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At least 19 recordsLinked to original sources
PubMed2002

A randomized controlled trial in a training institution comparing a pediatric variable stiffness colonoscope, a pediatric colonoscope, and an adult colonoscope.

BACKGROUND: There are few comparative data on the efficacy of different colonoscopes. This study compared the efficacy of a new pediatric variable stiffness colonoscope with that of standard pediatric and adult colonoscopes in the performance of routine colonoscopy. METHODS: Three hundred sixty-three consecutive patients were randomized to undergo colonoscopy with a pediatric variable stiffness (n = 122), pediatric (n = 114), or adult colonoscope (n = 127). Primary outcomes recorded were minutes to the cecum and completeness of the examination. Secondary outcomes included patient tolerance, use of abdominal compression, and endoscopists' assessment of the difficulty of the procedure. RESULTS: Cecal intubation rates were not statistically different between the groups: variable stiffness (94.3%), pediatric (96.5%), and adult (89.8%) (p = 0.099). There was no significant difference in mean insertion time, patient tolerance, use of abdominal compression, or endoscopists' global assessment or examination difficulty between groups. Overall, the initial completion rate of 93% increased to 97% on switching to a different colonoscope. Colonoscopy was unsuccessful more often and was more time consuming in women who had undergone hysterectomy. CONCLUSION: The variable stiffness colonoscope performs well, but does not appear to offer any distinct advantage over standard pediatric or adult colonoscopes for routine colonoscopy. Further study may identify subgroups of patients that benefit from this new technology.

Adult↗
PubMed2005

Is the variable-stiffness paediatric colonoscope more effective than a standard adult colonoscope for outpatient adult colonoscopy? A randomised controlled trial.

BACKGROUND: Trials with variable-stiffness colonoscopes have yielded conflicting results regarding efficacy and patient tolerance. AIM: We compared a variable-stiffness paediatric colonoscope with a standard adult colonoscope. METHODS: Two hundred and forty consecutive adult outpatients presenting for colonoscopy were randomised to either a variable-stiffness paediatric colonoscope or an adult colonoscope. If there was difficulty in performing colonoscopy with the assigned scope, the endoscopist was given the option of switching to the alternative instrument. In the condition of a severely fixed, angulated sigmoid colon, a final 'salvage' (backup) option was that of switching to an even thinner diameter paediatric colonoscope. RESULTS: The initial frequency of total colonoscopy was similar with the variable-stiffness paediatric colonoscope and adult colonoscope (95.8% versus 96.6%, p=1.0). Factoring in scope changes, the final frequency was 98.3% versus 99.2% (p=1.0). There was no statistical difference between the two groups in terms of insertion time, doses of sedative medications, scales of procedure difficulty, or patient satisfaction. CONCLUSIONS: Adult colonoscope and variable-stiffness paediatric colonoscope are both effective instruments for routine colonoscopy. In cases when the use of the initial scope is unsuccessful, switching to the alternative scope may permit passage to the caecum. There are occasional patients with fixed, angulated sigmoid colons in whom use of an even thinner diameter paediatric colonoscope can be helpful.

Adult↗
PubMed2002

Use of a variable-stiffness colonoscope allows completion of colonoscopy after failure with the standard adult colonoscope.

BACKGROUND AND STUDY AIMS: Experts fail to reach the cecum in 2 - 10% of colonoscopies. The purpose of this case series was to evaluate the efficacy of a small-caliber, variable-stiffness colonoscope in patients with incomplete colonoscopy. PATIENTS AND METHODS: The variable-stiffness colonoscope (Olympus America XPCF-140AL) was used by the same examiner to reattempt colonoscopy immediately in all patients in whom colonoscopy to the cecum with the standard colonoscope was incomplete. RESULTS: Sixteen of 385 attempted colonoscopies (4.2%) did not reach the cecum with the standard colonoscope due to looping (n = 12), fixed angulation of the sigmoid colon (n = 3), and diverticulosis (n = 1). The procedures were deemed a failure after a mean of 28 min, despite the use of abdominal pressure and positional change in all patients. Fifteen of the 16 patients (94 %) had a complete colonoscopy with the variable-stiffness colonoscope. One patient had an incomplete colonoscopy with the variable-stiffness colonoscope due to an obstructing mass in the transverse colon that was not reached by the standard colonoscope. With the variable-stiffness colonoscope, the mean time to cecal intubation was 10.3 min; four patients (25 %) required a change in patient position, and six patients (37.5 %) required abdominal pressure. CONCLUSIONS: A variable-stiffness colonoscope allowed completion of colonoscopy in all patients without obstruction who had an incomplete colonoscopy with the standard colonoscope. Further study is needed to determine whether the variable-stiffness colonoscope should be used routinely for colonoscopy.

Adult↗
PubMed1976

Routine and blind histological diagnoses on colonoscopic biopsies compared to clinical-colonoscopic observations in patients without and with colitis.

Of the 110 patients examined, complete agreement was found between the blind and routine histological studies in the sections from 69 patients (63%), between the blind histological study and that of colonoscopy in 66 patients (60%), and between the routine histological diagnoses and those of colonoscopy in 73 patients (66%). The diagnosis of a normal colonic mucosa was made by blind study on colonoscopic biopsies in 32 patients, by the routine one in 36 patients, and by clinical-colonoscopic examination in 40 cases, the percentage of agreement with the colonoscopic diagnosis being 68 and 72, respectively. The diagnosis of unspecific non-ulcerative colitis was made by the blind histological study in 43 patients, by the routine histological examination in 58 cases, and by colonoscopy in 41 patients. The percentage of agreement between the histological studies and the clinical-colonoscopic diagnoses was 61 and 78, respectively. A diagnosis of ulcerative colitis was made by the blind histological study in 35 patients, by the routine histological examination in 16, and by colonoscopy in 27 cases. The percentages of agreement between the histological studies and the diagnoses by clinical-colonoscopic examination were 82 and 59, respectively. The differences in symptomatology between groups were small, except for a high occurrence of diarrhoea and blood in stool in ceses with ulcerative colitis, as evaluated by blind histological study. The findings stress the importance of following defined criteria for histological examination.

Biopsy↗
PubMed2000

Usefulness of a pediatric colonoscope for colonoscopy in adults.

BACKGROUND: There are few published data on how different types of colonoscopes affect success in reaching the cecum and patient comfort. We examined the feasibility of using a pediatric colonoscope for routine colonoscopy in adults and investigated whether there were subgroups of patients in whom use of this instrument was preferable. METHODS: One-hundred fifty adults undergoing outpatient colonoscopy were randomized to colonoscopy with a standard colonoscope (Olympus CF-100L) or with a pediatric colonoscope (Olympus PCF-100). All procedures were performed by a faculty endoscopist and timed by an independent observer. After examinations, the endoscopist graded procedure difficulty and patients were given a questionnaire that assessed their experience. RESULTS: The adult (n = 77) and pediatric (n = 73) colonoscope groups were comparable in all outcomes measured, including success in reaching the cecum (91% vs. 93%, p = 0.61), mean time to reach the cecum (11.4 vs. 9.7 min, p = 0.07), mean total procedure time (21.8 vs. 21.9 min, p = 0.95), mean meperidine dose (55 vs. 52 mg, p = 0.17); median midazolam dose (2.0 mg in both groups, p = 0.10), the endoscopists' perception of procedure difficulty, and patient comfort scales. Of the 7 patients in whom colonoscopy with the adult colonoscope was unsuccessful, the cecum was reached in 4 by switching to a pediatric colonoscope (all women, 3 of whom had prior hysterectomy). In the 5 patients in whom colonoscopy with the pediatric colonoscope was unsuccessful, the cecum was reached in 1 by switching to an adult colonoscope. Including the cases in which the cecum was reached by switching to the alternative colonoscope, the overall frequency of cecal intubation was 143 of 150 (95%). Subgroup analysis disclosed no difference between the 2 groups in outcomes when gender, presence of diverticulosis, and patient size were considered. Colonoscopy with the pediatric colonoscope was more successful than with the adult instrument in reaching the cecum in women with prior hysterectomy (11 of 12 [92%] vs. 15 of 21 [71%]); however, the numbers in each group were relatively small and the difference was not significant (p = 0.22). CONCLUSIONS: The pediatric colonoscope is suitable for routine colonoscopy in adults. It is also useful in patients in whom colonoscopy with the adult colonoscope is unsuccessful in reaching the cecum (particularly in women). Additional study is needed to see if the pediatric colonoscope is actually superior to the adult colonoscopy for routine colonoscopy in women with prior hysterectomy.

Adult↗
PubMed2002

Usefulness of a pediatric colonoscope for routine colonoscopy in women who have undergone hysterectomy.

BACKGROUND: Colonoscopy can be difficult in some women who have undergone hysterectomy, which can be associated with a fixed, angulated sigmoid colon caused by postoperative pelvic adhesions. Our goal was to determine whether colonoscopy is easier and more comfortable for women after hysterectomy when performed with a pediatric colonoscope, which is thinner in diameter and more flexible than a standard "adult" colonoscope. METHODS: One hundred women with a history of hysterectomy undergoing outpatient colonoscopy were randomized in unblinded fashion to colonoscopy with a standard colonoscope (CF-100L or CF-Q140L, Olympus) or with a pediatric colonoscope (PCF-100, Olympus). All procedures were performed by a faculty endoscopist and timed. After examination, the endoscopist graded procedure difficulty, and patients were given a questionnaire that assessed their experience. RESULTS: The cecum was intubated more frequently in the pediatric colonoscope group than in the standard colonoscope group (96.1% vs. 71.4%, p < 0.001). Success increased in the standard colonoscope group to 89.8% when the pediatric colonoscope was used to complete the examination. There were no differences in the two groups in terms of mean total procedure times (21.4 minutes vs. 22.6 minutes), mean doses of meperidine administered (57 mg both groups), mean doses of midazolam administered (1.5 mg vs. 1.7 mg), scales of procedure difficulty as graded by the endoscopists, and comfort scales as graded by patients. For the cases in which the cecum was intubated, the mean time to reach the cecum (11.7 minutes for the pediatric colonoscope group vs. 12.7 minutes for the adult) was similar. CONCLUSIONS: The pediatric colonoscope is a reasonable choice for colonoscopy in women who have had a hysterectomy. Alternatively, if the endoscopist elects to start the procedure with a standard colonoscope, it is helpful to have a pediatric colonoscope available for use should a fixed, angulated sigmoid colon be encountered that cannot be easily or safely traversed with the standard colonoscope.

Cecum↗
PubMed2004

170 degrees wide-angle colonoscope: effect on efficiency and miss rates.

BACKGROUND: Small polyps are routinely missed during colonoscopy even with careful examination. AIM: To determine and compare endoscopic efficiency and polyp miss rate between a prototype 170 degrees wide-angle (WA) colonoscope and a standard (S) colonoscope. METHODS: Two consecutive same-day colonoscopies were performed in 50 patients with intact colons. The patients were randomized to undergo the first colonoscopy with either the prototype WA 170 degrees angle of view colonoscope or an S adult 140 degrees angle of view colonoscope. RESULTS: The mean time for insertion was 2.09 (1.09) min versus 2.53 (1.47) min (p= 0.002) for the WA colonoscope and the S colonoscope, respectively. Similarly, the mean time for examination during withdrawal was shorter with the WA colonoscope (4.98 (0.94) vs 5.74 (1.12) min; p < 0.0001). The mean insertion time for the second examination was shorter than the insertion time for the first examination, irrespective of the colonoscope (p= 0.006). However, the withdrawal times were not significantly different between the first and second examinations (p= 0.11). The miss rate for all polyps with the WA colonoscope (19%) was similar to the miss rate with the S colonoscope (27%; p= 0.19). The miss rates for adenomas with the WA (10/33; 30.3%) and the S scope (15/50; 30%) were similar (p= 0.98). CONCLUSIONS: The use of the WA colonoscope was associated with a reduction in insertion time to the cecum, as well as examination time during withdrawal. No evidence was found that the accuracy of the two colonoscopes differs.

Adenoma↗
PubMed1996

Use of a pediatric colonoscope improves the success of total colonoscopy in selected adult patients.

BACKGROUND: Colonoscopy using a standard adult colonoscope can be difficult or impossible when there is a fixed, angulated sigmoid colon or stricture. It is sometimes possible to traverse such segments using a smaller-diameter, more flexible pediatric colonoscope. METHODS: For this prospective study, one endoscopist started 645 consecutive, elective colonoscopies with a standard adult Olympus CF-100L colonoscope (52% women, 48% men). There were 36 examinations (5.6%) in which the adult colonoscope could not be passed through a fixed, angulated sigmoid colon (n = 34) or a sigmoid colonic stricture (n = 2). In such instances (33 women and 3 men), the endoscopist switched to a pediatric colonoscope. RESULTS: The pediatric colonoscope successfully reached the cecum in 21 of the 36 cases (58.3%). The figure was 38.5% for the older Olympus CF-P20L fiberoptic colonoscope (n = 13) and 69.6% for the newer Olympus PCF-100 videocolonoscope (n = 23). Concomitant conditions in the 34 patients in whom the pediatric colonoscope was used because of a fixed, angulated sigmoid included previous pelvic surgery in 22, pelvic radiation therapy in 2, pelvic endometriosis in 3, and two with previous sigmoid diverticulitis. CONCLUSIONS: The pediatric colonoscope, and particularly the newer Olympus PCF-100 colonoscope, is very useful in adult patients in whom it is not possible to traverse a fixed, angulated sigmoid colon or stricture using the standard adult colonoscope. This is predominantly a problem of female patients. Previous pelvic surgery may be an important causative factor in this regard.

Colon↗
PubMed2001

Effect of variable stiffness colonoscopes on cecal intubation times for routine colonoscopy by an experienced examiner in sedated patients.

BACKGROUND AND STUDY AIMS: Variable-stiffness colonoscopes allow passage of the rectosigmoid colon in a flexible mode, followed by stiffening to prevent looping. This feature might allow faster cecal intubation. PATIENTS AND METHODS: Consecutive patients without previous colonic or rectal resection, inflammatory bowel disease, or anticipated need for either a pediatric or standard insertion tube were evaluated. Four Olympus colonoscopes, including a standard "adult" insertion-tube diameter variable-stiffness colonoscope (VSA), a pediatric variable-stiffness colonoscope (VSP), a standard "adult" colonoscope (CF-140) (SA), and a standard "pediatric" colonoscope (PCF-140) (SP) were used in rotation. RESULTS: Among 358 consecutive patients, 99.2% of exams were complete to the cecum. The stiffening device was activated in 61% and 80% of the adult and pediatric variable-stiffness examinations, respectively. The examiner judged the device to be very useful, somewhat useful, and of no help in 46%, 44%, and 10% of VSA colonoscope examinations and 55%, 33%, and 12% of VSP colonoscope examinations. However, the mean cecal insertion time was 4.04 minutes, with no difference between the four colonoscopes (P=0.98). The percentage of intubations in < 2 minutes was 15.4%, 2-3 minutes 25.9%, 3-4 minutes 19.1%, 4-5 minutes 16.0%, and >5 minutes 23.7%, with no significant difference between the colonoscopes. CONCLUSIONS: Variable-stiffness colonoscopes were frequently judged useful by an experienced examiner but did not impact cecal intubation times in sedated patients. Additional studies by other experienced and inexperienced examiners, as well as evaluation of additional technical improvements and evaluation in unsedated patients, are needed.

Biomechanical Phenomena↗
PubMed2005

Ultrathin colonoscope with a diameter of 9.8 mm for total colonoscopy.

BACKGROUND: The pediatric colonoscope is superior to the standard colonoscope in some patients with a fixed, angulated colon. A colonoscope thinner than the pediatric one is thought to outperform even the pediatric colonoscope in such cases. This study was conducted to assess the efficacy of an ultrathin colonoscope, 9.8 mm in diameter, comparing it with pediatric and standard colonoscopes. METHODS: Three types of colonoscopes were used: ultrathin, pediatric, and standard. A total of 287 consecutive patients were assigned to three groups: ultrathin (n=94), pediatric (n=98), and standard (n=95). First assessment was the ratio of cecal intubation and the reasons for unsuccessful colonoscopy. The second was the time to cecal intubation. RESULTS: Cecal intubation rates were not different among three groups (96% in each). The main reasons for failed colonoscopy were looping in the ultrathin group, and angulation or stricture in the pediatric and standard groups. Mean time to the cecum was slightly longer in the ultrathin group (6.5 minutes) than the pediatric group (5.6 minutes) and standard group (6.1 minutes), but there were no significant differences among three groups. CONCLUSION: Colonoscopy with the ultrathin colonoscope was as successful as with the pediatric and standard colonoscopes. The advantage of the ultrathin colonoscope might be notable in cases with stricture or severe angulation.

Adult↗
PubMed2003

Accessing proximal aspects of folds and flexures during colonoscopy: impact of a pediatric colonoscope with a short bending section.

OBJECTIVE: Accessing the proximal sides of colorectal folds, flexures, and valves can be difficult endoscopically and can contribute to missed lesions and failed therapeutic procedures. The aim of this study was to determine whether a prototype colonoscope with a short bending section could facilitate accessing difficult to reach areas proximal to folds, flexures, and valves. METHODS: In a nonrandomized study, the prototype colonoscope, a standard pediatric colonoscope, and a standard adult colonoscope were used to attempt retroflexion in the cecum and, if unsuccessful, in the right colon. RESULTS: The prototype colonoscope allowed cecal retroflexion, including clear visualization of the ileocecal valve and the cecal mucosa medial to the valve, in 95% of attempts. A standard pediatric colonoscope was successful in 50% and a standard adult colonoscope in 24.5%. The prototype was more successful than both the standard pediatric (p < 0.001) and the standard adult instrument (p < 0.001). The standard pediatric colonoscope was successful more often than the standard adult colonoscope (p = 0.02). CONCLUSIONS: Using the ability to retroflex in the cecum as a surrogate marker, a prototype pediatric colonoscope with a short bending section seems to facilitate retroflexion and visualization of the proximal aspects of difficult to see regions in the proximal colon.

Colon↗
PubMed2005

Impact of bending section length on insertion and retroflexion properties of pediatric and adult colonoscopes.

BACKGROUND: Colonoscopes with short bending sections facilitate retroflexion but their effect on other aspects of colonoscope insertion are unknown. We sought to determine the impact of short bending on cecal insertion, terminal ileal intubation, and proximal colon retroflexion. METHODS: Two studies were performed. In study 1, we randomized 104 adult patients with intact colons to undergo colonoscopy with a standard pediatric colonoscope (Olympus PCF-160), a prototype pediatric colonoscope with short bending in four directions (PCF-AYL), or a prototype pediatric colonoscope with short bending in two directions, and normal bending in two directions (PCF-AY3L). In study 2, we randomized 70 patients with intact colons to undergo colonoscopy with a prototype 170 degrees wide angle colonoscope (CFQ160-WL) with a standard bending section length or to a prototype 170 degrees colonoscope with a short bending section (CFQ160-W2L). RESULTS: In study 1, the cecum was reached in all patients. Using the AYL, the cecal intubation time (4.08 min) was significantly longer when compared to both the PCF-160 (2.62 min; p=0.0001) and the AY3L (3.25 min; p=0.02). The AYL required the application of abdominal pressure (79%) and activation of the variable stiffness device (70%) more frequently when compared to both the PCF-160 (32%; p=0.0001 and 41%; p=0.02, respectively) and the AY3L (34%; p=0.0003 and 41%; p=0.02, respectively). Successful cecal retroflexion was possible less often with the PCF-160 (57%) when compared to either the AYL (94%; p=0.005) or AY3L (91%; p=0.001). The ability to intubate the terminal ileum was similar in all three groups (PCF-160 and AY3L 100%; AYL 94%) as was the time needed to intubate (p=0.73). Depth of ti intubation was deeper for the PCF-160 when compared to the AYL (p=0.0002) or AY3L (p=0.02). There was a trend toward deeper ileal intubation with the AY3L compared to AYL (p=0.09). In study 2, no difference was noted in cecal intubation time (p=0.1) or in frequency of application of abdominal pressure (p=0.28), position change (p=0.15), or activation of the stiffening device (p=0.46). Cecal retroflexion was successful more often when using the W2L when compared to the WL (p=0.00001). CONCLUSION: Short bending sections facilitate proximal colon retroflexion for both pediatric and adult colonoscopes, but can negatively impact cecal insertion and terminal ileal intubation in pediatric colonoscopes. A pediatric colonoscope with short bending in only two directions had good function for both cecal insertion and proximal colon retroflexion.

Cecum↗
PubMed1995

Colonoscope length and procedure efficiency.

We reviewed 195 colonoscopies to determine whether procedure efficiency differed with the use of an intermediate-length (135 cm) colonoscope compared with a long (165 cm) colonoscope. The cecum was intubated with the 135-cm scope in 92.6% of procedures and with the 165-cm colonoscope in 96.8% of procedures (chi 2 method, p = 0.26). The mean procedure duration was 36.7 min for 107 complete procedures performed with the 135-cm colonoscope and 48.4 min for 55 examinations using the 165-cm colonoscope (t test, p < 0.001). Colonoscopy with the 135-cm instrument required mean meperidine and midazolam doses of 59.9 mg and 1.8 mg, respectively, compared with doses of 69.1 mg and 2.0 mg, respectively, with the 165-cm colonoscope. The differences were not significant. Although the cecal intubation rate is slightly less for the 135-cm colonoscope, insertion takes significantly less time and is probably more comfortable for the patient than with the 165-cm colonoscope.

Adult↗
PubMed2002

The variable stiffness colonoscope: assessment of efficacy by magnetic endoscope imaging.

BACKGROUND: Variable-stiffness colonoscopes combine the flexibility of pediatric instruments for negotiation of the sigmoid colon with the ability to stiffen the insertion tube to prevent or control looping after straightening. Previous studies have found wide variation in the efficacy of the stiffening mechanism. Thus, two studies were conducted to assess the potential benefit of the stiffening device and its optimal use. METHODS: In study 1, the effect of routinely stiffening the straightened variable-stiffness colonoscopes in the mid-descending colon was determined in 82 patients. Two insertions were performed (mid-descending colon to cecum) in each patient with and without application of the stiffening device (randomized). The time to negotiate the proximal colon (mid-descending to cecum), time to pass the variable-stiffness colonoscopes across the splenic flexure into the transverse colon, time to pass the right colon, and ancillary maneuvers used were recorded for each insertion. In study 2, consecutive patients, excluding any with previous colonic resection, were examined by using standard adult variable-stiffness colonoscopes. Real-time views of the procedure with magnetic endoscope imaging were recorded for all examinations, but procedures were randomized to be done either with (n = 88), or without (n = 87) the endoscopist viewing the magnetic endoscope imaging display. Whenever stiffening was applied, the anatomic location of the colonoscope tip and stiffness efficacy were recorded. RESULTS: In study 1, time taken to negotiate the proximal colon (p = 0.0041) and time to negotiate the splenic flexure (p = 0.006) were significantly shorter and ancillary maneuvers performed were fewer (p = 0.0014) with the stiffening device activated. In study 2, stiffening was used with similar frequency in patients examined with and without the magnetic endoscope imaging view, most commonly for passing the splenic flexure (71%), but also in the transverse colon (12%), right colon (9%), and sigmoid/descending colon (8%). Stiffening was significantly more effective when used in combination with magnetic endoscope imaging (69% with imager vs. 45% without imager; p = 0.0102). CONCLUSIONS: Overall, the variable-stiffness device used was effective in controlling looping 57% of the time. Activating maximum stiffness appears to be effective once the sigmoid colon has been negotiated and the colonoscope straightened with the tip in the proximal colon, reducing the number of ancillary maneuvers and shortening the insertion time through the proximal colon. Routine magnetic endoscope imaging further enhances the efficacy of the variable-stiffness colonoscopes by helping to identify the optimal time for stiffening.

Colon↗
PubMed2005

A retrospective analysis of cecal barotrauma caused by colonoscope air flow and pressure.

BACKGROUND: This study addressed the question of whether barotrauma during colonoscopy is sufficient to rupture the colon. METHODS: A total of 3000 colonoscopies were retrospectively analyzed, and the colonoscopes used for these procedures were evaluated in an in vitro analysis. Air pressure at the tip of the colonoscopes and air flow through the instruments were measured. The equation F=F MAX-P TIP/R was used to graph flow values (F) from the maximum measured flow (F MAX), the calculated resistance to air flow offered by the colonoscope (R), and the air pressure observed at the colonoscope tip (P TIP ). RESULTS: Four perforations occurred during 1500 consecutive colonoscopies performed with equipment from one manufacturer (Pentax Precision Instrument Corp., Orangeburg, NY) whereas, no perforation occurred during 1500 consecutive colonoscopies performed with equipment from another manufacturer (Olympus America Corp., Melville, NY) ( p < or =0.06). The Pentax colonoscopes used in patients with barotrauma-induced cecal perforations insufflated air at a rate greater than 1.46 L/m at 80 mmHg intraluminal pressure. Olympus colonoscopes did not. In vitro maximum air-flow rates of 2 L/m at a tip pressure of 0 mm Hg separated the Pentax from the Olympus instruments ( p <0.022). Conclusions Colonoscopes with maximum flow rates of less than 2 L/m at 0 mmHg tip pressure have insufficient flow capacity to generate flows above 1.46 L/m at 80 mmHg intraluminal pressure and thus may protect patients from cecal barotrauma.

Adult↗
PubMed1991

Documenting the use of fluoroscopy during colonoscopic examination: a prospective study.

To determine the patterns of fluoroscopy use during colonoscopy, 500 consecutive patients undergoing colonoscopic examination were studied over a 6-month period. The procedures were performed on 195 patients by three gastroenterologists and on 305 patients by three colon and rectal surgeons. The study group comprised 237 women and 263 men aged an average of 62 years (range, 12-90 years). The results revealed that fluoroscopy was used during 37% of colonoscopic examinations. The most common indications for fluoroscopy were the treatment of sigmoid loops (42%) and the localization of the colonoscope tip (51%), totaling 93% of 312 fluoroscopic checks. The suspected position of the colonoscope tip was inaccurate in 15% (47/312) of fluoroscopic checks. The most common bowel location of the colonoscope tip during the fluoroscopic checks was the hepatic flexure (24%), followed by the cecum (21%). In all, 53% (166/312) of fluoroscopic checks involved the right colon. The selective use of fluoroscopy during more difficult cases was emphasized by the significantly longer time required for the procedure (36 vs 26 min) and the significantly lower cecal intubation rate (79% vs 99%). In summary, fluoroscopy is deemed to be a safe, reliable technique that facilitates the completion of difficult colonoscopic examinations. It is especially helpful in the treatment of sigmoid loops and in the precise localization of the position of the colonoscope tip, especially during negotiation of the right colon.

Adolescent↗
PubMed2000

Cost-utility of one-time colonoscopic screening for colorectal cancer at various ages.

OBJECTIVE: One-time colonoscopy has been recommended as a possible colorectal cancer (CRC) screening strategy. Because the incidence of colorectal neoplasia increases with age, the effectiveness and cost of this strategy depend on the age at which screening occurs. The purpose of this study was to investigate the age-dependent cost-utility of one-time colonoscopic screening. METHODS: We constructed a computer simulation model of the natural history of colorectal neoplasia. This model was used to compare the cost-utility of no screening and age-based strategies employing one-time colonoscopic screening (age ranges evaluated: 45-49, 50-54, 55-59, and 60-64 yr). RESULTS: We determined that one-time colonoscopic screening in men age <60 yr and in women age <65 yr dominates never screening and screening at older ages. For both sexes, one-time colonoscopic screening between 50 and 54 yr of age is associated with a marginal cost-utility of less than $10,000 per additional quality-adjusted life-year compared to screening between 55 and 60 yr of age. One-time colonoscopic screening between 45 and 49 yr of age is either dominated (women) or associated with a marginal cost-utility of $69,000/per quality-adjusted life-year (men) compared to screening between 50 and 54 yr of age. The marginal cost-utility of one-time colonoscopic screening is relatively insensitive to plausible changes in the cost of colonoscopy, the cost of CRC treatment, the sensitivity of colonoscopy for colorectal neoplasia, the utility values representing the morbidity associated with the CRC-related health states, and the discount rate. CONCLUSIONS: One-time colonoscopic screening between 50 and 54 yr of age is cost-effective compared to no screening and screening at older ages in both men and women. Screening in men between 45 and 49 yr of age may be cost-effective compared to screening between 50 and 54 yr of age depending on societal willingness to pay.

Age Factors↗