Improved colorectal adenoma detection with a transparent retractable extension device

BACKGROUND AND AIMS: Colonoscopy is an excellent but imperfect modality for colorectal cancer screening and prevention. We studied the effects of a retractable transparent extension device on adenoma detection rate as well as on intubation and withdrawal times. METHODS: Colonoscopy with or without the transparent retractable extension (TRE) was performed by one endoscopist. A subset of patients with colonic adenomas were randomized to repeat colonoscopy with or without a TRE device. Adenoma removal was done at the second colonoscopy. The principal outcome parameters were the cecal intubation time, withdrawal time, and the number, size, and location of adenomas detected. RESULTS: The study was done in two parts. First, 835 patients underwent colonoscopy with or without the TRE. The patients' demographic characteristics, the indications for colonoscopy, the cecal intubation time and withdrawal time, and the proportion of patients with adenomas (29.0%vs 24.1%) (P= 0.11) were similar between the two techniques. The number of adenomas detected with the TRE was significantly higher than that without the extension (205 vs 150) (P= 0.04). Second, 60 patients with adenomas found at colonoscopy without the device were randomized to repeat colonoscopy within 3 months. Hood-assisted colonoscopy revealed 20% more adenomas than the initial procedure compared to a 4% increase without the hood (P= 0.029). CONCLUSIONS: Colonoscopy with a TRE device improved the adenoma detection rate without affecting intubation and withdrawal times.     

Hood Colonoscopy in Trainees: A Useful Adjunct to Improve the Performance

Background

The use of a transparent hood to improve colonoscopic performance has recently been proposed.

Aims

The purpose of this study was to evaluate whether using the hood might improve the cecal intubation rate, cecal intubation time, number of attempts needed to intubate the ileo-cecal valve, and polyp detection rate in trainees.

Methods

Patients undergoing colonoscopy (n = 378) were randomized in two groups, one studied with hood colonoscopy (n = 179) and the other (n = 199) with standard examination.

Results

No differences were found between hood and standard colonoscopy with respect to cecal intubation rate (95 vs 92 %), whereas hood colonoscopy significantly shortened the cecal intubation time, the number of attempts needed to intubate the ileo-cecal valve, and the overall polyp detection rate (p < 0.01 for all these variables).

Conclusions

Hood colonoscopy might represent a useful adjunct to standard colonoscopy, especially improving the performance of endoscopic trainees.     

Sedation-free colonoscopy using an upper endoscope is tolerable and effective in patients with low body mass index: a prospective randomized study

OBJECTIVE: Small-caliber upper endoscopes can be used safely and effectively for sedation-free colonoscopy. The objective of the study is to assess the efficacy of a small-caliber upper endoscope (9.2 mm) comparing with a standard colonoscope (12.2 mm). METHODS: In a prospective trial, patients undergoing sedation-free colonoscopy were randomly assigned to the upper endoscope (E) or the standard colonoscope (C). Outcome measures included patient self-assessed pain score (4-point scale), endoscopist-assessed pain score (4-point scale), cecal intubation rate, difficult cecal intubation rate (>900 s), number of polyps detected, and complication rates. RESULTS: A total of 244 patients were entered. Clinical characteristics were not different between the two groups. Cecal intubation was achieved in 91.0% of the patients in each group. The mean patient self-assessed pain score (SD) was significantly lower in the E group compared with the C group: 1.44 (0.81) versus 2.08 (1.10), p < 0.001. The mean endoscopist assessment of patient pain score (SD) was significantly lower in the E group compared with the C group as well: 1.27 (0.67) versus 1.58 (0.90), p= 0.003. In patients with low body mass index (BMI < 22 kg/m(2)), the cecal intubation rate was significantly higher in the E group (97.7%vs 79.4%, p= 0.026) and the difficult cecal intubation rate was significantly lower in the E group (9.3%vs 32.4%, p= 0.011). There were no significant differences in the number of polyps detected and complication rates between the two groups. CONCLUSION: A small-caliber upper endoscope is tolerable and effective for sedation-free colonoscopy, especially in patients with low BMI.     

A prospective trial of variable stiffness colonoscopes with different tip diameters in unsedated patients

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.     

Technical performance of colonoscopy in patients sedated with nurse-administered propofol

OBJECTIVES: Nurse-administered propofol has gained attention as a safe and effective means of sedation for patients undergoing endoscopic procedures. However, little is known about the effect of propofol on the technical performance of colonoscopy. METHODS: Three separate studies were conducted. In the first study, we reviewed procedure notes from consecutive colonoscopies performed by a single experienced endoscopist at our hospital endoscopy unit on patients sedated with either nurse-administered propofol (n = 162) or midazolam/narcotic (n = 164). In the second study, 100 eligible colonoscopy outpatients were randomized to receive either nurse-administered propofol (n = 50) or midazolam/fentanyl (n = 50). In both studies, the measured parameters included visualization of the cecum, time required to reach the cecum, repositioning of the patient, and the application of abdominal counterpressure. In a third study, we reviewed the rate of cecal intubation and colonic perforation in the first 2357 patients in our unit receiving nurse-administered propofol. RESULTS: In the retrospective comparative study, there was no difference in the cecal intubation rate in those receiving propofol (99.4%) compared to those receiving midazolam/narcotic (97%; p= 0.1), and three of five failed cecal intubations in the latter group resulted from obstructing masses. Patients sedated with propofol were repositioned less frequently compared to those receiving midazolam/narcotic (3.7%vs 26.2%) (p < 0.0001). Abdominal pressure was employed in 9.9% of patients sedated with propofol compared to 19.5% (p= 0.01) of those given midazolam/narcotic. The mean time to reach the cecum was lower in the propofol group than in the midazolam/narcotic group (4.6 min vs 6.0 min, p= 0.002). In the prospective randomized study, the endoscopist intubated the cecum in all 100 patients. Patients in the propofol group were repositioned less frequently than those in the midazolam/fentanyl group (2%vs 24%, respectively, p= 0.001). The number of cases requiring abdominal counterpressure was not significantly different between the propofol and midazolam/fentanyl groups (12%vs 24%, respectively, p= 0.1). The mean time to reach the cecum in the propofol group (3.2 min) was similar to that in the midazolam/fentanyl group (3.8 min, p= 0.08). Among the first 2357 patients in our unit undergoing colonoscopy with nurse-administered propofol, the rate of complete colonoscopy was 99.2% and there were no perforations. CONCLUSION: Nurse-administered propofol sedation is safe and simplifies the technical performance of colonoscopy compared to midazolam/narcotic sedation.     

Quality assessment of colonoscopic cecal intubation: an analysis of 6 years of continuous practice at a university hospital

BACKGROUND: Despite increased emphasis on endoscopic performance indicators, e.g., cecal intubation rates, limited data from actual clinical practice have been published. OBJECTIVES: Retrospective database review to determine the rate and documentation of cecal intubation during colonoscopy at the University of Maryland Medical Center. METHODS: We reviewed 5,477 consecutive colonoscopies performed by 10 faculty gastroenterologists at a University hospital over a 6-yr period (March 1, 1999 to February 28, 2005). Unadjusted cecal intubation rates were analyzed as were rates that were adjusted based on the U.S. Multi-Society Task Force on Colorectal Cancer recommendations. We analyzed trends in overall and individual cecal intubation rates, circumstances that impact these rates, and the quality of documentation of cecal intubation. RESULTS: The overall adjusted cecal intubation rate for the entire 6 yr was 90.3%, and increased over the study period with the highest adjusted rate (93.7%) in the most recent year studied. There was no correlation between cecal intubation rate and patient age, gastroenterology fellow involvement, or endoscopist experience and number of procedures/year. In contrast, colon cancer screening, male gender, outpatient colonoscopy, and adequate bowel preparation predicted a higher cecal intubation rate. Written and photographic documentation of cecal intubation improved significantly after 2002. CONCLUSIONS: Our analysis revealed cecal intubation and documentation rates that meet current guidelines, and identified factors that may cause substantial variance in these rates depending on the nature of the practice. The present analysis confirms that computerized databases can be used to assess individual and group cecal intubation and documentation rates on an annual basis, and to make these data available to the public.     

Use of the Endocuff during routine colonoscopy examination improves adenoma detection: A meta-analysis

AIM To perform meta-analysis of the use of Endocuff during average risk screening colonoscopy.METHODS Scopus, Cochrane databases, MEDLINE/Pub Med, and CINAHL were searched in April 2016. Abstracts from Digestive Disease Week, United European Gastroenterology, and the American College of Gastroenterology meeting were also searched from 2004-2015. Studies comparing EC-assisted colonoscopy(EAC) to standard colonoscopy, for any indication, were included in the analysis. The analysis was conducted by using the Mantel-Haenszel or DerS imonian and Laird models with the odds ratio(OR) to assess adenoma detection, cecal intubation rate, and complications performed. RESULTS Nine studies(n = 5624 patients) were included in the analysis. Compared to standard colonoscopy, procedures performed with EC had higher frequencies for adenoma(OR = 1.49, 95%CI: 1.23-1.80; P = 0.03), and sessile serrated adenomas detection(OR = 2.34 95%CI: 1.63-3.36; P 0.001). There was no significant difference in cecal intubation rates between the EACgroup and standard colonoscopy(OR = 1.26, 95%CI: 0.70-2.27, I2 = 0%; P = 0.44). EAC was associated with a higher risk of complications, most commonly being superficial mucosal injury without higher frequency for perforation.CONCLUSION The use of an EC on colonoscopy appears to improve pre-cancerous polyp detection without any difference in cecal intubation rates compared to standard colonoscopy.     

Randomized, double-blinded, placebo-controlled trial of intravenously administered hyoscine N-butyl bromide in patients undergoing colonoscopy with patient-controlled sedation

BACKGROUND: A prospective, double-blinded, placebo-controlled randomized trial was conducted to investigate the effect of the antispasmodic hyoscine N-butyl bromide (Buscopan) during colonoscopy. METHODS: A total of 120 patients undergoing colonoscopy were randomized to receive either 40 mg of hyoscine N-butyl bromide (n=60) or normal saline solution (n=60) intravenously as premedication. Colonoscopy was performed under patient-controlled sedation. Outcome measures included cecal intubation and total procedure time, demanded and administered doses of patient-controlled sedation, spasm score, pain score, endoscopist satisfaction score, patient willingness to repeat colonoscopy, and vital signs (blood pressure, pulse rate) during colonoscopy. RESULTS: Mean cecal intubation time in the hyoscine N-butyl bromide group was significantly longer than the control group (12.20 vs. 9.74 minutes; p=0.04; but correction for multiple testing of data removed this significance). The use of hyoscine N-butyl bromide was associated with a significantly lower endoscopist mean satisfaction score (6.47 vs. 7.30; p=0.04; but correction for multiple testing of data removed this significance), higher demanded and administered mean doses of patient-controlled sedation (respectively, 34.80 and 7.25 vs. 24.20 and 5.87; p=0.045; p=0.04, respectively; but correction for multiple testing of data removed these findings of significance), fewer patients willing to repeat colonoscopy (60% vs. 83.9%; p=0.005), and more hemodynamic instability (p<0.001) when compared with the control group. No significant difference was found in the total procedure time, spasm score, or pain score. CONCLUSIONS: Premedication with intravenously administered hyoscine N-butyl bromide impedes colonoscope insertion and causes greater patient discomfort, as well as hemodynamic instability.     

Relationship of Colonoscopy Completion Rates and Endoscopist Features

The success rate for reaching the cecum has been widely discussed as an indicatorof technical expertise for colonoscopy. However, few studies have addressed the impact of endoscopist-specific parameters on cecal intubation rates. The aim of this study wasto characterize the relationship between endoscopist-specific parameters (age, gender, experience level, annual procedure volume, insertion and withdrawal times) and cecal intubation rates for colonoscopy. Procedural data from all colonoscopies performed by gastroenterologists at the outpatient endoscopy unit of Rochester Methodist Hospital, Minnesota, between January and December 2003 were reviewed. Procedural data of 45 endoscopists who performed 17,100 colonoscopies over the study period were analyzed. The average cecal intubation rate was 93.9% (SD, 2.9%). Higher experience level (> 9 years [median]) was significantly predictive of a cecal intubation rate > 94% (OR = 3.43; 95% CI, 1.03–12.29; P = 0.04). Although higher procedure volume was not predictive of higher colonoscopy completion rates overall, when analysis was confined to the junior faculty members (< 5 years experience), completion rates for those endoscopists doing > 200 per year (92.5%) was significantly higher than for those doing < 200 per year (88.5%; P = 0.04). Our observations suggest that cecal intubation rates increase with increasing endoscopist experience. Moreover, among junior endoscopists, an annual volume of at least 200 procedures appears to be required to maintain adequate competence. Future prospective studies should provide data to support consensus guidelines recommending minimum annual procedure numbers required for maintenance of endoscopic competence among trained endoscopists.     

肠镜用水温度对注水法肠镜影响的临床分析

目的探讨不同温度的肠镜检查用水对注水法肠镜的影响。 方法随机对照单盲研究，纳入2017年8月至2018年2月因体检行肠镜检查患者300例，随机分为三组：注气组100人；注室温水组（22 ℃）100人；注加热水组（38 ℃）100人。由三名内镜医生随机进行单人肠镜操作，记录腹痛评分、达回盲部时间、检查成功率、息肉的检出率、体位变化、腹部按压、肠镜检查满意度、退镜时间、诊断结果等数据。 结果注气组、注室温水组、注加热水组的三组患者的腹痛评分（5.5±4.0；3.0±2.0；3.0±1.0）、达回盲部时间（187.00±131.25 s；268.00±89.50 s；250±103.50 s）、退镜时间（137.5±62.00 s；156.50±76.25 s；156.00±67.00 s）、肠镜检查满意度（74%；87%；90%）有统计学差异（P<0.05）；三组患者的检查成功率（94%；98%；97%）、息肉检出率（19.15%；24.49%；23.71%）、腹部按压及体位变化等均无统计学差异（P>0.05）；其中，腹痛评分注气组明显高于注水组（P<0.05），室温水组与加热水组间无差异（P>0.05）；肠镜检查满意度注水组明显高于注气组（P<0.05），室温水组与加热水组间无差异（P>0.05）；达回盲部时间与退镜时间注水组明显长于注气组（P<0.05），室温水组与加热水组间无差异（P>0.05）。 结论在非麻醉的肠镜检查中，注水法能够减少患者的腹痛，提高患者满意度，但与注气法相比会延长操作时间。水温的升高对患者的腹痛评分、到达回盲部时间、退镜时间、肠镜检查满意度、检查成功率、息肉的检出率、体位变化及腹部按压等无影响。因此室温水也可用于注水肠镜检查中。     

低渣全营养配方粉在结肠镜肠道准备中的应用价值

目的 探讨一种低渣全营养配方粉在结肠镜检查前肠道准备的价值。方法 采用单中心前瞻性随机对照研究。按是否服用一种专门用于肠道准备设计的预包装低渣饮食（麦孚畅清）,将受试者随机数学表法分为试验组和对照组,比较两组患者在肠道准备质量、依从性以及耐受性方面的差异。结果 总共入组61例受试者,试验组32例,对照组29例。试验组与对照组比较,肠道准备评分（7.8±1.0）分比（7.1±1.3）分（P=0.037）,肠道准备合格率87.5%（28/32）比79.3%（23/29）（P=0.388）,饮食限制依从率78.1%（25/32）比55.2%（16/29）（P=0.057）,肠道准备完成率93.8%（30/32）比93.1%（27/29）（P=0.919）,回盲部插管率100.0%（32/32）比100.0%（29/29）,进镜时间（9.1±2.9） min比（9.8±3.7） min（P=0.417）,不良反应发生率3.1%（1/32）比3.4%（1/29）（P=0.944）,临检前饥饿感34.4%（11/32）比48.3%（14/29）（P=0.102）。结论 此种全营养配方粉显著提高了肠道准备评分,但其在提高肠道准备合格率、患者依从性以及耐受性方面的作用仍需更大样本的随机对照研究以进一步证实。     

Water intubation method can reduce patients' pain and sedation rate in colonoscopy: A meta‐analysis

Several randomized controlled trials (RCT) have shown that water infusion in lieu of air insufflation reduces sedation rate and pain score and increases cecal intubation rate in colonoscopy. The aim of the present study was to confirm the beneficial effects of the water intubation method over the air method. Electronic databases were searched to identify RCT reporting colonoscopy detection using the water method. The pooled data of sedation rate, pain score and other procedure‐related outcomes were analyzed. Then, 15 full‐text articles were selected and assessed. Nine trials with high‐quality scores were enrolled into this meta‐analysis including a total of 1414 participants. Pooled odds ratio (OR) of sedation rate was 0.392 (95% confidence interval (CI): 0.288–0.533, P = 0.000). Pooled weighted mean difference (WMD) of pain score was ?1.543 (95% CI: ?2.107–?1.069,P = 0.000). Pooled OR of cecal intubation rate was 1.90 (95% CI: 1.29–2.82, P = 0.001). Pooled OR of polyp detection rate and adenoma detection rate were 0.805 (95% CI: 0.606–1.069, P = 0.134) and 0.913 (95% CI: 0.681–1.223, P = 0.168), respectively. Pooled WMD of cecal intubation time was 0.701 (95% CI: ?0.486–1.889, P = 0.247). This meta‐analysis confirmed that the water method significantly reduced sedation rate and degree of pain without decreasing cecal intubation rate and disease detection rate and without requiring more cecal intubation time, suggesting that the novel water method is better than the conventional air method in colonoscopy detection.     

An adequate level of training for technical competence in screening and diagnostic colonoscopy: a prospective multicenter evaluation of the learning curve

BACKGROUND: Various training programs in colonoscopy recommend that trainees should perform at least 100 to 200 procedures to be considered technically competent at diagnostic colonoscopy. OBJECTIVE: Our purpose was to determine the adequate level of training for technical competence in screening and diagnostic colonoscopy. DESIGN: A prospective multicenter trial. SETTING: Fifteen tertiary care academic medical centers. PATIENTS: Over 8 months we prospectively evaluated the procedures of 24 first-year GI fellows in 15 tertiary care academic medical centers. A total of 4351 colonoscopies were assessed prospectively with variable clinical factors. INTERVENTION: Cecal intubation was documented by photographing the identified cecal landmarks, including the appendiceal orifice and the ileocecal valve. MAIN OUTCOME MEASUREMENTS: Acquisition of competence (success rate) was evaluated for colonoscopic training on the basis of 2 objective criteria: (1) adjusted completion rate (>90%) and (2) cecal intubation time (<20 minutes). RESULTS: The overall success rate was 83.5% (3635/4351). The mean cecal intubation time was 9.23 +/- 4.63 minutes. The success rate significantly improved and reached the requisite standard of competence after 150 procedures (71.5%, 82.6%, 91.3%, 94.4%, 98.4%, and 98.7%, respectively, for every 50 consecutive blocks). The polyp detection rate did not improve significantly during the 8 months and was not correlated with the learning curve. In addition, mean time to cecal intubation decreased significantly, from 11.16 to 8.39 minutes, after 150 procedures. Logistic regression analysis found that prolonged cecal intubation was caused by the following factors: elderly patients, female sex, low body mass index, poor bowel preparation, poor American Society of Anesthesiologists status, abdominal pain as an indication, instructor's supervision, and low case volume. LIMITATIONS: We did not record final pathologic reports of detected polyps and withdrawal time. CONCLUSIONS: Competence in technically efficient screening and diagnostic colonoscopy generally requires experience with more than 150 cases. Also, factors associated with prolonged cecal intubation for typical trainees did not differ from those for experienced colonoscopists.     

Method of colonoscopy in 42 consecutive patients presenting after prior incomplete colonoscopy

OBJECTIVES: Cecal intubation is one of the goals of colonoscopy. We sought to describe the methodology used by a single experienced examiner to perform colonoscopy in a consecutive group of patients with challenging colons. METHODS: Records of 42 consecutive patients with one or more prior unsuccessful attempts at colonoscopy by a gastroenterologist or surgeon and referred for a repeat attempt at colonoscopy were reviewed. RESULTS: Colonoscopy was complete to the cecum in 40 of the 42 patients (95%). An array of methods was employed, including propofol sedation (n = 2), pediatric colonoscope (n = 8), an external straightener (n = 9), external straightener with pediatric colonoscope (n = 2), upper endoscope (n = 8), guidewire exchange (n = 3), and enteroscope with a colon straightener (n = 1) or an enteroscope straightener (n = 1). CONCLUSIONS: A variety of methods and instruments were employed to achieve a high cecal intubation rate during colonoscopy in a group of patients with prior incomplete colonoscopies. Others may find one or more of these methods useful in patients with challenging colons.     

Impact of bending section length on insertion and retroflexion properties of pediatric and adult colonoscopes

BACKGROUND: Colonoscopes with short bending sections facilitate retroflexion but their effect on other aspects of colonoscope insertion are unknown. We sought to determine the impact of short bending on cecal insertion, terminal ileal intubation, and proximal colon retroflexion. METHODS: Two studies were performed. In study 1, we randomized 104 adult patients with intact colons to undergo colonoscopy with a standard pediatric colonoscope (Olympus PCF-160), a prototype pediatric colonoscope with short bending in four directions (PCF-AYL), or a prototype pediatric colonoscope with short bending in two directions, and normal bending in two directions (PCF-AY3L). In study 2, we randomized 70 patients with intact colons to undergo colonoscopy with a prototype 170 degrees wide angle colonoscope (CFQ160-WL) with a standard bending section length or to a prototype 170 degrees colonoscope with a short bending section (CFQ160-W2L). RESULTS: In study 1, the cecum was reached in all patients. Using the AYL, the cecal intubation time (4.08 min) was significantly longer when compared to both the PCF-160 (2.62 min; p=0.0001) and the AY3L (3.25 min; p=0.02). The AYL required the application of abdominal pressure (79%) and activation of the variable stiffness device (70%) more frequently when compared to both the PCF-160 (32%; p=0.0001 and 41%; p=0.02, respectively) and the AY3L (34%; p=0.0003 and 41%; p=0.02, respectively). Successful cecal retroflexion was possible less often with the PCF-160 (57%) when compared to either the AYL (94%; p=0.005) or AY3L (91%; p=0.001). The ability to intubate the terminal ileum was similar in all three groups (PCF-160 and AY3L 100%; AYL 94%) as was the time needed to intubate (p=0.73). Depth of ti intubation was deeper for the PCF-160 when compared to the AYL (p=0.0002) or AY3L (p=0.02). There was a trend toward deeper ileal intubation with the AY3L compared to AYL (p=0.09). In study 2, no difference was noted in cecal intubation time (p=0.1) or in frequency of application of abdominal pressure (p=0.28), position change (p=0.15), or activation of the stiffening device (p=0.46). Cecal retroflexion was successful more often when using the W2L when compared to the WL (p=0.00001). CONCLUSION: Short bending sections facilitate proximal colon retroflexion for both pediatric and adult colonoscopes, but can negatively impact cecal insertion and terminal ileal intubation in pediatric colonoscopes. A pediatric colonoscope with short bending in only two directions had good function for both cecal insertion and proximal colon retroflexion.     

Comparison of Water Immersion Versus Air Insufflation Colonoscopy Under Various Bowel Preparation Conditions

Background: To investigate the differences between water immersion (WI) and air insufflation (AI) for colonoscopy under various bowel preparation conditions. Methods: In this study, 526 outpatients were randomly assigned to two groups, namely a WI group (n = 263) and an AI group (n = 263). During the procedure, the quality of bowel preparation, abdominal pain score, cecal intubation rate (CIR), adenoma detection rate (ADR), the intubation times, and other indicators were recorded. After reaching the cecum, each group of patients was subdivided into one of four grades (excellent, good, fair, and poor) according to the quality of bowel preparation.Results: Under various bowel preparation conditions, the pain scores of the AI group were higher than those of the WI group (P < .05), but there was no significant difference between the two groups in CIR (P > .05). For the WI group compared with the AI group, the cecal intubation time (CIT) was prolonged under good bowel preparation (P = .045) and fair bowel preparation (P < .001). No significant differences were observed between the two groups on ADR in all patients (P = .476).Conclusion: Compared with AI colonoscopy, WI colonoscopy can decrease colonoscopy-related pain in patients for unsedated colonoscopy under various bowel preparation conditions, but there is no significant difference in CIR. WI colonoscopy requires longer CIT in patients with good and fair bowel preparation conditions. WI colonoscopy does not significantly increase ADR.     

Factors that influence cecal intubation rate during colonoscopy in deeply sedated patients

Background and Aim: The technical performance of colonoscopy performed in deeply sedated patients differs from that performed without sedation or under minimal to moderate sedation. The aim of this study is to evaluate the factors affecting cecal intubation during colonoscopy performed under deep sedation. Methods: A total of 5352 consecutive subjects who underwent a screening colonoscopy as part of a health check‐up between January 2008 and December 2008 at an academic hospital were reviewed. All endoscopies were performed with deep sedation using combination propofol or propofol alone. Data collected included characteristics of the patients (age, gender, body mass index, bowel habits, history of abdominal or pelvic surgery, quality of bowel preparation, and presence/absence of colonic diverticula) and characteristics of the colonoscopists (experience level, colonoscopy procedure volume, and instrument handling method). These factors were analyzed to evaluate their impact on cecal intubation rates. Results: The crude cecal intubation rate was 98% and the adjusted cecal intubation rate was 98.3%. The mean cecal intubation time was 5.6 ± 3.2 min. Multivariate logistic regression analysis demonstrated that patient age greater than 60 years, constipation, poor colon preparation and a two‐person colonoscopy procedure were independently associated with lower cecal intubation rates. Conclusions: Colonoscopy performed under deep sedation by experienced colonoscopists results in high cecal intubation rates. Among the significant patient‐related predictors influencing the cecal intubation, the quality of the bowel preparation was the only modifiable factor. When performed by experienced hands, the one‐person method was associated with higher cecal intubation rates than the two‐person method.     

Feasibility of full-spectrum endoscopy:Korea’s first full-spectrum endoscopy colonoscopic trial

AIM: To evaluate the full-spectrum endoscopy(FUSE) colonoscopy system as the first report on the utility thereof in a Korean population.METHODS: We explored the efficacy of the FUSE colonoscopy in a retrospective, single-center feasibility study performed between February 1 and July 20, 2015. A total of 262 subjects(age range: 22-80) underwent the FUSE colonoscopy for colorectal cancer screening, polyp surveillance, or diagnostic evaluation. The cecal intubation success rate, the polyp detection rate(PDR), the adenoma detection rate(ADR), and the diverticulum detection rate(DDR), were calculated. Also, the success rates of therapeutic interventions were evaluated with biopsy confirmation.RESULTS: All patients completed the study and the success rates of cecal and terminal ileal intubation were 100% with the FUSE colonoscope; we found 313 polyps in 142 patients and 173 adenomas in 95. The overall PDR, ADR and DDR were 54.2%, 36.3%, and 25.2%, respectively, and were higher in males, and increased with age. The endoscopists and nurses involved considered that the full-spectrum colonoscope improved navigation and orientation within the colon.No colonoscopy was aborted because of colonoscope malfunction.CONCLUSION: The FUSE colonoscopy yielded a higher PDR, ADR, DDR than did traditional colonoscopy, without therapeutic failure or complications, showing feasible, effective, and safe in this first Korean trial.     

Ultrathin colonoscope with a diameter of 9.8 mm for total colonoscopy

BACKGROUND: The pediatric colonoscope is superior to the standard colonoscope in some patients with a fixed, angulated colon. A colonoscope thinner than the pediatric one is thought to outperform even the pediatric colonoscope in such cases. This study was conducted to assess the efficacy of an ultrathin colonoscope, 9.8 mm in diameter, comparing it with pediatric and standard colonoscopes. METHODS: Three types of colonoscopes were used: ultrathin, pediatric, and standard. A total of 287 consecutive patients were assigned to three groups: ultrathin (n=94), pediatric (n=98), and standard (n=95). First assessment was the ratio of cecal intubation and the reasons for unsuccessful colonoscopy. The second was the time to cecal intubation. RESULTS: Cecal intubation rates were not different among three groups (96% in each). The main reasons for failed colonoscopy were looping in the ultrathin group, and angulation or stricture in the pediatric and standard groups. Mean time to the cecum was slightly longer in the ultrathin group (6.5 minutes) than the pediatric group (5.6 minutes) and standard group (6.1 minutes), but there were no significant differences among three groups. CONCLUSION: Colonoscopy with the ultrathin colonoscope was as successful as with the pediatric and standard colonoscopes. The advantage of the ultrathin colonoscope might be notable in cases with stricture or severe angulation.     

Should a colonoscopy be offered routinely to patients with CT proven acute diverticulitis? A retrospective cohort study and meta-analysis of best available evidence

BACKGROUND The current guidelines suggest that patients should undergo endoscopic evaluation of the colonic lumen after an episode of computed tomography(CT)proven acute diverticulitis to rule out malignancy. The usefulness of routine endoscopic evaluation of CT proven diverticulitis remains unknown.AIM To establish whether routine colonoscopy should be offered to patients after an episode of diverticulitis.METHODS We performed a retrospective study, comparing two groups: a diverticulitis group and a control group. The diverticulitis group consisted of patients undergoing a colonoscopy after an episode of diverticulitis. The control group consisted of asymptomatic patients undergoing a screening sigmoidoscopy. We also performed a systematic review and meta-analysis. We searched electronic data resources to identify all relevant studies. The primary outcome was the number of adenomas found, while the secondary outcomes were the number of cancers and polyps identified, and the adenoma risk.RESULTS68 and 1309 patients were included in the diverticulitis and control groups respectively. There was no difference in the risk of adenomas(5.9% vs 7.6%, P =0.59), non-advanced adenomas(5.9% vs 6.9%, P = 0.75), advanced adenomas(0%vs 0.8%, P = 1), cancer(0% vs 0.15%, P = 1.00), and polyps(16.2% vs 14.2%, P =0.65) between both groups. Meta-analysis of data from 4 retrospective observational studies, enrolling 4459 patients, showed no difference between the groups in terms of risk of adenomas(RD =-0.05, 95%CI:-0.11, 0.01, P = 0.10),non-advanced adenomas(RD =-0.02, 95%CI:-0.08, 0.04, P = 0.44), advanced adenomas(RD =-0.01, 95%CI:-0.04, 0.02, P = 0.36), cancer(RD = 0.01, 95%CI:-0.01, 0.03, P = 0.32), and polyps(RD =-0.05, 95%CI:-0.12, 0.02, P = 0.18).CONCLUSION Routine colonoscopy may not be appropriate in patients with acute diverticulitis.High quality prospective studies are required for more robust conclusions.