ABSTRACT
BACKGROUND AND PURPOSE: The time required for a colonoscopy must be justified under economic aspects. The objective of this study was to analyze patient- and staff-related factors influencing the time for cecal and ileal intubation. PATIENTS AND METHODS: A prospective study was performed on 500 consecutive patients undergoing colonoscopy in 2005. The authors analyzed patient age, gender, height, weight, surgical history, the presence of liver cirrhosis and splenomegaly, the number of children given birth, the presence of colorectal cancer and inflammatory bowel disease, the quality of bowel preparation, sedation, and the experience of the attending colonoscopist, the nurse and the team as factors of possible relevance to cecal and ileal intubation time. RESULTS: The cecum was reached in 495/500 examinations (99%). Intubation of terminal ileum was possible in 477/500 patients (96%). Mean cecal and ileal intubation times were 10.5+/-10.2 min and 6.4+/-7.9 min, respectively. Time to cecal intubation was related to the experience of the endoscopist (p=0.009), the nurse (p=0.04) and the whole team (p=0.002), as well as to an adequate cleaning of the bowel (p=0.01). CONCLUSION: A short intubation time requires experienced staff in combination with an adequate cleaning of the bowel without reference to biological or pathologic factors except for colon-shortening surgery. The gain in examination quality by inspecting the terminal ileum comes to the cost of a prolongation of insertion time of 25-30% in experienced hands.
Subject(s)
Cecal Diseases/diagnosis , Colonic Diseases/diagnosis , Colonoscopy/statistics & numerical data , Ileal Diseases/diagnosis , Time and Motion Studies , Adolescent , Adult , Aged , Aged, 80 and over , Cathartics , Cecal Diseases/surgery , Clinical Competence , Colonic Diseases/surgery , Colorectal Neoplasms/diagnosis , Colorectal Neoplasms/surgery , Efficiency , Female , Gastrointestinal Hemorrhage/etiology , Humans , Ileal Diseases/surgery , Male , Middle Aged , Young AdultABSTRACT
BACKGROUND & AIMS: Crohn's disease (CD) and ulcerative colitis (UC) are associated with chronic tissue damage and continuous tissue repair. A central, but not well-characterized, event during this process is the migration of activated fibroblasts to the wound. METHODS: Human colonic lamina propria fibroblasts (CLPF) were isolated from patients with CD and UC and from healthy controls and were characterized by immunocytochemistry. Migration assays of CLPF were performed in the modified 48-well Boyden chamber. Focal adhesion kinase (FAK) and FAK autophosphorylation in migrating CLPF were determined by Western blotting. FAK mRNA expression was investigated by Northern blotting. RESULTS: The migration of CD-CLPF and UC-CLPF was significantly reduced when compared with control-CLPF. This was correlated with a decrease in FAK phosphorylation, whereas, in migrating control-CLPF, an increase was found. Similarly, the presence of the inflammatory mediators interferon (IFN)-gamma (50 ng/mL) or tumor necrosis factor (TNF) (30 ng/mL) in conditioned medium significantly reduced the migration of control-CLPF to 41% +/- 4% or 30% +/- 7%, respectively. Preincubation of control-CLPF with TNF (20 ng/mL) and IFN-gamma (10 ng/mL) for 3 days reduced their migratory response to 10% of control (P < 0.001), which also was correlated with a decrease in FAK phosphorylation. Culture of IFN-gamma/TNF-treated CLPF for a further 7 days without cytokines did not restore the migratory potential and FAK phosphorylation, indicating a persistent functional change. CONCLUSIONS: CD- and UC-CLPF have a reduced migratory potential compared with normal CLPF. That may be caused by contact with IFN-gamma and TNF. This loss of migratory potential was correlated with diminished FAK phosphorylation.
