Differences in colonoscopy technique impact quality

Kravochuck, Sara E.; Gao, Runlin; Church, James M.

doi:10.1007/s00464-013-3355-z

Cited by 9 publications

(6 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…First, the MOAA/S score in the AR1 group was higher than AR2 and AR3 groups at T1, indicating that 0.15 mg/kg and 0.2 mg/kg remimazolam could achieve better sedation at the beginning of the operation. It was necessary for colonoscopic polypectomy because colonoscope insertion, especially in the sigmoid colon, was time-consuming and technically challenging [ 44 ], so patients in the initial stage were insulted more severely. Second, BIS values in AR1 group were significantly higher than AR3 group at T4, and the time to full alert was a little longer in AR3 group compared with the AR1 and AR2 groups.…”

Section: Discussionmentioning

confidence: 99%

Sedative effect of remimazolam combined with alfentanil in colonoscopic polypectomy: a prospective, randomized, controlled clinical trial

et al. 2022

View full text Add to dashboard Cite

Background Remimazolam is a newer benzodiazepine with properties of rapid onset, short duration of action, and fast recovery. Our study was to evaluate the effects of different doses of remimazolam combined with alfentanil in colonoscopic polypectomy. Methods One hundred twenty patients were randomly divided into four groups: alfentanil and propofol (AP) group, alfentanil and remimazolam 0.1 mg/kg (AR1 group), 0.15 mg/kg (AR2 group), or 0.2 mg/kg (AR3 group). Patients in the four groups received alfentanil 10 μg/kg, followed by propofol 2 mg/kg and three dosages of remimazolam. Modified Observer's Assessment of Alertness and Sedation (MOAA/S) scale, heart rate (HR), oxygen saturation (SpO2), respiratory rate (RR), bispectral index (BIS) values and mean arterial pressure (MAP) were collected at intervals of 5 min and analyzed at different time points: before anesthesia (T0), 5 min (T1), 10 min (T2), 15 min after anesthesia (T3) and at the end of surgery (T4). The average MAP was calculated utilizing the average of all MAP values. The primary outcome was the success rate of sedation. Secondary outcomes included time to full alert and adverse events. Results The success rate of sedation was 100% among the four groups. The incidence of hypotension was significantly decreased (all P < 0.05) and the average MAP was higher in AR1-AR3 groups than AP group (all P < 0.001). None of the patients developed bradycardia or hypertension during surgery in all study groups. BIS values were higher (all P < 0.001) and the time to full alert was statistically shorter in AR1-AR3 groups (all P < 0.05) compared with the AP group. The MOAA/S score in AR1 was higher than AR2 (P < 0.05) and the AR3 group (P < 0.05) at T1 and BIS values in the AR1 group were significantly higher than AR3 group (P < 0.05) at T4. Conclusions Remimazolam combined with alfentanil have a non-inferior sedative effect than propofol during the colonoscopic polypectomy. Moreover, this combination of two short-acting drugs might be a safer alternative. Trial registration The clinical trial was registered on (16/05/2021, ChiCTR2100046492).

show abstract

Section: Discussionmentioning

confidence: 99%

Sedative effect of remimazolam combined with alfentanil in colonoscopic polypectomy: a prospective, randomized, controlled clinical trial

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Since each patient will have different needs and each colon will be a unique challenge, the procedure requires patience and experience [13]. In 2014, Lee et al described the three-application style of colonoscopy [14].…”

Section: Discussionmentioning

confidence: 99%

The Relationship Between Colonoscopy Practice Style, Operator Ergonomics and Procedure Quality

Besler,

Celayir,

Teke

et al. 2023

Cureus

View full text Add to dashboard Cite

Objective: We aimed to compare three endoscopy operators who performed colonoscopy in three different styles in terms of procedure results, colonoscopy quality, and operator comfort during the procedure.Patients and methods: A total of 246 patients, who underwent routine screening colonoscopy for precancerous lesions between May and December 2022 in Istanbul Haydarpaşa Numune Education and Research Hospital, Istanbul, Turkey, were prospectively analyzed. The results of three different styles (single operator sitting, single operator standing, and two operators standing) were compared with each other. The following criteria were examined: polyp/adenoma detection rate, number of polyps detected per patient, cecal intubation rate, total procedure time, number of endoscope corrective maneuvers, number of patient position corrections during the procedure, and the endoscopist's subjective pain scale after the procedure.Results: The number of corrections and changes in scope position, rates of changing the patient's position during the procedure, and the postprocedural fatigue degree of the endoscopist were the highest for the single-operator standing style (p<0.001). The total processing time and post-procedure fatigue degree of the endoscopist were the lowest for the single-operator sitting style (p<0.001). The adenoma detection rate was the highest for single-operator standing style (37.8% vs 22.0% and 29.3%). The strongest predictive factors for the total procedure time were the colonoscopy style and patient age. The strongest predictive factors for the change in the total number of detected polyps were colonoscopy style, patient gender, and patient age. Independent of all other factors, the total detected number of polyps was statistically significantly higher for the single-operator standing style compared to other styles (B=-0.217, 95% confidence interval: -0.369 --0.066 and p=0.005) (B=-0.172, 95% confidence interval: -0.326 --0.017 and p=0.029).Conclusions: Two conclusions were drawn from this study. For routine screening colonoscopy, the singleoperator sitting style seems to be superior to other styles in terms of the shortest procedure time and the least tiring. However, the widely used single-operator standing style should be preferred over other styles in terms of the highest adenoma detection rate although it is most tiring and time-consuming.

show abstract

“…While multiple studies have investigated the minimal number of colonoscopies a trainee needs to perform before reaching satisfactory proficiency in colonoscopies, few studies have examined how colonoscopies should be performed by trainees during their learning period to both maximize the quality of the procedure for their patients and meet the trainees' educational goals. Studies have shown that colonoscopy quality is closely related to many factors, including patient factors (age, sex, race, underlying disease), cecal intubation, bowel preparation quality, careful examination of mucosal surfaces, colonoscopy withdrawal time (WT), and procedure time (1,(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13). Moreover, studies have shown that the skill of individual endoscopist and the withdrawal technique are also related to colonoscopy quality (13).…”

Section: Introductionmentioning

confidence: 99%

Improving trainee colonoscopy performance by investigating the withdrawal time from individual colonic segments: a single-center observational study

Huang

Chen

et al. 2021

Ann Palliat Med

View full text Add to dashboard Cite

Background:The colonoscopy withdrawal time (WT) and adenoma detection rate (ADR) are widely used quality indicators for colonoscopy. However, no study has investigated the appropriate colonoscopy WTs of individual colonic segments that will allow trainees to achieve a higher ADR. Thus, we analyzed for the first time the relationship between colonoscopy WT and the ADR/polyp detection rate (PDR) in the proximal, left-sided and entire colon among trainees.Methods: This retrospective study involved 611 consecutive patients who underwent colonoscopy from March 2018 to March 2019 performed by 6 trainees in the Endoscopy Center of Shanghai General Hospital. The WTs for the individual colonic segments and any significant findings of colonoscopies were retrospectively retrieved from the trainees' records and verified in the endoscopy center database. ADR/PDR was defined as the number of colonoscopies detecting at least 1 polyp/adenoma divided by the total number of colonoscopies. Comparisons of PDR and ADR between the 2 groups were conducted using chi-square test. Multilevel analysis was performed to consider individual differences among the 6 trainees. Multilevel binary logistic regression analysis was performed to analyze the factors that influenced the PDR, ADR and advanced adenoma detection rate (AADR) for the entire colon, and trainee status was included as a random effect.

show abstract

Differences in colonoscopy technique impact quality

Abstract: Use of ancillary techniques for colonoscope insertion minimizes pain, narcotic use, and hypoxia/hypotension. The product of benzodiazepine dose and narcotic dose is a good way of assessing sedative effect.

Cited by 9 publications

References 10 publications

Sedative effect of remimazolam combined with alfentanil in colonoscopic polypectomy: a prospective, randomized, controlled clinical trial

Sedative effect of remimazolam combined with alfentanil in colonoscopic polypectomy: a prospective, randomized, controlled clinical trial

The Relationship Between Colonoscopy Practice Style, Operator Ergonomics and Procedure Quality

Improving trainee colonoscopy performance by investigating the withdrawal time from individual colonic segments: a single-center observational study

Contact Info

Product

Resources

About