Colonoscopy Group Research Articles

Factors Associated With Incomplete Colonoscopy: A Population-Based Study

The U.S. Multi-Society Task Force on Colorectal Cancer sets a target of cecal intubation in at least 90% of colonoscopies. We conducted a population-based study to determine the colonoscopy completion rate and to identify factors associated with incomplete procedures. Men and women 50 to 74 years of age who underwent a colonoscopy in Ontario between January 1, 1999, and December 31, 2003, were identified. The first (index) colonoscopy was classified as complete or incomplete. A generalized estimating equations model was used to evaluate the association between patient, endoscopist (specialty, colonoscopy volume), and setting (academic hospital, community hospital, private office) factors and incomplete colonoscopy. A total of 331,608 individuals had an index colonoscopy, of which 43,483 (13.1%) were incomplete. Patients with an incomplete colonoscopy were older (odds ratio [OR] 1.20 per 10-year increment; 95% confidence interval [CI]=1.18-1.22), more likely to be female (OR 1.35; 95% CI: 1.30-1.39), have a history of prior abdominal surgery (OR 1.07; 95% CI: 1.05-1.09) or prior pelvic surgery (OR 1.04; 95% CI: 1.01-1.06). For colonoscopies done in a private office, the odds of an incomplete procedure were more than 3-fold greater than for procedures done in an academic hospital (OR 3.57; 95% CI: 2.55-4.98). In usual clinical practice in Ontario, 13.1% of colonoscopies are incomplete. The factors most strongly associated with incomplete colonoscopy were increased patient age, female sex, and having the procedure in a private office. Quality improvement programs are needed to improve colonoscopy completion rates.

Câncer de cólon: como diagnosticá-lo? Trabalho prospectivo

OBJETIVO: Analisar o perfil clínico de portadores de câncer colorretal (CCR). MÉTODOS: Estudo prospectivo com 390 pacientes submetidos a colonoscopia. 152 assintomáticos Grupo A (G-A) e 238 sintomáticos com CCR Grupo B (G-B). Analisamos história familiar (HF), sintomas, Índice de massa Corpórea (IMC), localização do tumor e histopatologia. P<0,05 foi considerado significativo. RESULTADOS: Média de idade, 62+/-9 G-A e 61+/-13 G-B, P>0,05. HF positiva em 79 (31%) com CCR, contra 34 (32%) sem câncer, P>0,05. IMC no G-A foi 25+/-4 contra 27+/-4 no G-B P>0,05. No G-A 9 (5,9%) tiveram CCR. Câncer superficial em 1 (11%) no G-A contra 21 (8,8%) no G-B, P>0,05. Câncer em cólon esquerdo em 6 (66%) no G-A contra 168 (69%) no G-B, P>0,05. Alteração do hábito intestinal com sangue, cólon esquerdo 56 (60%) contra 13 (31%) no direito P<0,01. Emagrecimento com anemia mais freqüentes em tumor de cólon direito quando comparado com esquerdo, 30 (44%) versus 31 (17%) e 36 (46%) versus 15 (8%) p<0,01. Sintomas há mais de 6 meses em 157 (63%) Adenocarcinoma moderadamente diferenciado em 166 (67%), bem diferenciado em 63 (25%) e pouco diferenciado em 18 (7%). CONCLUSÕES: O perfil de risco para CCR precisa ser aprimorado.

The cleansing result of oral sodium phosphate is inversely correlated with time between the last administration and colonoscopy

There is some evidence that the timing of sodium phosphate (NaP) ingestion affects the cleansing result. The objective of this study was to evaluate the correlation of cleansing result with the timing of ingestion of NaP. 214 consecutive outpatients scheduled to undergo colonoscopy were enrolled in the study. All patients filled out a detailed questionnaire concerning the execution of bowel cleansing. Concomitant with colonoscopy, patient characteristics were recorded and after the procedure the cleansing result was scored. The correlation between cleansing score and time from the last dose of NaP to colonoscopy was evaluated. For further analysis, patients were divided into three groups regarding the time lag from NaP taking to colonoscopy (group 1, 6 h or less; group 2, 6-12 h; group 3, 12 h or more). 204 patients had complete colonoscopy and enough data to be analyzed for the study. The Pearson correlation coefficient for the time between the last dose of NaP and colonoscopy was -0.450 (p=0.0001) showing an inverse correlation. The mean cleansing score (+/-SEM) of group 1 was 4.00+/-0.12, for group 2 it was 3.56+/-0.12, and for group 3 it was 2.64+/-0.14. There were statistically significant differences between all groups. The cleansing result of NaP is inversely correlated with the time between last dose of NaP and colonoscopy. Colonoscopy should be preferably performed within 12 hours of taking the second dose of NaP.

Role of computed tomographic colonoscopy of postoperative surveillance in patient with gastric cancer

To examine the diagnostic yield of colorectal neoplasia at computed tomographic colonoscopy (CTC) as well as the feasibility of contrast enhanced CTC in patients with gastric cancer. To examine the incidence of colon polyp we selected postoperative 188 gastric cancer patients, which we refer to as the 'colon polyp survey group'. To examine the feasibility of CTC for early detection of colon cancer or advanced colon adenoma, we selected 47 gastric cancer patients (M:F 29:18, mean age 53.8 years), which we call the 'CT colonoscopy group'. All the 47 patients underwent successive CTC and colonoscopy on the same day. Totally 109 colon polyps were observed from 59 out of 188 gastric cancer patients, the incidence rate of colon polyps in gastric cancer patients being 31.4%. The sensitivity of CTC in detecting individuals with at least 1 lesion of any size was 57.1%, the specificity was 72.7%, the positive predictive value was 47.1%, and the negative predictive value was 71.9%. When the cutoff size was decreased to 6 mm, the sensitivity and specificity were 80.0% and 92.9%, respectively, with positive and negative predictive values of 57.1% and 97.5%, respectively. Only one patient was classified as false negative by virtual colonoscopy. The diagnostic yield of colorectal polyp was 31.4% in patients with gastric cancer, and contrast enhanced CTC is an acceptable tool for the detection of synchronous colorectal advanced adenoma and postoperative surveillance of gastric cancer patients.

Chromoendoscopy: A new vision for colonoscopic surveillance in IBD

Chromoendoscopy: A new vision for colonoscopic surveillance in IBD

Does Chromoendoscopy with Structure Enhancement Improve the Colonoscopic Adenoma Detection Rate?

Colonoscopy is still considered the standard investigation for the detection of colorectal adenomas, but the miss rate, especially for small and flat lesions, remains unacceptably high. Chromoscopy has been shown to increase the yield for lesion detection in inflammatory bowel disease. The aim of this randomized prospective study was to determine whether a combination of chromoscopy and structure enhancement could increase the adenoma detection rate in high-risk patients. All patients included in the trial had a personal history of colorectal adenomas and/or a family history of colorectal cancer (but excluding genetic syndromes). They were randomized to one of two tandem colonoscopy groups, with the first pass consisting of conventional colonoscopy for both groups, followed by either chromoscopy and structure enhancement (the "study" group) or a second conventional colonoscopy (the control group) for the second-pass colonoscopy. All detected lesions was examined histopathologically after endoscopic resection or biopsy. The principal outcome parameter was the adenoma detection rate; the number, histopathology, and location of lesions was also recorded. A total of 292 patients were included in the study (146 patients in each group). The patients' demographic characteristics, the indications for colonoscopy, and the quality of bowel preparation were similar in the two groups. There was a significant difference between the two groups with respect to the median duration of the examination (18.9 minutes in the control group vs. 27.1 minutes for the study group, P < 0.001). Although more hyperplastic lesions were detected throughout the colon in the study group ( P = 0.033), there was no difference between the two groups in either the proportion of patients with at least one adenoma or in the total number of adenomas detected. Chromoscopy and structure enhancement diagnosed significantly more diminutive adenomas (< 5mm) in the right colon, compared with controls ( P = 0.039). On the basis of our results we cannot generally recommend the systematic use of chromoscopy and structure enhancement in a high-risk patient population, although the detection of small adenomas in the proximal colon was improved.

The Approach to Dysplasia Surveillance in Inflammatory Bowel Disease

The association between inflammatory bowel disease (IBD) and the development of colorectal cancer (CRC) was first described over eight decades ago (1). However, it was not until the late 1970s that the true clinical significance of this association was appreciated. It is now accepted that both ulcerative colitis (UC) and Crohn’s disease (CD) are associated with an increased risk of CRC (2). It is believed that CRC arises from dysplastic precursor lesions. Unlike the typical dysplasia-carcinoma sequence, the dysplastic lesions are believed to arise in flat mucosa and do not assume a mass-like or polypoid lesion. A recent meta-analysis (3) of 116 published articles estimated the risk of CRC in UC to be 2% at 10 years, 8% at 20 years and 13% at 30 years. Aside from the duration of the disease, the extent (4), family history (5,6) and early onset of CRC (7), along with concomitant primary sclerosing cholangitis (PSC) (8,9), are risk factors for the development of CRC. Similar rates of CRC have recently been demonstrated in patients with CD (10). This epidemiological relationship has led to the practice of surveillance colonoscopy in groups at risk. The initial intent of entering patients into a dysplasia surveillance program was to stratify patients into high-risk groups in need of proctocolectomy and low-risk groups who could continue in the surveillance program. Dr Remo Panaccione

Urgent Colonoscopy for Evaluation and Management of Acute Lower Gastrointestinal Hemorrhage: A Randomized Controlled Trial

We hypothesized that early intervention in patients with lower gastrointestinal bleeding (LGIB) would improve outcomes and therefore conducted a prospective randomized study comparing urgent colonoscopy to standard care. Consecutive patients presenting with LGIB without upper or anorectal bleeding sources were randomized to urgent purge preparation followed immediately by colonoscopy or a standard care algorithm based on angiographic intervention and expectant colonoscopy. A total of 50 patients were randomized to each group. A definite source of bleeding was found more often in urgent colonoscopy patients (diverticula, 13; angioectasia, 4; colitis, 4) than in the standard care group (diverticula, 8; colitis, 3) (the odds ratio for the difference among the groups was 2.6; 95% CI 1.1-6.2). In the urgent colonoscopy group, 17 patients received endoscopic therapy; in the standard care group, 10 patients had angiographic hemostasis. There was no difference in outcomes among the two groups-including: mortality 2%versus 4%, hospital stay 5.8 versus 6.6 days, ICU stay 1.8 versus 2.4 days, transfusion requirements 4.2 versus 5 units, early rebleeding 22%versus 30%, surgery 14%versus 12%, or late rebleeding 16%versus 14% (mean follow-up of 62 and 58 months). Although urgent colonoscopy identified a definite source of LGIB more often than a standard care algorithm based on angiography and expectant colonoscopy, the approaches are not significantly different with regard to important outcomes. Thus, decisions concerning care for patients with acute LGIB should be based on individual experience and local expertise.

A randomized single-blind trial of split-dose PEG-electrolyte solution without dietary restriction compared with whole dose PEG-electrolyte solution with dietary restriction for colonoscopy preparation

Colonoscopy preparation regimens are poorly tolerated, requiring the use of a large volume of an unpalatable solution and diet restriction for adequate cleansing. The aim of this study was to compare the efficacy of two regimens of bowel preparation before colonoscopy: a whole dose of polyethylene glycol electrolyte solution (PEG-E), with diet restriction vs. a split dose with no diet restriction. A total of 141 patients (ages 20-84 years, 81 men) were randomly assigned to receive either 4 L PEG-E, along with a liquid diet the day before colonoscopy (Group A) or 2 L PEG-E with a regular diet the day before colonoscopy followed by another 2 L PEG-E on the day of the procedure (Group B). The quality of the preparation was graded by the endoscopist (poor to excellent), who was blinded to the type of preparation. Tolerability of the assigned preparation and adverse effects were recorded by an independent investigator by using a questionnaire administered before colonoscopy. Intra- and interobserver variability was studied by using randomly chosen videotapes of colonoscopies performed as part of the study. There were 73 patients in Group A and 68 patients in Group B. The quality of the preparation was significantly better in Group B ( p = 0.011). The tolerability of the preparation regimen was not different overall between study groups in terms of side effects (except for bloating, which was more frequent in Group B, p = 0.039) or willingness to repeat the preparation. There was a nonsignificant trend toward improved adherence to the assigned preparation in favor of Group B ( p = 0.062). Inter- and intraobserver variability analysis showed good to excellent correlation among endoscopists. Colonic preparation with split-dose PEG-E and no dietary restriction provides better quality colon cleansing than whole-dose preparation, with no significant impact on patient tolerability and side effects.

Prospective Comparison of Cardiopulmonary Events during Minilaparoscopy and Colonoscopy under Conscious Sedation

Cardiorespiratory parameters were examined throughout diagnostic minilaparoscopy procedures. The same parameters were analyzed during colonoscopy, and the data were compared. Sixty-five consecutive unselected patients undergoing minilaparoscopy (group 1: ASA I, n = 34; group 2: ASA II/III, n = 31) and 61 consecutive unselected patients undergoing colonoscopy (group 3: ASA I, n = 31; group 4: ASA II/III, n = 30) were included. Oxygen saturation (Sao (2)), heart rate (HR) and mean arterial pressure (RRm) were measured continuously, and 12-lead electrocardiography (ECG) recordings were made at specific times during each procedure. Minor differences were observed, particularly after premedication, probably due to different dosage regimens and timing in the two examination techniques. After premedication, testing for differences from baseline values showed a minor decrease in Sao (2) and RRm in the minilaparoscopy groups in comparison with the colonoscopy groups (median Sao (2), group 1: 99.9 % +/- 0 vs. group 3 : 100 % -1, P = 0.0078; median RRm, group 1: 99.5 - 4 mm Hg vs. group 3 : 96 -16 mm Hg, P = 0.046, and median RRm, group 2 : 110 + 1 mm Hg vs. group 4 : 101 -13.5 mm Hg, P = 0.0007). HR increased in minilaparoscopy in comparison with colonoscopy (median HR: group 2 : 77 + 4 beats/min vs. group 4 : 75.5 +/- 0 beats/min; P = 0.01). Comparison of defined relevant pathological changes in Sao (2), RRm, HR, and ECG showed no significant differences. These data indicate that diagnostic minilaparoscopy under conscious sedation is only associated with limited risk in patients with compensated cardiopulmonary diseases. This is probably due to the low insufflation pressure used.

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.

Prevalence of Adenomas among Young Individuals at Average Risk for Colorectal Cancer

We evaluated the prevalence and characteristics of adenomas in a young population not genetically predisposed for the development of colorectal cancer (CRC). The databases of the Dutch Hereditary Colorectal Cancer Registry were used. The study population included patients (n = 444) who had regular endoscopy until mutation analysis revealed they did not carry the (Adenomatous Polyposis Coli (APC)/Mismatch Repair) gene defect identified in their family. At first colonoscopy (n = 342; 50% males, mean age 37 yr) a total of 19 adenomas (10 males, mean age 50 yr, range 24-91 yr) and two CRCs (2 males, age 49 and 72 yr) were identified, and at first sigmoidoscopy (n = 102; 53% males, mean age 29 yr) three adenomas (2 males, age 8, 40, and 41 yr) were found. A second colonoscopy was performed in 14 patients with, and in 162 patients without an adenoma. Three of 14 patients (21%) developed a new adenoma (all >50 yr) and 8 of 162 (5%) patients developed their first adenoma during follow-up. In the colonoscopy group, the cumulative proportion of patients free of adenomas at age 50 yr was 86%. Of all adenomas diagnosed during colonoscopy (n = 49), 65% were located distal from the flexura lienalis. Of the adenomas detected during all endoscopies (n = 53), 9.8% were > or =7 mm, 7.5% showed high-grade dysplasia, and 7.5% showed tubulovillous features. On the basis of our findings during colonoscopy we conclude that the risk of developing adenomas/CRC in young individuals without genetic risk factors is low. Adenoma surveillance programs should focus on young individuals with a positive family (or personal) history for adenomas/CRC, or on individuals >50 yr.

Incidence of Proximal Lesions in Patients with Occlusive Colorectal Cancer

BACKGROUD: Little is known about proximal lesions in patients with occlusive colorectal cancer. AIM: To evaluate the characteristic of occlusive colorectal cancer and their proximal lesions. MATERIAL AND METHODS: We examined 72 patients with occlusive colorectal cancer diagnosed by colonoscopy (Group A). They were compared with 300 patients with non-occlusive T3 or T4 colorectal cancer (Group B). RESULTS: The mean age was 62.9 years in group A (39 males and 33 females) and 60.7 years in group B (190 males and 110 females). Forty-nine (68.1%) patients in group A and 226 (75.3%) patients in group B had their main lesions in the distal colon or rectum. Among the patients with distal cancer, 17 (34.7%) patients in group A and 73 (32.3%) patients in group B underwent postoperative colonoscopy and 11 (64.7%) lesions from 7 patients in group A and 50 (68.5%) lesions from 28 patients in group B were detected. Six of 11 lesions (54.5%) in group A and 9 of 50 lesions (18.0%) in group B were malignant polyp (defined as those > 10mm in diameter and those with high-grade dysplasia or invasive cancer). Two invasive cancers were included in group A. CONCLUSION: The number of proximal lesions in patients with occlusive colorectal cancer was the same as those in patients with non-occlusive cancer. However, malignant polyp was detected more frequently in patients with occlusive colorectal cancer (p=0.0192). It would be useful to further investigate how to evaluate proximal lesions in patients with occlusive colorectal cancer.

Urgent colonoscopy for evaluation and management of acute lower gastrointestinal hemorrhage: A randomized controlled trial

RESULTS: A total of 50 patients were randomized to each group. A definite source of bleeding was found more often in urgent colonoscopy patients (diverticula, 13; angioectasia, 4; colitis, 4) than in the standard care group (diverticula, 8; colitis, 3) (the odds ratio for the difference among the groups was 2.6; 95% CI 1.1–6.2). In the urgent colonoscopy group, 17 patients received endoscopic therapy; in the standard care group, 10 patients had angiographic hemostasis. There was no difference in outcomes among the two groups—including: mortality 2% versus 4%, hospital stay 5.8 versus 6.6 days, ICU stay 1.8 versus 2.4 days, transfusion requirements 4.2 versus 5 units, early rebleeding 22% versus 30%, surgery 14% versus 12%, or late rebleeding 16% versus 14% (mean follow-up of 62 and 58 months).

Methylene blue-aided chromoendoscopy for the detection of intraepithelial neoplasia and colon cancer in ulcerative colitis

Background & Aims: Timely diagnosis of intraepithelial neoplasias (IN) and colitis-associated colon carcinomas (CRC) is crucially important for the treatment of ulcerative colitis (UC). We performed a randomized, controlled trial to test whether chromoendoscopy (CE) might facilitate early detection of IN and CRC in UC. Methods: A total of 263 patients with long-standing UC (≥8 years) were screened for potential inclusion in the study, 165 of whom were randomized at a 1:1 ratio to undergo conventional colonoscopy or colonoscopy with CE using 0.1% methylene blue. Five mucosal biopsy specimens were taken every 10 cm between the rectum and cecum. Circumscript lesions in the colon were evaluated according to a modified pit pattern classification. Results: In the CE group, there was a significantly better correlation between the endoscopic assessment of degree (P = 0.0002) and extent (89% vs. 52%; P < 0.0001) of colonic inflammation and the histopathologic findings compared with the conventional colonoscopy group. More targeted biopsies were possible, and significantly more IN were detected in the CE group (32 vs. 10; P = 0.003). Using the modified pit pattern classification, both the sensitivity and specificity for differentiation between non-neoplastic and neoplastic lesions were 93%. Conclusions: Based on our prospective randomized trial, CE permits more accurate diagnosis of the extent and severity of the inflammatory activity in UC compared with conventional colonoscopy. In addition, CE with methylene blue is a novel tool for the early detection of IN and CRC in patients with UC. These findings have important implications for medical and surgical interventions.

Use of sustained GERD medication therapy, physician prescribing patterns, and medical costs among surgically managed GERD patients

2% vs. 4%, hospital stay 5.8 vs 6.6 days, ICU stay 1.8 vs. 2.4 days, transfusion requirements 4.2 vs. 5 units, early rebleedng 22% vs. 30%, surgery 14% vs. 12%, fate rebleeding 16% vs. 14% (mean follow-up of 62 and 58 months). There was a trend toward lower transfusion requirements in the urgent colonoscopy group, however, this did not reach statistical significance. Conclusion: Although urgent colonoscopy identified a definitive source of bleeding more often than a standard care algorithm in patients with acute LGIB, the approaches are equivalent with regard to important outcomes. Thus, decisions concemng care should be based on ndividual experience and local expertise.

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.

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

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. 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. 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). 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.

Faecal calprotectin and faecal occult blood tests in the diagnosis of colorectal carcinoma and adenoma

BACKGROUND AND AIMSTesting for faecal occult blood has become an accepted technique of non-invasive screening for colorectal neoplasia but lack of sensitivity remains a problem. The aim of this study...

Clinical application of a new colonoscope with variable insertion tube rigidity: A pilot study

Background: Colonic loop formation can prolong colonoscopy, increase patient discomfort, and preclude complete examination. A colonoscope with variable insertion tube rigidity may facilitate colonoscopy. Our aim was to determine whether the use of a colonoscope with variable insertion tube rigidity reduces insertion time and improves patient acceptance of colonoscopy. Methods:Fifty patients were randomly assigned to undergo colonoscopy with a conventional colonoscope or a variable rigidity colonoscope (VRC). Patient acceptance, dosage of medication, use of abdominal pressure, and patient repositioning were assessed. Statistical analysis was performed by the 2-sample Wilcoxon rank sum test and an extension of Fisher exact test. Results:The groups were comparable with respect to age, gender, and medications required during colonoscopy. The cecum was reached in all 25 patients who underwent colonoscopy with the VRC, including 1 patient in whom the cecum was not reached at a previous colonoscopy with a conventional instrument. In the conventional colonoscopy group, the cecum was not reached in 4 patients (2 poor preparation, 2 loop formation). There was no significant difference between the 2 groups with respect to insertion time. In the group that underwent colonoscopy with the variable rigidity instrument, less abdominal pressure was required ( p = 0.05), and nursing assessment of patient discomfort was more favorable ( p = 0.05). There were no complications and no significant differences in the intubation time to cecum or in repositioning, patient acceptance, or patient assessment of abdominal pain. Conclusion:The use of a variable rigidity colonoscope reduced the frequency of abdominal pressure but did not affect intubation time to cecum, repositioning, patient acceptance, or patient assessment of abdominal pain.