used selectively in patients with looping during conventional colonoscopy.
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Affiliation(s)
- Axel Eickhoff
- Medical Department C, Klinikum Ludwigshafen gGmbH, Department of Interdisciplinary Endoscopy, University Hamburg-Eppendorf, Martinistrasse 52, Hamburg, Germany.
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Uraoka T, Kato J, Kuriyama M, Hori K, Ishikawa S, Harada K, Takemoto K, Hiraoka S, Fujita H, Horii J, Saito Y, Yamamoto K. CO 2 insufflation for potentially difficult colonoscopies: Efficacy when used by less experienced colonoscopists. World J Gastroenterol 2009; 15:5186-92. [PMID: 19891018 PMCID: PMC2773898 DOI: 10.3748/wjg.15.5186] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [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 clarify the effectiveness of CO2 insufflation in potentially difficult colonoscopy cases, particularly in relation to the experience level of colonoscopists.
METHODS: One hundred twenty potentially difficult cases were included in this study, which involved females with a low body mass index and patients with earlier abdominal and/or pelvic open surgery or previously diagnosed left-side colon diverticulosis. Patients receiving colonoscopy examinations without sedation using a pediatric variable-stiffness colonoscope were divided into two groups based on either CO2 or standard air insufflation. Both insufflation procedures were also evaluated according to the experience level of the respective colonoscopists who were divided into an experienced colonoscopist (EC) group and a less experienced colonoscopist (LEC) group. Study measurements included a 100-mm visual analogue scale (VAS) for patient pain during and after colonoscopy examinations, in addition to insertion to the cecum and withdrawal times.
RESULTS: Examination times did not differ, however, VAS scores in the CO2 group were significantly better than in the air group (P < 0.001, two-way ANOVA) from immediately after the procedure and up to 2 h later. There were no significant differences between either insufflation method in the EC group (P = 0.29), however, VAS scores for CO2 insufflation were significantly better than air insufflation in the LEC group (P = 0.023) immediately after colonoscopies and up to 4 h afterwards.
CONCLUSION: CO2 insufflation reduced patient pain after colonoscopy in potentially difficult cases when performed by LECs.
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Davila ML, Davila RE. The demise of air insufflation and the rise of the warm water infusion method. Gastrointest Endosc 2009; 70:511-4. [PMID: 19699980 DOI: 10.1016/j.gie.2009.05.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2009] [Accepted: 05/11/2009] [Indexed: 12/10/2022]
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Shafik AA, Asaad S, Loka MM, Wahdan M, Shafik A. Colosigmoid junction: morphohistologic, morphometric, and endoscopic study with identification of colosigmoid canal with sphincter. Clin Anat 2009; 22:243-9. [PMID: 19089999 DOI: 10.1002/ca.20738] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
To study the anatomical structure of the colosigmoid junction, 15 cadaveric specimens were studied morphologically, another 15 histologically, and a morphometric study was done in 10 specimens. Specimens consisted of the descending colon, sigmoid colon, and the colosigmoid junction. Histologic specimens were stained with hematoxylin and eosin and Masson's trichrome stain. Morphometric studies used an image analysis system. The colosigmoid junction was investigated endoscopically in 18 healthy volunteers. A narrow segment having a mean length of 5.2 +/- 1.1 cm was identified both externally and internally between the descending and sigmoid colon. We called this segment the colosigmoid canal. Mucosal folds were found crowded in the colosigmoid canal, the lower end of which formed a nipple and was surrounded by a fornix. Histologically, the colosigmoid canal mucosa showed multiple folds. Its circular muscle was thicker than that of the descending or the sigmoid colon and confirmed morphometrically. The longitudinal muscle was thicker in only 4 of 10 specimens. Both the narrowing and the mucosal crowding were verified endoscopically. The colosigmoid junction is the narrow segment between the descending and the sigmoid colon. Histologic, morphometric and endoscopic studies indicated the presence of a sphincter in the colosigmoid canal. A colosigmoid sphincter is suggested to control the passage of colonic contents from the descending colon to the colosigmoid canal as well as to prevent reflux of sigmoid contents into the descending colon.
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Affiliation(s)
- Ali A Shafik
- Department of Surgery and Experimental Research, Faculty of Medicine, Cairo University, Cairo, Egypt
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Abstract
The focus on colorectal neoplasia has led to an exponential increase in the use of colonoscopy in many countries. Although colonoscopy facilitates the diagnosis and treatment of colonic disease, there are public health issues that include access, training, diagnostic accuracy, complications and additions to health-care costs. Because of this, colonoscopists have a responsibility to ensure that the procedure is appropriate, safe and of high-quality. This article addresses the issue of variation in technical skills that is known to exist within the endoscopic community, even among individuals with similar experience. While some of this variation reflects innate manual dexterity, another aspect is variation in the adoption of technical manoeuvers that facilitate various aspects of the procedure including rates for cecal intubation. Although technical manoeuvers are difficult to evaluate in controlled trials, there is persuasive data that high cecal intubation rates can be achieved by minimizing inflation and looping in the sigmoid colon and by the appropriate use of positional changes and abdominal pressure. In difficult settings, there is also benefit from the use of non-standard endoscopes and various accessories including overtubes.
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Affiliation(s)
- Ian C Roberts-Thomson
- Department of Gastroenterology and Hepatology, The Queen Elizabeth Hospital, Woodville South, South Australia 5011 Australia.
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Hsieh YH, Zhou AL, Lin HJ. Long pediatric colonoscope versus intermediate length adult colonoscope for colonoscopy. J Gastroenterol Hepatol 2008; 23:e7-e10. [PMID: 18702687 DOI: 10.1111/j.1440-1746.2007.04864.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND Controversy exists on how the length and diameter of colonoscopes affect the quality of colonoscopy. The aim of this study was to compare a long pediatric colonoscope with an intermediate length adult colonoscope with regards to completion rate and cecal intubation time. Whether either scope may be more efficient in any subgroups was also investigated. METHODS Asymptomatic patients admitted to the physical check-up department of Buddhist Dalin Tzu Chi General Hospital were included. A single endoscopist performed all of the colonoscopic examinations under sedation. Consecutive patients were randomized to undergo colonoscopy with either intermediate length adult colonoscope (CF-240I) or long pediatric colonoscope (PCF-240L). The success rate and time required to reach cecum were compared between the two groups. RESULTS Between April 2005 and February 2006, a total of 918 patients were enrolled. Incomplete colonoscopy occurred in 21 (2.3%) cases (14 in the CF-240I group and seven in the PCF-240L group, P > 0.1). The overall cecal mean insertion time was 6.00 +/- 3.66 min. There was no significant difference between the CF-240I and PCF 240L groups with regard to the cecal intubation rate (96.9% vs 98.5%, P = 0.18), the need for abdominal pressure (71.7% vs 73.4%, P = 0.55) and change of position (13.5% vs 11.5%, P = 0.37). However, the cecal intubation time was shorter in the CF-240I group (5.75 +/- 3.18 vs 6.26 +/- 3.30 min, P = 0.02). Subgroup analysis by sex, age, and body mass index showed comparable outcomes between the two groups except that the cecal intubation times were significantly shorter in the CF-240I group when only men (4.78 +/- 2.57 vs 5.50 +/- 2.93 min, P < 0.01) or those younger than 50 years (5.50 +/- 2.90 vs 6.25 +/- 3.68 min, P = 0.02) were considered. CONCLUSION Cecal intubation time is shorter in patients examined with an intermediate length adult colonoscope, mainly in the subgroups of men and those younger than 50 years of age.
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Affiliation(s)
- Yu-Hsi Hsieh
- Department of Medicine, Division of Gastroenterology, Buddhist Dalin Tzu Chi General Hospital, Chia-Yi, Taiwan.
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Abstract
In the United States sedation for colonoscopy is usual practice. Unsedated colonoscopy is limited to a small proportion of unescorted patients and those with a personal preference for no sedation. Over 80% of patients who accept the option of as-needed sedation can complete colonoscopy without sedation. Colonoscopy in these unsedated patients is performed with techniques similar to those used in the sedated patients. Uncontrolled observations indicate willingness to repeat colonoscopy amongst these patients was correlated significantly with low discomfort score during the examination. Methods reported to minimize patient discomfort or enhance cecal intubation during sedated or unsedated colonoscopy included use of pediatric colonoscope, variable stiffness colonoscope, gastroscope, and inhalation of nitrous oxide or insufflation of carbon dioxide, hypnosis, music, audio distraction, or simply allowing the patients to participate in administration of the medication. Research focusing on confirming the efficacy of a simple inexpensive nonmedication dependent method for minimizing discomfort will likely improve the outcome of care and more importantly will ensure compliance with future surveillance in patients accepting the unsedated option.
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Chen PJ, Shih YL, Chu HC, Chang WK, Hsieh TY, Chao YC. A prospective trial of variable stiffness colonoscopes with different tip diameters in unsedated patients. Am J Gastroenterol 2008; 103:1365-71. [PMID: 18513270 DOI: 10.1111/j.1572-0241.2008.01812.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Few data exist comparing the clinical versatility of variable stiffness (VS) colonoscopes with different tip diameters and stiffness ranges. We compared the intubation time and success rate, maneuvering ease, and patient comfort of three colonoscopes: pediatric VS (PVSC), nonmagnifying adult VS (AVSC), and magnifying VS (MVSC). METHODS Two hundred sixteen consecutive patients scheduled for routine colonoscopy were randomized to undergo colonoscopy with one of the three different colonoscopes (PVSC N = 72, AVSC N = 72, MVSC N = 72). Outcome measurements included time required for cecal intubation, success rate for cecal intubation, maneuvering ease, and patient comfort. RESULTS The overall success rate for cecal intubation was 95.83%. Intubation time was significantly different among the groups (PVSC 12.88 +/- 7.11 min, AVSC 9.25 +/- 5.16 min, MVSC 9.62 +/- 5.55 min; P < 0.01). Intubation time with PVSC required about 3 min more when compared with AVSC or MVSC. Multivariate analyses revealed that colonoscopy with AVSC required 3 min less when compared with PVSC (P= 0.03). Age greater than 55 yr, waist circumference, prior hysterectomy, and pain experienced by patients were also factors affecting intubation time. CONCLUSIONS In this study, a PVSC might not decrease patient discomfort or intubation time. The ideal colonoscope is the AVSC that has a modest diameter and stiffness range and thus is capable of achieving both a short intubation time and an acceptable comfort level. We also should bear in mind that MVSC has an additional function of magnifying observation.
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Affiliation(s)
- Peng-Jen Chen
- Division of Gastroenterology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Routine colonoscopy with a standard gastroscope. A randomized comparative trial in a western population. Int J Colorectal Dis 2008; 23:443-6. [PMID: 18097675 DOI: 10.1007/s00384-007-0415-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2007] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Colorectal cancer screening increased the workload of colonoscopic procedures in endoscopic units. Recent developments advocated the use of smaller and more flexible scopes to achieve the goal of a complete examination to the cecum. Therefore, the use of an upper GI scope for colonoscopy can be considered. MATERIALS AND METHODS Six-hundred and fifty consecutive patients (age, 64 +/- 20 years, 395 women) undergoing routine colonoscopy were examined with either a standard colonoscope or an upper GI scope in randomized order. In case of an incomplete examination, colonoscopy was repeated with the alternative instrument in the same session. All patients underwent bowel preparation with 4 1 of a polyethylene glycol solution, and the examinations were performed under conscious sedation (midazolam and pethidine i.v.) by a single investigator. RESULTS Because of insufficient colonic preparation or refusal to participate, 28 patients had to be excluded. Both groups (colonoscope group, n = 315, upper GI scope group, n = 307) were well comparable with respect to their demographic data, previous abdominal surgery, the presence of diverticulosis, and the number of former colonoscopic examinations, respectively. Successful cecum intubation was achieved in 96% of the cases in the colonoscope group and in 93% of the patients from the upper GI scope group (p = 0.82). However, the time until the cecum was reached was prolonged to 8.7 +/- 2.4 min when using the upper GI scope compared with 8.2 +/- 2.3 min in the colonoscope group (p = 0.006). In the colonoscope group, a switch to the upper GI scope enables a complete colonoscopy in all but three cases (11/14, 79%) whereas this aim was only achieved vice versa in the upper GI scope group (using a colonoscope) in 7 of 21 patients (33%, p = 0.04). CONCLUSION Routine colonoscopy can be performed effectively with standard upper GI scopes in a western population if no colonoscope is available.
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Shida T, Katsuura Y, Teramoto O, Kaiho M, Takano S, Yoshidome H, Miyazaki M. Transparent hood attached to the colonoscope: does it really work for all types of colonoscopes? Surg Endosc 2008; 22:2654-8. [PMID: 18297353 DOI: 10.1007/s00464-008-9790-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2007] [Revised: 01/19/2008] [Accepted: 01/23/2008] [Indexed: 12/11/2022]
Abstract
BACKGROUND Recently the use of a transparent hood attached to the tip of the colonoscope has been reported to be useful in cecal intubation, especially in difficult colonoscopy cases. However, patient comfort with or without the use of a transparent hood, the type of colonoscope most suitable for this device have not been fully evaluated. METHODS A total of 372 patients undergoing routine colonoscopy were evaluated. No sedatives were used as a principle, and patients with prior abdominal surgery were excluded. A single endoscopist performed all the examinations. Four types of colonoscopes were used: CF-230I and CF-Q240AI as a standard colonoscope, PCF-240I and PCF-P240AI as a small-caliber colonoscope (Olympus, Tokyo, Japan). A disposable transparent hood was used (Olympus, Tokyo, Japan). Patients were randomly divided into four groups; standard colonoscope without transparent hood (96 patients), standard colonoscope with transparent hood (82 patients), small-caliber colonoscope without transparent hood (102 patients), and small-caliber colonoscope with transparent hood (92 patients). Cecal intubation time, rate, modified visual analogue scale (VAS) of patient's pain, and technical difficulty were evaluated among the four groups. RESULTS Standard colonoscope with the transparent hood showed the shortest cecal intubation time, and lowest modified VAS scale of pain and technical difficulty among the four groups. However there was no significant difference with regard to small-caliber colonoscopes with or without the transparent hood. CONCLUSIONS Transparent hood may be a handy and a cost-effective device for reducing pain and simplifying cecal intubation, especially when using a standard adult colonoscope in routine colonoscopy.
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Affiliation(s)
- Takashi Shida
- Department of General Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
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Hsieh YH, Zhou AL, Lin HJ. Comparing different methods of activating the variable stiffness function of a pediatric variable stiffness colonoscope. J Chin Med Assoc 2008; 71:23-9. [PMID: 18218556 DOI: 10.1016/s1726-4901(08)70068-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Previous studies on variable stiffness colonoscopes showed mixed results. Different methods of activating the variable stiffness function were used and might explain part of the controversy. To determine the most efficient way of activating the variable stiffness function, this study compared 3 methods (no activation, regular activation, activation on an as-needed basis) using 1 single type of pediatric variable stiffness colonoscope. METHODS Asymptomatic patients admitted for physical check-up at the Buddhist Dalin Tzu Chi General Hospital were included. A single endoscopist performed all of the colonoscopic examinations of patients under sedation using a variable stiffness pediatric colonoscope. Consecutive patients were randomized to undergo colonoscopy using 3 different methods of activating the variable stiffness function: no activation ("no" group), regular activation at descending colon ("regular" group), and activation on an as-needed basis ("as-needed" group). Completion rate, cecal intubation time, and use of adjunct measures were evaluated and compared among the 3 groups. Subgroup analysis by gender was also performed. RESULTS Between January and July 2006, a total of 250 patients were enrolled. The completion rates of the examinations were 97.6%, 91.7% and 96.4% in the no, regular and as-needed groups, respectively (p = 0.17). The cecal intubation times were 5.6 +/- 2.6 minutes, 5.6 +/- 2.7 minutes and 6.2 +/- 2.3 minutes, respectively (p = 0.22). Multivariate logistic regression analysis showed that activation of the variable stiffness function regularly (odds ratio [OR], 0.53; 95% confidence interval [CI], 0.28, 0.98; p = 0.04) or on an as-needed basis (OR, 0.52; 95% CI, 0.28, 0.97; p = 0.04) were independent factors that were related with less use of abdominal pressure. When only women were considered, the completion rate was lower in the regular group (98.0%, 86.8% and 96.5%, p = 0.04). The use of abdominal pressure was more in the no group than the other 2 groups (56%, 34% and 33%, p = 0.03). When only men were considered, the cecal intubation time was longer in the as-needed group (4.6 +/- 1.4, 4.6 +/- 1.8 and 5.8 +/- 2.5 minutes, p = 0.02). The other outcomes were similar in both genders. CONCLUSION The 3 different methods did not result in significantly different completion rates or cecal intubation times. However, activation of the variable stiffness function decreased the need for abdominal pressure. When males and females were considered separately, activation of the variable stiffness function on an as-needed basis in females was the only useful setting.
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Affiliation(s)
- Yu-Hsi Hsieh
- Department of Medicine, Buddhist Dalin Tzu Chi General Hospital, Chia-Yi, Taiwan
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Lee DWH, Li ACN, Ko CW, Chu DW, Chan KC, Poon CM, Sin KS, Leung KF, Sze TS, Chan ACW, Chung SCS. Use of a variable-stiffness colonoscope decreases the dose of patient-controlled sedation during colonoscopy: a randomized comparison of 3 colonoscopes. Gastrointest Endosc 2007; 65:424-9. [PMID: 17321243 DOI: 10.1016/j.gie.2006.08.027] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2006] [Accepted: 08/21/2006] [Indexed: 02/07/2023]
Abstract
BACKGROUND The variable-stiffness colonoscope incorporates different degrees of stiffness of the insertion tube, which can be adjusted during the examination. Whether its use can lead to reduced procedure-related pain and sedative use is unknown. OBJECTIVE Our purpose was to compare the use of 3 types of colonoscope with different shaft stiffnesses in relation to procedure-related pain and sedative consumption. DESIGN Prospective randomized trial. SETTING Endoscopy unit of a university-affiliated hospital. PATIENTS Consecutive patients undergoing ambulatory colonoscopy. INTERVENTIONS Random assignment was made of patients into 3 groups to receive colonoscopic examinations by one of the 3 types of colonoscope: conventional standard adult size, 1.3-m; 1.6-m; and the new variable-stiffness adult size, full-length (1.6-m) colonoscope. A mixture of propofol and afentanil, delivered by a patient-controlled syringe pump, was used for sedation in all groups. MAIN OUTCOME MEASURES Outcome measures included dose of patient-controlled sedation consumed, pain score, cecal intubation rate, cecal intubation time, requirement of abdominal pressure and change of patients' positions during colonoscopy, and endoscopists and patients' satisfaction scores according to a visual analog scale. RESULTS A total of 335 patients were randomized. Patients in group 3 used significantly less propofol (in milligrams per kilograms, mean [SD]) compared with the other 2 groups (group 1: 1.00 [0.75], group 2: 0.93 [0.62], and group 3: 0.75 [0.65]; P = .02; 1-way analysis of variance). The mean (SD) pain score was also lower in group 3. LIMITATIONS The endoscopists were not blinded. CONCLUSION The use of the new variable-stiffness adult-size colonoscope significantly reduced procedure-related pain and doses of sedative medications during colonoscopy.
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Affiliation(s)
- Danny W H Lee
- Departments of Surgery and Anesthesiology, North District Hospital and Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, China
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Benjamin SB. Pain or performance: what's more important during colonoscopy? Gastrointest Endosc 2007; 65:430-1. [PMID: 17321244 DOI: 10.1016/j.gie.2006.11.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2006] [Accepted: 11/11/2006] [Indexed: 12/12/2022]
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Abstract
In up to 10% to 20% of colonoscopies, complete intubation of the colon may be considerably difficult. A principal cause of difficulty is looping of the endoscope shaft in a floppy, often tortuous segment of the colon that typically happens in the sigmoid colon. Also, if looping is not recognized and the scope is advanced with abandon, the risk of perforation will rise. Special "variable stiffness" colonoscopies are expensive and have not been unequivocally shown to be useful in preventing looping. The simplest approach to prevent looping is perhaps the use of an over-tube to prevent the shaft from bowing out. The ShapeLock could offer an ideal over-tube that is flexible enough to safely and easily negotiate bends in the colon but when needed be rigid enough to prevent looping with just a snap of its handle. It also has potential other applications including enteroscopy, transgastric endoscopy and access to difficult regions of the upper gastrointestinal tract.
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Affiliation(s)
- Rami Hawari
- Division of Gastroenterology and Hepatology, University of Texas Medical Branch 4.106 McCullough Building, 301 University Boulevard, Galveston, TX 77555-0764, USA
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Abstract
BACKGROUND Nonrigid environments such as the human colon present unique challenges for the navigator in maintaining spatial orientation. Conventional wisdom suggests that a navigational aid, similar to a map, that provides critical shape information would be useful. This article presents a design concept for a colonoscopy navigational aid and the results of an experiment conducted to evaluate the display for supporting navigation and spatial orientation in simulated colonoscopy. METHODS A navigational aid was designed to present shape information in an augmented reality display. A total of 14 untrained subjects performed a colonoscopy procedure in rigid and nonrigid colon models, with and without the navigational aid display, in a Latin square design. Performance measures such as time, distance or efficiency of travel, and location and direction error were recorded, together with subjective measures of confidence and workload. RESULTS The results showed that, unlike navigating in rigid environments, the subjects spent more time navigating in the nonrigid environment (p < 0.01) and traveled a longer total distance (p = 0.01). The navigational aid had no effect on performance, as compared with the no aid condition. However, subjective measures showed that the subjects were more confident about their determination of location and direction (p < 0.01). They also preferred having the aid during navigation. CONCLUSION A navigational aid or map that provides shape information does not seem to improve performance in colonoscopy. In fact, it may lead to a false sense of security about location and orientation in the colon. The value of a map for training purposes remains to be examined.
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Affiliation(s)
- C G L Cao
- Department of Mechanical Engineering, Tufts University, Medford, MA 02155, USA.
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Matsushima M, Suzuki T, Tokiwa K, Teraoka H, Ushiyama A, Saitoh T, Watanabe KI, Sakamoto I, Kobayashi K, Watabe R, Shirai T, Mine T. PROPER SELECTION OF COLONOSCOPE ACCORDING TO GENDER, AGE AND BMI OF THE PATIENT. Dig Endosc 2006. [DOI: 10.1111/j.0915-5635.2006.00602.x] [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: 02/23/2023]
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Abstract
The main purpose of this article is to outline various devices of varying practicality that have been described that might allow the examination of the colon by other means. These methods include tip propulsion by various methods, robotics, wireless endoscopy, free capsule endoscopy, specialized overtube use, and toposcopy.
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Affiliation(s)
- Paul Swain
- Department of Surgical Oncology and Technology, Imperial College, St Mary's Hospital, 41 Willow Road, London NW3 1TN, UK.
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Abstract
The use of sedation for routine endoscopic procedures, including colonoscopy, varies widely across cultures. This variation in sedation practice is greater than any other culturally based variation in the technical performance of endoscopy. This article sequentially reviews the technical performance of colonoscopy in patients who undergo unsedated colonoscopy, sedation with narcotics and benzodiazepines, and deep sedation with propofol. For each of these approaches to colonoscopy, the advantages and disadvantages also are listed and discussed.
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Affiliation(s)
- Douglas K Rex
- Indiana University Hospital, 550 North University Boulevard, Indianapolis, IN 46202, USA.
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Shah SG, Saunders BP. Aids to insertion: magnetic imaging, variable stiffness, and overtubes. Gastrointest Endosc Clin N Am 2005; 15:673-86. [PMID: 16278132 DOI: 10.1016/j.giec.2005.08.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Inserting the colonoscope quickly and safely without undue patient discomfort is the primary aim of the colonoscopist. The inherently mobile, flexible and unpredictable nature of the colon means that looping occurs frequently during insertion and the colonoscopist must constantly strive to keep the instrument straight whilst at the same time advancing the tip towards the caecum. Colonoscopists have struggled with insertion for many years but recent developments described in this chapter have the potential to make insertion easier and more predictable.
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Affiliation(s)
- Syed G Shah
- Department of Gastroenterology, Bradford Royal Infirmary, Duckworth Lane, West Yorkshire BD9 6RJ, UK
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Fukuda S, Mikami T, Shimoyama T, Hanabata N, Iwamura H, Munakata A. Withdrawing method of the stiffening tube incidentally inserted into the descending colon. World J Gastroenterol 2005; 11:5390-1. [PMID: 16149153 PMCID: PMC4622816 DOI: 10.3748/wjg.v11.i34.5390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
We experienced a very rare complication of colonoscopy, a migration of stiffening tube into the colorectum. We herein introduce a withdrawing method of migrating stiffening tube incidentally inserted into the colorectum. A 65-year-old Japanese woman underwent colonoscopy because of abdominal discomfort. We used stiffening tube to insert the scope to the proximal colon because of her redundant sigmoid colon. When withdrawing the scope, we realized that the tube was fully inside the colorectum. We could not remove the tube instantly, and it reached the splenic flexure, finally. We reinserted the scope through the migrating tube, straightened the scope, and withdrew it holding a slight angle of the scope over the proximal end of the tube. Then, we could safely remove the tube along with the scope through the anus.
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Affiliation(s)
- Shinsaku Fukuda
- First Department of Internal Medicine, Hirosaki University School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori 036-8562, Japan
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Abstract
Colonoscopy has been available since the early 1970s and has become critical to the diagnosis and management of colorectal disorders. Features of the modern colonoscope and its variants are discussed, including the role of paediatric and variable stiffness colonoscopes for difficult insertion. The place of magnetic endoscope imaging systems and simulators in routine colonoscopy and training are examined. Finally, several recent innovations are used to illustrate how colonoscopy may evolve in the future, including new takes on the current instrument as well as potentially revolutionary pain-free, technically-easy, robotic devices for examination of the bowel.
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Ramakrishnan K, Scheid DC. Selecting patients for flexible sigmoidoscopy. Determinants of incomplete depth of insertion. Cancer 2005; 103:1179-85. [PMID: 15674852 DOI: 10.1002/cncr.20904] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Flexible sigmoidoscopy (FS) is an effective method to prevent and reduce mortality from colorectal carcinoma (CRC). Incomplete depth of insertion (IDI) during FS may result in missed polyps and carcinomas. To determine whether it is possible to predict IDI, the authors analyzed factors that affected the depth of insertion in FS. METHODS For the current study, FS results were recorded prospectively over a 5-year period. A questionnaire was administered to the patient by the investigator prior to FS to collect data, including age, gender, weight, comorbid illnesses, history of prior abdominal and pelvic surgeries, family history of colon carcinoma or polyps, and prior FS or colonoscopies. The depth of insertion of the flexible sigmoidoscope from the anal verge, which was defined as the reading on the outside of the instrument at its maximal insertion, was measured in centimeters. IDI was defined as a depth of insertion < 50 cm. Classification and regression tree analysis was used to develop a model that included variables predictive of IDI. RESULTS The best classification tree included gender, age < 69 years (in women), and a history of hysterectomy. Men had a < 5% risk of an IDI and women age < 69 years without a hysterectomy fared as well (6.6%). Older women and younger women who underwent hysterectomy had higher rates of IDI (29.2% and 22.3%, respectively.) CONCLUSIONS The authors developed a model based on age, gender, and hysterectomy status that, after further validation, may be useful for predicting which patients likely will have an incomplete examination. In those patients who have a high probability of IDI, the choice can be made to offer colonoscopy or perform FS under sedation, with analgesia, or with the help of distraction techniques.
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Affiliation(s)
- Kalyanakrishnan Ramakrishnan
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73104, USA.
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Dafnis G, Granath F, Påhlman L, Ekbom A, Blomqvist P. Patient factors influencing the completion rate in colonoscopy. Dig Liver Dis 2005; 37:113-8. [PMID: 15733524 DOI: 10.1016/j.dld.2004.09.015] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2004] [Accepted: 09/07/2004] [Indexed: 12/11/2022]
Abstract
BACKGROUND Since its introduction in the late 1960s, the technology of colonoscopy has developed rapidly, and the competence of the endoscopists has increased. Still, a complete colonoscopy is not always possible to perform. AIM To assess, in a population-based setting, which patient factors influence the success rate. PATIENTS AND METHODS All colonoscopy records during 1979-1995 in one Swedish county (population 258,000) were retrieved. Information was obtained about each patient's sex and age, date of examination, the endoscopist and indications for colonoscopy, findings, type of colonoscopy and reasons for an incomplete colonoscopy. Results were assessed by univariate and multivariate analyses. RESULTS Of 5145 colonoscopies, 4153 (81%) were complete. Completion rates were influenced by (odds ratio for completion [95% confidence intervals]): sex, male versus female (2.00 [1.39-2.86]); age, youngest quartile versus oldest quartile (1.49 [1.04-2.13]); indication for colonoscopy, previous colonic surgery or long-standing colitis versus other indications (2.08 [1.23-3.45]); and diverticulosis, presence versus no presence (0.79 [0.62-0.99]). The time period (proxy variable for the development of endoscopes) had no impact on completion rates. CONCLUSIONS The completion rate was lower than that has been reported from previous hospital-based studies. Lower completion rates were found in women, older patients and in patients with diverticulosis. Higher completion rates were noted in patients with previous colonic surgery and long-standing colitis. The completion rates were not influenced by the development of the endoscopes.
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Affiliation(s)
- G Dafnis
- Department of Surgery, University Hospital, SE-75185 Uppsala, Sweden.
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Schembre D. Smart endoscopes. Gastrointest Endosc Clin N Am 2004; 14:709-16, ix. [PMID: 15363775 DOI: 10.1016/j.giec.2004.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This article explores some of the innovations that already have been incorporated into endoscopes as well as imagines the kinds of advances that could transform endoscopes from passive tools into more active participants. It will be up to the planners and engineers and ultimately the marketplace to determine what is not only achievable but also useful.
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Affiliation(s)
- Drew Schembre
- Virginia Mason Medical Center, 1100 9(th) Avenue, Mail Stop C3-GAS, Seattle, WA 98111, USA.
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