Water immersion colonoscopy facilitates straight passage of the colonoscope through the sigmoid colon without loop formation: <scp>R</scp>andomized controlled trial

Asai, Satoshi; Fujimoto, Naoki; Tanoue, Koujirou; Akamine, Eisuke; Nakao, Eisuke; Hashimoto, Kirie; Ichinona, Takumi; Nambara, Mikio; Sassa, Seitarou; Yanagi, H; Hirooka, Norifumi; Mori, Takuji; Ogawa, Minoru; Ogaẃa, Atsuhiro

doi:10.1111/den.12406

Cited by 23 publications

(12 citation statements)

References 29 publications

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“…We have reported a technique for colonoscope insertion without sedation 12131415. In this technique, 200 mL of water is infused at the rectosigmoid and complete air suction is performed from the rectosigmoid.…”

Section: Discussionmentioning

confidence: 99%

“…However, while sedation can reduce discomfort, it can also mask the psychological influence of the colonoscopy procedure on colonic motility. We have previously reported the water-aided colonoscope insertion technique, called the “collapse-submergence method” or “water-navigation method.”12131415 Using this technique, colonoscopy can be performed without the administration of sedatives. When colonoscopy was performed without sedatives during cancer screening in men, colonic movements such as peristalsis and spasm persisted for ≥8 minutes after administration of scopolamine butyl bromide in approximately 14% of the population 11.…”

Section: Introductionmentioning

confidence: 99%

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Colonic dysmotility and morphological abnormality frequently detected in Japanese patients with irritable bowel syndrome

et al. 2017

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Background/AimsColonoscopy and computed tomography (CT) are used primarily to exclude organic diseases in patients with irritable bowel syndrome (IBS), rather than to assess the pathophysiology of IBS. We aimed to evaluate colonic dysmotility and morphology in Japanese patients with IBS.MethodsOne hundred eighty-four patients with IBS and 49 asymptomatic controls who underwent colonoscopy in combination with CT colonography or barium enema were retrospectively reviewed between 2008 and 2012. Water-aided colonoscopy was performed without sedation by a single endoscopist. The duration and pattern of colonic movement and cecal intubation time were recorded. To assess colonic morphology, barium enema or CT colonography were performed immediately after colonoscopy.ResultsColonic dysmotility was more frequent in the IBS group (28.8% vs. 2.0% in controls, P<0.001), especially in cases of IBS with diarrhea (IBS-D) (IBS with constipation [IBS-C] 28.8% vs. IBS-D 60.0% vs. mixed IBS [IBS-M] 5.1%, P<0.001). Colonic morphological abnormality was more frequent in the IBS group than in the control group (77.7% vs. 24.5%, P<0.001), especially in IBS-M and IBS-C groups (IBS-C 77.5% vs. IBS-D 48.9% vs. IBS-M 100%, P<0.001). Most patients with IBS with colonic dysmotility had experienced stress related to their symptoms. Cecal intubation time was significantly longer in the IBS group than in the control group (12.1±6.9 minutes vs. 4.6±1.9 minutes, P<0.001).ConclusionsUnsedated colonoscopy, combined with radiographic findings, can detect colonic dysmotility and morphological abnormality. Technical difficulties observed during cecal intubation may partially explain the pathophysiology of IBS.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Colonic dysmotility and morphological abnormality frequently detected in Japanese patients with irritable bowel syndrome

et al. 2017

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“…In a clinical perspective the time spent from anus to cecum on the phantom was very short even for those with experience (▶ Table 2) [31,32]. Moreover, in the clinic patients resemble a much more heterogeneous group with various anatomic formations and loop management in the clinic pose a greater challenge compared to our setup [32,33].…”

Section: Novicesmentioning

confidence: 93%

Using computerized assessment in simulated colonoscopy: a validation study

et al. 2020

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Background and study aims Patient safety during a colonoscopy highly depends on endoscopist competence. Endoscopic societies have been calling for an objective and regular assessment of the endoscopists, but existing assessment tools are time-consuming and prone to bias. We aimed to develop and gather evidence of validity for a computerized assessment tool delivering automatic and unbiased assessment of colonoscopy based on 3 dimensional coordinates from the colonoscope. Methods Twenty-four participants were recruited and divided into two groups based on experience: 12 experienced and 12 novices. Participants performed twice on a physical phantom model with a standardized alpha loop in the sigmoid colon. Data was gathered directly from the Olympus ScopeGuide system providing XYZ-coordinates along the length of the colonoscope. Five different motor skill measures were developed based on the data, named: Travel Length, Tip Progression, Chase Efficiency, Shaft movement without tip progression, and Looping. Results The experinced had a lower travel length (P < 0.001), tip progression (P < 0.001), chase efficiency (P = 0.001) and looping (P = 0.006), and a higher shaft movement without tip progression (P < 0.001) reaching the cecum compared with the novices. A composite score was developed based on the five measurements to create a combined score of progression, the 3D-Colonoscopy-Progression-Score (3D-CoPS). The 3D-CoPS revealed a significant difference between groups (experienced: 0.495 (SD 0.303) and novices –0.454 (SD 0.707), P < 0.001). Conclusion This study presents a novel, real-time computerized assessment tool for colonoscopy, and strong evidence of validity was gathered in a simulation-based setting. The system shows promising opportunities for automatic, unbiased and continuous assessment of colonoscopy performance.

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“…The algorithm proposed in our previous publication was modified for patients that were most challenging in our previous retrospective study and in the current subsequent 50-person prospective cohort: 1) patients with redundant colons and very high BMI and/or more than one prior incomplete colonoscopy; and 2) patients with tortuous colons and very low BMI. In these patients, water immersion was included in the algorithm, based on data showing that water immersion decreases looping in redundant colons and decreases patient pain during colonoscopy 11 12 13 14 . We hypothesized that water immersion would facilitate completion of colonoscopy in these particular groups because additional measures, such as abdominal pressure and patient repositioning, were unlikely to be as effective in the high BMI group, and low BMI has been associated with increased pain during colonoscopy 15 .…”

Section: Methodsmentioning

confidence: 99%

Development and validation of an algorithm to complete colonoscopy using standard endoscopes in patients with prior incomplete colonoscopy

et al. 2017

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Background and study aims Incomplete colonoscopy may occur as a result of colon angulation (adhesions or diverticulosis), endoscope looping, or both. Specialty endoscopes/devices have been shown to successfully complete prior incomplete colonoscopies, but may not be widely available. Radiographic or other image-based evaluations have been shown to be effective but may miss small or flat lesions, and colonoscopy is often still indicated if a large lesion is identified. The purpose of this study was to develop and validate an algorithm to determine the optimum endoscope to ensure completion of the examination in patients with prior incomplete colonoscopy. Patients and methods This was a prospective cohort study of 175 patients with prior incomplete colonoscopy who were referred to a single endoscopist at a single academic medical center over a 3-year period from 2012 through 2015. Colonoscopy outcomes from the initial 50 patients were used to develop an algorithm to determine the optimal standard endoscope and technique to achieve cecal intubation. The algorithm was validated on the subsequent 125 patients. Results The overall repeat colonoscopy success rate using a standard endoscope was 94 %. The initial standard endoscope specified by the algorithm was used and completed the colonoscopy in 90 % of patients. Conclusions This study identifies an effective strategy for completing colonoscopy in patients with prior incomplete examination, using widely available standard endoscopes and an algorithm based on patient characteristics and reasons for prior incomplete colonoscopy.

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Water immersion colonoscopy facilitates straight passage of the colonoscope through the sigmoid colon without loop formation: Randomized controlled trial

Abstract: Water immersion increases the success rate of insertion through the sigmoid colon without loop formation. This practical technique, requiring only preparation of a cap and water, is useful without compromising cecal intubation rate, cecal intubation time, or polyp detection rate.

Cited by 23 publications

References 29 publications

Colonic dysmotility and morphological abnormality frequently detected in Japanese patients with irritable bowel syndrome

Colonic dysmotility and morphological abnormality frequently detected in Japanese patients with irritable bowel syndrome

Using computerized assessment in simulated colonoscopy: a validation study

Development and validation of an algorithm to complete colonoscopy using standard endoscopes in patients with prior incomplete colonoscopy

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