Ultrathin Colonoscope Research Articles

Review of oral and pharyngolaryngeal benign lesions detected during esophagogastroduodenoscopy.

Recent advancements in endoscopy equipment have facilitated endoscopists' detection of neoplasms in the oral cavity and pharyngolaryngeal regions. In particular, image-enhanced endoscopy using narrow band imaging or blue laser imaging play an integral role in the endoscopic diagnosis of oral and pharyngolaryngeal cancers. Despite these advancements, limited studies have focused on benign lesions that can be observed during esophagogastroduodenoscopy in the oral and pharyngolaryngeal regions. Therefore, this mini-review aimed to provide essential information on such benign lesions, along with representative endoscopic images of dental caries, cleft palate, palatal torus, bifid uvula, compression by cervical osteophytes, tonsil hyperplasia, black hairy tongue, oral candidiasis, oral and pharyngolaryngeal ulcers, pharyngeal melanosis, oral tattoos associated with dental alloys, retention cysts, papilloma, radiation-induced changes, skin flaps, vocal cord paresis, and vocal fold leukoplakia. Whilst it is imperative to seek consultation from otolaryngologists or dentists in instances where the diagnosis cannot be definitively ascertained by endoscopists, the merits of attaining foundational expertise pertaining to oral and pharyngolaryngeal lesions are unequivocal. This article will be a valuable resource for endoscopists seeking to enhance their understanding of oral and pharyngolaryngeal lesions.

Candy cane syndrome: A systematic review.

Candy cane syndrome (CCS) is a condition that occurs following gastrectomy or gastric bypass. CCS remains underrecognized, yet its prevalence is likely to rise due to the obesity epidemic and increased use of bariatric surgery. No previous literature review on this subject has been published. To collate the current knowledge on CCS. A literature search was conducted with PubMed and Google Scholar for studies from May 2007, until March 2023. The bibliographies of the retrieved articles were manually searched for additional relevant articles. Twenty-one articles were identified (135 patients). Abdominal pain, nausea/vomiting, and reflux were the most reported symptoms. Upper gastrointestinal (GI) series and endoscopy were performed for diagnosis. Surgical resection of the blind limb was performed in 13 studies with resolution of symptoms in 73%-100%. In surgical series, 9 complications were reported with no mortality. One study reported the surgical construction of a jejunal pouch with clinical success. Six studies described endoscopic approaches with 100% clinical success and no complications. In one case report, endoscopic dilation did not improve the patient's symptoms. CCS remains underrecognized due to lack of knowledge about this condition. The growth of the obesity epidemic worldwide and the increase in bariatric surgery are likely to increase its prevalence. CCS can be prevented if an elongated blind loop is avoided or if a jejunal pouch is constructed after total gastrectomy. Diagnosis should be based on symptoms, endoscopy, and upper GI series. Blind loop resection is curative but complex and associated with significant complications. Endoscopic management using different approaches to divert flow is effective and should be further explored.

Strategies to manage the difficult colonoscopy.

During endoscopy, an endoscopist is inevitably faced with the occasional "difficult colonoscopy," in which the endoscopist finds it challenging to advance the endoscope to the cecum. Beyond optimization of technique, with minimized looping, minimal insufflation, sufficient sedation, and abdominal splinting when needed, sometimes additional tools may be needed. In this review, we cover available techniques and technologies to help navigate the difficult colonoscopy, including the ultrathin colonoscope, rigidizing overtube, balloon-assisted colonoscopy and the abdominal compression device.

Utility of Diagnostic Colonoscopy in Pediatric Intestinal Disease.

Background: The roles and methods of diagnostic colonoscopy in pediatric patients were previously demonstrated. With advances in medical equipment and the increasing need for pediatric endoscopic diagnosis, we compared recent results with those previously reported. Methods: A retrospective analysis was conducted on pediatric patients aged ≤15 years, comparing those who underwent their first diagnostic colonoscopy between 1 January 2007 and 28 February 2015 with those who did so between 1 March 2015 and 28 February 2022 at Kurume University Hospital. Results: A total of 274 patients were included, including 110 in the previous study and 164 in the present study. The main indications were hematochezia in the previous study (63/110, 57.3%) and abdominal pain in the present study (64/164, 39.0%). Ulcerative colitis (74/274, 27.0%) was the most common diagnosis in both studies. The major difference from the previous study was an increase in the number of Crohn’s disease and eosinophilic gastrointestinal disorder cases. Bowel preparation with magnesium citrate was significantly increased across all ages in the present study (142/164, 86.6%). Midazolam + pentazocine was used for sedation in most cases (137/164, 83.5%). An ultrathin upper endoscope was mainly used in patients aged ≤6 years, while ultrathin colonoscopes were applied in patients aged 7–12 years. Conclusion: In the present study, appropriate changes were found in the roles and methods of diagnostic colonoscopy in pediatric patients compared to the previous study. The increasing trend of patients presenting with inflammatory bowel disease and eosinophilic gastrointestinal disorder worldwide indicates the importance of colonoscopy in infants and children.

Ultrathin colonoscopy can improve complete preoperative colonoscopy for stenotic colorectal cancer: Prospective observational study.

Preoperative colonoscopy is often incomplete for stenotic colorectal cancers (CRC). This prospective observational study aimed to evaluate the ability of an ultrathin colonoscope (UTC) to inspect the whole colon by passing through the stenotic CRC. All patients who underwent preoperative colonoscopy for stenotic CRCs at Shizuoka Cancer Center were examined for eligibility. If a standard colonoscope (PCF-H290ZI) could not pass because of a stenosis, the patients were recruited. All of the eligible patients were prospectively enrolled when informed consent could be obtained, and complete colonoscopy was attempted again using an UTC (PCF-PQ260L). Patients with stent placement and those requiring right hemicolectomy were not recruited. Primary endpoints were pass-through and cecal intubation rates. The detected synchronous neoplasias (adenomas and cancers) and their pathological findings after resection were evaluated. A total of 100 patients were enrolled between September 2017 and February 2019. The mean age was 65.6±10.8years, and 59% were male. The pass-through and cecal intubation rates were 67% (67/100) and 58% (58/100), respectively. Synchronous lesions located proximal to the stenoses were detected in 65.5% (38/58) of the complete colonoscopies, with a total of 86 lesions, including 18 advanced neoplasias with three invasive cancers. When standard colonoscopy cannot pass through stenotic CRC, ultrathin colonoscopy can be considered as an option to inspect the whole colon proximal to the stenosis because treatment strategy can potentially be changed by detecting synchronous neoplasias proximal to the stenosis before surgery. (UMIN000028505).

Initial Experience of a Community Gastroenterology Practice with Ultraslim Colonoscopy

Colonoscopies are performed for cancer screening as well as for other diagnostic and therapeutic reasons. It is considered successful if cecal intubation is achieved and adequate mucosa is visualized. It is not always possible to achieve cecal intubation due to multiple reasons such as sharp angulation or fixed segments of the colon and stricture. A pediatric colonoscope (PDC) and an ultrathin colonoscope (UTC) are used as a tool to negotiate sharp angulation and the fixed segments of the colon because their small diameter allows easy movement. An ultrathin colonoscope is used at many practices as a rescue in situations where standard colonoscopes have failed. Our study highlights the use of an ultraslim scope in both rescue situations and as the initial colonoscope of choice in an ambulatory endoscopy center.

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.

Su1710 Evaluation of Discomfort During Colonoscopy With a New Ultrathin Flexible Colonoscope in Crohn's Disease. -a Randomized Controlled Trial-

Su1710 Evaluation of Discomfort During Colonoscopy With a New Ultrathin Flexible Colonoscope in Crohn's Disease. -a Randomized Controlled Trial-

Clinical impact of ultrathin colonoscopy for Crohn's disease patients with strictures.

Mucosal healing is now the ideal treatment goal for patients with Crohn's disease (CD) and endoscopy is suitable for both visualizing the intestinal mucosa and optimizing treatment according to the objective endoscopic findings; however, passing through strictures with a conventional colonoscope is sometimes difficult. An ultrathin colonoscope (outer diameter 9.2 mm) has been developed for superior insertion performance. CD patients with strictures that could not be passed with a conventional colonoscope were eligible for entry into the study. We investigated the rate of passage of the ultrathin colonoscope beyond strictures. We also investigated the clinical impact of optimizing the treatment strategy according to the endoscopic findings beyond the stricture. Of 49 patients, the ultrathin colonoscope could pass the stricture in 59.2% (29/49). The main reason for failure compared with the "pass" group was anal stricture (P = 0.005). When including finger bougie for severe anal stricture, passage of the stricture was achieved in 83.7% (41/49) of cases and the oral mucosa beyond the stricture was visualized. In these cases, 56.1% (23/41) had treatment efficacy confirmed and 43.9% (18/41) required a change of treatment. Importantly, half (9/18) of them were in clinical remission. There were no complications of the study. The ultrathin colonoscope could provide optimized treatment based on objective findings of the activity of the oral-side mucosa in CD patients complicated with stricture. Selection of the appropriate endoscope to visualize the responsible lesion is essential to optimize the treatment strategy in each case of CD.

Evaluation of discomfort during colonoscopy with conventional and ultrathin colonoscopes in ulcerative colitis patients

In patients with ulcerative colitis (UC), colonoscopy is an essential procedure for evaluating mucosal damage, and treatment outcomes. A new flexible ultrathin colonoscope (PCF-PQ260) has been developed to readily pass through tortuous and narrow lesions of the colon and cause minimum patient discomfort. The objective of the present study was to evaluate the comfort and performance of this new type of scope in UC patients who underwent colonoscopy for estimation of mucosal inflammation, basically without sedation. In a prospective, single-center setting, among 107 UC patients who were to undergo colonoscopy, 84 eligible cases were randomly assigned to the new ultrathin flexible colonoscope, PCF-PQ260 (n = 42) or to a conventional colonoscope, PCF-Q260A (n = 42). Main outcome measure was patient pain level determined by visual analogue scale (VAS) with 0 = none, and 100 = extremely painful. Other outcomes were cecal intubation time, rate of complete intubation (to reach the cecum) and rate of procedural complications. VAS score was significantly lower in the new-scope group as compared with the conventional-scope group: mean ± SD, median (range): 19.3 ± 16.9, 14 (0-62) vs 32.0 ± 21.6, 31.8 (0-100, P = 0.005). However, cecal intubation rate (97.6%) and time (4 min) were similar in the two groups. There was no procedure-related serious complication in either group. The findings indicated that the flexible ultrathin colonoscope PCF-PQ260 has significantly better tolerability in UC patients compared to a conventional colonoscope.

Tu1551 Ultra-THIN Versus Pediatric Instruments for Colonoscopy in Older Female Patients: a Randomized Trial

Pediatric colonoscopes, with an 11 mm outer diameter insertion tube, are often used to negotiate the female colon. Gastroscopes, which are thinner than pediatric colonoscopies, are occasionally required to negotiate angulated sigmoid colons. However, the use of ultra-thin colonoscopes (6.8 mm diameter, standard length) for such difficult cases has not been studied. The aim of this study was to compare the use of an ultra-thin instrument with a pediatric instrument for colonoscopy in older female patients.

Standard or ultrathin device for colonoscopy?

We read with great interest the article by Töx et al. [1]. The authors compared the use of an ultrathin colonoscope (UTC) and a standard colonoscope with regard to demand for propofol during colonoscopy. They found that use of a new type of UTC was associated with less propofol consumption, lower patient sedation levels, and less pain compared with the standard colonoscope. But the time to intubation of the ileum was longer. These findings have relevance for the clinical practice of colonoscopy but are limited in some respects.

Colonoscopy, pain and fears: Is it an indissoluble trinomial?

Colonoscopy is the reference method in the secondary prevention, diagnosis and, in some cases, treatment of colorectal cancer. It can often cause pain associated with embarrassment, anxiety, and physical and emotional discomfort. Pain intensity is influenced by a lot of factors, and there is a strict relationship among pain, pain perception, and mind. Several methods can be used to break the trinomial colonoscopy, pain and fear. Sedoanalgesia is recommended by several guidelines. If no sedation is offered, the patient must accept a higher chance of unacceptable discomfort and the endoscopist a lower chance of completing the procedure because of patient discomfort. Other non-pharmacologic methods such as acupuncture, music, and hydrocolonoscopy can be used as alternatives to pharmacologic sedoanalgesia. Furthermore, new endoscopic technologies such as variable-stiffness colonoscopes and ultrathin colonoscopes, or the use of carbon dioxide instead of air for colon insufflation, can reduce the pain caused by colonoscopy. In the future, technical improvements such as wireless capsules or robotic probes, will probably enable to overcome the present concept of colonoscopy, avoiding the use of traditional endoscopes. However, at present the poor attention paid by endoscopists to the pain and discomfort caused by colonoscopy can not be justified. There are several methods to reduce pain and anxiety and to break the trinomial colonoscopy, pain and fear. We must use them.

Tu1325 A Prospective Randomized Study of the Efficiency of an Ultrathin Colonoscope in Unsedated Colonoscopy: an Interim Report

Olympus Corporation (Tokyo, Japan) has developed an ultrathin colonoscope (UTC, PCF-PQ260) with an outer diameter of 9.2mm. The UTC has two additional functions. One is the function of passive-bending. The instrument has the secondary bending section just behind the original bending section. This bending section bends passively and it is extremely flexible. The second feature is the function of high force transmission. When the tip of the colonoscope reach at the proximal colon, pushing force is reduced by forming loops in the sigmoid colon with a conventional small-caliber colonoscope, but by changing the material of insertion tube, pushing force is transmitted well. The aim of this study was to assess the efficiency of the UTC during colonoscopy, comparing it with a conventional pediatric colonoscope (PCF, PCF-Q260AL) with an outer diameter of 11.3 mm.

Sa1516 Effectiveness of a New Type Ultrathin Colonoscope in Colonoscopy of Patients With Active Ulcerative Colitis

Sa1516 Effectiveness of a New Type Ultrathin Colonoscope in Colonoscopy of Patients With Active Ulcerative Colitis

Propofol sedation for colonoscopy with a new ultrathin or a standard endoscope: a prospective randomized controlled study

The majority of colonoscopies in Germany are performed under conscious sedation. Previous studies reported that pediatric colonoscopes reduce the demand for sedative drugs and may improve cecal intubation. The aim of this study was to compare a new ultrathin and a standard colonoscope in terms of propofol demand during colonoscopy. A total of 203 patients were prospectively randomized to undergo colonoscopy with either a 9.5-mm ultrathin (UTC) colonoscope or a standard colonoscope of variable stiffness. Initially, 40 or 60 mg of propofol were administered according to body weight, followed by bolus injections of 20 mg as deemed necessary. Propofol was administered by a separate physician who was blinded to the endoscope used. Sedation levels were defined according to guidelines; pain and complaints were recorded on a numeric rating scale. Significantly less propofol was required to reach the cecum with the UTC (adjusted mean 94.9 mg [95 % confidence interval (CI) 85.7 - 105.0] vs. 115.3 mg [95 %CI 105.8 - 124.7]; P = 0.003). The level of sedation and pain score were lower with the UTC (sedation level 1 76 % vs. 61 %; P = 0.003; pain score adjusted mean 2.0 [95 %CI 1.7 - 2.4] vs. 2.8 [95 %CI 2.5 - 3.1]; P = 0.001). The rate of ileal and cecal intubation, time to reach the cecum, number of external compressions, withdrawal time, polyp and adenoma detection rate, and patient satisfaction were not different between the two colonoscopes. The time to intubate the ileum was longer with the UTC (1.73 minutes [95 %CI 1.42 - 2.04] vs. 1.22 minutes [95 %CI 0.91 - 1.52]; P = 0.020). Use of a new ultrathin colonoscope was associated with reduced propofol consumption, lower patient sedation levels, and less pain than the standard colonoscope, but ileal intubation time was longer.

P253 Effectiveness of a new type ultrathin colonoscope in colonoscopy of patients with active ulcerative colitis

bisacodyl tablets. The noninferiority margin was > 9.0%. If noninferiority criteria were satisfied, a test for superiority was performed. If the lower bound of the CI was >0%, superiority was demonstrated. Results: A total of 603 randomised patients self-administered either P/MC (n = 305) or PEG + 2 bisacodyl tablets (n = 298). P/MC was superior compared with PEG + 2 bisacodyl tablets in overall colon cleansing (CI: 3.4) and in cleansing of the ascending (CI: 4.9), mid (CI: 1.6), and recto-sigmoid (CI: 0.4) segments of the colon. Overall colon cleansing was successful in a greater number of patients receiving P/MC than PEG + 2 bisacodyl tablets (84.2% vs 74.4%). Similarly, the proportion of patients who were successfully cleansed was higher for P/MC than for PEG + 2 bisacodyl tablets in the ascending (89.5% vs 78.8%), mid (92.4% vs 85.9%), and recto-sigmoid (92.4% vs 87.2%) segments of the colon. The incidence of treatmentemergent adverse events (TEAEs) was similar between P/MC and PEG + 2 bisacodyl tablets (69.2% vs 72.8%). Commonly reported TEAEs attributed to P/MC or PEG + 2 bisacodyl tablets were nausea (2.6% vs 3.7%), vomiting (1.0% vs 3.4%), headache (1.6% vs 1.7%), and chills (0% vs 1.0%). Conclusions: P/MC administered as a split dose in preparation for colonoscopy is superior in colon cleansing and has a similar short-term safety profile compared with day-before dosing of PEG + 2 bisacodyl tablets.

Commentaire de travail de K. Garborg et al., pp.740

See also: Reduced pain during screening colonoscopy with an ultrathin colonoscope: a randomized controlled trialEndoscopy 2012; 44(08): 740-746DOI: 10.1055/s-0032-1309755

Reduced pain during screening colonoscopy with an ultrathin colonoscope: a randomized controlled trial

Screening colonoscopy for colorectal cancer (CRC) is recommended in several countries, but uptake rates are often low. Fear of pain and also time-consuming costly sedation are barriers for colonoscopy, and thus development of colonoscopy equipment that decreases patient discomfort is worthwhile. This randomized controlled trial investigated the performance of an ultrathin colonoscope in CRC screening. Consecutive participants in a colonoscopy screening trial were randomized to examination with an ultrathin prototype colonoscope or a standard colonoscope. The main outcome measure was pain during the examination. Participants rated pain (no, slight, moderate, severe) using a validated questionnaire. From 187 enrolled participants (80 women [43 %]), 162 (87 %) responded to the questionnaire. The study groups were similar regarding baseline characteristics. Pain scores were significantly lower in the prototype instrument group compared with the standard group (78 % vs. 29 % of patients with no pain in prototype and standard groups, respectively; odds ratio [OR] 0.11; 95 % confidence interval [CI] 0.06 - 0.23; P < 0.001). Cecal intubation rate was 98 % in the prototype group and 92 % in the standard group (P = 0.085). Sedation was used in 2 % and 7 % in the prototype and standard groups respectively (P = 0.12). Adenoma detection rate was 13 % in the prototype group vs. 24 % in the standard group (P = 0.052). The new ultrathin Olympus colonoscope decreases patient pain during screening colonoscopy. This feature may improve uptake and patient satisfaction in screening colonoscopy. Further study is needed to evaluate the lower adenoma detection rate.

1173 Improved Colonoscopy Screening With an Ultra Thin Colonoscope: A Randomized Controlled Trial

1173 Improved Colonoscopy Screening With an Ultra Thin Colonoscope: A Randomized Controlled Trial