ABSTRACT
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.
ABSTRACT
Aim and Objective: Colonoscopy is generally considered a painful procedure requiring sedation. Due to the high cost of sedation colonoscopy, coupled with the attendant morbidity and mortality, there is a general trend towards unsedated colonoscopy. The aim of this study was to determine the effect of unsedated colonoscopy on the success of caecal intubation, factors predictive of painful procedure and to compare with results elsewhere. Materials and Methods: Forty one consecutive patients who underwent colonoscopy were recruited into this study. The study was carried out at a privately owned low-volume endoscopy centre: Gilead specialist hospital (GSH), Ado-Ekiti, Nigeria from January 2010 to December 2011. Ethical approval for the study was obtained from the centre’s Research and Ethics Committee and all the patients gave their individual written consent. SPSS version 15.0 (SPSS, Inc., Chicago, Illinois, USA) was deployed for statistical analysis using the t-test for quantitative variables and χ2 test for qualitative variables. Differences were considered to be statistically significant if P value was less than 0.05. Results: The male: female ratio was 1.93:1. The mean age of the studied population was 53.20±9.53 years [age range from 30-71. The indications for colonoscopy were; lower gastrointestinal bleeding (41.5%), abdominal pain or discomfort (19.5%), diarrhea (12.2%), suspected cancer [Patients with history of GI bleeds, weight loss, recurrent diarrhoea and ileus (12.2%), constipation (7.3%) and routine examination (7.3%). Overall, caecal intubation was achieved in 70.7% of cases while in 29.3% caecal intubation was unsuccessful. With on demand analgesia, and exclusion of both cases of obstruction (tumors) and poor bowel preparations, caecal intubation rate rose to 94.3%. Causes of unsuccessful caecal intubation included: abdominal pain or discomfort (33.3%), bowel obstruction (25%), poor bowel preparation (16.7%), anxiety (6.6%) and obesity (8.3%). Colonoscopy findings were haemorrhoids (36.6%), polyps (17.1%), colorectal cancer (14.6%), arteriovenous malformations (7.3%), anal fissure (4.9%), inflammatory bowel disease (2.4%) and normal findings (17.1%). Bowel preparation was adjudged adequate in 80.5% (33/41) of the patients. Female gender and abdominal pain as indication for colonoscopy were found to be predictive for painful colonoscopy (p<0.05). Conclusion: Unsedated colonoscopy with on demand analgesia is advocated in resource poor countries to minimize the direct and indirect costs of colonoscopy. It is also recommended to minimize patient burden in screening and surveillance colonoscopy. Colonoscopists are advised to use the warm water (37°C) method in this setting as against the traditional air insufflations to achieve a high success rate of caecal intubation.
ABSTRACT
A decade ago, failure of cecal intubation due to pain in ~20% of scheduled unsedated patients in the author's veterans practice prompted the search for a less uncomfortable approach. Methods that minimized discomfort or enhance cecal intubation included use of pediatric, variable stiffness, computer-assisted, 3-dimensional magnetic imaging colonoscope, gastroscope, and inhalation of nitrous oxide or insufflation of carbon dioxide; use of hypnosis, music, audio distraction, or simply allowing patients to participate in medication administration. In addition, several water-related techniques (as adjuncts to air insufflation) enhanced speed and success of intubation, reduced discomfort but did not appear to alter the amount of medications used. Because of simplicity, the water-related techniques added to turning off of the air pump were evaluated in a series of trial-and-error modifications. The result was the development of a water infusion in lieu of air insufflation method. Subsequent refinements included suction removal of all residual air to minimize angulations at flexures. Water exchange during insertion was used to suspend and removal feces to clear the luminal view while distention of the colonic lumen was minimize. Observational studies followed by randomized controlled trials confirmed the water method (simplified nomenclature) had significant impacts on discomfort both during and after colonoscopy: reduction of medication requirement; attenuation of insertion-related discomfort, enhancement of cecal intubation, decrease of pain after colonoscopy, increase in reported willingness to repeat unsedated colonoscopy in the patients examined without sedation and reduction of recovery time burden in patients accepting the option of sedation on demand.