Limited Low-Air Insufflation Is Optimal for Colonoscopy

Hsieh, Yu Hsi; Tseng, Kuo‐Chih; Lin, Hwai Jeng

doi:10.1007/s10620-010-1210-9

Cited by 5 publications

(3 citation statements)

References 33 publications

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“…It has been demonstrated that about 60 % of patients undergoing colonoscopy develop post-procedural abdominal pain 7 , which is likely due to air retention in small and large intestines with gaseous dilatation 7 . Therefore, a variety of different methods have been proposed to reduce post-procedural discomfort, including application of carbon dioxide 7 , colon decompression 5 , rectal tube placement 8 , limited air insufflation 9 , and warm water infusion 10 . It has been reported that the placement of a rectal tube after colonoscopy may improve procedure-related satisfaction and discomfort symptoms, suggesting its utility for the management of abdominal distension following colonoscopy 8 .…”

Section: Discussionmentioning

confidence: 99%

Comparison of rectal suction versus rectal tube insertion for reducing abdominal symptoms immediately after unsedated colonoscopy

Liu

Lei

et al. 2015

Endosc Int Open

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Background and study aims: Abdominal discomfort and bloating are common symptoms after colonoscopy. We aimed to compare the effects of direct rectal suction with insertion of a rectal tube on reducing abdominal symptoms after unsedated colonoscopy. Patients and methods: Consecutive patients undergoing colonoscopy were randomized to have direct rectal suction or placement of a rectal tube immediately after colonoscopy. Post-procedure abdominal pain and bloating were measured with a 0 – 100 visual analogue scale. All participants ranked their satisfaction with either direct rectal suction or insertion of a rectal tube. Results: Abdominal pain and bloating were significantly reduced by direct rectal suction and placement of a rectal tube at 1 minute (both P < 0.05) and 3 minutes (both P < 0.05) after the colonoscopy. Direct rectal suction significantly reduced abdominal pain at 1 minute (P = 0.001) and 3 minutes (P = 0.005) after colonoscopy compared with rectal tube insertion. Bloating was significantly lower in patients with direct rectal suction compared to those with rectal tube insertion at 1 minute (P = 0.03) after colonoscopy. Greater satisfaction was found in patients with direct rectal suction compared to those with rectal tube insertion (P = 0.009). Conclusion: Direct rectal suction is more effective than rectal tube placement in reducing abdominal symptoms immediately after colonoscopy. Our study suggests that direct rectal suction is useful in providing relief of symptoms when patients are having difficulty expelling air or are experiencing abdominal symptoms following colonoscopy.

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Section: Discussionmentioning

confidence: 99%

Comparison of rectal suction versus rectal tube insertion for reducing abdominal symptoms immediately after unsedated colonoscopy

Liu

Lei

et al. 2015

Endosc Int Open

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“…Many "tricks" have been used to increase cecal intubation by experienced endoscopists, which include limiting air insufflation on intubation, suctioning air when encountering difficult angulation, minimizing loop formation with counter pressure, applying clockwise torque during shortening, and applying abdominal pressure. One recent randomized study that compared high-air to low-air insufflation and low-air insufflation limited to the rectum and sigmoid colon during colonoscopy showed that limited use of low-air insufflation in the rectum and sigmoid during insertion was associated with a shorter cecal intubation time, less sedation, and decreased post-procedure abdominal bloating [14].…”

Section: General Principles and Simple Maneuversmentioning

confidence: 99%

Technical Advances in Getting to the Cecum

Lau

2010

Curr Colorectal Cancer Rep

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Clinical demand for colonoscopy has increased with the introduction of colorectal cancer screening worldwide. The goal is a complete, comfortable, and high-quality procedure. Up to one third of colonoscopies are challenging, and incomplete colonoscopy occurs in 10% of cases. High cecal intubation rates can be achieved by minimizing air insufflation and looping, and by using ancillary maneuvers such as position change and abdominal pressure. In difficult cases, changing to a non-standard endoscope, the use of magnetic endoscopic imaging, and endoscopic accessories including a transparent cap or an overtube can be an effective measure. The use of carbon dioxide instead of air insufflation reduces post-procedure discomfort. A new technique involving water immersion in lieu of air insufflation may reduce discomfort and facilitate insertion to the cecum. Data from alternative novel colonoscopy platforms including capsule colonoscopy, Neoguide, Invendoscope, and the Aer-O-scope appear promising, and prospective clinical studies are warranted.

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“…CAC may have a role in improving cecal intubation in a difficult or failed colonoscopy. A recent study revealed that the limited use of low-air insufflation in the rectum and sigmoid colon shortened cecal intubation time and reduced post-procedural abdominal bloating [21]. With the cap, easier anticipation of the direction in which the colonoscope should be advanced, with less air insufflation, potentially enables more comfortable examination.…”

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confidence: 99%

Can Cap-Assisted Colonoscopy Be a Savior for Right Side Interval Cancer?

Kim

2012

Dig Dis Sci

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There is no doubt that effective colorectal cancer screening relies on early identification and removal of polyps with neoplastic potential [1,2]. Although colonoscopy is regarded as the best method for detecting colonic neoplasm, it does have limitations. Right-sided lesions, flat polyps, and variable detection of endoscopist adenoma are all reasons why polyps are missed and interval cancers develop after a negative screening colonoscopy. Successful colorectal cancer protection by colonoscopy depends on complete intubation of the colon combined with careful and complete visualization of the colonic mucosal surface on withdrawal. A large populationbased study showed that failure to intubate the cecum is not uncommon, especially for less experienced endoscopists; it was estimated to occur in 13.1 % of attempted colonoscopies [3]. Furthermore, occurrence of missed adenoma ranging from 13 to 26 % has been reported [4]. Adenoma detection has been shown to be an independent predictor of the risk of interval colorectal cancer after screening colonoscopy [5]. Several types of new technology have therefore been developed to improve adenoma detection, including high-definition white-light colonoscopy, pan-chromoendoscopy, wide-angle colonoscopy, virtual chromoendoscopy, third-eye retroscopy (TER), and cap-assisted colonoscopy (CAC) [6].CAC is a simple method in which a transparent or nontransparent rubber cap is attached to the tip of a colonoscope with an appropriate protrusion length. The cap can be readily equipped and the field of vision is not substantially affected by the cap. Although conflicting results have been reported after recent studies that compared CAC with standard colonoscopy (SC), CAC has been reported to be associated with improved polyp detection, reduced cecal intubation time, and enhanced cecal intubation [7][8][9][10].Theoretically, CAC can detect polyps better than SC, especially those behind semilunar folds. CAC can help depress semilunar folds, thereby reducing the blind mucosal surface area, and may improve the efficiency of adenoma detection [6]. A study of lesions missed at colonoscopy but detected by computed tomography colonography revealed that 67 % lie on the proximal side of semilunar folds [11]. The cap also keeps the tip of the endoscope a distance from the colonic mucosa, particularly around colonic bends, and provides a continuous visual field of the lumen direction. CAC seeks to reduce the percentage of the colonic mucosal surface that is left unexamined in a ''complete'' colonoscopy [12]. Largescale meta-analyses have revealed that CAC improves the detection of colonic neoplasm compared with standard colonoscopy (SC) both in terms of the number of patients identified with at least one polyp and in terms of the polyp miss rate determined by tandem colonoscopy [6,13]. It seems that CAC predominantly improves the detection of small (6-9 mm) and diminutive (5 mm) adenomas. A study of colonoscopic miss rates determined by back-toback colonoscopies revealed the miss rate was 13 % for sm...

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Limited Low-Air Insufflation Is Optimal for Colonoscopy

Abstract: We found that limited use of low-air insufflation in the rectum and sigmoid is the procedure of choice for colonoscopic examination.

Cited by 5 publications

References 33 publications

Comparison of rectal suction versus rectal tube insertion for reducing abdominal symptoms immediately after unsedated colonoscopy

Comparison of rectal suction versus rectal tube insertion for reducing abdominal symptoms immediately after unsedated colonoscopy

Technical Advances in Getting to the Cecum

Can Cap-Assisted Colonoscopy Be a Savior for Right Side Interval Cancer?

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