Low-cost colonoscopic simulator and colonoscope to train basic skills in colonoscopy during undergraduate studies

Objective: To develop a low-cost simulator model and a colonoscope with materials that are easily accessible to offer training on colonoscopy skills during undergraduate studies. Since this is the procedure of choice for colorectal cancer screening, the general practitioner must be able to recognize its main indications, preparation, and complications. Methods: Using materials such as a mannequin, a vehicle inspection camera, a conduit, polyvinyl chloride (PVC) pipe, acrylic, wood, and red paint, we built a simulator and a 150-cm long and 20-to-25-mm thick colonoscope. The colonoscope's handle and handhold were made of acrylic, the colonoscope's mobile end was made with articulated PVC rings, and the up and down movements were performed according to the traction of the steel cables. The camera attached to its distal end enables connection to a smartphone to view the image. In the simulator, the conduit was inserted into the mannequin to simulate the curvatures of the colon. Red spray paint was used to simulate the staining of the colonic mucosa in the inner region of the mannequin and the adventitial layer in the outer region. Results: We were able to build a simulator and a colonoscope with a total amount of R $ 182.82 (roughly US$ 36.50). Both were tested and proved to be useful in the acquisition of psychomotor and cognitive skills in colonoscopy. Conclusion The simulator and colonoscope developed by us are cost-effective, useful in the acquisition of psychomotor and cognitive skills in colonoscopy, and can facilitate the structuring of a training program for undergraduate students. (AU)

Analysis on clinicopathological features of 617 patients with colorectal cancer / 中国内镜杂志

Objective To summarize the clinicopathological features with 617 cases colorectal cancer and explore reliable clues for early diagnosis. Methods Retrospective analysis of clinical, endoscopic, pathological features and DNA mismatch repair of 617 cases of colorectal cancer was made from January 2008 to March 2017. Results The overall diagnostic yield of colorectal cancer was 2.35% (596/25 308). 18 patients were diagnosed as simultaneous multiple colorectal cancer (3.02%, 18/596). Males and females ratio is 1.34 : 1.00. The average age diagnosed was 66.8 years old. The proportion of colon cancer was 76.68% (457/596), while cancer located in right side of the colon was 39.17%. Occurrence rate of right colonic cancer were higher in female group (47.34%) than that in male group (33.46%) (P = 0.003). Well and moderately differentiated adenocarcinoma was observed in 84.60% (522/617) of the patients. The ratio of mucinous adenocarcinoma was 6.81% (42/617). Totally 230 patients received the DNA mismatch repair, and 57 patients were diagnosed as defective DNA mismatch repair (24.78%). Defective DNA mismatch repair (dMMR) was associated with right colonic cancer, poorly differentiated adenocarcinoma, signet-ring carcinoma and mucinous adenocarcinoma (P < 0.05). Conclusions Colonoscopy screening in the elderly patients deserves great attention. Raise awareness of simultaneous multiple colorectal cancer. Pay attention to the screening of right colon cancer in female. The DNA mismatch repair should be detected in right colonic cancer, poorly differentiated adenocarcinoma, signet-ring carcinoma and mucinous adenocarcinoma.

Combined Use of Single-balloon Enteroscope and Colonoscope for Self-expandable Metal Stent Placement in Patients with Malignant Small Intestinal Obstruction: a Single-center Comparative Clinical Observation / 华中科技大学学报（医学）（英德文版）

Small intestinal obstruction is a common complication of primary gastrointestinal cancer or metastatic cancers.Patients with this condition are often poor candidates for surgical bypasses,and placement of self-expanding metal stent (SEMS) can be technically challenging.In this study,we examined the feasibility of combined application of single-balloon enteroscope (SBE) and colonoscope for SEMS placement in patients with malignant small intestinal obstruction.Thirty-four patients were enrolled in this study,among which 22 patients received SEMS placement by using SBE and colonoscope,while the other 12 patients received conservative medical treatment.The patients were followed up for one year.Stent placernent was technically feasible in 95.5％ (21/22).Clinical improvement was achieved in 86.4％ (19/22).For the 19 clinical success cases,the average time of benefits from a gastric outlet obstruction scoring system (GOOSS) increase ≥1 was 111.9±89.5 days.For the 12 patients receiving conservative medical treatment,no significant improvement in GOOSS score was observed.Moreover,a significant increase of Short-Form-36 health survey score was observed in the 19 patients at time of 30 days after stent placement.By Kaplan-Meier analysis,a significant survival improvement was observed in patients with successful SEMS placement,compared with patients receiving conservative medical treatment.Taken together,combined use of SBE and colonoscope makes endoscopic stent placement feasible in patients with malignant small intestinal obstruction,and patients can benefit from it in terms of prolonged survival and improved quality of life.

Application of simethicone before colonoscope examination / 中国内镜杂志

Objective To explore the application effect of simethicone combined with compound polyethylene glycol electrolyte powder before colonoscope examination. Methods 106 cases underwent colonoscope examination from October 2013 to December 2015 were enrolled in the study. Then all the cases were divided into 2 groups randomly, each with 53 cases. Patients in the control group were treated with simple oral administration of compound polyethylene glycol electrolyte powder, patients in observation group were combined using simethicone and polyethylene glycol electrolyte powder. The preoperative bowel preparation score, lesion detection and the changes of liver and renal function and electrolyte in the two groups were recorded respectively. Results Patients in the observation group were better than the control group in both the bowel preparation score and the detection rate (P < 0.05). There were no obvious adverse reactions in the course of the two groups. Conclusions Simethicone can eliminate intestinal bubbles, and combined use with polyethylene glycol electrolyte powder before colonoscope examination can significantly improve intestinal cleaning effect, improve the colonoscope examination image, enhance the detection rate of lesions.

Clinical analysis of 134 patients with ileocecal disease / 重庆医学

Objective To investigate the clinical characteristics and diagnosis and treatment of ileocecal disease.Methods The general data,clinical manifestations,imaging examinations,colonoscopy and pathological examination and diagnosis of 134 patients in our hospital with ileocecal disease from September 2009 to March 2016 were collected.The clinical characters were summarized by retrospective analysis.Results A total of 134 cases with ileocecal disease were collected,and 36(26.87％)of them were ileocecal cancer,30(22.39％)of them were inflammatory bowel disease,26(19.40％)of them were intestinal tuberculosis.The main clinical manifestations of ileocecal lesion were abdominal pain,abdominal distention,diarrhea,bloody stool,etc.The colonoscopy imaging showed mucosal hyperemia,edema,erosion,ulcer and tumors on the intestinal tract.The benign lesions mainly showed ulcer with mucosal erosion and edema,and the ileocecal cancer showed neoplasm.CT examination was the common imaging method,and 93(69.40％)cases got tested.49 cases had operation,in which 7 cases had misdiagnosed before operation,and the rate of misdiagnosis was 14.28％.Conclusion The ileocecal disease is mainly benign lesions,and the process of diagnosis is complex;the rate of misdiagnosis is a little high.

Development and application of sheet for postural change during painless colonoscopy / 医疗卫生装备

Objective To develop a sheet for postural change during painless colonoscopy.Methods The sheet was made of medical canvas whose body had a size of 110 cm (length) × 80 (width) cm.The body had a waistband at its each side,and the waistband had 5 nylon Velcro at each side to tie it to the patient's waist.There were 6 canvas handles at the back of the body,which were in parallel with the waistband for drawing the patient during postural change.A tearing mechanism with Velcro existed at the hip area to facilitate the hip exposure during colonoscopy.Two shoes covers were at right under the body to hold the feet when the patient bent his knees.Results The sheet significantly shortened operation time,increased working efficiency and protected the patient's privacy when compared with manual operation.Conclusion The sheet gains high safety,convenience and efficiency for postural change during painless colonoscopy,and thus is worthy promoting in the hospitals.

A Randomized Controlled Trial of Comparison on Time and Rate of Cecal and Termianl Ileal Intubation according to Adult-Colonoscope Length: Intermediate versus Long

For a complete colonoscopic examination, a high intubation rate and a short intubation time have been demanded to colonoscopists, if possible. The aim of the present study was to compare these examination parameters, intubation time and rate, according to the length of colonoscope. A total of 507 healthy Korean subjects were randomly assigned into two groups: intermediate length adult-colonoscope (n=254) and long length adult-colonoscope (n=253). There were significant differences in cecal intubation time and in terminal ileal intubation rate according to the length of the colonoscope. Time-to-cecal intubation was shorter for the intermediate-scope group than for the long-scope group (234.2 +/- 115.0 sec vs 280.7 +/- 135.0 sec, P < 0.001). However, the success rate of terminal ileal intubation was higher in the long-scope group than in the intermediate-scope group (95.3% vs 84.3%, P < 0.001). There were no significant differences in other colonoscopic parameters between the two groups. The intermediate length adult-colonoscope decreased the time to reach the cecum, whereas the long-scope showed a success rate of terminal ileal intubation. These findings suggest that it is reasonable to prepare and use these two types of colonoscope appropriate to the needs of the patient and examination, instead of employing only one type of colonoscope.

Focos de criptas aberrantes correlación endoscópico-morfológica con el uso de Endoscopios de alta resolución sin magnificación

Este trabajo tiene como propósito la descripción de los focos de criptas aberrantes utilizando colonoscopio de alta resolución sin magnificación. Los focos de criptas aberrantes se observan como lesiones planas o ligeramente elevadas, con un diámetro entre 1-4 mm, pueden presentar depresión central y con endoscopia de alta resolución, aún sin magnificación es posible ver el patrón de criptas. Usualmente se encuentran en la cercanía de adenomas. Una vez visualizada la lesión se procedió a realizar cromoscopía previa irrigación con 3-5 cc de ácido acético al 0,5 % como agente mucolítico, luego de 30 segundos se irrigó la zona con el colorante: azul de metileno al 0,5% o índigo carmín 0,5-1 %. Se intentó clasificar las lesiones de acuerdo a los criterios establecidos en la literatura para tratar de establecer correlación con el diagnóstico histológico. Se incluyeron 40 pacientes, en 67,5 % de los casos los focos de criptas aberrantes fueron localizados en colon recto-sigmoides. Existió una correlación endoscópica e histológica entre los focos de criptas aberrantes displásica y alta asociación con pólipos.

In our study, we used standard high resolution colonoscope to describe aberrant crypt foci. Aberrant crypt foci are either flat or slightly elevated lesions with a 1 to 4 mm of diameter with central depression. Usually these foci have been close to adenomas. Once the lesion was identified, it was first irrigated with 0.5% of acetic acid to remove mucus from the surface. After 30 seconds it was irrigated again with 0.5 % methylene blue or 0.5 to 1% indigo carmine. We tried to classify the lesion based on the literature criteria and compare it with the histopathology diagnosis. 40 patients were evaluated in this study, 67, 5 % of the aberrant crypt foci were located in rectosigmoid colon. We found direct histopathologic and endoscopic correlation between dysplasic aberrant crypt foci and high association with polyps.

A Case of Bleeding from Proximal Jejunal GIST Diagnosed by Colonoscopy through the Oral Approach / 대한소화기내시경학회지

Gastrointestinal bleeding from small bowel lesions is uncommon but it is the most common cause of obscure gastrointestinal bleeding that can go undiagnosed using traditional upper endoscopy and colonoscopy. Recently, various new methods, including wireless capsule endoscopy and double-balloon enteroscopy have been used to detect and manage small bowel lesions. A 51-year-old man was admitted with hematochezia. The source of bleeding could not be identified using conventional upper endoscopy and colonoscopy. Wireless capsule endoscopy revealed a mass-like lesion with active blood spurting in the proximal jejunum. Finally, a tumor with central ulceration was detected at the proximal jejunum using a clean colonoscope through the oral approach. This lesion was surgically resected, and the histology findings were consistent with a gastrointestinal stromal tumor. We report a case of gastrointestinal bleeding from a proximal jejunal GIST diagnosed by clean colonoscopy through the oral approach with a review of the relevant literature.

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.