Cimetropium bromide does not improve polyp and adenoma detection during colonoscope withdrawal: A randomized, double-blind, placebo-controlled study.

BACKGROUND: Endoscopic inspection of colonic mucosa is disturbed by colonic folds and peristalsis, which may result in missed polyps. Cimetropium bromide, an antispasmodic agent, inhibits peristalsis and colonic spasms, which may improve polyp detection. The purpose of this randomized, double-blind, placebo-controlled study was to investigate whether cimetropium bromide could improve polyp and adenoma detection in the colorectum and right colon. METHODS: Patients undergoing screening or diagnostic colonoscopy were randomized to receive intravenous cimetropium bromide (5 mg) or placebo after cecal intubation. The primary outcomes were the number of polyps per patient (PPP) and adenomas per patient (APP); secondary outcomes were the polyp detection rate (PDR), adenoma detection rate (ADR), and advanced neoplasm detection rate (ANDR). RESULTS: A total of 181 patients were analyzed; 91 patients received cimetropium bromide and 90 patients received placebo. Cimetropium bromide and placebo groups did not significantly differ in the PPP and APP for the colorectum (1.38 ±â€Š1.58 vs 1.69 ±â€Š2.28, P = .298; 0.96 ±â€Š1.27 vs 1.11 ±â€Š1.89, P = .517, respectively) and right colon (0.70 ±â€Š0.95 vs 0.78 ±â€Š1.21, P = .645; 0.47 ±â€Š0.81 vs 0.51 ±â€Š0.81, P = .757, respectively). Two groups also did not significantly differ in the PDR, ADR, and ANDR for the colorectum and right colon. Furthermore, there were no difference between groups in the PPP, APP, PDR, ADR, and ADNR in a sub-analysis of expert and non-expert endoscopists. CONCLUSIONS: Cimetropium bromide did not improve polyp and adenoma detection in the colorectum and right colon during colonoscope withdrawal, regardless of the expertness of the endoscopist. However, its use may be helpful in patients with active peristalsis or for beginning endoscopists during standard colonoscopy without a transparent cap.

Epidemiologic characteristics of patients with inflammatory bowel disease undergoing colonoscopy.

BACKGROUND: The aim was too describe the demographic characteristics of patients with inflammatory bowel disease (IBD) undergoing colonoscopy. METHODS: The Clinical Outcomes Research Initiative (CORI) maintains a database of endoscopic procedures in diverse clinical practices distributed throughout the US. The data from 2000-2007 were used to analyze the demographic characteristics of patients with Crohn's disease (CD) and ulcerative colitis (UC). RESULTS: During the period 2000-2007, 4631 patients with CD and 6619 patients with UC were compared to a control population of 826,207 patients without IBD. CD and UC patients were significantly (P < 0.0001) younger than controls: 41.7 ± 18.4, 47.3 ± 17.4, 59.2 ± 14.0 years, respectively. CD and UC were less common among nonwhite than white endoscopy patients: odds ratio (OR) = 0.64 (0.58-0.70) for CD and OR = 0.71 (0.66-0.77) for UC. Endoscopy for IBD was only slightly less common among female than male CD patients (0.94, 0.89-1.00), but significantly less common among female than male UC patients (0.72, 0.68-0.75). Compared with community/private practices, relatively more endoscopies were performed among IBD patients in academic institutions: OR = 1.68 (1.56-1.81) for CD and OR = 1.27 (1.19-1.36) for UC. The race-, sex-, and age-adjusted rates of CD and UC were both significantly higher in the northern than southern regions of the US, with a significant correlation of r = 0.89, degrees of freedom = 4, P = 0.017 between the geographic distributions of the two diagnoses. CONCLUSIONS: The endoscopy patterns of IBD patients may be influenced in part by the epidemiology of these two diagnoses, as well as by underlying trends in the utilization of colonoscopy.

Increased utilization of flexible endoscopic methods during colorectal resection over a 3-year period.

INTRODUCTION: Intraoperative endoscopy (IE) is performed during some colorectal resections (CRR) mainly to inspect circular stapled anastomoses (CSA) and to locate small neoplasms. This study's purpose was to determine how often rigid and flexible lower endoscopic methods were used during CRR by one colorectal surgeon over three 1-year periods. METHODS: Data concerning the indication for surgery and IE, type of resection, and the use of rigid and flexible methods were obtained from a prospective database and from hospital charts during Period 1 (P1), 1/1/05 to 12/31/05; P2, 7/1/06 to 6/31/07; and P3, 7/01/07 to 6/30/08. The endoscopic CO2 insufflation device was introduced during P2. The utilization rates (UR) for rigid and flexible methods and the overall UR in each time period were compared. The chi(2) and Fisher exact test were used for analysis. RESULTS: No significant differences were found in overall endoscopy UR between periods (94-109/per period.) A significantly higher flexible UR was noted during P3 (43.1% of all CRR) than during P1 (18.6%, P < .001) or P2 (28.7%, P < .03). There was a concomitant significant drop in the rigid UR during Period 3 (1.8% of all CRR) when compared with P1 (24.5%, P < .001) or P2 (27.7%, P < .001). CONCLUSION: The overall UR did not significantly vary; however, during P3 the flexible UR increased whereas the rigid UR decreased (vs P1, P2; P < .05). The addition of extra endoscopes and an endoscopic CO2 insufflation device to the operating room coincided with increased flexible UR.

Work and resources needed for endoscopic resection of large sessile colorectal polyps.

BACKGROUND & AIMS: Large sessile colon polyps often are referred for surgical resection, even when amenable to endoscopic resection. The aim of this study was to describe the resource use of endoscopic resection of large sessile colon polyps compared with small polyps with respect to physician time and equipment use. METHODS: Retrospectively, procedure time, medication use, and equipment use were recorded for 184 consecutive patients with sessile colorectal polyps 2 cm or larger in size and for 184 consecutive control patients with only sessile polyps less than 2 cm in size or pedunculated polyps. RESULTS: The mean duration of colonoscopy in patients with large sessile colon polyps averaged 51.4 (SD, 25.6) minutes compared with 20.0 (SD, 8.6) minutes for the control group (P < .0001). The large-polyp group required much more equipment to complete the polypectomy (eg, injection catheters and cautery probes) (P < .0001). CONCLUSIONS: Our results indicate that the costs of endoscopic large sessile adenoma resection in physician work and equipment are substantially greater than the costs of resection of small adenomas. These costs may be a deterrent to endoscopic resection of large sessile adenomas and may warrant increased reimbursement for those procedures, particularly if predictions that colonoscopic procedures will become more complex in the future are realized.

Endoscopic shuffling, infection control, and the clinical practice of push enteroscopy.

Failure to identify and diagnose the site and cause of obscure bleeding or some other gastrointestinal disorder may be an indication for push enteroscopy. During this procedure, a long, narrow, flexible gastrointestinal endoscope, known as a push enteroscope, is advanced into the upper gastrointestinal tract to examine and evaluate the proximal section (first one third) of the small bowel. Because of limited funding and inadequate instrument availability, some gastrointestinal endoscopy units may perform this procedure using a colonoscope instead of a push enteroscope. Although not specifically designed for push enteroscopy, colonoscopes are less expensive than push enteroscopes and readily available for clinical use in virtually every gastrointestinal endoscopy unit. The use of a colonoscope or other lower gastrointestinal endoscope to perform push enteroscopy or another upper gastrointestinal procedure (or the use of an upper gastrointestinal endoscope to perform a lower gastrointestinal procedure) is defined in this article as endoscopic shuffling. Although it is arguably efficient and cost effective (and in some instances may improve clinical outcomes), endoscopic shuffling raises a number of economic, legal, medical, and ethical questions and concerns, several of which are discussed in this article, with a particular focus on infection control.

Coloscopy simulation: towards endoscopes improvement.

Minimally invasive surgery progresses have allowed to greatly decrease patient suffering. A way to improve these techniques is to use active tools, which could adapt to the inspected environment. The development of these tools is very complex. So simulation methods can be significantly helpful in order to produce the most suitable tools while limiting the quantity of physical prototypes. We work on the design of a simulator for virtual coloscopy. Besides the virtual prototyping aspect for new active endoscopic devices, we can also use it as a training simulator once the device is designed. To do so, we have to address the simulation process of the colon. This article is mainly devoted to the description of the chosen models for the colon behaviour, which are used for the simulator. Some experimental results are presented which confirm the validity of the different choices. To finish, sigmoid untwisting operation is presented as a benchmark test to prove the efficiency of the simulator.