Use of a variable-stiffness colonoscope decreases the dose of patient-controlled sedation during colonoscopy: a randomized comparison of 3 colonoscopes

Lee, Danny W.H.; Li, Anthony C.N.; Ko, Chi-Wah; Chu, David W.; Chan, Konan; Poon, Chi‐Ming; Sin, Kwok-sang; Leung, K. K.; Sze, Tak-Suen; Chan, Angus C.W.; Chung, S. C. S.

doi:10.1016/j.gie.2006.08.027

Cited by 31 publications

(28 citation statements)

References 11 publications

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“…In the sedated patients, the use of a variable-stiffness colonoscope significantly minimized procedure-related pain [14,15], reduced the dose of sedative medications during colonoscopy [15], and shortened cecal intubation time [14]. In the unsedated patients, the variable-stiffness colonoscope allowed favorable examination compared with conventional colonoscope regarding completeness, time to cecal intubation, and comfort of patients undergoing colonoscopy, irrespective of the examiner's experience [6].…”

Section: Resultsmentioning

confidence: 99%

Methods of Reducing Discomfort During Colonoscopy

Leung

2007

Dig Dis Sci

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In the United States sedation for colonoscopy is usual practice. Unsedated colonoscopy is limited to a small proportion of unescorted patients and those with a personal preference for no sedation. Over 80% of patients who accept the option of as-needed sedation can complete colonoscopy without sedation. Colonoscopy in these unsedated patients is performed with techniques similar to those used in the sedated patients. Uncontrolled observations indicate willingness to repeat colonoscopy amongst these patients was correlated significantly with low discomfort score during the examination. Methods reported to minimize patient discomfort or enhance cecal intubation during sedated or unsedated colonoscopy included use of pediatric colonoscope, variable stiffness colonoscope, gastroscope, and inhalation of nitrous oxide or insufflation of carbon dioxide, hypnosis, music, audio distraction, or simply allowing the patients to participate in administration of the medication. Research focusing on confirming the efficacy of a simple inexpensive nonmedication dependent method for minimizing discomfort will likely improve the outcome of care and more importantly will ensure compliance with future surveillance in patients accepting the unsedated option.

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Section: Resultsmentioning

confidence: 99%

Methods of Reducing Discomfort During Colonoscopy

Leung

2007

Dig Dis Sci

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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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“…Doses used for PCS are rather similar, as measured in mg per demand or mg/kg per dose demand. Doses of propofol vary from 4.8 mg as a single bolus dose with zero lock-out [57], via doses of 20 mg including 1 min lock-out [50], to 0.25 mg/kg per demand [58]. PCS is considered a valid method for procedural sedation, but is not applicable for every patient;…”

Section: Outcome Measurementmentioning

confidence: 99%

Patient-controlled sedation in procedural care

Nilsson¹

2015

Linköping University Medical Dissertations

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Use of a variable-stiffness colonoscope decreases the dose of patient-controlled sedation during colonoscopy: a randomized comparison of 3 colonoscopes

Cited by 31 publications

References 11 publications

Methods of Reducing Discomfort During Colonoscopy

Methods of Reducing Discomfort During Colonoscopy

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

Patient-controlled sedation in procedural care

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