Success Rate Of Cecal Intubation Research Articles

Prospective evaluation of the motorized spiral enteroscope for previous incomplete colonoscopy.

Background and study aims A significant percentage of colonoscopies remain incomplete because of failure to intubate the cecum. The motorized spiral enteroscope (MSE) technique, originally developed for deep small bowel enteroscopy, may be an effective alternative technique in cases of incomplete examination of abnormally long colons (dolichocolon). We prospectively evaluated the success rate of cecal intubation, safety and the therapeutic consequences of using MSE after incomplete conventional colonoscopy. Patients and methods A total of 36 consecutive patients with an indication for diagnostic and/or therapeutic colonoscopy were prospectively enrolled in this multicenter trial. All patients had undergone at least one incomplete colonoscopy attributed to abnormally long colons. Patients with incomplete colonoscopy due to stenosis were excluded. Results Twenty-two men and 14 women (median age 66 years, range 35–82) were enrolled. Median procedure time was 30 minutes (range 16–50). Cecal intubation rate was 100 % and median cecal intubation time was 10 minutes (range 4–30). Abnormalities, mostly neoplastic lesions, were detected in 23 of 36 patients, corresponding to a diagnostic yield of 64 %. All these findings were in the right side of the colon and had not been described by the antecedent incomplete coloscopy. No adverse events occurred. Conclusions In case of a difficult and long colon, MSE is safe and effective for diagnostic and therapeutic colonoscopy. It may provide an attractive solution to accomplish completeness of previous incomplete colonoscopies in these patients.

A93 USEFULNESS OF A NOVEL SMARTPHONE APP IN GASTROINTESTINAL ENDOSCOPY TO TRACK PROCEDURE NUMBERS AND THERAPEUTIC INTERVENTIONS

BackgroundEndoscopy teaching is an integral part of gastroenterology (GI) training. Though the number of completed endoscopic procedures does not equate competency, procedure tracking is useful for monitoring an individual’s learning progress. Currently, procedure tracking is typically done on an informal basis using paper or electronic spreadsheets. These methods are non-standardized and may not be shareable between trainees and their programs.Endostation is a smartphone app created by the University of Alberta Therapeutic Endoscopy Program to facilitate the tracking of endoscopic procedures. The app allows trainees to record the number of endoscopies and details such as cecal intubation (CI), ERCP cannulation, and therapeutic interventions. Data can be accessed by users via the app and website (www.endostation.ca), allowing for close monitoring of trainees’ learning progress.AimsOur primary objective was to evaluate the usefulness of the app for tracking the number of endoscopic procedures and therapeutic interventions. Our secondary objective was to evaluate the acquisition of endoscopy skills based on quality endoscopic parameters such as CI rate and ERCP cannulation rate.MethodsOne therapeutic endoscopy fellow and two GI residents were recruited for the study. Participants were asked to document their procedures over the study period (9-month for therapeutic endoscopy fellow, 12-month for GI residents). Total number of procedures was summed for each trainee. Acquisition of endoscopy skills was tracked by comparing success rates of CI and ERCP cannulation at different points within the study period.ResultsThe therapeutic endoscopy fellow recorded 415 cannulation attempts, 209 sphincterotomies, 282 stone extractions, 71 plastic stent placements, and 37 metal stent placements. There was a significant difference in the cannulation success rate when comparing the 1st trimester and the 3rd trimester of the study period (68% vs 85%; p= 0.0012) (Fig 1).The two GI residents respectively recorded 335 and 170 colonoscopies plus 454 and 305 gastroscopies. Resident 1 recorded 58 polypectomies, 9 esophageal variceal banding, and 16 non-variceal hemostasis. Resident 2 recorded 17 polypectomies, 12 esophageal variceal banding, and 9 non-variceal hemostasis. The CI success rate was significantly higher for both residents when comparing the first 4 months of training vs the last 4 months [24% vs 88% for resident 1 (p=0.00001); 15% vs 42% for resident 2 (p= 0.001)] (Fig 1).ConclusionsThe smartphone app (Endostation) was a useful tool for endoscopic procedure tracking. Data from the app was useful in demonstrating improvement in CI rate and ERCP cannulation rate over the study period. Funding AgenciesNone

Mo1667 WATER EXCHANGE ALONE (WE) AND WATER EXCHANGE WITH CHROMOENDOSCOPY (CWE) SIGNIFICANTLY ENHANCED DETECTION OF PROXIMAL COLON SESSILE SERRATED LESIONS (SSLS) COMPARED WITH AIR INSUFFLATION (AI) IN A RCT

Proximal colon hyperplastic polyps (HP), with a different pathology compared to distal HP, are more closely related to sessile serrated adenoma/polyps (SSA/P) (CGH 2013;11:760). Collectively proximal sessile serrated lesions (SSLs: SSA/P and HP) are linked to proximal colon cancers through a different pathway than conventional adenoma-carcinoma sequence. Predominantly flat, proximal SSLs are more difficult to identify by endoscopy with AI; and as missed lesions, are believed to contribute to interval cancers in the proximal colon. We completed a RCT (NCT01607255) comparing sedated screening colonoscopy performed with chromoendoscopy and water exchange (CWE), water exchange alone (WE) and air insufflation (AI). In a 2017 ACG late breaking abstract we reported that there were no differences in patient demographics (age and BMI), cecal intubation success rate, overall and proximal colon adenoma detection rate (ADR) (primary outcome) amongst groups. Overall and proximal colon ADR were >60% and >50%, respectively, confirming high quality examinations. We have now completed further analysis of the secondary outcome of proximal colon SSLs and procedural variables. 480 patients were randomized to sedated screening colonoscopy performed with CWE (160), WE (161) and AI (159) method. AI was performed with conventional air insufflation. WE was performed with air button turned off and water was infused/suctioned (exchanged) to facilitate scope insertion until cecal intubation. Air insufflation was used on withdrawal to facilitate removal of lesions. CWE used a dilute (0.008%) solution of indigo carmine and the method was otherwise same as WE. Polyps were removed using biopsy forceps, cold or hot snares. Table 1 shows the proximal colon SSLs detection rate was significantly higher for CWE and WE than AI (26.3%, 23.6% and 11.3%, respectively, p=0.002). Compared to AI, insertion time was not prolonged, withdrawal time was shorter, and withdrawal bowel prep score was significantly better, with WE. Single operator and subjects limited to Veterans; SSLs are only surrogate markers of, and not interval cancers. Use of WE or CWE significantly and equally improved detection of SSLs in the proximal colon compared to AI. Since missed proximal colon SSLs may account for proximal colon interval cancers developed through an alternative pathway (DCR 2009;52:1535), the enhanced detection of proximal colon SSLs could reduce risks of interval cancers (AJG 2012;107:1315-30). Without prolonging insertion time, with shorter withdrawal time and significantly better withdrawal bowel prep score, WE alone is sufficient to produce a significant improvement in proximal colon SSLs compared to AI. WE could improve clinical outcome by reducing interval cancers. The prevention of interval cancers by WE deserves to be studied.Tabled 1Table 1. Comparison of proximal SSLs detection rateProcedure characteristicsOverall p-valuesTukey adjusted p-values for pairwise [email protected]CWE (N=160)WE (N=161)AI (N=159)CWE vs WECWE vs AIWE vs AICecal intubation time (SD) min.13.3 (7.8)12.0 (6.3)12.2 (7.8).22**nsnsnsWithdrawal time (SD) min. with adenoma26.2 (8.6)20.2 (8.6)21.8 (10.2)<.001**<.001.003.52Volume water infused for procedure (SD) ml655.5 (513.6)614.0 (478.9)479.2 (457.5).004**.08<.001<.001Overall preparation in2.45 (0.29)2.49 (0.24)2.48 (0.27).41**nsnsnsOverall preparation out#3.33 (0.39)3.48 (0.34)3.22 (0.36)<.001**<.001.03<.001Proximal colon SSLs (HP/ SSA/P) detection rate (%)26.323.611.3.002.58<.001.004CWE=chromoendoscopy + water exchange; WE=water exchange; AI=air insufflation; SSLs=sessile serrated lesions (sessile serrated adenoma/polyp + hyperplastic polyps); Proximal colon: splenic flexure to cecum; SD=standard deviation.*Chi square test and **Wilcoxon rank sum test, p<0.05 is significant; ns=not significant @ only pairwise comparisons for tests for which the omnibus test was significant are required. Open table in a new tab

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

To evaluate the full-spectrum endoscopy (FUSE) colonoscopy system as the first report on the utility thereof in a Korean population. 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. 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. 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.

The feasibility of total water colonoscopy

Traditional colonoscopy is done using minimal air insufflations to distend the colon upon scope insertion until the cecum is reached. Residual stool in the colon is removed with water irrigation and suction. Biopsy and removal of lesions is usually performed on scope withdrawal. Water (exchange) colonoscopy utilizing water infusion in lieu of air insufflations on scope insertion compared favorably to air colonoscopy in screening colonoscopy. Upon reaching the cecum, the residual water is suctioned and air insufflated to distend the colon to facilitate inspection and removal of lesions on scope withdrawal. In randomized controlled trials (RCTs), it has been reported that the water method improves overall success rate of cecal intubation with unsedated colonoscopy, reduces medications requirement in sedated colonoscopy, and increases the proportion of patients completing colonoscopy without sedation medications when given the option of on-demand sedation compared with the conventional air method. Further analysis of RCTs indicated that the water exchange method (with suction removal of dirty water before infusing clean water on scope insertion) is associated with an increase in overall as well as proximal adenoma detection rate (ADR) when compared with the air method. While removal of lesions including biopsies and polypectomy are done normally on scope withdrawal under air insufflations, we examine the possibility of performing total water colonoscopy and polypectomy without using air insufflations.

Indigocarmine added to the water exchange method enhances adenoma detection - a RCT

Chromoendoscopy with dye spray and the water method both increase adenoma detection. Adding indigocarmine to the water method will enhance further the effectiveness of the latter in adenoma detection. Screening colonoscopy was performed with the water method (control) or with 0.008% indigocarmine added (study) by two endoscopists. Randomization was based on computer-generated codes contained in blocks of pre-arranged opaque sealed envelopes. High resolution colonoscopes were used. Upon insertion into the rectum, air was suctioned. With the air pump turned off, water was infused using a blunt needle adaptor connected to the scope channel and a foot pump to facilitate scope insertion until the cecum was reached. Residual stool causing cloudiness was suctioned followed by infusion of clear or colored water (water exchange) to facilitate scope passage with minimal distention of the colonic lumen. Upon seeing the appendix opening under water, water was suctioned and air was insufflated to facilitate inspection on scope withdrawal. Sample size calculation revealed 168 patients (84/group) needed to be randomized. Study was IRB-approved and registered (NCT01383265). There were no significant differences in mean age, gender distribution, BMI, and family history of colon cancer. Cecal intubation success rate was 100% in both groups. The overall adenoma detection rate was 44% (water only) versus 62% (water with indigocarmine), respectively (p=0.03). One cancer was detected in each group. In a RCT, indigocarmine at 0.008% concentration, added to the water method, significantly enhanced further the effectiveness of the latter in detecting adenomas.

The cap-assisted technique enhances colonoscopy training: prospective randomized study of six trainees

Colonoscopy and polypectomy procedures have effectively reduced the incidence of colorectal cancer. Currently, competence in colonoscopy is an essential part of the education program for gastrointestinal (GI) trainees. However, considerable training is required for the optimal performance of a colonoscopy. This study involved six colonoscopy trainees, three of whom used the cap whereas the others did not. Each trainee managed 100 cases of screening colonoscopy from beginning to end. The cecal intubation success rate, cecal intubation time, polyp detection rate, adenoma detection rate, advanced adenoma detection rate, and adenocarcinoma detection rate were checked. The rate of successful cecal intubation and the cecal intubation time were reviewed every 10 cases. The cecal intubation rate was 80.7 % (242/300) in the cap group and 63.3 % (190/300) in the non-cap group. The average cecal intubation time was 13.7 min in the cap group and 18.7 min in the non-cap group. The statistical analysis of these results suggested that the cap group had a significantly higher success rate (p < 0.001) and a shorter cecal intubation time (p < 0.001) than the non-cap group. However, the two groups did not differ significantly in the detection rate for polyps (45.3 vs 43 %; p = 0.565), adenomas (26.3 vs 25 %; p = 0.709), advanced adenomas (2.6 vs 0.6 %; p = 0.056), or adenocarcinomas (5.3 vs 3 %; p = 0.153). Cap-assisted colonoscopies might help to increase the rate of cecal intubation success and shorten the cecal intubation time for GI trainees.

The water method is effective in difficult colonoscopy—it enhances cecal intubation in unsedated patients with a history of abdominal surgery

BACKGROUND: Colonoscopy in unsedated patients in the US is considered to be difficult. Success rate of cecal intubation is limited by discomfort. Colonoscopy in patients with a history of abdominal surgery is also considered to be difficult due to adhesion-related bowel angulations. The water method has been shown to significantly reduce pain during colonoscopy. OBJECTIVE: To test the hypothesis that the water method enhances the completion of colonoscopy in unsedated patients with a history of abdominal surgery. DESIGN: The data bases of two parallel RCT were combined and analyzed. SETTING: Two Veterans Affairs endoscopy units. PATIENT AND METHODS: The water and air methods were compared in these two parallel RCT examining unsedated patients. Those with a history of abdominal surgery were selected for evaluation. MAIN OUTCOME MEASUREMENTS: Completion of unsedated colonoscopy. RESULTS: Among patients with a history of abdominal surgery, the proportion completing unsedated colonoscopy in the water group (19 of 22) was significantly higher than that (11 of 22) in the air group (p=0.0217, Fisher's exact test). LIMITATIONS: Small number of predominantly male veterans, unblinded colonoscopists, not all types of abdominal surgery (e.g. hysterectomy, gastrectomy) predisposing to difficult colonoscopy were represented. CONCLUSION: This proof-of-principle assessment confirms that in patients with a history of abdominal surgery the water method significantly increases the proportion able to complete unsedated colonoscopy. The water method deserves to be evaluated in patients with other factors associated with difficult colonoscopy.

Magnifying gastroscopy using a soft black hood for difficult colonoscopy

Various methods are reported as aids to cecal intubation for cases in which colonoscopy is difficult. This study aimed to investigate prospectively whether a gastroscope with magnification function, narrow-band imaging (NBI), and a soft black hood can aid insertion in cases of difficult colonoscopy and facilitate both accurate diagnosis and safe treatment. This prospective study recruited 177 patients. All were examined with a magnifying gastroscope. A commercially available soft black hood was attached to the gastroscope during insertion and magnification. Difficult colonoscopy was anticipated before colonoscopy in cases of patients with at least one of the following factors: low BMI (<20kg/m(2)), adhesion due to previous surgery, or previous colonoscopy that could not reach to the cecum. The success rate and duration of cecal intubation then were assessed. All detected lesions were evaluated by magnifying NBI and then classified as non-neoplastic or neoplastic for endoscopic diagnosis. Subsequently, all the lesions were removed and examined histologically for comparison. The overall success rate of cecal intubation was 100% (177/177), and the mean time taken to reach the cecum was 5.9min. A total of 156 lesions were detected endoscopically, and the overall diagnostic accuracy of NBI with magnification was 98.7%. No associated complications occurred. Magnifying gastroscopy using a soft black hood and NBI is useful for cecal intubation in cases wherein colonoscopy is difficult, facilitating accurate diagnosis and safe treatment.

VHM08 Water Immersion Colonoscopy Technique

VHM08 Water Immersion Colonoscopy Technique

A hypothesis-generating review of the water method for difficult colonoscopy

Objective. Several factors such as significant procedure-related discomfort, excessive intubation time or failed cecal intubation have been associated with difficult colonoscopy. An update of these factors and colonoscopy techniques reported to be efficacious in enhancing completion of cecal intubation in difficult colonoscopy patients is provided in this review. Material and methods. A Medline search (January 2006 to July 2010) was conducted using the following search terms: colonoscopy, difficult, abdominal pain, and discomfort. Results. Reviewed data are tabulated for presentation. Several water-related techniques have been described separately as adjuncts to usual air insufflation to minimize discomfort, reduce intubation time and improve success rate of cecal intubation. A combination of these techniques was subjected to trial-and-error modifications followed by randomized controlled comparisons. Progressive improvement in colonoscopy outcomes that paralleled stepwise incorporation of exclusion of air insufflation, removal of residual colonic air by suction and removal of residual feces by water exchange during the insertion phase has been described. Conclusions. The water method is potentially important for improving results of colonoscopy (cecal intubation) especially in unsedated patients. The unsedated option may lower costs. The success of the water method in difficult cases should be evaluated in randomized controlled trials. The call should be considered and explored by endoscopists interested in improving the quality of colonoscopy. A multicenter study to optimize the number of cases will be most desirable. In pragmatic terms, the use of the water method in difficult (unsedated) colonoscopy in the United States did receive recent editorial endorsement.

Is there a place for sedationless colonoscopy?

Usedated colonoscopy is routinely available in many parts of the world. In the US, only educated professionals appear to be knowledgeable enough to request the unsedated option. Colonoscopists have also been willing to perform unsedated colonoscopy when a patient presents without an escort after undergoing bowel purge preparation. While the actual side-effects of sedation are minimal, the escort requirement and time burden of sedation are barriers to the uptake of screening colonoscopy in the US. The recent trend of deep sedation with propofol for screening colonoscopy increases the efficiency of the colonoscopists at significant costs (e.g. anesthetist reimbursement). The options of as needed and on demand sedation permit patients to complete colonoscopy without sedation. The latter appears to be potentially less coercive. Nurses with experience in the unsedated options recognize the benefit of the quick turn-around of the examination room and shortened occupancy of the recovery area. Discharge planning can be optimized due to absence of amnesia. Patients completing unsedated colonoscopy have given their endorsement of the options. Pain and discomfort continue to limit the success rate of cecal intubation to about 80%. A recently described water method (warm water infusion in lieu of air insufflation combined with removal of all residual colonic air by suction and residual feces by water exchange) has the potential of decreasing procedural discomfort and enhancing cecal intubation in unsedated colonoscopy. The availability of the novel water method assures colonoscopists that high success rate of cecal intubation can be achieved in the unsedated patients.

Usefulness of Warm Water and Oil Assistance in Colonoscopy by Trainees

Success rate of cecal intubation, endoscopist's difficulty, and procedure-related patient pain are still problems for beginners performing colonoscopy. New methods to aid colonoscopic insertion such as warm water instillation and oil lubrication have been proposed. The aim of this study is to evaluate the feasibility of using warm water or oil in colonoscopy. Colonoscopy was performed in 117 unsedated patients by three endoscopists-in-training. Patients were randomly allocated to three groups, using a conventional method with administration of antispasmodics, warm water instillation, and oil lubrication, respectively. Success rate of total intubation within time limit (15 min), cecal intubation time, degree of endoscopist's difficulty, and level of patient discomfort were compared among the three groups. Cecal intubation time was shorter in the warm water group than in the conventional and oil groups. Degree of procedural difficulty was lower in the warm water group, and patient pain score was higher in the oil lubrication group, compared with the other groups. However, there was no significant difference in success rate of intubation within time limit among the three groups. The warm water method is a simple, safe, and feasible method for beginners. Oil lubrication may not be a useful method compared with conventional and warm water method.

Novel Applications of Balloon Endoscopy

Double-balloon endoscopy has been available for investigation of the small bowel since 2001, concomitantly with capsule endoscopy. Beyond established indications, endoscopic examination of the small bowel is currently performed in many clinical conditions involving the small bowel, which were under investigated in the past. Biopsies of lesions observed by capsule endoscopy or balloon enteroscopy can be taken and the lesions can sometimes be treated during a balloon Endoscopic procedure. Double-balloon endoscopy can be used in patients when conventional endoscopy was incomplete. The main applications of double-balloon endoscopy are the examination of patients with a surgically modified gastrointestinal tract and colonoscopy after a previously failed attempt to reach the cecum. In the latter indication, using a dedicated double-balloon colonoscope, the success rate of cecal intubation may be nearly 100%.

Initial Experience with a New Double Balloon Colonoscope in Patients with Prior Incomplete Colonoscopy

Background: The success rate of cecal intubation with a standard colonoscope is reported to be 80-95%. Despite using thinner & more flexible endoscopes, incomplete colonoscopy remains a significant problem. Double-balloon colonoscopy (DBC), using a push-and-pull technique with balloons on both the overtube and endoscope, may facilitate completion of the colonic exam after prior incomplete colonoscopy. Recent studies show that retrograde double balloon enteroscopy can be used for completion of colon examination but the technique is limited by the length of the scope (200 cm) and looping. A new double-balloon colonoscope (Fujinon FC450-B15C) is now available with a shorter length of 152 cm. Aim: To evaluate the procedural characteristics and success rate of DBC in patients with a prior incomplete exam. Methods: A retrospective chart review from January 1, 2008 through November 10, 2008 was performed to identify all patients who had undergone DBC after a prior incomplete colonoscopy using a conventional colonoscope. IRB approval was obtained. Baseline demographic information, procedural information from the initial colonoscopy and repeat DBC, and endoscopic findings during DBC were collected. Successful DBC was defined as cecal intubation. Data are presented as mean ± SD. Results: Twenty patients with incomplete colonoscopies (70% females, 68.5 ± 13.1 years, BMI 27.9 ± 4.3 kg/m2) were referred for DBC. The extent of initial exam was beyond the splenic flexure in 40% of cases. In 70% looping prevented cecal intubation. With DBC, 95% of procedures were completed beyond the splenic flexure and the cecal intubation rate was 80%. DBC allowed removal of polyps in an additional 9 patients. DBC failed to reach the cecum in 4 cases, 3 due to looping and 1 due to angulation. There was no difference in the quality of colonic preparations between the exams. Average procedure times and medication doses for DBC procedures are presented in Table 1. Conclusions: The new double balloon colonoscope is an effective technique for intubation of the cecum after incomplete colonoscopy with a standard colonoscope. However, incomplete colonoscopy, especially due to looping of the colon is not entirely eliminated with this new technology.

Colonoscopy Scheduling for Elderly Patients: Morning or Afternoon Sessions and Does It Make a Difference?

Purpose: Colonoscopy in the elderly can be a technically challenging procedure and it may result, in case of incomplete tests, in inconvenience and extra healthcare costs. Time of colonoscopy is an easily modifiable factor, if it proved to impact on the completion rate. The aim of the study was to determine whether the time of a test (morning or afternoon session) impact on the success rate of cecal intubation. Methods: We retrospectively reviewed all colonoscopies performed between March 2006 and 2007 in an endoscopy unit of a District General Hospital in UK. Patients aged ≥ 75 years old were considered as elderly. Time of procedure was classified as morning (if before 12:59 hr) or afternoon session (if after 13:00 hr) and preparation as good or poor, according to report. Results: A total of 1885 colonoscopies was performed; (morning procedures 630, 347 [female] and 283 [male]; afternoon procedures1255, 698 [female] and 557 [male]). Four hundred eighty three (483) were performed in elderly patients, ([female] 286, [male] 197) and 324 in afternoon sessions ([female]196, [male]128). In 284 patients (83 morning, 201 afternoon) examination failed cecal intubation (15%) and in 235 (12.4%) preparation was poor (78 in morning sessions). Higher incompletion rate was found in elderly 93/483 (19.25%) vs. younger patients 191/1402 (13.6%), P < 0.05 and among women 184/1045 (17.6%) vs. men 100/ 840 (11.9%), P < 0.001; on the other hand, men ≥75 years old had worse preparation ([female] 28/286 or 9.9% vs. [male] 32/ 197 or 16.2%, P < 0.05). Regarding the afternoon sessions, [female]≥ 75 years old had higher cecal intubation failure rate than [female] < 75 years old (elderly [female] 46/196 or 23.4% vs. younger [female] 83/502 or 16.5%, P < 0.05) and than elderly men, as well (elderly [female] 46/196 or 23.4% vs. elderly [male] 16/128 or 12.5%, P < 0.05). No differences were observed in preparation either between sessions or between elderly and younger patients. Conclusion: Afternoon colonoscopies have an impact on the completion rate, especially in elderly women. Scheduling these colonoscopies in morning sessions might avoid the need for further procedures.

Factors that predict incomplete colonoscopy: thinner is not always better

OBJECTIVE: The aim of this study was to determine whether anatomic factors such as body mass index (BMI) impacts the success rate of cecal intubation during colonoscopy. METHODS: We retrospectively reviewed the cecal intubation rate of 2000 colonoscopies performed at our institution from March 1997 to March 1999. The analysis sample was composed of charts for all incomplete procedures and a sample (23%) of complete examinations that were randomly selected. Data collected included age, gender, height, weight, bowel habits, abdominal surgery, psychiatric medication use, the presence of diverticular disease, amount of sedation administered, and location and reason for halting the examination. Patients were divided by BMI: thin (BMI ≤22.1), average weight (BMI >22.1–25.0), overweight (BMI = 25.1–29.9), and obese (BMI >30). RESULTS: Colonoscopies in women had a lower adjusted completion rate (94.8%) than in men (98.2%) ( p < 0.005). A low BMI in women was predictive of an incomplete examination ( p < 0.001). Factors that did not predict incomplete examinations in women included age and previous hysterectomy. The small number of male patients with an incomplete examination (n = 16) precluded accurate identification of any factors. CONCLUSIONS: Women with a low BMI (especially <22) were more likely to have an incomplete procedure. This finding may have implications for colorectal cancer screening in female patients.

Factors That Predict Incomplete Colonoscopy: Thinner Is Not Always Better

The aim of this study was to determine whether anatomic factors such as body mass index (BMI) impacts the success rate of cecal intubation during colonoscopy. We retrospectively reviewed the cecal intubation rate of 2000 colonoscopies performed at our institution from March 1997 to March 1999. The analysis sample was composed of charts for all incomplete procedures and a sample (23%) of complete examinations that were randomly selected. Data collected included age, gender, height, weight, bowel habits, abdominal surgery, psychiatric medication use, the presence of diverticular disease, amount of sedation administered, and location and reason for halting the examination. Patients were divided by BMI: thin (BMI < or = 22.1), average weight (BMI > 22.1-25.0), overweight (BMI = 25.1-29.9), and obese (BMI > 30). Colonoscopies in women had a lower adjusted completion rate (94.8%) than in men (98.2%) (p < 0.005). A low BMI in women was predictive of an incomplete examination (p < 0.001). Factors that did not predict incomplete examinations in women included age and previous hysterectomy. The small number of male patients with an incomplete examination (n = 16) precluded accurate identification of any factors. Women with a low BMI (especially < 22) were more likely to have an incomplete procedure. This finding may have implications for colorectal cancer screening in female patients.

Colonoscopy in patients without sedation: an experience from Nepal

Background: Colonoscopy is considered a painful procedure requiring routine intravenous sedation, however there are number of potential advantages to performing colonoscopy without sedation. Objective: To determine the effect of unsedated colonoscopy on the success rate of caecal intubation. Methods: All charts of patients who had unsedated colonoscopy from September 2010 to August 2011 were reviewed. Patient characteristics including age, gender, and mode of presentation were collected. The reasons for incomplete colonoscopy and sites reached were recorded. Results: During the study period, 127 examinations were performed without sedation. The mean age of the patients was 41.9 years with 79% males. The most common indication for performing colonoscopy was irritable bowel syndrome and the predominant endoscopic finding was colitis other than inflammatory bowel disease. The completion rate was 80.3%. Conclusion: In this study, sedation probably affects the overall success rate of cecal intubation. But unsedated colonoscopy can be used in resource poor settings to minimize direct and indirect costs of colonoscopy. DOI: http://dx.doi.org/10.3126/hren.v10i1.6003 HREN 2012; 10(1): 27-29