Impact of water exchange colonoscopy on endoscopy room efficiency: a systematic review and meta-analysis

Cadoni, Sergio; Hassan, Cesare; Frazzoni, Leonardo; Ishaq, Sauid; Leung, Felix W.

doi:10.1016/j.gie.2018.07.020

Cited by 37 publications

(33 citation statements)

References 36 publications

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“…34 In a meta-analysis comparing water exchange with a combined group of air and CO 2 insufflation, water exchange was also associated with a higher patient willingness to undergo repeat procedures. 35 Recent network meta-analyses comparing air insufflation, CO 2 insufflation, water exchange, and water immersion techniques demonstrated that air insufflation is associated with the highest pain scores and water exchange with the lowest pain scores. 36,37 Beyond colonoscopy technique, the Multisociety Sedation Curriculum for Gastrointestinal Endoscopy 38 provides a standardized approach to training in sedation administration that can help ensure appropriate and safe sedative practices for endoscopy.…”

Section: Discussionmentioning

confidence: 99%

Propofol versus midazolam with or without short-acting opioids for sedation in colonoscopy: a systematic review and meta-analysis of safety, satisfaction, and efficiency outcomes

Dossa

Medeiros

Keng

et al. 2020

Gastrointestinal Endoscopy

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Background and Aims: Propofol is increasingly being used for sedation in colonoscopy; however, its benefits over midazolam (AE short-acting opioids) are not well quantified. The objective of this study was to compare safety, satisfaction, and efficiency outcomes of propofol versus midazolam (AE short-acting opioids) in patients undergoing colonoscopy. Methods: We systematically searched Medline, Embase, and the Cochrane library (to July 30, 2018) for randomized controlled trials of colonoscopies performed with propofol versus midazolam (AE short-acting opioids). We pooled odds ratios for cardiorespiratory outcomes using mixed-effects conditional logistic models. We pooled standardized mean differences (SMDs) for patient and endoscopist satisfaction and efficiency outcomes using random-effects models. Results: Nine studies of 1427 patients met the inclusion criteria. There were no significant differences in cardiorespiratory outcomes (hypotension, hypoxia, bradycardia) between sedative groups. Patient satisfaction was high in both groups, with most patients reporting willingness to undergo a future colonoscopy with the same sedative regimen. In the meta-analysis, patients sedated with propofol had greater satisfaction than those sedated with midazolam (AE short-acting opioids) (SMD, .54; 95% confidence interval [CI], .30-.79); however, there was considerable heterogeneity. Procedure time was similar between groups (SMD, .15; 95% CI, .04-.27), but recovery time was shorter in the propofol group (SMD, .41; 95% CI, .08-.74). The median difference in recovery time was 3 minutes, 6 seconds shorter in patients sedated with propofol. Conclusions: Both propofol and midazolam (AE short-acting opioids) result in high patient satisfaction and appear to be safe for use in colonoscopy. The marginal benefits to propofol are small improvements in satisfaction and recovery time. (Gastrointest Endosc 2020;91:1015-26.) Sedation used in colonoscopy can improve the experience for both patients and endoscopists. Globally, there is considerable variation in sedative practices. 1 In Europe, sedative use varies substantially by country and by region. 2 In some areas almost all patients receive sedation for colonoscopy, whereas in other areas Abbreviations: ASA,

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Section: Discussionmentioning

confidence: 99%

Propofol versus midazolam with or without short-acting opioids for sedation in colonoscopy: a systematic review and meta-analysis of safety, satisfaction, and efficiency outcomes

Dossa

Medeiros

Keng

et al. 2020

Gastrointestinal Endoscopy

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“…In fact, even more angioectasias were found with the use of CO 2 , in spite of the fact that WE has a magnification effect. Furthermore, the cecal intubation time was lower compared with those that used WE in colonoscopies studies using CO 2 insufflation (12). A difference in the duration of the procedure was found, but this may be related with the lower insertion depth reached with WE.…”

Section: Discussionmentioning

confidence: 81%

Efficacy and safety of water-exchange enteroscopy compared to carbon dioxide insufflation during enteroscopy

et al. 2020

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Introduction: carbon dioxide (CO 2) insufflation during enteroscopy reduces procedure time and subsequent symptoms and increases the insertion depth compared with room air. In colonoscopy, the water-exchange (WE) technique is associated with less pain compared with CO 2 insufflation. The WE technique is not well studied in enteroscopy. The aim of this study was to compare the efficacy and safety of enteroscopy with WE and CO 2. Methods: a prospective, comparative and observational study was performed of double balloon enteroscopies (DBE) that were randomized in two groups. The first group used WE while the second group used CO 2 insufflation. The data collected was evaluated via univariate analysis and multiple logistic regression (variables with p ≤ 0.10 according to the univariate analysis). Results: forty-six DBE were included; 23 in each arm. The median age of cases was 63.5 years and 37% were female. There were no statistical differences between the groups with regard to the access route, findings, therapy and complications. Four patients (20%) in the CO 2 group had adverse events (abdominal distension and pain) and one in the WE group (nausea), which was not statistically significant. The median insertion depth was greater in the CO 2 group; 260 cm vs 160 cm (p = 0.048). Multiple logistic regression showed a statistically significant difference in the insertion depth using CO 2 insufflation (OR 1.009, 1.001-1.017; p = 0.034). Conclusions: DBE with a CO 2 insufflation technique and WE are safe with a greater insertion depth with CO 2 .

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“…Due to the high use of propofol at some hospitals, there may be endoscopists who have not performed colonoscopy under moderate sedation at all or for some time who would feel uncomfortable doing so. For these individuals, skills enhancement courses can be beneficial by providing strategies to minimise patient discomfort and improve caecal intubation and adenoma detection rates, such as by teaching torque steering and loop reduction, varying patient positioning to facilitate passage of the colonoscope,22–26 and use of carbon dioxide insufflation27–29 and water infusion techniques 30–32. Further recommendations made by the expert panel for improving patient experience under moderate sedation are provided in table 1.…”

Section: Discussionmentioning

confidence: 99%

Practice recommendations for the use of sedation in routine hospital-based colonoscopy

Dossa

Dubé

Tinmouth

et al. 2020

BMJ Open Gastroenterol

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ObjectiveAlthough sedation improves patient experience during colonoscopy, there is great jurisdictional variability in sedative practices. The objective of this study was to develop practice recommendations for the use of moderate and deep sedation in routine hospital-based colonoscopy to facilitate standardisation of practice.DesignWe recruited 32 multidisciplinary panellists to participate in a modified Delphi process to establish consensus-based recommendations for the use of sedation in colonoscopy. Panel members participated in a values assessment survey followed by two rounds of anonymous online voting on preliminary practice recommendations. An inperson meeting was held between voting rounds to facilitate consensus-building. Consensus was defined as >60% agreement/disagreement with recommendation statements; >80% agreement/disagreement was considered indicative of strong consensus.ResultsTwenty-nine panellists participated in the values assessment survey. Panellists ranked all factors presented as important to the development of practice recommendations. The factor considered most important was patient safety. Patient satisfaction, procedural efficiency, and cost were considered less important. Strong consensus was achieved for all nine practice recommendations presented to the panel. These recommendations included that all endoscopists be able to perform colonoscopy with moderate sedation, that an endoscopist and a single trained nurse are sufficient for performing colonoscopy with moderate sedation, and that anaesthesia-provided deep sedation be used for select patients.ConclusionThe recommendations presented in this study were agreed on by a multidisciplinary group and provide guidance for the use of sedation in routine hospital-based colonoscopy. Standardised sedation practices will promote safe, effective, and efficient colonoscopy for all patients.

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Impact of water exchange colonoscopy on endoscopy room efficiency: a systematic review and meta-analysis

Abstract: Based on parameters of procedural time, the impact of WE colonoscopy on endoscopy room turnaround yields an increase in total procedure time of about 2 minutes and is associated with significant improvement in specific patient-centered outcomes.

Cited by 37 publications

References 36 publications

Propofol versus midazolam with or without short-acting opioids for sedation in colonoscopy: a systematic review and meta-analysis of safety, satisfaction, and efficiency outcomes

Propofol versus midazolam with or without short-acting opioids for sedation in colonoscopy: a systematic review and meta-analysis of safety, satisfaction, and efficiency outcomes

Efficacy and safety of water-exchange enteroscopy compared to carbon dioxide insufflation during enteroscopy

Practice recommendations for the use of sedation in routine hospital-based colonoscopy

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