Technical Performance of Colonoscopy: The Key Role of Sedation/Analgesia and Other Quality Indicators

Radaelli, Franco; Meucci, G.; Sgroi, Giovanni; Minoli, Giorgio

doi:10.1111/j.1572-0241.2007.01778.x

Cited by 193 publications

(146 citation statements)

References 35 publications

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“…35 A grave concern in the U.S. regarding unsedated colonoscopy is the belief that the procedure is painful. [10][11][12] Indeed, worldwide the success rate of unsedated colonoscopy have been reported to be 67% 36 , 76% 30,37 , 78% 31,38 , 81% 39,40 , 82% 41 and 83%. 41 A novel method of water infusion in lieu of air insufflation significantly improved the success rate of cecal intubation to 97% in an observational study.…”

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confidence: 99%

“…Warm water was infused in lieu of air insufflation as the "principal modality" to decrease the discomfort of colonoscope insertion. Warm to touch tap water or water at body temperature (37 o C maintained by a water bath) was used because data in one publication support its effect in minimizing colonic spasms. The warm water was infused through the biopsy channel using a peristaltic pump via a tube fitted with a blunt needle adaptor.…”

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Is there a place for sedationless colonoscopy?

Leung

2011

jig

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REVIEW REVIEWUnsedated colonoscopy is available on a routine basis in many parts of the world.1 This paper will discuss the components of patient time burden of sedation, 2 tabulate the extent and significance of sedation-related complications 3 and review how various options without routine sedation impact these events in the context of colorectal cancer screening and surveillance. In the end we shall address the question in the title of this manuscript if there is a place for sedationless (unsedated) 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 sideeffects 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.

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Is there a place for sedationless colonoscopy?

Leung

2011

jig

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“…[10] In their very comprehensive study including more than 50,000 cases, Bannert et al [7] have shown that colonoscopy performed under sedation increased CIR in both men and women. Radaelli et al [11] reported that, CIR in colonoscopies with sedation and without sedation are in turn 84.2% and 76.1%. This rate is quite low when compared to ours.…”

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confidence: 99%

Does Propofol Sedation Increase the Cecal Intubation Rate in Colonoscopy?

Tardu¹

2017

Laparosc Endosc Surg Sci

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“…The effectiveness of pediatric and variable stiffness instruments was evaluated in so-called "difficult colonoscopies" [3][4][5] as well as the use of sedation/analgesia and the level of sedation [6][7][8], the effectiveness of different methods of bowel preparation and the effect of colonoscopist experience [9]. Some studies attempted to investigate the possible influence of different instruments on cecal intubation rate and time [6].…”

Section: Introductionmentioning

confidence: 99%