A prospective trial of variable stiffness pediatric vs. standard instrument colonoscopy

Kaffes, Arthur J.; Mishra, Alok; Ding, Steven; Hope, Rick; Williams, Stephen J.; Gillespie, Peter E.; Bourke, Michael J.

doi:10.1016/s0016-5107(03)02017-0

Cited by 39 publications

(24 citation statements)

References 18 publications

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“…Because of these factors, cecal intubation failures are caused by angulation, looping, and pain. 6 Pediatric colonoscopes, 6,8,9 gastroscopes, 6,10 variable-stiffness colonoscopes, 11 and enteroscopes 6,12 have been used to improve cecal intubation rates in the past decade. These instruments are effective, but require extremely difficult techniques and are sometimes inexact.…”

mentioning

confidence: 99%

A multicenter, prospective trial of total colonoscopy using a short double-balloon endoscope in patients with previous incomplete colonoscopy

Katsuki

Ohata

Abe

et al. 2012

Gastrointestinal Endoscopy

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mentioning

confidence: 99%

A multicenter, prospective trial of total colonoscopy using a short double-balloon endoscope in patients with previous incomplete colonoscopy

Katsuki

Ohata

Abe

et al. 2012

Gastrointestinal Endoscopy

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“…Various studies have been completed comparing standard colonoscopes with variable stiffness colonoscopes (4)(5)(6)(7)(8)(9). A meta-analysis (10) that included 7 randomized studies showed that the percentage of cecal intubation was greater with variable stiffness colonoscopes when compared to standard colonoscopes, with less abdominal pain and reduced sedation needed, without differences related to the duration of cecal intubation and use of auxiliary tasks (manual compression and posture changes).…”

Section: Discussionmentioning

confidence: 99%

“…These endoscopes combine the flexibility of a pediatric colonoscope with the stiffness of a standard adult colonoscope through a simple device that increases or decreases the insertion tube stiffness. To date, several controlled studies (4)(5)(6)(7)(8)(9) and two meta-analysis (10,11) have been conducted comparing this type of colonoscope with standard colonoscopes which have shown that the variable stiffness colonoscope decreases caecal intubation time and patient discomfort. However, in a previous study in our centre (12) we found that it is not always necessary to use the variable stiffness function.…”

Section: Introductionmentioning

confidence: 99%

Factors related to the effectiveness of variable stiffness colonoscope: results of a multivariate analysis

Sola-Vera

Uceda

Brotons

et al. 2014

Rev. esp. enferm. dig.

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Background: Various studies and two meta-analysis have shown that a variable stiffness colonoscope improves cecal intubation rate. However, there are few studies on how this colonoscope should be used.Objective: The aim of this study was to identify factors related to the advancement of the colonoscope when the variable stiffness function is activated.Methods: Prospective study enrolling consecutive patients referred for colonoscopy. The variable stiffness colonoscope (Olympus CF-H180DI/L®) was used. We performed univariate and multivariate analyses of factors associated with the success of the variable stiffness function.Results: After the data inclusion period, 260 patients were analyzed. The variable stiffness function was used most in the proximal colon segments (ascending and transverse colon 85 %; descending/sigmoid colon 15.2 %). The body mass index was lower in patients in whom the endoscope advanced after activating the variable stiffness than those in which it could not be advanced (25.9 ± 4.8 vs. 28.3 ± 5.4 kg/m 2 , p = 0.009). The endoscope advanced less frequently when the stiffness function was activated in the ascending colon versus activation in other segments of the colon (25 % vs. 64.5 % ascending colon vs. other segments; p < 0.05). In the multivariate analysis, only the colon segment in which the variable stiffness was activated was an independent predictor of advancement of the colonoscope.Conclusions: The variable stiffness function is effective, allowing the colonoscope advancement especially when applied in the transverse colon, descending colon and sigmoid. However, when used in the ascending colon it has a lower effectiveness.

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“…Several studies have attempted to determine if different instruments have effects either on caecal intubation or time to caecal intubation. The findings however are conflicting, with some studies showing a benefit [2][3] and others none [4][5][6] . Most of these studies made comparisons between different types of Olympus colonoscopes, i.e.…”

Section: To the Editormentioning

confidence: 99%

Does type of instrument influence colonoscopy performance and sedation practice?

Arasaradnam

Hurlstone²

2007

WJG

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To The ediTorIn the UK, clear guidelines exist as to the expected level of competence an individual endoscopist should achieve. This is of utmost importance given the variance in practice among endoscopic departments as highlighted by the National Colonoscopy audit in 2002 [1] . The audited variables included sedation practice, caecal completion and complication rates, but not the type of instrument used.The type of instrument used has been shown by some groups to influence colonoscopy performance; for example paediatric colonoscopies are thought to aid intubation in patients with fixed angulation of the colon whilst variable stiffness colonoscopes are useful to negotiate tortuous recto-sigmoid junctions. Several studies have attempted to determine if different instruments have effects either on caecal intubation or time to caecal intubation. The findings however are conflicting, with some studies showing a benefit [2][3] and others none [4][5][6] . Most of these studies made comparisons between different types of Olympus colonoscopes, i.e. single manufacturer rather than an alternative (Fujinon/Pentax). Furthermore, only one study [2] assessed the dose and type of sedation used whilst in two studies [4,5] , assessments were by a single experienced endoscopist. Thus, it is difficult to conclude definitively if a different make of colonoscope in less experienced hands influences not only colonoscopic performance but also sedation practice. The aim of this study was to determine if the type of colonoscope used could influence not only caecal intubation rates but also sedation practice.We studied 199 consecutive procedures on two sites performed by a single endoscopist prospectively. The first 105 procedures were performed using the Olympus EVIS CF 240 variable stiffness scope whilst the subsequent 94 were performed using a Fujinon EC-450 WL scope. Demographic data, dose and type of sedation used as well as caecal and terminal ileal intubation rates were recorded. Results are shown in Table 1.Indications for colonoscopy were similar in both groups as were hysterectomy rates (5%). Mean list size was 5 (range 4-6) patients and the number of therapeutic procedures was 8 (8%) in the first 105 procedures and 20 (21%) in the subsequent 94. Adjusted completion rates were superior with the Olympus colonoscope (97% vs 89%; P < 0.001) compared to the Fujinon colonosocpe. Similarly, adjusted analgesic dose was also significant with patients endoscoped with the Olympus colonoscope requiring less Midazolam (2.7 mg vs 3.7 mg; P < 0.001) whilst none required any opioid analgesics. Moreover, 30% endoscoped with the Olympus colonoscope required no sedation at all. Individual departmental caecal completion rates were similar to those of the endoscopist in this study, thereby precluding a learning curve phenomenon with the different make of colonoscopes. Although this study was not randomised and for obvious reasons cannot be blinded, operator bias was reduced as the operator had near equal experience with both types of scopes. This ...

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A prospective trial of variable stiffness pediatric vs. standard instrument colonoscopy

Cited by 39 publications

References 18 publications

A multicenter, prospective trial of total colonoscopy using a short double-balloon endoscope in patients with previous incomplete colonoscopy

A multicenter, prospective trial of total colonoscopy using a short double-balloon endoscope in patients with previous incomplete colonoscopy

Factors related to the effectiveness of variable stiffness colonoscope: results of a multivariate analysis

Does type of instrument influence colonoscopy performance and sedation practice?

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