Os efeitos da educação aprimorada, realizada por enfermeiros na qualidade do preparo intestinal para colonoscopia / Effect of nurse-performed enhanced patient education on colonoscopy bowel preparation quality / Los efectos de la educación perfeccionada, realizada por enfermeros en la calidad de la preparación intestinal para colonoscopia

Resumo Objetivo: avaliar o efeito da educação aprimorada realizada por enfermeiros no preparo intestinal adequado e na taxa de intubação cecal. Método: estudo prospetivo, quasi-experimental e comparativo com abordagem quantitativa. Os pacientes no grupo de intervenção (n=150) receberam a educação aprimorada e telefonemas para lembrá-los do procedimento. O grupo de controle (n=156) recebeu as instruções padrão da clínica por escrito. As taxas de preparo intestinal adequado e outros indicadores da qualidade da colonoscopia foram comparadas entre os grupos. Resultados: as pontuações obtidas na Boston Bowel Preparation Scale e a taxa de preparo intestinal adequado foram maiores no grupo de intervenção do que no grupo de controle (6,76±2,1 vs. 5,56±2,4, p=0,000, e 80% vs. 69,2%, p=0,031). A taxa de intubação cecal foi mais alta no grupo de intervenção (80% vs. 67,3%, p=0,012). A taxa de intubação cecal malsucedida devido ao preparo intestinal inadequado foi de 0% no GI, enquanto que o GC obteve uma taxa de 17,6%. Além disso, a taxa de biópsia foi maior no grupo de intervenção (28% vs. 13,3%, p=0,002). Conclusão: a educação do paciente aprimorada e realizada por enfermeiros aumenta as taxas de preparo intestinal adequado e, consequentemente, as taxas de intubação cecal. Para alcançar os padrões de qualidade de colonoscopia recomendados nas diretrizes, recomendamos que a educação do paciente inclua diferentes ferramentas de treinamento e seja realizada por profissionais da saúde.

Abstract Objective: to evaluate the effect of nurse-performed enhanced patient education sessions on adequate bowel preparation and cecal intubation rates. Method: a prospective, quasi-experimental, comparative study with a quantitative approach. The intervention group (n=150) received education enhanced by a visual presentation and reminder calls. The control group (n=156) received the clinic's standard written instructions. Adequate bowel preparation rates and other colonoscopy quality indicators were compared between the groups. Results: Boston Bowel Preparation scale scores and adequate bowel preparation rates were higher in the intervention group than in the control group (respectively, 6.76±2.1 vs. 5.56±2.4, p=0.000, and 80% vs. 69.2%, p=0.031). The cecal intubation rates were higher in the intervention group (80% vs. 67.3%, p=0.012). Due to inadequate bowel preparation, unsuccessful cecal intubation rates were 0% in the intervention group and 17.6% in the control group. Biopsy rates were higher in the intervention group (28% vs. 13.3%, p=0.002). Conclusion: the nurse-performed enhanced patient education sessions increase adequate bowel preparation rates and, in parallel, cecal intubation rates. To reach the colonoscopy quality standards recommended in the guidelines, it is suggested that patient education be supported by different training tools and given by health professionals.

Resumen Objetivo: evaluar el efecto de la educación perfeccionada realizada por enfermeros en la preparación intestinal adecuada y en las tasas de intubación cecal. Método: estudio prospectivo, casi experimental y comparativo, con abordaje cuantitativo. El grupo de intervención (n=150) recibió la educación perfeccionada y llamadas telefónicas recordatorias. El grupo de control (n=156) recibió las instrucciones estándar de la clínica por escrito. Las tasas de preparación intestinal adecuadas y otros indicadores de la calidad de la colonoscopia fueron comparadas entre los grupos. Resultados: las puntuaciones obtenidas en la Boston Bowel Preparation Scale y las tasas de preparación intestinal adecuadas fueron en el grupo de intervención mayores que en el grupo de control (6,76±2,1 vs. 5,56±2,4, p=0,000, y 80% vs. 69,2%, p=0,031, respectivamente). Las tasas de intubación cecal fueron mayores en el grupo de intervención (80% vs. 67,3%, p=0,012). La tasa de intubación cecal fracasada debido a la preparación intestinal inadecuada fue de 0% en el GI, en cuanto que el GC obtuvo una tasa de 17,6%. Además de eso, las tasas de biopsia fueron mayores en el grupo de intervención (28% vs. 13,3%, p=0,002). Conclusión: la educación del paciente perfeccionada y realizada por enfermeros aumenta las tasas de preparación intestinal adecuadas y, consecuentemente, las tasas de intubación cecal. Para alcanzar los estándares de calidad de colonoscopia recomendados en las directrices, recomendamos que la educación del paciente sea apoyada por diferentes herramientas de entrenamiento y realizada por profesionales de la salud.

Quality Assessment of Colonoscopy in CWM Hospital From 2012 to 2016

Introduction@#Colonoscopy is the cornerstone in diagnosis and management of colorectal disease allowing direct optical diagnosis, tissue sampling for histological analysis and therapy of colonic lesions. It is a multi-step process and therefore assessment of all aspects of the procedure must be addressed. The main aim of the study is to assess the quality of colonoscopy services in the Colonial War Memorial Hospital from 1st January, 2012 to December 2016.@*Methodology@#A 5-year single-centre, retrospective study.@*Results@#A total of 341 colonoscopies were included in the study. Six Quality indicators of colonoscopy which are applicable to our setting were chosen for the study. The study showed a Cecal Intubation rate of 67% is well below the recommended rate of 90%. The bowel preparation quality is adequate in 53% of the cases compared to a recommended rate of 85%. The withdrawal time has not yet been introduced however, an average withdrawal time of above 6 minutes is recommended for a quality colonoscopy. Acquisition of biopsies in diarrhoea patients was 79% (100% tissue acquisition rate was recommended for quality of colonoscopy). @*Conclusion@#The quality of colonoscopy services carried out at the Colonial War Memorial Hospital has room for improvement in the parameters determining the quality of colonoscopies.

Warm water infusion versus air insufflation in the application of difficult colonoscopy / 中国内镜杂志

Objective To explore the effects of warm water insufflation applied in difficult colonoscopy on its success rate, insertion time, operation difficulty level and tolerance of patients. Method 200 cases of the difficult defecation of non-narcotic colonoscopy, IBS and always has a history of pelvic/abdominal surgery patients, were randomly divided into warm water infusion group (experimental group) and traditional method of air insufflation group (control group), then compare the differences of the success rate of the two groups of patients, the insertion time and degree of tolerance in patients. Results All the patients completed the investigation in this study, neither bowel perforation nor other complications occurred. Experimental group success rate of the whole colon examination, the insertion time, the operator satisfaction and check again wishes were significantly higher than that of control group (P 0.05) in Polyp detection rate. Conclusion Warm water insufflation colonoscopy can effectively improve the tolerance and accelerating the colonoscopy in patients with difficult insertion process, improve work efficiency, and is an ideal method, which is worth of promoting.

Effects of transparent cap-fitted colonoscope combined with carbon dioxide injection on the cecal intubation time and detection of colonicpolyps / 中国内镜杂志

Objective To observe and explore the effects of transparent cap-fitted colonoscope combined with carbon dioxide injection on the cecal intubation time and detection of colonic polyps during enteroscopy. Methods 216 patients underwent colonoscopy from January 2014 to June 2016 were selected and randomly divided into A, B, C groups according to random number table, 72 cases in each. Group A with transparent cap-fitted colonoscopy, group B with CO2 injection before colonoscopy, and group C combined with the above two methods and then underwent colonoscopy, cecal intubation time and colonic polyp detection rate were compared among the three groups during the inspection. Results A, B, C groups with cecal intubation ratio showed no significant differences (95.8% vs 90.3% vs 98.6%) (χ2 = 5.34, P = 0.069); the sequence of mean cecal intubation time was group Cgroup A>group B (38.9% vs 34.7% vs 23.6%) (χ2 = 4.10, P = 0.129). The sequences of visual analogue scale score after 10 min [(4.35 ± 0.62) vs (4.88 ± 0.85) vs (5.57 ± 1.05)] and 30 min [(3.04 ± 0.37) vs (3.30 ± 0.56) vs (4.41 ± 0.84)] of coloscope withdraw were both group C

Related factors predicting unsuccessful colonoscopy without sedation / 中国内镜杂志

Objective To find the related factors of the unsuccessful unsedated colonoscopy. Methods Clinical data of 1 726 consecutive subjects who underwent colonoscopy without sedation from April 2014 to January 2015 at the second affiliated hospital of Soochow university were analyzed. Data included characteristics of the patients (age, gender, body mass index, degree of education, the bowel-cleaning drugs, previous colonoscopy experience, bowel habits, history of chronic disease, history of sport, history of abdominal or pelvic surgery, the indication of colonoscopy, mood, quality of bowel preparation, and presence/absence of colonic diverticulum), the characteristics of the physicians (procedure experience, the instrument handling method). These factors were analyzed to evaluate their impact on result of unsedated colonoscopy. Results This study included 1 726 patients (male/female: 927/799). These patients' average age was 50.04 years old, the cecal intubation rate was 91.6%, and the average intubation time was 10.27 minutes. The multiple regression analysis showed the elderly patient, lower BMI, irritability, consti﹣pation, poor bowel preparation were associated with the lower cecal intubation rate. Conclusions The elderly patient, lower BMI, irritability, constipation and poor bowel preparation were associated with the failure of unsedated colonoscopy. In clinical practice, quality improvement programs are needed to improve the rate of total colonoscopy.

Obesity and Cecal Intubation Time

BACKGROUND/AIMS: Obesity is a much-debated factor with conflicting evidence regarding its association with cecum intubation rates during colonoscopy. We aimed to identify the association between cecal intubation (CI) time and obesity by eliminating confounding factors. METHODS: A retrospective chart review of subjects undergoing outpatient colonoscopy was conducted. The population was categorized by sex and obesity (body mass index [BMI, kg/m2]: I, <24.9; II, 25 to 29.9; III, ≥30). CI time was used as a marker for a difficult colonoscopy. Mean CI times (MCT) were compared for statistical significance using analysis of variance tests. RESULTS: A total of 926 subjects were included. Overall MCT was 15.7±7.9 minutes, and it was 15.9±7.9 and 15.5±7.9 minutes for men and women, respectively. MCT among women for BMI category I, II, and III was 14.4±6.5, 15.5±8.3, and 16.2±8.1 minutes (p=0.55), whereas for men, it was 16.3±8.9, 15.9±8.0, and 15.6±7.2 minutes (p=0.95), respectively. CONCLUSIONS: BMI had a positive association with CI time for women, but had a negative association with CI for men.

Colonoscopia en niños: comparación técnica de inmersión modificada con estándar. Reporte preliminar / Colonoscopy in children: technical comparison of the modified inmersion vs the standard technique. Preliminary report

Introducción: El dolor y las dificultades técnicas constituyen un problema al realizar la colonoscopia estándar. El empleo de agua en la colonoscopia es una técnica que facilita la inserción del instrumento y se relaciona con mejor tolerabilidad por el paciente. Objetivo: comparar la colonoscopia de inmersión modificada con la colonoscopia estándar como mejor técnica y uso de menos sedación en niños. Pacientes y Método: estudio prospectivo y aleatorizado, desde septiembre de 2012 a marzo de 2013. Grupo A: inmersión con agua e insuflación. Grupo B: con insuflación (estándar). Se evaluó la tasa de intubación cecal y tiempo de intubación cecal, sedación adicional, analgesia y tolerabilidad del paciente considerando la presencia de dolor. Resultados: Grupo A: 10 niños, edad promedio 6,6 años (rango: 2-11), 76,92% varones. Grupo B: 13 niños, edad promedio: 6,3 años (rango: 2-12), 70% varones. La indicación más frecuente del estudio fue rectorragia en ambos grupos. La tasa de intubación del ciego, en el grupo A fue 80% frente a 61,53% del grupo B, OR=2,5 (IC 95%= 0,37-16,89), El tiempo promedio de intubación del ciego en el grupo A fue 9,18 minutos + 3,51 y en el grupo B 13,97 minutos + 4,88, sin diferencia significativa (p=0.2362). Sedación adicional y administración de bromuro de butilhioscina fue requerida en 1/9(10%) del grupo A y en 8/13(61,53%) del grupo B, con una diferencia significativa (p=0.0288), con mejor tolerabilidad del procedimiento en el grupo A. Conclusiones: la técnica de agua e insuflación en la colonoscopia en niños se asoció a menor sedación y mejor tolerabilidad del procedimiento. La aplicación de la técnica en un grupo más numeroso permitirá establecer un mejor tiempo y éxito en la intubación cecal.

Introduction: Pain and technical difficulties are a problem when performing standard colonoscopy. The use of water in colonoscopy is a technique that facilitates insertion of the instrument and is associated with better tolerated by the patient. Objective: To compare the modified immersion colonoscopy versus standard colonoscopy as better technical and use less sedation in children. Patients and Methods: A prospective, randomized study, from September 2012 to March 2013. Group A: immersion in water and air insuffl ation. Group B: with insufflation (standard). We evaluated the rate cecal intubation, cecal intubation time, additional sedation, analgesia and tolerability considering the presence of pain. Results: Group A: 10 children, mean age 6.6 years (range: 2-11), 76.92% males. Group B: 13 children, mean age 6.3 years (range: 2-12), 70% male. The most frequent indication was rectal bleeding in both groups. The cecal intubation rate in group A was 80% compared to 61.53% in group B, OR = 2.5 (95% CI = 0.37 to 16.89), The average cecal intubation in group A was 9,18 minutes + 3,51 y en el grupo B 13,97 minutes + 4,88, without significant difference (p = 0.2362). Additional sedation Butylscopolamine bromide administration was required in 1/9 (10%) in group A and in 8/13 (61.53%) in group B, with a significant difference (p = 0.0288), with better tolerability process in group A. Conclusions: technique of water and air insuffl ation on colonoscopy in children was associated with less sedation and better tolerability of the procedure. The application of the technique in a larger group will establish a better time and cecal intubation success.

Experiencia preliminar con insuflacion de dióxido de carbono versus aire en colonoscopia ambulatoria con sedación sin monitoreo de anestesiología / Preliminary experience with carbon dioxide versus air insufflation in outpatient colonoscopies with sedation in absecence of anesthesiology monitoring

Introducción: El dióxido de carbono (CO2) es un gas rápidamente absorbido de la luz intestinal previniendo distensión abdominal, disminuyendo dolor intra y post procedimiento, requerimientos de sedación y duración del procedimiento. Objetivo: Comparar el efecto de la insuflación con CO2 y aire en el tiempo de intubación y extubación colónica, dosis de anestésicos y dolor abdominal en pacientes sedados sin monitoreo anestesiológico. Diseño: Estudio prospectivo, randomizado, hospital terciario (enero-mayo 2013). Pacientes y Métodos: 72 pacientes fueron sometidos a colonoscopia por un endoscopista experto. Pacientes con previa cirugía de colon, mala preparación, colonoscopias terapéuticas (resección y disección) fueron excluídos. 63 pacientes completaron el estudio, insuflación con aire (33) y CO2 (30). Videocolonoscopio Olympus 180 y Bomba CO2 UCR Olympus fueron usados. Tiempo intubación del ciego y extubación colon, dosis de anestésicos y dolor abdominal (post-procedimiento, 30 min y 24 horas) fueron evaluados. Resultados: De los pacientes insuflados con aire 7(21,2%) presentaron dolor inmediatamente post colonoscopia vs 2(6,7%) CO2 (p = 0,198), a los 30 minutos: 4 (12,1%) grupo aire vs 2 (6,7%) CO2 (p = 0,759) y a las 24 horas: 0 (0%) aire vs 2 (6,7%) CO2 (p = 0,431). Intubación cecal 4,5 ± 2,0 minutos grupo aire vs 3,9 ± 2,1 CO2 (p = 0,876) Extubación colon aire vs CO2 (3,9± 3,3 vs 5,7 ± 4,5 min) (p = 0,081). Del grupo aire 14 pacientes (42,2%) tenían cirugía abdominal previa vs 16 (53,3%) CO2 (p = 0,540). En el grupo CO2 se realizó terapéutica endoscópica 20 vs 11 pacientes grupo aire (p = 0,0771) Dosis Propofol 159 ± 40 mg aire vs 153 ± 63 mg CO2 (p = 0,642). Uso analgésicos post procedimiento 7 (21,21%) aire vs 4 (13,33%) CO2 (p = 0,624). Conclusiones: Nuestros resultados demuestran que pareciese ser que el CO2 no beneficia intubación y extubación del colon, reducción del dolor abdominal post procedimiento, dosis de propofol y uso de analgésicos en pacientes sedados sin monitoreo de anestesiología.

Introduction: Carbon dioxide (CO2) gas is rapidly absorbed from the intestinal lumen preventing bloating, reducing intra-and post-procedure pain, sedation requirements and duration of the procedure. Objective: To compare the effect of CO2 and air insufflation at the time of intubation and extubation colonic doses of anesthetic and abdominal pain in patients without monitoring anesthesiologist sedated. Design: Prospective, randomized, tertiary hospital (January- May 2013). Patients and Methods: 72 patients underwent colonoscopy by an experienced endoscopist. Patients with prior colon surgery, poor preparation, therapeutic colonoscopies (resection and dissection) were excluded. 63 patients completed the study, air insufflation (33) and CO2 (30). Videocolonoscopio Olympus 180 and Olympus UCR CO2 pump were used. Blind intubation time extubation colon, anesthetic doses and abdominal pain (post-procedure, 30 min and 24 hours) were evaluated. Results: Of the seven patients insufflated with air (21.2%) had pain immediately post colonoscopy vs 2 (6.7%) CO2 (p = 0.198), 30 minutes: 4 (12.1%) vs. air group 2 (6.7%) CO2 (p = 0.759) and 24 hours: 0 (0%) air vs 2 (6.7%) CO2 (p = 0.431). Cecal intubation group air 4.5 ± 2.0 minutes vs group CO2 3.9 ± 2.1 min(p = 0.876). Extubation colon group air vs group CO2 (3.9 ± 3.3 vs 5.7 ± 4.5 min) (p = 0.081). Group air 14 patients (42.2%) had previous abdominal surgery vs 16 (53.3%) CO2 (p = 0.540). In the CO2 group therapeutic endoscopy was performed 20 air group vs. 11 patients (p = 0.0771). Dose Propofol air 159 ± 40 mg vs. 153 ± 63 mg CO2 (p = 0.642). Use post-procedure pain 7 (21.21%) air vs. 4 (13.33%) CO2 (p = 0.624). Conclusions: Our results demonstrate that seemed to be that the CO2 does not benefi t bowel intubation and extubation, abdominal pain reduction post procedure, dose of propofol and analgesic use in monitoring sedated patients without anesthesia.

Efficacy of Hood-cap Assisted Colonoscopy; Comparison with Conventional Colonoscopy

BACKGROUND/AIMS: A few studies showed that hood-cap assisted colonoscopy (CAC) had improved cecal intubation rate and cecal intubation time but did not help in finding colon polyps in comparison with conventional colonoscopy (CC). However, other studies have shown different results. Therefore, we investigated the efficacy of CAC for the cecal intubation time and polyp detection rate. METHODS: Patients for colonoscopy in Busan St. Mary's Medical Center were enrolled to this randomized controlled trial between July 2010 and September 2010. The evaluated outcomes were polyp detection rate, adenoma detection rate, and cecal intubation time in all patients, in difficult cases (history of previous abdominal or pelvic surgery, obesity, old age), and in the expert and non-expert groups. RESULTS: A total of 260 patients enrolled in this study were randomly allocated to the CAC group (n=130), or CC group (n=130). The overall cecal intubation time was shorter in the CAC group (5.7+/-3.4 min vs. 7.8+/-5.7 min, P<0.001). The polyp detection rate was higher in the CAC group (58.4% vs. 43%, P=0.008). The cecal intubation time in the expert and non-expert groups were shorter in the CAC group (expert: 4.1+/-2.2 min vs. 5.5+/-2.0 min, P=0.001; non-expert: 6.7+/-3.7 min vs. 9.4+/-5.9 min, P=0.001). CONCLUSIONS: The use of CAC improved the detection rate of colon polyps and shortened the cecal intubation time for both the expert and non-expert groups.

Efficacy of Transparent Cap-attached Colonoscopy: Does It Improve the Quality of Colonoscopy?

PURPOSE: Recently, the use of a transparent cap attached to the tip of the colonoscope has been revealed to be helpful in both detecting colorectal polyps and shortening the intubation time to the cecum. The aim of this study was to examine the usefulness of transparent cap-attached colonoscopy (CAC) as compared with conventional colonoscopy (CC) in terms of the technical ease and efficiency. METHODS: Colonoscopies from a total of 228 patients between May and October 2008 were prospectively collected. All colonoscopies were performed by single colorectal surgeon whose experience exceeded 3,000 colonoscopies. Patients were assigned to the CAC group (n=114) or to the CC group (n=114). The cecal intubation rate and time, the polyp detection rate, the adenoma detection rate, the withdrawal time, and the visual analogue scale (VAS) of the patient's pain were compared. RESULTS: There were no significant differences in the age, sex, body mass index, previous history of abdominal operation, diverticulosis, and the degree of bowel preparation between the two groups. The cecal intubation rate was 100% in both groups. The cecal intubation time was significantly shorter in the CAC group than in the CC group overall (5.3+/-4.0 min vs. 7.6+/-4.3 min, P<0.001), as well as for female (6.1+/-2.8 min vs. 9.1+/-4.7 min, P<0.001) patients. There were no statistically significant differences in the total colonoscopy time (13.1+/-6.3 min vs. 14.5+/-5.2 min, P=0.066), the polyp detection rate (38.6% vs. 33.3%, P=0.408), the adenoma detection rate (28.1% vs. 25.4%, P=0.654), and the VAS scale of pain (2.48 vs. 2.74, P=0.353) between the CAC and the CC groups. CONCLUSION: The transparent cap is effective in shortening the cecal intubation time, especially in female patients.

A Comparative Study for Usefulness of a Variable-Stiffness Colonoscope to a Conventional Colonoscope / 대한소화기내시경학회지

BACKGROUND/AIMS: Loop formation during colonoscopy can adversely effect on completion rates, speed of intubation and patient tolerance of the procedure. The ability to vary endoscope shaft flexibility may help insertion to the cecum. The aim was to compare a variable colonoscope with adjustable shaft stiffness to a conventional colonoscope (CC). METHODS: Consecutive patients attending for day case colonoscopy were randomized for examination with either the conventional colonoscope (Olympus CF200Z) or a variable stiffness (VS) colonoscope (CFQ240AL). The time to the cecum, inserted length of scope at cecum, need for abdominal compression, need for rotation of body position and pain scores of patient were analyzed. RESULTS: Of 158 cases, 69 were performed with the CC, and 89 with VS. There was no difference in intubation time between VS (mean 5.15+/-2.61 min) and CC (6.01+/-3.31 min) in experienced group. However, intubation time was quicker with VS than with CC (VS: 8.48+/-5.59, CC: 11.58+/-4.70, p=0.039) and number of loop formation was less with VS (mean 1.20) than with CC (mean 1.84) (p=0.043) in trainee group. There were no significant differences in inserted length of scope at cecum, need for abdominal compression, pain score or need for patient rotation between VS and CC in two groups. CONCLUSIONS: There was no significant difference in cecal intubation time between two groups in experienced group. However, in trainee group, the intubation time was quicker and the number of loop formation were lower in VS group than CC group.