Colonoscope Group Research Articles

Efficacy of a small-caliber colonoscope for pain in female patients during unsedated colonoscopy: a randomized controlled study.

Background and study aims Female sex has been identified as a factor increasing patients’ pain during colonoscopy. The aim of this randomized controlled study was to investigate the efficacy of a small-caliber colonoscope, PCF-PQ260 L, for limiting pain in women during unsedated colonoscopy. Patients and methods Women who underwent unsedated colonoscopy were randomly allocated to either the small-caliber or standard colonoscope group. The primary outcome was overall pain and secondary outcomes were maximum pain and procedural measures. In addition, the effects of colonoscope type were analysed using analysis of covariance and logistic regression with adjustment for stratification factors, age and prior abdomino-pelvic surgery. Results A total of 220 women were randomly assigned to the small-caliber (n = 110) or standard (n = 110) colonoscope groups. Overall and maximum pain scores were significantly lower in the small-caliber colonoscope group than the standard colonoscope group (overall pain, 20.0 vs. 32.4, P < 0.0001; maximum pain, 28.9 vs. 47.2, P < 0.0001). The small-caliber colonoscope group achieved a superior cecal intubation rate (99 % vs. 93 %, P = 0.035). The rate of patient acceptance of unsedated colonoscopy in the future was higher in the small-caliber colonoscope group than in the standard colonoscope group (98 % vs. 87 %, P = 0.003). In addition, the small-caliber colonoscope was superior with respect to reducing pain and improving the rate of patient acceptance of unsedated colonoscopy with adjustment. Conclusions This study demonstrates the efficacy of the small-caliber colonoscope for reducing pain in women and improving their rate of acceptance of unsedated colonoscopy.

A prospective randomized study of the use of an ultrathin colonoscope versus a pediatric colonoscope in sedation-optional colonoscopy.

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. 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. 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. Compared with a pediatric colonoscope, the UTC was associated with reduced overall and maximum pain during colonoscopy, with no difference in ADR.

Intermediate-length colonoscope needs more training duration than long-length colonoscope

Objective. Few data are available on the influence of a colonoscope length for trainees, which could affect both the duration of training and colonoscopy quality. We conducted this study to validate which scope needs more duration for training to reach technical competence and to shows better quality indicators during diagnostic colonoscopy. Materials and methods. We conducted a prospective randomly assigned study from April 2010 to February 2011 at Asan Medical Center. Among the 1329 patients enrolled, 1200 colonoscopies were analyzed. We compared cecal intubation rate, adenoma detection rate, cecal intubation time (<20 min), and withdrawal time between the trainees using the intermediate-length colonoscope and those using long-length colonoscope. Results. Trainees who used the long-length colonoscope showed a higher overall cecal intubation rate (88.2% vs. 81.0%, p = 0.001) and adenoma detection rate (49.7% vs. 34.2%, p < 0.001) than those using the intermediate-length colonoscope. The successful cecal intubation rate improved significantly and reached the requisite standard of competence (>90%) after 90 procedures in the long-length colonoscope group. However, the trainees using the intermediate-length colonoscope reached the requisite standard of competence after 150 procedures. Logistic regression analysis revealed that prolonged cecal intubation was associated with the use of the intermediate-length colonoscope, poor colon preparation, a small number of esophagastroduodenoscopy or sigmoidoscopy procedures conducted, and pain during procedures. Conclusions. During the same training period, use of the long-length colonoscope in trainee was better in terms of reaching competency and quality indicators, and was less painful for the patients during colonoscopic procedures.

Comparative study of a responsive insertion technology (RIT) colonoscope versus a variable-stiffness colonoscope

recently, Olympus developed a new prototype (XCF-Q180AY2L) with responsive insertion technology (RIT), which besides the still known variable stiffness technology, included a passive bending section and a new high force insertion tube. Our objective was to investigate whether the use of this prototype could ease colonoscope insertion, increasing the cecal intubation rate, and/or shortening the cecal intubation time. the study was designed as a prospective observational study in 305 consecutive patients from a colo-rectal cancer screening program. We compared colonoscopies performed with conventional colonoscopes (CFH180AL/CFQ160L) with those performed with the prototype XCF-Q180AY2L. End points were mean cecal and terminal ileal intubation times, cecum intubation rate, and need for specific maneuvers. All colonoscopies were performedunder sedation with intravenous propofol. Finally, 288 patients were included. no complications were observed. Complete cecal intubation rate was 100 % in both groups. The ileum could be reached in 98.95 % of cases. Mean time required to reach the cecum was shorter in the prototype endoscope group (4.31 min, SD 2.63 min) than in the conventional endoscope group (4.66 min, SD 2.52 min) (p < 0.05). Compared with the standard colonoscope group, we observed in the prototype group less subjective sensation of difficultyin the passage of the sigma (p < 0.01), fewer maneuvers when it proved necessary to straighten the scope (p < 0.01), and less frequent need to modify the stiffness of the endoscope (p < 0.05). we concluded that the prototype endoscope (XCFQ180AY2L) facilitated colonoscope insertion, requiring slightly less time to reach the cecum than a standard colonoscope.

Randomized trial of standard versus magnetic endoscope imaging colonoscopes for unsedated colonoscopy

Unsedated colonoscopy has potential benefits, including decreased costs and decreased risks. To determine whether patient comfort during unsedated colonoscopy can be improved through the use of a magnetic endoscopic imaging (MEI) colonoscope compared with a standard colonoscope. Prospective, patient-blinded, randomized, controlled trial. San Francisco Veterans Affairs Medical Center. Veterans undergoing outpatient screening or surveillance colonoscopy. Use of a standard or MEI colonoscope during unsedated colonoscopy. The primary outcome variable was patient perception of pain using a 7-point scale. The secondary endpoint was patient willingness to undergo a future unsedated colonoscopy. Of the 160 patients enrolled, 140 completed an unsedated colonoscopy in the study protocol. In a per-protocol analysis, the mean and median pain score was 3.12 (standard deviation 1.22) and 4 (interquartile range 2-4) for the standard colonoscope group and 3.06 (standard deviation 1.13) and 3 (interquartile range 2-4) for the MEI group, where 3 was mild pain (P = not significant). Overall, 80% of subjects were willing to undergo a future unsedated colonoscopy for screening or surveillance. In an intention-to-treat analysis, 80% of subjects (64/80) in the standard colonoscope arm and 79% in the MEI arm (63/80) were willing to undergo a future unsedated colonoscopy (P = not significant). Single-center study of mostly male veterans. This patient-blinded, randomized, controlled trial did not demonstrate any difference in patient perception of pain or willingness to undergo unsedated examinations when using the MEI versus the conventional colonoscope. Unsedated colonoscopy is generally feasible and well tolerated and is associated with high patient satisfaction rates.

Upper gastrointestinal tract colonoscopes for colonoscopy

Routine colonoscopy can be done with upper gastrointestinal tract endo scopes when standard colono scopes are unavailable, shows a study (Int J Colorectal Dis, published online Dec 19, 2007; DOI: 10.1007/s00384-007-0415-7). The upper gastrointestinal tract endoscope off ers potential advantages for navigating anatomy involving severe angulation and loop formation be cause of the narrower diameter and greater fl exibility of the equipment. However, such endoscopes could be hamp ered by the fact that, in some patients, they might not be long enough to reach, and completely examine, the caecum. A recent study showed upper gastrointestinal tract endoscopes were used successfully in a South Korean population, “but questions remain over whether they would be eff ective in westerners who are taller and heavier”, says fi rst author of the present study, Till Wehrmann (Krankenhaus Siloah, Hannover, Germany). 650 patients undergoing sedated colonoscopy over 2 years were randomly assigned to have the procedure, with a standard colonoscope or upper gastrointestinal tract endoscope. During the procedure an independent observer assessed the caecal intubation rate and total time until the cecum was reached. Caecum intubation was achieved in 96% of the standard colonoscope group, compared with 93% in the upper gastrointestinal endoscope group (p=0·82). Additionally, mean time until the caecum was reached was 8·2±2·3 min in the colonoscope group, compared with 8·7±2·4 min in the upper gastrointestinal endoscope group (p=0·006). The authors suggest that the extra 30–40 seconds might be due to a need to undertake straightening procedures with the upper gastrointestinal endoscope to overcome its shorter length. “Our data suggest that upper gastrointestinal tract endoscopes can be used if no colonoscope is available, which may facilitate the workfl ow of instruments and scheduling of patients in a busy endoscopy suite”, says Wehrmann, add ing that the use of an upper gastrointestinal tract endoscope could be especially helpful in people with a lower body mass index and anticipated angulated or stenosed anatomy. Juergen Riemann (Klinikum Ludwigshafen, Ludwigshafen, Ger many) com ments, “the study underlines the experience of endoscopists who have known for sometime that upper gastrointestinal tract endoscopes can, in many cases, be used in the lower gastrointestinal tract. It may further stimulate colleagues in busy units to use gastroscopes for colonoscopy provided their disinfection is excellent”.

Routine colonoscopy with a standard gastroscope. A randomized comparative trial in a western population

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. 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. 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). Routine colonoscopy can be performed effectively with standard upper GI scopes in a western population if no colonoscope is available.

Colonoscope Position Detecting System's Impact on Patient-Based Comfort and Efficiency of Colonoscopy

A magnetic imaging system of colonoscope (Unit of Position Detection: UPD, Olympus Optical Co., Ltd.) provides a new facility for viewing of the position of the colonoscope during examination, without exposing patients or medical staff to radiation. The aim of this prospective study was to compare UPD system with routine colonoscopy. This study examines whether UPD system improves insertion time to the cecum and patient discomfort. Methods: From Jan. 2004 to Nov. 2004, consecutive 2021 patients undergoing colonoscopy were randomly assigned to receive colonoscopy with either UPD colonoscope or ordinary colonoscope. Patients with colon stenosis or bleeding were excluded from the study. Patients who received sedation were also excluded. Three experienced endoscopists (experienced more than 1000 colonoscopies), and two less experienced endoscopists (experienced 200-1000) performed colonopy in this study. Parameters used in this study were the insertion time to the cecum, visual analog scale of patients discomfort (the patients marked on the linear scale grading the discomfort experienced during colonoscopy (0 cm, no pain; 10 cm, worst pain of life), using rate of abdominal counter pressure by medical staffs. Results: 1. A total of 1897 patients were enrolled in the study. 1587 patients were assigned to be in the UPD group and 310 in the ordinary colonoscope group. 2. There was a trend toward shorter insertion time in UPD group than that in ordinary colonoscopy group (mean ± SD: 512 ± 332 sec. vs. 633 ± 452 sec.), which is not statistically significant. In the cases of insertion time of less than 15 minutes, there was no difference in insertion time(360 ± 188 vs. 348 ± 158), while there was a greater trend toward shorter insertion time in UPD group (1218 ± 688 vs. 1689 ± 899). 3. There was a trend toward less pain in UPD group than ordinary colonoscope group 2.24 ± 1.12 vs. 2.58 ± 1.51). This trend is greater when the subject is limited to the cases of insertion time of longer than 15 minutes (3.55 ± 1.33 vs. 4.22 ± 2.11). 3. Using rate of abdominal counter pressure was 12.5% in UPD group and 8.4% in ordinary colonoscope group. Conclusion: These results indicated that UPD system is more useful in comparatively difficult cases. It seems easier for the medical staffs to perform abdominal counter pressure in UPD group.

Usefulness of Attaching a Short Cap for Colonoscopy of Obese Patients

BACKGROUND: Attaching a hood to the tip of a colonoscope is considered to facilitate total colonoscopy. By using the hood, it has been reported that an operator can easily keep distance between lens of colonoscope and colonic mucosa, and can obtain a better view by straightening haustra of colon. However, because of length of the hood, edge of the hood interferes with view of colonoscope, and colonic mucosa may be captured by suction into inside of the hood. A much shorter cap might resolve these shortcomings. The aim of this study is to evaluate the usefulness of the short cap for total colonoscopy. PATIENTS AND METHODS: From September 1 2003 to November 30 2003, consecutive 139 patients were randomly allocated to non-capped colonoscopes or capped colonoscopes. All examinations were performed with PCF230I or PCF240I (Olympus, Tokyo, Japan). Evaluated outcomes were completeness of the examination to the cecum, insertion time to the cecum, patient's tolerance and complications. RESULTS: Of 139 patients, 64 patients were allocated to capped colonoscopes and 75 patients to non-capped colonoscopes. Total colonoscopy could be achieved in all cases. The median insertion time to the cecum was 13.5 minutes in capped colonoscope group and 13.0 minutes in non-capped colonoscope group (p=0.6). No difference was found in patient's tolerance, and no complication occurred. There was no significant difference according to gender, history of abdominal open surgery, bowel movement and endoscopic findings (e.g. diverticula). However, in the cases whose BMI (Body Mass Index) were over 23, median insertion time to the cecum showed significant difference; 10.5minutes in capped colonoscope group (28 cases) vs 14.5 minutes in non-capped colonoscope group (33 cases)(p<0.05, Mann-Whitney U-test). There was no difference in the cases whose BMI was below 23. CONCLUSION: Attaching a short cap may contribute to facilitate total colonoscopy in the patients with obese tendency.

A prospective trial of variable stiffness pediatric vs. standard instrument colonoscopy

Background The pediatric variable stiffness colonoscope is believed to have theoretical advantages over the standard colonoscope, however a systematic evaluation of this instrument in routine clinical practice involving adult patients is lacking. Methods Consecutive patients (blinded) undergoing colonoscopy in an outpatient endoscopy center by one of 4 experienced colonoscopists had the procedure performed with a standard colonoscope (n = 384) or pediatric variable stiffness colonoscope (n = 413). Failure to negotiate the sigmoid colon within 10 minutes was regarded as a failure and, if suitable, the patient was crossed over to colonoscopy with the alternative instrument. Results Median (95% CI) time to the cecum was significantly faster in the pediatric variable stiffness colonoscope group (odds ratio 5.0: 95% CI[4.7,5.3] minutes) compared with the standard colonoscope group (odds ratio 5.5: 95% CI[5.2,5.8] minutes, p = 0.01). There were 22 failures overall (2.8%), 14 in the standard colonoscope group (3.6%) and 8 in the pediatric variable stiffness colonoscope group (1.9%; p = 0.1). With regard to the 14 failures in the standard colonoscope group, colonoscopy was attempted with the pediatric variable stiffness colonoscope in 13 and completed successfully in 12 (92%). The pediatric variable stiffness colonoscope was superior in cases of severe stenosing diverticular disease; two of 27 examinations with the pediatric variable stiffness colonoscope were rated as failed vs. 12 of 18 with the standard colonoscope ( p<0.001). Conclusions Intubation time was faster with the pediatric variable stiffness colonoscope, but use of this instrument was not associated with a superior cecal intubation rate compared with the standard colonoscope. However, in patients with severe stenosing diverticular disease, the intubation rate with the pediatric variable stiffness colonoscope was superior.

Usefulness of a pediatric colonoscope for routine colonoscopy in women who have undergone hysterectomy

Background: Colonoscopy can be difficult in some women who have undergone hysterectomy, which can be associated with a fixed, angulated sigmoid colon caused by postoperative pelvic adhesions. Our goal was to determine whether colonoscopy is easier and more comfortable for women after hysterectomy when performed with a pediatric colonoscope, which is thinner in diameter and more flexible than a standard “adult” colonoscope. Methods: One hundred women with a history of hysterectomy undergoing outpatient colonoscopy were randomized in unblinded fashion to colonoscopy with a standard colonoscope (CF-100L or CF-Q140L, Olympus) or with a pediatric colonoscope (PCF-100, Olympus). All procedures were performed by a faculty endoscopist and timed. After examination, the endoscopist graded procedure difficulty, and patients were given a questionnaire that assessed their experience. Results: The cecum was intubated more frequently in the pediatric colonoscope group than in the standard colonoscope group (96.1% vs. 71.4%, p < 0.001). Success increased in the standard colonoscope group to 89.8% when the pediatric colonoscope was used to complete the examination. There were no differences in the two groups in terms of mean total procedure times (21.4 minutes vs. 22.6 minutes), mean doses of meperidine administered (57 mg both groups), mean doses of midazolam administered (1.5 mg vs. 1.7 mg), scales of procedure difficulty as graded by the endoscopists, and comfort scales as graded by patients. For the cases in which the cecum was intubated, the mean time to reach the cecum (11.7 minutes for the pediatric colonoscope group vs. 12.7 minutes for the adult) was similar. Conclusions: The pediatric colonoscope is a reasonable choice for colonoscopy in women who have had a hysterectomy. Alternatively, if the endoscopist elects to start the procedure with a standard colonoscope, it is helpful to have a pediatric colonoscope available for use should a fixed, angulated sigmoid colon be encountered that cannot be easily or safely traversed with the standard colonoscope. (Gastrointest Endosc 2002;55:838-41.)