Use of an abdominal obstetric binder in colonoscopy: A randomized, prospective trial

Use of an abdominal binder in colonoscopies performed by trainees in gastrointestinal endoscopy: a randomized, double-blind, sham-controlled trial

BACKGROUND

Colonoscopy is a widely used diagnostic and therapeutic tool for colonic diseases and serves as the preferred screening method for colorectal cancer (CRC). A common difficulty during colonoscopy is the looping of the colon, which can result in patient discomfort, prolonged cecal intubation time (CIT), and the need for auxiliary maneuvers. This study aimed to evaluate the efficacy and safety of using an abdominal binder during colonoscopy performed by trainees.

METHODS

This randomized, double-blind, sham-controlled trial was conducted at a tertiary center. Participants were outpatients aged 20-80 years undergoing elective colonoscopy. They were randomly assigned to either the abdominal binder (AB) group or the sham binder (SB) group. The primary outcome measured was cecal intubation time. Secondary outcomes included the need for manual abdominal compression and postural adjustments during the procedure.

RESULTS

A total of 211 participants were enrolled in the study. The median CIT was significantly shorter in the AB group compared to the SB group (728 s vs. 774 s, p = 0.008). Additionally, the AB group demonstrated a significantly reduced need for manual abdominal compression (p ≤ 0.001) and postural adjustments (p = 0.01). The requirement for abdominal compression decreased by 40% (95% CI 27.7-52.9%), while the need for postural changes was reduced by 9.4% (95% CI 1.9-88.7%).

CONCLUSION

The use of an abdominal binder during colonoscopy performed by trainees significantly reduced cecal intubation time and minimized the need for ancillary maneuvers, such as manual abdominal compression and postural adjustments.

THE USE OF ABDOMINAL CORSETS ON COLONOSCOPY: A PROSPECTIVE RANDOMISED CONTROLLED TRIAL

BACKGROUND

Colonoscopy is a widely used endoscopic procedure to investigate diseases of the colon and rectum. Colonoscopy procedure has difficulties for the patient and endoscopist.

AIMS

To investigate whether the use of an abdominal corset can make the colonoscopy procedure easier and faster.

METHODS

This is a prospective randomised controlled study. Patients over 18 years of age who underwent elective colonoscopy in our clinic were evaluated. Patients were divided into two groups according to the use of the corset. Variables were compared between the groups.

RESULTS

A total of 204 patients were included in the study. Corsets were used in 97 patients and not used in 107 patients. The need for manual compression was found to be decreased in the corset use group. There was no effect of corset use on cecal intubation time in the general population. It was found that cecal intubation time decreased with corset use in patients with body mass index - BMI<30 and male gender.

CONCLUSIONS

The need for manual compression can be reduced by the use of an abdominal corset during colonoscopy. The use of an abdominal corset may make the colonoscopy procedure faster and easier for the endoscopist and the patient.

The impact of abdominal compression devices on colonoscopy outcomes: a systematic review and meta-analysis of randomized controlled trials

OBJECTIVE

Colonoscopy is the gold standard method for colorectal cancer screening. Looping occurs in 91% of cases undergoing colonoscopy and can cause patient discomfort, prolonged cecal intubation time (CIT), and colon perforation. This meta-analysis investigates the impact of abdominal compression devices (ACD) on colonoscopy outcomes.

METHODS

A systematic review and meta-analysis synthesizing randomized controlled trials (RCTs), retrieved by systematically searching: PubMed, EMBASE, WOS, SCOPUS, and Cochrane through February 2nd, 2023. Continuous and dichotomous outcomes were pooled using mean difference (MD) and risk ratio (RR) along with confidence interval (CI) using Revman. Our review protocol was prospectively published on PROSPERO with ID: CRD42023397344.

RESULTS

We included eight RCTs with a total of 1,889 patients. ACD was effective to decrease CIT (MD: -2.15 with a 95% CI [-3.49, -0.80], p = .002), postural change (RR: 0.57 with 95% CI [0.49, 0.66], p = .00001), and VAS pain score (MD: -1.49 with 95% CI [-1.81, -1.17], p = .0001). However, there was no difference between ACD and control groups regarding manual compression (RR: 0.65 with 95% CI [0.42, 1.00], p = .05), complete colonoscopy rate (CCR) (RR: 1.01 with 95% CI [0.99, 1.04], p = .31), and cecal intubation length (CIL) (MD: -2.25 with 95% CI [-7.64, 3.14], p = .41).

CONCLUSION

ACD during colonoscopy may enhance patient comfort by reducing CIT, pain, and postural changes. Nevertheless, additional RCTs are necessary to validate these results and determine the most suitable approach to utilize ACD for colonoscopy.

Ergonomics of Endoscopy

Optimal endoscopic operations incorporate ergonomic principles into the endoscopy environment benefiting endoscopists, endoscopy unit personnel, and patients. A high prevalence of occupational musculoskeletal injuries is well established among endoscopists and gastroenterology nurses. Ergonomics can be integrated into all facets of the endoscopy unit including scheduling, endoscopy unit design, training programs, and investment in technology. Preprocedure, intraprocedure, and postprocedure areas should aim to deliver patient safety, privacy, and comfort, while also supporting endoscopists and staff with adjustable rooms and effective work flows. Team-wide educational initiatives can improve ergonomic awareness. These strategies help mitigate risks for musculoskeletal injuries and can lead to increased productivity. The COVID-19 area brings novel challenges to endoscopy.

The effectiveness of using an abdominal binder during colonoscopy: a randomized, double-blind, sham-controlled trial

BACKGROUND

Prolongation of cecal intubation time (CIT) directly affects the comfort of the patient and the colonoscopist. In this study, the effectiveness of using an abdominal binder (AB) during colonoscopy on procedure time and colonoscopy outcomes was investigated.

METHODS

We conducted a parallel randomized double-blind sham-device-controlled study of patients who underwent elective outpatient colonoscopy between 1 May 2020, and 31 August 2020. Participants were randomly assigned to AB (n = 173) and sham binder (SB) (n = 173) groups. The primary outcome was CIT. Secondary outcomes were the need for auxiliary maneuvers, the cecum intubation length (CIL) of the colonoscope, visual analog scale (VAS) score, narcotic analgesic dose, and colonoscopy results. Moreover, subgroup analysis was performed in terms of age and obesity indices.

RESULTS

A total of 346 patients were enrolled in the study. The mean CIT was similar between groups (AB group 240 secs, control group 250 secs, p > .05). Manual pressure requirement was less in the AB group (27 vs. 36%, p = .069). VAS score and the need for extra narcotic analgesic drugs were prominently lower in the AB group (p < .001, p = .016, respectively). In the subgroup analyses, in participants at the age of <60 and waist-to-height ratio (WHtR) ≥0.5, manual pressure requirements were significantly shorter in the AB group (p = .017, p = .032, respectively).

CONCLUSION

AB use in selected patients may be advantageous during colonoscopy because it reduces the need for analgesics and post-procedure pain, and reduces the need for auxiliary maneuvers in relatively young and obese patients.

Colonoscopy using back brace support belt: A randomized, prospective trial

BACKGROUND AND AIM

Looping is a major problem in colonoscopy, and it prolongs procedure time. We evaluated the efficacy and safety of an external abdominal compression device (back brace support belt; Maxbelt) with respect to cecal insertion time and other outcomes.

METHODS

We performed a prospective study on outpatients undergoing elective colonoscopy in Toyoshima Endoscopy Clinic. Subjects were randomly assigned to groups and were subjected to either Maxbelt (n = 39) or no device (control, n = 38) during colonoscopy. The colonoscopist was blinded to the study. The primary outcome that was observed was insertion time.

RESULTS

The intubation time of the Maxbelt group was shorter than that of the no device group, but the difference was not significant (3.29 vs 4.49 min, P = 0.069). After stratifying by age, the use of Maxbelt significantly decreased cecal intubation time in elderly participants (age ≥ 45) compared to no device group (3.27 vs 5.00 min, P = 0.032). The use of the Maxbelt significantly decreased insertion difficulty encountered by the colonoscopist (P = 0.01). There was no difference in adenoma detection rate, manual pressure, position change, and adverse event.

CONCLUSIONS

The use of a back brace support belt could be a viable approach for colonoscopy in elderly patients. (University Hospital Medical Information Network: UMIN000029361).

Effects of Encircled Abdominal Compression Device in Colonoscopy: A Meta-Analysis

: Background and Aim: The efficacy of encircling abdominal compression devices in colonoscopies is inconsistent. We performed a meta-analysis of randomized controlled trials (RCTs) in which encircling abdominal compression devices were compared with control in colonoscopies.

METHODS

We systematically searched RCTs published in the Cochrane Library, PubMed, and the Igaku-Chuo-Zasshi database. The data from the eligible RCTs were combined using the random-effects model. The weighted mean differences (WMDs), pooled odds ratios (ORs), and 95% confidence intervals (CIs) were calculated.

RESULTS

Five RCTs were included in this meta-analysis. Compared to the control group, encircling abdominal compression devices significantly reduced the caecal intubation time (WMD: -1.31, 95% CI: -2.40 to -0.23, p = 0.02). Compared to the control group, encircling abdominal compression devices significantly decreased the frequency of postural change (OR 0.30, 95% CI: 0.22 to 0.41, p < 0.00001). Compared to the control group, the use of encircling abdominal compression devices significantly reduced the need for abdominal compression (OR: 0.35, 95% CI: 0.17 to 0.70, p = 0.003).

CONCLUSIONS

Encircling abdominal compression devices in colonoscopies was found to reduce the caecal intubation time and the frequency of abdominal compression.