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Kim A, Kim H, Kim ER, Kim JE, Hong SN, Chang DK, Kim YH. Risk factors and management of iatrogenic colorectal perforation in diagnostic colonoscopy: a single-center cohort study. Scand J Gastroenterol 2024; 59:749-754. [PMID: 38380637 DOI: 10.1080/00365521.2024.2316766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 02/05/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND AND AIMS Diagnostic colonoscopy plays a central role in colorectal cancer screening programs. We analyzed the risk factors for perforation during diagnostic colonoscopy and discussed the treatment outcomes. METHODS We performed a retrospective analysis of risk factors and treatment outcomes of perforation during 74,426 diagnostic colonoscopies between 2013 and 2018 in a tertiary hospital. RESULTS A total of 19 perforations were identified after 74,426 diagnostic colonoscopies or sigmoidoscopies, resulting in a standardized incidence rate of 0.025% or 2.5 per 10,000 colonoscopies. The majority (15 out of 19, 79%) were found at the sigmoid colon and recto-sigmoid junction. Perforation occurred mostly in less than 1000 cases of colonoscopy (16 out of 19, 84%). In particular, the incidence of perforation was higher in more than 200 cases undergoing slightly advanced colonoscopy rather than beginners who had just learned colonoscopy. Old age (≥ 70 years), inpatient setting, low body mass index (BMI), and sedation status were significantly associated with increased risk of perforation. Nine (47%) of the patients underwent operative treatment and ten (53%) were managed non-operatively. Patients who underwent surgery were often diagnosed with delayed or concomitant abdominal pain. Perforations of rectum tended to be successfully treated with endoscopic clipping. CONCLUSIONS Additional precautions are required to prevent perforation in elderly patients, hospital settings, low BMI, sedated patients, or by a doctor with slight familiarity with endoscopies (but still insufficient experience). Endoscopic treatment should be actively considered if diagnosis is prompt, abdominal pain absent, and especially the rectal perforation is present.
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Affiliation(s)
- Aryoung Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Heejung Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eun Ran Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji Eun Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung Noh Hong
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong Kyung Chang
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young-Ho Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Wang C, Wu J, Zhang X, Lu X. Intestinal stent implantation using a water injection device with carbon dioxide and transparent cap: A case report. Medicine (Baltimore) 2023; 102:e36330. [PMID: 38050306 PMCID: PMC10695583 DOI: 10.1097/md.0000000000036330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/06/2023] [Indexed: 12/06/2023] Open
Abstract
RATIONALE Preoperative endoscopic intestinal stent placement can relieve the symptoms of malignant bowel obstruction (MBO) pending investigations, staging, and surgery, but it is a technically challenging procedure. This paper presents a woman with MBO who successfully underwent intestinal stent implantation using a water injection device with carbon dioxide and a transparent cap. PATIENT CONCERNS We reported a technique for endoscopic intestinal stent placement. A 60-year-old female patient was admitted for abdominal pain and poor bowel movement for 10 days. Computed tomography at a local hospital suggested local stenosis. DIAGNOSES A transparent cap was placed in front of a gastroscope and was used to cross part of the stenotic segment, with water being injected to fill the intestinal cavity continuously. An angiographic catheter was sent along the yellow zebra guidewire passing through the stenotic segment. After exchanging for a colonoscope, a 12-cm intestinal stent was placed along the guidewire. INTERVENTIONS The physician used a single-person water injection-assisted colonoscopy technique in combination with a carbon dioxide gas pump to assist with the air insufflation for colonoscope insertion through the lumen and repeatedly injected water solution to ensure a transparent colonoscopic view. OUTCOMES No intraoperative or postoperative complications were observed. One week after endoscopic intestinal stent placement, the patient underwent radical left hemicolectomy for colon cancer and release of bowel adhesion. The postoperative pathology revealed adenocarcinoma with perineural invasion. The patient recovered well after surgery. LESSONS Single-person intestinal stent implantation using a water injection device with carbon dioxide and a transparent cap can achieve endoscopic intestinal stent placement for MBO.
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Affiliation(s)
- Changxiong Wang
- Department of Digestive, Lishui Hospital of Traditional Chinese Medicine, Lishui, China
| | - Jianye Wu
- Department of Digestive, Lishui Hospital of Traditional Chinese Medicine, Lishui, China
| | - Xiaoqin Zhang
- Department of Digestive, Lishui Hospital of Traditional Chinese Medicine, Lishui, China
| | - Xianbao Lu
- Department of Digestive, Lishui Hospital of Traditional Chinese Medicine, Lishui, China
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Gornick D, Kadakuntla A, Trovato A, Stetzer R, Tadros M. Practical considerations for colorectal cancer screening in older adults. World J Gastrointest Oncol 2022; 14:1086-1102. [PMID: 35949211 PMCID: PMC9244986 DOI: 10.4251/wjgo.v14.i6.1086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/23/2022] [Accepted: 04/30/2022] [Indexed: 02/06/2023] Open
Abstract
Recent guidelines recommend that colorectal cancer (CRC) screening after age 75 be considered on an individualized basis, and discourage screening for people over 85 due to competing causes of mortality. Given the heterogeneity in the health of older individuals, and lack of data within current guidelines for personalized CRC screening approaches, there remains a need for a clearer framework to inform clinical decision-making. A revision of the current approach to CRC screening in older adults is even more compelling given the improvements in CRC treatment, post-treatment survival, and increasing life expectancy in the population. In this review, we aim to examine the personalization of CRC screening cessation based on specific factors influencing life and health expectancy such as comorbidity, frailty, and cognitive status. We will also review screening modalities and endoscopic technique for minimizing risk, the risks of screening unique to older adults, and CRC treatment outcomes in older patients, in order to provide important information to aid CRC screening decisions for this age group. This review article offers a unique approach to this topic from both the gastroenterologist and geriatrician perspective by reviewing the use of specific clinical assessment tools, and addressing technical aspects of screening colonoscopy and periprocedural management to mitigate screening-related complications.
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Affiliation(s)
- Dana Gornick
- Albany Medical College, Albany Medical College, Albany, NY 12208, United States
| | - Anusri Kadakuntla
- Albany Medical College, Albany Medical College, Albany, NY 12208, United States
| | - Alexa Trovato
- Albany Medical College, Albany Medical College, Albany, NY 12208, United States
| | - Rebecca Stetzer
- Division of Geriatrics, Albany Medical Center, Albany, NY 12208, United States
| | - Micheal Tadros
- Division of Gastroenterology, Albany Medical Center, Albany, NY 12208, United States
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Mota FL, Centeno DM, de Oliveira FJS, Pereira EMA, Jacinto SM, Cardoso PHAF, Armellini STN, D'Assuncao MA. The use of the cap and underwater technique as an aid in endoscopic diagnosis and treatment of upper gastrointestinal bleeding: case series. VIDEOGIE : AN OFFICIAL VIDEO JOURNAL OF THE AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY 2021; 6:518-521. [PMID: 34765848 PMCID: PMC8573699 DOI: 10.1016/j.vgie.2021.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND AND AIMS Upper GI bleeding (UGIB) is a medical emergency associated with elevated mortality and significant costs to the health care system. EGD is currently the method of choice for the diagnosis and management of these conditions. However, the location of bleeding lesions and technical difficulties in achieving endoscope stability may challenge even the most experienced endoscopists. Herein, we demonstrate the use of the cap and underwater technique as a helpful aid in these situations. METHODS We present a case series of 4 patients with acute UGIB who underwent EGD with suboptimal endoscopic visualization or technical difficulties in identifying the source of bleeding. A transparent plastic cap was attached to the distal tip of the gastroscope, and the water immersion technique (underwater) was used for endoscopic re-evaluation of the bleeding site. RESULTS Three patients presented with duodenal bleeding, and 1 was diagnosed with diffuse bleeding from the esophagus. The clear and accurate identification of the source of bleeding and effective hemostasis were possible after cap and underwater technique evaluation in all patients. CONCLUSION The use of the cap and underwater technique is a simple, safe, and low-cost strategy that improves the identification and control of UGIB in locations with poor visibility and technical challenges during endoscopic evaluation.
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Affiliation(s)
| | | | | | - Eduardo M A Pereira
- Department of Digestive Endoscopy, Hospital Sírio-Libanês, São Paulo, Brazil
| | | | - Pedro H A F Cardoso
- Department of Digestive Endoscopy, Hospital Sírio-Libanês, São Paulo, Brazil
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Cadoni S, Ishaq S, Hassan C, Falt P, Fuccio L, Siau K, Leung JW, Anderson J, Binmoeller KF, Radaelli F, Rutter MD, Sugimoto S, Muhammad H, Bhandari P, Draganov PV, de Groen P, Wang AY, Yen AW, Hamerski C, Thorlacius H, Neumann H, Ramirez F, Mulder CJJ, Albéniz E, Amato A, Arai M, Bak A, Barret M, Bayupurnama P, Cheung R, Ching HL, Cohen H, Dolwani S, Friedland S, Harada H, Hsieh YH, Hayee B, Kuwai T, Lorenzo-Zúñiga V, Liggi M, Mizukami T, Mura D, Nylander D, Olafsson S, Paggi S, Pan Y, Parra-Blanco A, Ransford R, Rodriguez-Sanchez J, Senturk H, Suzuki N, Tseng CW, Uchima H, Uedo N, Leung FW. Water-assisted colonoscopy: an international modified Delphi review on definitions and practice recommendations. Gastrointest Endosc 2021; 93:1411-1420.e18. [PMID: 33069706 DOI: 10.1016/j.gie.2020.10.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/08/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Since 2008, a plethora of research studies has compared the efficacy of water-assisted (aided) colonoscopy (WAC) and underwater resection (UWR) of colorectal lesions with standard colonoscopy. We reviewed and graded the research evidence with potential clinical application. We conducted a modified Delphi consensus among experienced colonoscopists on definitions and practice of water immersion (WI), water exchange (WE), and UWR. METHODS Major databases were searched to obtain research reports that could potentially shape clinical practice related to WAC and UWR. Pertinent references were graded (Grading of Recommendations, Assessment, Development and Evaluation). Extracted data supporting evidence-based statements were tabulated and provided to respondents. We received responses from 55 (85% surveyed) experienced colonoscopists (37 experts and 18 nonexperts in WAC) from 16 countries in 3 rounds. Voting was conducted anonymously in the second and third round, with ≥80% agreement defined as consensus. We aimed to obtain consensus in all statements. RESULTS In the first and the second modified Delphi rounds, 20 proposed statements were decreased to 14 and then 11 statements. After the third round, the combined responses from all respondents depicted the consensus in 11 statements (S): definitions of WI (S1) and WE (S2), procedural features (S3-S5), impact on bowel cleanliness (S6), adenoma detection (S7), pain score (S8), and UWR (S9-S11). CONCLUSIONS The most important consensus statements are that WI and WE are not the same in implementation and outcomes. Because studies that could potentially shape clinical practice of WAC and UWR were chosen for review, this modified Delphi consensus supports recommendations for the use of WAC in clinical practice.
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Affiliation(s)
- Sergio Cadoni
- CTO Hospital, Digestive Endoscopy Unit, Iglesias, Italy
| | - Sauid Ishaq
- Russell Hall, Dept. of Gastroenterology, Birmingham, United Kingdom; Birmingham City University, Birmingham, United Kingdom
| | - Cesare Hassan
- Nuovo Regina Margherita Hospital, Digestive Endoscopy Unit, Rome, Italy
| | - Přemysl Falt
- University Hospital and Faculty of Medicine, Palacky University, Olomouc, Czech Republic; Faculty of Medicine, Charles University, Hradec Králové, Czech Republic
| | - Lorenzo Fuccio
- S. Orsola-Malpighi University Hospital, Department of Medical and Surgical Sciences, Bologna, Italy
| | - Keith Siau
- JAG Clinical Fellow, JAG, Royal College of Physicians, London, United Kingdom
| | - Joseph W Leung
- Division of Gastroenterology and Hepatology, Sacramento VA Medical Center and University of California Davis School of Medicine, Sacramento, California, USA
| | - John Anderson
- Gloucestershire Hospitals NHS Foundation Trust, Gloucestershire, United Kingdom
| | - Kenneth F Binmoeller
- California Pacific Medical Center, Interventional Endoscopy Services, San Francisco, California, United States
| | | | - Matt D Rutter
- University Hospital North Tees NHS, Department of Gastroenterology, Stockton-on-Tees, United Kingdom; Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom
| | - Shinya Sugimoto
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | | | - Pradeep Bhandari
- Portsmouth University Hospital, Dept. of Gastroenterology, Portsmouth, United Kingdom
| | | | - Piet de Groen
- University of Minnesota, Division of Gastroenterology, Minneapolis, Minnesota, United States
| | - Andrew Y Wang
- Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, Virginia, United States
| | - Andrew W Yen
- Division of Gastroenterology and Hepatology, Sacramento VA Medical Center and University of California Davis School of Medicine, Sacramento, California, USA
| | - Chris Hamerski
- California Pacific Medical Center, Interventional Endoscopy Services, San Francisco, California, United States
| | - Henrik Thorlacius
- Lund University Surgery, Department of Gastrointestinal Surgery, Malmö, Sweden
| | - Helmut Neumann
- University Medical Center, Interventional Endoscopy Center, Medizinische Klinik und Poliklinik, Mainz, Germany
| | | | - Chris J J Mulder
- VU University Medical Center, Department of Gastroenterology, Amsterdam, The Netherlands
| | - Eduardo Albéniz
- Gastroenterology Department, Endoscopy Unit, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Arnaldo Amato
- Ospedale Valduce, Gastroenterology Unit, Como, Italy
| | - Makoto Arai
- Chiba University, Gastroenterology Department, Chiba, Japan
| | - Adrian Bak
- University of British Columbia, Department of Medicine, Kelowna, Canada
| | | | - Putut Bayupurnama
- Division of Gastroenterology and Hepatology, Internal Medicine Department, Faculty of Medicine, Gadjah Mada University, Sardjito General Hospital, Yogyakarta, Indonesia
| | - Ramsey Cheung
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, VA Palo Alto, California, United States
| | - Hey-Long Ching
- Sheffield Teaching Hospitals, Gastroenterology Department, Sheffield, United Kingdom
| | - Hartley Cohen
- Department of Medicine, VA Greater Los Angeles Health Care System, Los Angeles, United States; David Geffen School of Medicine at UCLA, Department of Medicine, Los Angeles, California, United States
| | - Sunil Dolwani
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Shai Friedland
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, VA Palo Alto, California, United States
| | - Hideaki Harada
- Department of Gastroenterology, New Tokyo Hospital, Gastroenterology, Matsudo, Chiba, Japan
| | - Yu-Hsi Hsieh
- Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin Township, Taiwan
| | - Bu Hayee
- King's College Hospital NHS foundation Trust, Gastroenterology Department, London, United Kingdom
| | - Toshio Kuwai
- NHO Kure Medical Center and Chugoku Cancer Center, Gastroenterology Department, Kure, Japan
| | | | - Mauro Liggi
- ASSL Carbonia, Sirai Hospital, Digestive Endoscopy Unit, Carbonia, Italy
| | - Takeshi Mizukami
- NHO Kurihama Medical and Addiction Center, Endoscopy Center, Yokosuka, Japan
| | - Donatella Mura
- ASSL Carbonia, Sirai Hospital, Digestive Endoscopy Unit, Carbonia, Italy
| | - David Nylander
- Newcastle Upon Tyne NHS Foundation Trust, Gastroenterology Department, Newcastle Upon Tyne, United Kingdom
| | - Snorri Olafsson
- Telemark Hospital, Gastroenterology Department, Skien, Norway
| | - Silvia Paggi
- Ospedale Valduce, Gastroenterology Unit, Como, Italy
| | - Yanglin Pan
- Xijing Hospital, Department of Gastroenterology, Xian, Republic of China
| | - Adolfo Parra-Blanco
- NIHR Nottingham Biomedical Research Centre, Department of Gastroenterology, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, United Kingdom
| | - Rupert Ransford
- Endoscopy Department Hereford County Hospital, Hereford, United Kingdom
| | | | - Hakan Senturk
- Bezmialem Vakif University Medicine Faculty, Department of Medicine, Istanbul, Turkey
| | - Noriko Suzuki
- Wolfson Unit for Endoscopy, St Mark's Hospital, London, United Kingdom
| | - Chih-Wei Tseng
- Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin Township, Taiwan
| | - Hugo Uchima
- Hospital Germans Triasi i Pujol, Teknon Medical Center, Gastroenterology, Barcelona, Spain
| | - Noriya Uedo
- Osaka International Cancer Institute, Department of Gastrointestinal Oncology, Osaka, Japan
| | - Felix W Leung
- Department of Medicine, VA Greater Los Angeles Health Care System, Los Angeles, United States; David Geffen School of Medicine at UCLA, Department of Medicine, Los Angeles, California, United States
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Murakami D, Harada H, Amano Y. An unexpected cause of lower gastrointestinal bleeding. Clin Case Rep 2021; 9:586-587. [PMID: 33489223 PMCID: PMC7813000 DOI: 10.1002/ccr3.3549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 10/06/2020] [Accepted: 10/19/2020] [Indexed: 11/25/2022] Open
Abstract
Although appendiceal bleeding is rare, physicians should keep this finding in mind as a possible cause of bleeding from the right colon because the colonoscopic diagnosis may be essential in determining the need for surgical intervention.
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Affiliation(s)
| | - Hideaki Harada
- Department of GastroenterologyNew Tokyo HospitalChibaJapan
| | - Yuji Amano
- Department of EndoscopyNew Tokyo HospitalChibaJapan
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Abstract
Compared with the traditional air insufflation method, water-assisted colonoscopy has many advantages in clinical application with regard to reduced abdominal pain, increased cecal intubation rate, increased detection rate of colon adenoma, and increased complete resection rate of larger polyps. It has gradually attracted more and more attention both in China and other countries. The aim of this article is to elaborate the invention, development, and therapeutic applications of water-assisted colonoscopy, as well as its advantages and shortcomings.
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Affiliation(s)
- Jun-Quan Shen
- Department of Anorectal Surgery, Yuyao People's Hospital, Yuyao 315400, Zhejiang Province, China
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8
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Effectiveness and safety of underwater techniques in gastrointestinal endoscopy: a comprehensive review of the literature. Surg Endosc 2020; 35:37-51. [PMID: 32856154 DOI: 10.1007/s00464-020-07907-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 08/17/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Conventional endoscopic resection techniques such as endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD), represent the standard of care for treatment of superficial gastrointestinal lesions. In 2012 a novel technique called underwater endoscopic mucosal resection (U-EMR) was described by Binmoeller and colleagues. This substantial variation from the standard procedure was afterwards applied at endoscopic submucosal dissection (U-ESD) and recently proposed also for peroral endoscopic myotomy (U-POEM) and endoscopic full-thickness resection (U-EFTR). METHODS This paper aims to perform a comprehensive review of the current literature related to supporting the underwater resection techniques with the aim to evaluate their safety and efficacy. RESULTS Based on the current literature U-EMR appears to be feasible and safe. Comparison studies showed that U-EMR is associated with higher "en-bloc" and R0 resection rates for colonic lesions, but lower "en-bloc" and R0 resection rates for duodenal non-ampullary lesions, compared to standard EMR. In contrast to U-EMR, little evidence supporting U-ESD are currently available. A single comparison study on gastric lesions showed that U-ESD had shorter procedural times and allowed a similar "en-bloc" resection rates compared to standard ESD. No comparison studies between U-ESD and ESD are available for colonic lesions. Finally, only some anecdotal experiences have been reported for U-POEM or U-EFTR, and the feasibility and effectiveness of these techniques need to be further investigated. CONCLUSIONS Further prospective studies are necessary to better explore the advantages of underwater techniques compared to the respective standards of care, especially in the setting of U-ESD where consistent data are lacking and where standardization of the technique is needed.
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Li JA, Zhong LL, Li B, Jiang DQ, Zhao YL. Diffuse telangiectasia of the colon: A case report. Medicine (Baltimore) 2020; 99:e21106. [PMID: 32846752 PMCID: PMC7447499 DOI: 10.1097/md.0000000000021106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
RATIONALE Colonic telangiectasia, also known as colonic angiodysplasia, refers to arteriovenous malformations that occur in the colon, which are common vascular lesions in the GI tract. PATIENT CONCERNS We report a patient, who was admitted to our hospital for colonoscopy. DIAGNOSES Under a microscope, all the segments of the whole colon and the varicose veins showed multiple flaky spider-like telangiectasia changes. The blood vessels were radially distributed and converged in the center. The largest blood vessel was about 10 mm in diameter and had a smooth surface with no ulcers, erosion, or bleeding. INTERVENTIONS It was recommended that the patient undergo a capsule endoscopy to examine small intestine. OUTCOMES The patient did not agree to endoscopy for personal reasons. During the follow-up half a year later, the patient had no melena with normal range of hemoglobin and red blood cell counts. The fecal occult blood test came out negative. LESSONS While the etiology of colonic telangiectasia remains unclear, it is common in the elderly, and is more associated with geriatric conditions and diseases, especially atherosclerotic diseases. Patients who are diagnosed with colonic telangiectasia but are asymptomatic, do not need further treatment. It is usually recommended to monitor the color of stool and check the hemoglobin and fecal occult blood regularly. Colonoscopy is the main method of diagnosis of colonic telangiectasia, and the positive rate is greater than 90%. This procedure should be performed when there is no bleeding or a small amount of bleeding.
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Affiliation(s)
- Jun-An Li
- Gastroenterology and Center of Digestive Endoscopy
| | - Li-Li Zhong
- Jilin Provincial Key Laboratory on Molecular and Chemical Genetic
| | | | | | - Yin-Long Zhao
- Gastroenterology and Center of Digestive Endoscopy
- Jilin Provincial Key Laboratory on Molecular and Chemical Genetic
- Cardiovascular Surgery
- Department of Nuclear Medicine, The Second Hospital of Jilin University, Changchun, Jilin, P. R. China
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Beintaris I, Esmaily S, Saunders BP, Rees CJ, Von Wagner C, Tsiamoulos Z, Hoare Z, Evans R, Yeo ST, Edwards RT, Larkin T, Veitch A, Chilton A, Bramble MG, Deane J, Rutter MD. The WASh Trial: water-assisted sigmoidoscopy in the English Bowel Scope Screening Programme: study protocol for a randomized multicenter trial. Endosc Int Open 2019; 7:E1574-E1582. [PMID: 31723580 PMCID: PMC6847695 DOI: 10.1055/a-0953-1468] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 04/23/2019] [Indexed: 02/06/2023] Open
Abstract
Background and study aims The English National Bowel Scope Screening Programme (BSSP) invites 55-year-olds for a one-off, unsedated flexible sigmoidoscopy (FSIG). Data from BSSP participant-reported experience studies shows 1 in 3 participants report moderate or severe discomfort. Water-assisted colonoscopy (WAS) may improve participants' comfort. The primary objective of this study is to ascertain if post-procedural participant-assessed pain is reduced in WAS compared with carbon dioxide (CO 2 ) insufflation, in invitees undergoing FSIG in BSSP. Patients and methods This is a multicenter, prospective, randomized, two-arm, single-blinded trial designed to evaluate the performance of WAS versus CO 2 insufflation in BSSP. Participants will be randomized to either CO 2 or WAS and will be asked to rate pain post-procedure. Key procedure-related data will be analyzed, including adenoma detection rates (ADR) and degree of sigmoid looping. A cost-effectiveness analysis of WAS versus CO 2 and a discrete choice experiment exploring preferences of participants for attributes of sigmoidoscopy will also be performed. Discussion This is the first trial in the United Kingdom (UK) to investigate the effects of WAS in a screening setting. If the trial shows WAS either reduces pain or increases ADR, this may result in a practice change to implement WAS in screening and non-screening endoscopic practice directly impacting on 256,000 people a year who will undergo BSSP FSIG by 2020. Trial funding came from National Institute for Health Research (NIHR) Research for Patient Benefit (RfPB) supported by the NIHR Clinical Research Network. The trial is actively recruiting. ID: 35866 ISRCTN: 81466870.
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Affiliation(s)
- Iosif Beintaris
- Department of Gastroenterology, University Hospital of North Tees, Stockton-On-Tees, UK
| | - Shiran Esmaily
- Department of Gastroenterology, University Hospital of North Tees, Stockton-On-Tees, UK
| | | | - Colin J. Rees
- Department of Gastroenterology, South Tyneside NHS Trust, South Shields UK
| | - Christian Von Wagner
- Research Department of Epidemiology and Public Health, University College London, UK
| | | | - Zoe Hoare
- North Wales Organisation for Randomised Trials in Health, UK
| | - Rachel Evans
- North Wales Organisation for Randomised Trials in Health, UK
| | - Seow Tien Yeo
- Centre for Health Economics and Medicines Evaluation, Bangor University, UK
| | - R. T. Edwards
- Centre for Health Economics and Medicines Evaluation, Bangor University, UK
| | | | - Andrew Veitch
- Department of Gastroenterology, New Cross Hospital, Wolverhampton, UK
| | - Andrew Chilton
- Department of Gastroenterology, Kettering General Hospital NHS Foundation Trust, UK
| | - Michael G. Bramble
- Department of Gastroenterology, James Cook University Hospital, Middlesbrough, UK
| | - Jill Deane
- Department of Gastroenterology, University Hospital of North Tees, Stockton-On-Tees, UK
| | - Matthew D. Rutter
- Department of Gastroenterology, University Hospital of North Tees, Stockton-On-Tees, UK,School of Medicine Pharmacy and Health, Durham University, UK,Northern Institute for Cancer Research, Newcastle University, UK,Corresponding author Matt Rutter North Tees and Hartlepool NHS Foundation Trust – GastroenterologyHardwick Rd, Hardwick Stockton-on-Tees TS24 9AHUnited Kingdom of Great Britain and Northern Ireland+01642 617617
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Catinean A, Neag MA, Tulbure M. The advantages of water immersion colonoscopy in ambulatory service. TURKISH JOURNAL OF GASTROENTEROLOGY 2019; 30:636-640. [PMID: 31290752 DOI: 10.5152/tjg.2019.18784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND/AIMS The purpose of this prospective study was to compare patients' discomfort during water immersion (WI) colonoscopy without sedation or available on request, with that of patients during air insufflation (AI) colonoscopy with sedation, in the ambulatory setting. MATERIAL AND METHODS A prospective observational study was conducted in 100 patients who performed a colonoscopy between August 2015 and February 2016 in an Ambulatory Gastroenterology Center in Cluj-Napoca, Romania. They were divided into two branches A and B. Patients in Group A underwent a classic colonoscopy with AI and standard sedation (2 mg of midazolam and 50 mg of tramadol), while patients in Group B underwent an unsedated or on demand sedation colonoscopy with WI technique. RESULTS The patients in group A presented a higher discomfort (statistically significant) compared to those in group B, and had also the median total discomfort score higher than those in group B. The patients in group A had also a higher discomfort score after examination. The total time of examination was the same in the two groups, but in group B the progression to cecum time was 3 minutes lower than for those in group A. A greater discomfort of the patient was correlated with the longer time required to reach the cecum. CONCLUSION In conclusion, WI colonoscopy is superior to AI technique in reducing insertion pain, progression-to-cecum time, minimizing sedation requirements and also in the willingness to repeat the technique.
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Affiliation(s)
- Adrian Catinean
- Department of Internal Medicine, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Maria Adriana Neag
- Department of Pharmacology, Toxicology and Clinical Pharmacology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Xu X, Ni D, Lu Y, Huang X. Diagnostic application of water exchange colonoscopy: A meta-analysis of randomized controlled trials. J Int Med Res 2019; 47:515-527. [PMID: 30632431 PMCID: PMC6381515 DOI: 10.1177/0300060518819626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Few well-designed studies have investigated water exchange colonoscopy (WE). We performed a meta-analysis to comprehensively evaluate the clinical utility of WE based on high-quality randomized controlled trials (RCTs) and to compare the impacts of WE, water immersion colonoscopy (WI), and gas-insufflation colonoscopy. Methods We searched the Cochrane Library, MEDLINE, Embase, PubMed, Elsevier, CNKI, VIP, and Wan Fang Data for RCTs on WE. We analyzed the results using fixed- or random-effect models according to the presence of heterogeneity. Publication bias was assessed by funnel plots. Results Thirteen studies were eligible for this meta-analysis. The colonoscopic techniques included WE as the study group, and WI and air- or CO2-insufflation colonoscopy as control groups. WE was significantly superior to the control procedures in terms of adenoma detection rate, proportion of painless unsedated colonoscopy procedures, and cecal intubation rate according to odds ratios. WE was also significantly better in terms of maximal pain score and patient satisfaction score according to mean difference. Conclusions WE can remarkably improve the adenoma detection rate, proportion of painless unsedated colonoscopy procedures, patient satisfaction, and cecal intubation rate, as well as reducing the maximal pain score in patients undergoing colonoscopy.
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Affiliation(s)
- Xiufang Xu
- The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Dongqiong Ni
- The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Yuping Lu
- The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Xuan Huang
- The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
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The impact of water-aided methods on pain reduction and adenoma detection rate during colonoscopy. ADVANCES IN DIGESTIVE MEDICINE 2018. [DOI: 10.1002/aid2.13067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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14
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Abstract
The correlation between a low adenoma detection rate (ADR) and interval cancers (ICs) has made ADR one of the most important quality indicators for colonoscopy. Data from nation-wide colorectal cancer (CRC) screening programs showed that there is room for improvement in ADR in order to reduce ICs in Taiwan. Measures with and without adjunct tools have been shown to have the potential to increase ADR, with the latter being more convenient to apply without additional cost. Optimal withdrawal techniques coupled with sufficient withdrawal time, training endoscopists with emphasis on recognition of subtle characteristics of flat lesions, dynamic position changes during the withdrawal phase, removing small polyps found during insertion, and retroflexion in the right colon have all been associated with increased ADR. In particular, water exchange (WE), which is characterized using water in lieu of air and suction removal of infused water during insertion, appears to meet the needs of colonoscopy patients in Taiwan. Analyses of both primary and secondary outcome variables of recently published studies have consistently shown that WE yields higher ADR than traditional air insufflation, even in propofol-sedated patients. Colonoscopists participating in the nationwide CRC screening program in Taiwan should consider applying one or more of the above measures to improve ADR and hopefully reduce ICs.
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Affiliation(s)
- Yu-Hsi Hsieh
- Division of Gastroenterology, Department of Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Felix W Leung
- Sepulveda Ambulatory Care Center, Veterans Affairs Greater Los Angeles Healthcare System, North Hill, CA, USA.,Division of Gastroenterology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Sugimoto S, Ohta Y, Fujii M, Matano M, Shimokawa M, Nanki K, Date S, Nishikori S, Nakazato Y, Nakamura T, Kanai T, Sato T. Reconstruction of the Human Colon Epithelium In Vivo. Cell Stem Cell 2017; 22:171-176.e5. [PMID: 29290616 DOI: 10.1016/j.stem.2017.11.012] [Citation(s) in RCA: 126] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 09/22/2017] [Accepted: 11/08/2017] [Indexed: 02/06/2023]
Abstract
Genetic lineage tracing has revealed that Lgr5+ murine colon stem cells (CoSCs) rapidly proliferate at the crypt bottom. However, the spatiotemporal dynamics of human CoSCs in vivo have remained experimentally intractable. Here we established an orthotopic xenograft system for normal human colon organoids, enabling stable reconstruction of the human colon epithelium in vivo. Xenografted organoids were prone to displacement by the remaining murine crypts, and this could be overcome by complete removal of the mouse epithelium. Xenografted organoids formed crypt structures distinctively different from surrounding mouse crypts, reflecting their human origin. Lineage tracing using CRISPR-Cas9 to engineer an LGR5-CreER knockin allele demonstrated self-renewal and multipotency of LGR5+ CoSCs. In contrast to the rapidly cycling properties of mouse Lgr5+ CoSCs, human LGR5+ CoSCs were slow-cycling in vivo. This organoid-based orthotopic xenograft model enables investigation of the functional behaviors of human CoSCs in vivo, with potential therapeutic applications in regenerative medicine.
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Affiliation(s)
- Shinya Sugimoto
- Department of Gastroenterology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Yuki Ohta
- Department of Gastroenterology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Masayuki Fujii
- Department of Gastroenterology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Mami Matano
- Department of Gastroenterology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Mariko Shimokawa
- Department of Gastroenterology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Kosaku Nanki
- Department of Gastroenterology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Shoichi Date
- Department of Gastroenterology, Keio University School of Medicine, Tokyo 160-8582, Japan; Fujii Memorial Research Institute, Otsuka Pharmaceutical Company, Limited, Shiga 520-0106, Japan
| | - Shingo Nishikori
- Department of Gastroenterology, Keio University School of Medicine, Tokyo 160-8582, Japan; Fujii Memorial Research Institute, Otsuka Pharmaceutical Company, Limited, Shiga 520-0106, Japan
| | - Yoshihiro Nakazato
- Department of Gastroenterology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Tetsuya Nakamura
- Department of Advanced Therapeutics for GI Diseases, Tokyo Medical and Dental University, Tokyo 113-8510, Japan
| | - Takanori Kanai
- Department of Gastroenterology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Toshiro Sato
- Department of Gastroenterology, Keio University School of Medicine, Tokyo 160-8582, Japan.
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Hsieh YH, Tseng CW, Hu CT, Koo M, Leung FW. Prospective multicenter randomized controlled trial comparing adenoma detection rate in colonoscopy using water exchange, water immersion, and air insufflation. Gastrointest Endosc 2017; 86:192-201. [PMID: 27988288 DOI: 10.1016/j.gie.2016.12.005] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 12/04/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Adenoma detection rate (ADR), defined as the proportion of patients with at least one adenoma of any size, is a quality indicator. We tested the hypothesis that water exchange (WE) improves ADR but water immersion (WI) has no adverse effect on ADR compared with air insufflation (AI). METHODS A prospective study was conducted at the Dalin Tzu Chi Hospital in southern Taiwan and the Hualien Tzu Chi Hospital in eastern Taiwan on patients randomly assigned to WE, WI, or AI with stratification by the 3 study colonoscopists. The primary outcome was ADR. RESULTS From July 2013 to December 2015, 651 patients were recruited and randomized into 3 groups with a 1:1:1 ratio (217 patients per group). Overall, ADR met quality standards: WE 49.8% (95% CI, 43.2%-56.4%), AI 37.8% (95% CI, 31.6%-44.4%), and WI 40.6% (95% CI, 34.2%-47.2%). Compared with AI, WE significantly increased ADR (P = .016). There was no difference between WI and WE. ADRs of WI and AI were comparable. Compared with AI, WE confirmed a longer insertion time, higher cleanliness score, but similar adenoma per positive colonoscopy (APPC) and withdrawal time with polypectomy. Subgroup analysis found WE significantly increased ADR in propofol-sedated patients. Multivariate generalized linear mixed model analysis revealed that age ≥50 years, WE (vs AI), colonoscopy indication, no previous history of colonoscopy, and withdrawal time >8 minutes were significant predictors of increased ADR. CONCLUSIONS Confirmation of prior reports showing WE, but not WI, increased ADR further strengthened the validity of our observations. WE significantly increased ADR in propofol-sedated patients. The outcome differences justify assessment of the role of WE in colorectal cancer prevention. Similar APPC and withdrawal times suggest that adequate inspection was performed on colonoscope withdrawal in each of the study arms. (Clinical trial registration number: NCT01894191.).
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Affiliation(s)
- Yu-Hsi Hsieh
- Division of Gastroenterology, Department of Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan; School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
| | - Chih-Wei Tseng
- Division of Gastroenterology, Department of Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan; School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
| | - Chi-Tan Hu
- School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan; Department of Gastroenterology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Malcolm Koo
- Department of Medical Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan; Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Felix W Leung
- Sepulveda Ambulatory Care Center, Veterans Affairs Greater Los Angeles Healthcare System, North Hill, California, USA; David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Mizukami T, Sugimoto S, Masaoka T, Suzuki H, Kanai T. Colonic dysmotility and morphological abnormality frequently detected in Japanese patients with irritable bowel syndrome. Intest Res 2017; 15:236-243. [PMID: 28522955 PMCID: PMC5430017 DOI: 10.5217/ir.2017.15.2.236] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 12/04/2016] [Accepted: 12/06/2016] [Indexed: 12/13/2022] Open
Abstract
Background/Aims Colonoscopy 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. Methods One 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. Results Colonic 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). Conclusions Unsedated 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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Affiliation(s)
- Takeshi Mizukami
- Endoscopy Center, NHO Kurihama Medical and Addiction Center, Yokosuka, Japan
| | - Shinya Sugimoto
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Tatsuhiro Masaoka
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hidekazu Suzuki
- Medical Education Center, Keio University School of Medicine, Tokyo, Japan
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
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Cadoni S, Falt P, Gallittu P, Liggi M, Smajstrla V, Leung FW. Impact of carbon dioxide insufflation and water exchange on postcolonoscopy outcomes in patients receiving on-demand sedation: a randomized controlled trial. Gastrointest Endosc 2017; 85:210-218.e1. [PMID: 27207825 DOI: 10.1016/j.gie.2016.05.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 05/04/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Water exchange (WE) is the least painful insertion method during colonoscopy. Its impact on postcolonoscopy discomfort has not been well-described. Carbon dioxide (CO2) insufflation consistently reduced postcolonoscopy discomfort. We compared postcolonoscopy outcomes of various combinations of insertion and withdrawal techniques (insertion-withdrawal modality): WE-CO2, WE-air insufflation (WE-AI), and CO2-CO2. METHODS A total of 240 patients undergoing on-demand sedation diagnostic colonoscopy were randomized to WE-CO2 (n = 79), WE-AI (n = 80), CO2-CO2 (n = 81), with postprocedural data collected up to 24 hours. The primary outcome was postcolonoscopy bloating. Other postcolonoscopy outcomes included pain scores, flatus and incontinence episodes, toilet use, interference with normal activities, patient satisfaction, and patient willingness to repeat the procedure. RESULTS Demographic and procedural data were comparable. Compared with WE-AI, WE-CO2 and CO2-CO2 resulted in significantly less bloating (all P < .0005) and lower pain scores (P values ranged from .008 to < .0005) up to 3 hours and fewer flatus episodes up to 6 hours (P values ranged from .003 to < .0005). WE-CO2 resulted in less interference with same-day activities compared with WE-AI (P = .043). The differences in postprocedural outcomes were significant, but the magnitude was small. Patient satisfaction and willingness to repeat the procedure were high and comparable among groups. WE was the least painful insertion technique (P < .0005). CONCLUSIONS The combination WE-CO2 appears to be the optimal choice to decrease pain during the examination and to reduce bloating and other undesired procedural outcomes afterward. If a CO2 insufflator is already available, it seems advisable to adopt the combination WE-CO2. In the absence of a CO2 insufflator, the cost effectiveness of the addition of withdrawal CO2 to WE in diagnostic and nondiagnostic settings needs to be critically assessed. (Clinical trial registration number: NCT02409979.).
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Affiliation(s)
- Sergio Cadoni
- Digestive Endoscopy Unit, St. Barbara Hospital, Iglesias, Italy
| | - Přemysl Falt
- Digestive Diseases Center, Vitkovice Hospital, Ostrava, Czech Republic
| | - Paolo Gallittu
- Digestive Endoscopy Unit, St. Barbara Hospital, Iglesias, Italy
| | - Mauro Liggi
- Digestive Endoscopy Unit, St. Barbara Hospital, Iglesias, Italy
| | - Vit Smajstrla
- Digestive Diseases Center, Vitkovice Hospital, Ostrava, Czech Republic
| | - Felix W Leung
- Sepulveda Ambulatory Care Center, Veterans Affairs Greater Los Angeles Healthcare System, North Hills, California, USA; David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles, California, USA
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Ohgo H, Imaeda H, Yamaoka M, Yoneno K, Hosoe N, Mizukami T, Nakamoto H. Irritable bowel syndrome evaluation using computed tomography colonography. World J Gastroenterol 2016; 22:9394-9399. [PMID: 27895427 PMCID: PMC5107703 DOI: 10.3748/wjg.v22.i42.9394] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 08/24/2016] [Accepted: 09/12/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the morphology of the colon in patients with irritable bowel syndrome (IBS) by using computed tomography colonography (CTC).
METHODS Twelve patients with diarrhea type IBS (IBS-D), 13 patients with constipation type IBS (IBS-C), 12 patients with functional constipation (FC) and 14 control patients underwent colonoscopy following CTC. The lengths of the rectosigmoid colon, transverse colon and the total colon were measured. The diameters of the rectum, sigmoid colon, descending colon, transverse colon, and ascending colon were measured.
RESULTS The mean length of the total colon was 156.5 cm in group C, 158.9 cm in group IBS-D, 172.0 cm in group IBS-C, and 188.8 cm in group FC. The total colon in group FC was significantly longer than that in group C (P < 0.05). The mean length of the rectosigmoid colon was 56.2 cm, 55.9 cm, 63.6cm, and 77.4 cm (NS). The mean length of the transverse colon was 49.9 cm, 43.1 cm, 57.0 cm, and 55.0 cm. The transverse colon in group IBS-D was significantly shorter than that in group IBS-C (P < 0.01) and that in group FC (P = 0.02). The mean diameter of the sigmoid colon was 4.0 cm, 3.3 cm, 4.2 cm, and 4.3 cm (NS). The mean diameter of the descending colon was 3.6 cm, 3.1 cm, 3.8 cm, and 4.3 cm. The descending colon diameter in group IBS-D was significantly less than that in group IBS-C (P = 0.03) and that in group FC (P < 0.001). The descending colon diameter in group FC was significantly greater than that in group C (P = 0.04). The mean diameter of the transverse colon was 4.4 cm, 3.3 cm, 4.2 cm, and 5.0 cm (NS).
CONCLUSION CT colonography might contribute the clarification of subtypes of IBS.
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Cadoni S, Falt P, Sanna S, Argiolas M, Fanari V, Gallittu P, Liggi M, Mura D, Porcedda ML, Smajstrla V, Erriu M, Leung FW. Insertion water exchange increases right colon adenoma and hyperplastic polyp detection rates during withdrawal. Dig Liver Dis 2016; 48:638-43. [PMID: 27017108 DOI: 10.1016/j.dld.2016.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 02/09/2016] [Accepted: 03/04/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Single site studies in male Veterans in the U.S. reported increased detection of presumptive cancer precursors (adenomas, hyperplastic polyps) in the proximal colon (cecum-splenic flexure) by water exchange. AIMS Assess the reproducibility of the observation. METHODS Analysis of secondary outcomes collected prospectively in 3 similarly designed randomized controlled trials using water exchange, water immersion and insufflation (air or carbon dioxide). MAIN OUTCOME detection rates of adenomas and hyperplastic polyps in proximal, transverse and right colon (cecum-ascending). RESULTS 704 males (173 screening) were evaluated. In the proximal colon, WE showed increased detection of small adenomas (p=0.009) and adenomas plus hyperplastic polyps (p=0.015) (vs insufflation); increased detection of adenomas plus hyperplastic polyps of any size (p=0.045) and of small size (p=0.04) (vs water immersion). In the right colon water exchange increased detection of small adenomas (19% vs 12.1%, p=0.04) (vs insufflation); small adenomas (19% vs 12%, p=0.038), adenomas plus hyperplastic polyps of any size (25% vs 16.7%, p=0.028) and of small size (23.7% vs 14.6%, p=0.012) (vs water immersion). Water exchange significantly improved bowel cleanliness. Sedation had no impact on lesion detection. CONCLUSIONS Water exchange is a superior insertion technique for detection of adenomas and hyperplastic polyps primarily in the right colon, especially those of small size.
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Affiliation(s)
- Sergio Cadoni
- Digestive Endoscopy Unit, St. Barbara Hospital, Iglesias, CI, Italy.
| | - Přemysl Falt
- Digestive Diseases Center, Vìtkovice Hospital, Ostrava, Czech Republic
| | - Stefano Sanna
- Digestive Endoscopy Unit, N. S. di Bonaria Hospital, San Gavino Monreale, VS, Italy
| | - Mariangela Argiolas
- Digestive Endoscopy Unit, N. S. di Bonaria Hospital, San Gavino Monreale, VS, Italy
| | - Viviana Fanari
- Digestive Endoscopy Unit, N. S. di Bonaria Hospital, San Gavino Monreale, VS, Italy
| | - Paolo Gallittu
- Digestive Endoscopy Unit, St. Barbara Hospital, Iglesias, CI, Italy
| | - Mauro Liggi
- Digestive Endoscopy Unit, St. Barbara Hospital, Iglesias, CI, Italy
| | - Donatella Mura
- Digestive Endoscopy Unit, St. Barbara Hospital, Iglesias, CI, Italy
| | - Maria L Porcedda
- Digestive Endoscopy Unit, N. S. di Bonaria Hospital, San Gavino Monreale, VS, Italy
| | - Vit Smajstrla
- Digestive Diseases Center, Vìtkovice Hospital, Ostrava, Czech Republic
| | - Matteo Erriu
- Department of Surgical Sciences, University of Cagliari, Cagliari, CA, Italy
| | - Felix W Leung
- Sepulveda Ambulatory Care Center, Veterans Affairs Greater Los Angeles Healthcare System, North Hills, CA, USA; David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA, USA
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Abstract
Colonoscopy is an important and frequently performed procedure. It is effective in the prevention of colorectal cancer and is an important test in the investigation of many gastrointestinal symptoms. This review focuses on developments over the last 5 years that have led to changes in aspects of colonoscopy, including patient preparation, technical factors, therapeutic procedures, safety, and quality.
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Affiliation(s)
- Thomas J.W. Lee
- North Tyneside General Hospital, North Shields, UK
- Northern Region Endoscopy Group, North Shields, UK
| | - Shelley Nair
- North Tyneside General Hospital, North Shields, UK
| | | | - Matthew D. Rutter
- Northern Region Endoscopy Group, North Shields, UK
- University Hospital of North Tees, Stockton on Tees, UK
- School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees, UK
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Sugimoto S, Mizukami T. Discrepancy in the classification of water immersion from water exchange colonoscopy. Gastrointest Endosc 2016; 83:676-7. [PMID: 26897056 DOI: 10.1016/j.gie.2015.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 10/14/2015] [Indexed: 12/11/2022]
Affiliation(s)
- Shinya Sugimoto
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Takeshi Mizukami
- Endoscopy Center, NHO Kurihama Medical and Addiction Center, Kanagawa, Japan
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Rodríguez-García JL, Carmona-Sánchez R, Rosas-Vitorino C. Usefulness of oil lubrication during colonoscopy: A comparative study with the conventional technique. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2016; 81:28-34. [PMID: 26780984 DOI: 10.1016/j.rgmx.2015.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 12/02/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND The different forms of lubrication are among the most simple, accessible, and economic techniques that have been implemented for improving the diagnostic performance of colonoscopy. AIM To determine whether the use of oil improved the number of complete colonoscopies, facilitated the procedure, reduced pain, or improved the study's diagnostic performance, compared with the conventional lubrication technique. PATIENTS AND METHODS One hundred and seventy-five patients referred for colonoscopy were alternately allocated to receive treatment with the standard lubrication method with chlorhexidine gel (group 1) or lubrication with corn oil administered through the working channel (group II). The number of complete colonoscopies, the length of time needed to reach the cecum, the degree of difficulty estimated by the endoscopist and the assistant, the level of pain at the end of the study estimated by the patient, and the endoscopic findings were all determined. RESULTS Eighty-eight patients made up group I and 87 made up group II. No statistically significant differences were found between the two groups in relation to general characteristics, the number of complete colonoscopies (93 vs. 97%, respectively), the time needed to reach the cecum (8:00 vs. 8:41min, respectively), the level of pain at the end of the study, or the detection of polyps. The degree of difficulty was slightly lower in group II, but with no statistical significance. CONCLUSIONS Lubrication with oil during colonoscopy did not improve the number of complete colonoscopies, did not facilitate the study, nor did it reduce pain or increase the diagnostic performance of the study, when compared with the conventional technique.
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Affiliation(s)
| | | | - C Rosas-Vitorino
- Departamento de Enfermería, Hospital Ángeles-CMP, San Luis Potosí, México
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Subramaniam S, Kandiah K, Bhandari P. CO2 insufflation or warm water infusion for unsedated colonoscopy: A randomized controlled trial in patients with chronic constipation in China. Saudi J Gastroenterol 2016; 22:1-2. [PMID: 26831600 PMCID: PMC4763522 DOI: 10.4103/1319-3767.173752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Sharmila Subramaniam
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK,Address for correspondence: Dr. Sharmila Subramaniam, Queen Alexandra Hospital, Portsmouth, UK. E-mail:
| | - Kesavan Kandiah
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
| | - Pradeep Bhandari
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
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Rodríguez-García J, Carmona-Sánchez R, Rosas-Vitorino C. Usefulness of oil lubrication during colonoscopy: A comparative study with the conventional technique. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2016. [DOI: 10.1016/j.rgmxen.2015.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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