Modifiable factors associated with patient-reported pain during and after screening colonoscopy

Bugajski, Marek; Wieszczy, Paulina; Hoff, Geir; Rupiński, Maciej; Reguła, Jarosław; Kaminski, Michal F.

doi:10.1136/gutjnl-2017-313905

Cited by 57 publications

(67 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…19,33 The ADR were similar in the two groups in the current study, probably due to more patients with positive fecal occult blood, who tend to have a higher ADR, 34 in the AI group. 36 Its short halflife (4-8 min) and the low dose required for on-demand sedation help achieve a quick recovery time. Despite its increasing acceptance among colonoscopists, 35 propofol has not been evaluated as the sedative agent for on-demand sedation as far as we know.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Feasibility of sedation on demand in Taiwan using water exchange and air insufflation: A randomized controlled trial

Hsieh

Tseng

Koo

et al. 2019

J of Gastro and Hepatol

View full text Add to dashboard Cite

Background and Aim Completion of colonoscopy without sedation eliminates sedation cost and complications. Reported in the United States and Europe, on‐demand sedation is not routine practice in Taiwan. Water exchange (WE), characterized by infusion and nearly complete removal of infused water during insertion, reduces insertion pain compared to air insufflation (AI) during colonoscopy. We evaluated the feasibility of on‐demand sedation in Taiwan. In a randomized controlled trial of WE vs AI colonoscopy, we also aimed to determine if WE augmented the implementation by reducing insertion pain and decreasing sedation requirement. Methods This prospective patient‐blinded study randomized patients to AI or WE (75 patients/group) to aid insertion. The primary outcome was the proportion of patients completing without sedation. Results In the AI and WE groups, 76.0% and 93.3% (P = 0.006) completed without need for sedation, respectively. The WE group had lower insertion pain score (mean [SD]) (4.0 [2.9] vs 2.1 [2.6], P < 0.001), lower doses of propofol (25.7 [52.7] mg vs 9.1 [35.6] mg, P = 0.012), and less time in the recovery room (3.4 [7.4] vs 1.5 [5.5], P = 0.027) than the AI group. Patient satisfaction scores and willingness to repeat if needed in the future were similar. Conclusion On‐demand sedation was feasible in Taiwan. The completion rate without sedation was high in patients (76.0% with standard AI) open to the option (no prior intent to receive the standard of full or minimal sedation). WE augmented the implementation by reducing insertion pain and decreasing sedation requirement without adversely affecting patient satisfaction or willingness to repeat.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Propofol also produces greater pain relief than benzodiazepine-opioid sedation. 36 Its short halflife (4-8 min) and the low dose required for on-demand sedation help achieve a quick recovery time. However, because of its narrow therapeutic window, an anesthesia specialist is usually required to administer it.…”

Section: Discussionmentioning

confidence: 99%

Feasibility of sedation on demand in Taiwan using water exchange and air insufflation: A randomized controlled trial

Hsieh

Tseng

Koo

et al. 2019

J of Gastro and Hepatol

View full text Add to dashboard Cite

show abstract

“…The proportion of patients receiving conscious sedation and analgesics varies widely between different countries. [14,[16][17][18][19] Moreover, the differences between countries are even larger for the use of propofol [17,19,22,33].…”

Section: Accepted M Manuscriptmentioning

confidence: 99%

“…[12][13][14][15] The use and type of sedation varies widely between endoscopists and in general between countries. [14,[16][17][18][19] Existing literature is conflicting on the risk of complications after colonoscopy according to the sedation type. [14,[20][21][22] Sedation practices within the Dutch national CRC screening program are yet unknown.…”

Section: Introductionmentioning

confidence: 99%

Impact of sedation on the Performance Indicator of Colonic Intubation

et al. 2020

View full text Add to dashboard Cite

Background: Performance Indicator of Colonic Intubation (PICI) has been introduced as new measure of high-quality colonic intubation. Adequate PICI was defined as cecal intubation without significant discomfort and use of minimal sedation. In a UK national audit, adequate PICI was achieved in 54.1% of colonoscopies and associated with higher polyp detection rates. In this study, achievement of PICI was assessed within the Dutch colorectal cancer (CRC) screening program and the association between PICI and the adenoma detection rate (ADR) was determined. Furthermore, we assessed the achievement of the performance indicator using the Dutch median midazolam dose. Methods: This retrospective study was conducted within the Dutch FIT-based CRC screening program. Colonoscopy and pathology data were prospectively collected in a national database. Data between 01-01-2016 and 01-01-2018 were analyzed. Adequate PICI was defined as successful cecal intubation, Gloucester Comfort Scale (GCS) between 1 - 3 and use of ≤ 2.5 mg midazolam. Results: During the study period, 107.328 colonoscopies were performed. Adequate PICI was achieved in 49.500 (46.1%) colonoscopies. In the colonoscopies with inadequate PICI, this was due to higher sedation dosages in 87.8%. Adequate PICI was associated with higher ADR (OR: 1.16; 95%CI: 1.12-1.20). When using a cut-off of 5 mg midazolam, median dose in this Dutch population, adequate PICI was achieved in 95.410 colonoscopies (88.9%). Conclusion: PICI appears to be an indicator that is heavily dependent on sedation practice. Because of wide variation in sedation practice between individual endoscopists and countries, the benefit of PICI as quality indicator is limited.

show abstract

“…One way to detect such diseases at an early stage, is to make screening of the digestive system a common procedure beyond a certain age. However, fear of pain and difficulties caused by screening methods like colonoscopy [2], is a major factor limiting the number of people who would volunteer for such screening. In order to motivate as many people as possible to perform preemptive screening, it is vital that the procedure is not unpleasant.…”

Section: Introductionmentioning

confidence: 99%

Error reduction through post processing for wireless capsule endoscope video

Floor

Farup

Pedersen

et al. 2020

J Image Video Proc.

View full text Add to dashboard Cite

The wireless capsule endoscope (WCE) is a pill-sized device taking images, which are transmitting to an on-body receiver, while traveling through the digestive system. Since image data is transmitted through the human body, which is a harsh medium for electromagnetic wave propagation, noise may at times heavily corrupt the reconstructed image frames. A common way to combat noise is to use error-correcting codes. In addition one may also utilize interand intra frame correlation to reduce the impact of noise at the receiver side, placing no extra demand on the WCE. However, it is then of great importance that the chosen post processing methods do not alter the content of the image as this can lead to miss-detection by gastroenterologists. In this paper we will investigate the possibility for additional noise suppression and error concealment at the receiver side in a high intensity error regime. Due to the high correlation generally inherent in WCE video, satisfactory results are obtained, as concluded from both subjective tests with gastroenterologists as well as the structural similarity (SSIM) metric. More surprisingly, the subjective tests indicate that the inpainted frames in many cases can be used for clinical assessment. These results indicate that one can apply error reduction through post processing together with error-correcting codes to obtain a more noise-robust system without any further demand on the WCE.

show abstract

Modifiable factors associated with patient-reported pain during and after screening colonoscopy

Abstract: We identified several independent, modifiable factors associated with pain during and after colonoscopy, of which individual endoscopist was the most important. Dedicated training should be considered to decrease variability among endoscopists.

Cited by 57 publications

References 37 publications

Feasibility of sedation on demand in Taiwan using water exchange and air insufflation: A randomized controlled trial

Feasibility of sedation on demand in Taiwan using water exchange and air insufflation: A randomized controlled trial

Impact of sedation on the Performance Indicator of Colonic Intubation

Error reduction through post processing for wireless capsule endoscope video

Contact Info

Product

Resources

About