AIM It is well known that colonoscopy can bedifficult due to abdominal pain induced duringcolonoscope insertion,if sedative agents are notgiven.Recently,an extra-flexible,small-diameter colonoscope(CF-SV,Olympus Inc.,...AIM It is well known that colonoscopy can bedifficult due to abdominal pain induced duringcolonoscope insertion,if sedative agents are notgiven.Recently,an extra-flexible,small-diameter colonoscope(CF-SV,Olympus Inc.,Japan)was developed in order to improve safetyand comfort.The aim of this study was toaccess the usefulness of the CF-SV.METHODS One hundred patients undergoingsigmoidoscopy were recruited and colonoscopywas performed by one experiencedcolonoscopist.First,a routine-type colonoscope(CF-2301)was inserted into the colon withoutsedation.When the patient complained ofabdominal pain(even if mild),the scope wasnot advanced further and was withdrawn afterthe anatomic location of its tip was determinedfluoroscopically.Then,the CF-SV was inserteduntil it reached the cecun or the site whereabdominal pain occurred.Previous abdominalsurgery and abdominal disease were consideredas unfavorable factors(UF)and the relationshipbetween abdominal pain and UF,age and genderwere investigated.Furthermore,the colonicinsertion pressures in 36 patients with abdominalpain were measured with a force gauge.RESULTS Thirty-four cases(34%)felt no painwith the CF-2301 and successful pancolon-0scopies to the cecum were performed.Sixty-six cases(66%)complained of abdominal pain.The procedure was painless for 47% of men and24% of women,respectively.The CF-2301 scopefailed to reach the sigmoid-descending colon junctions in 59(89.4%)of the 66 patientscomplaining of abdominal pain.However,CF-SVreached proximal area in 94.9% of those whofailed with CF-2301.The median pressure forpain-inducing was 700 g/cm^2.CONCLUSION Unsedated patients with UFwere prone to complain of pain when thestandard-type CF-2301 scope was used.Thenewly developed extra-flexible CF-SV is usefulfor the aged and for those with UF or being proneto suffer from abdominal pain.Sedative agentsmay be unnecessary if this new type ofcolonoscope is used.展开更多
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-expan...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 placement 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.展开更多
BACKGROUND Recently,with the advent of more advanced devices and endoscopic techniques,endoscopic retrograde cholangiopancreatography(ERCP)in Billroth II(B-II)patients has been increasingly performed.However,the proce...BACKGROUND Recently,with the advent of more advanced devices and endoscopic techniques,endoscopic retrograde cholangiopancreatography(ERCP)in Billroth II(B-II)patients has been increasingly performed.However,the procedures are difficult,and the techniques and strategies have not been defined.AIM To reveal the appropriate scope for ERCP in B-II patients.METHODS Sixty ERCP procedures were performed on B-II patients between June 2005 and May 2018 at Fukushima Medical University Hospital,and in 44 cases,this was the first ERCP procedure performed by esophagogastroduodenoscopy(EGDS)or colonoscopy(CS)after B-II gastrectomy.These cases were divided into two groups:17 cases of ERCP performed by EGDS(EGDS group)and 27 cases of ERCP performed by CS(CS group).The patient characteristics and ERCP procedures were compared between the EGDS and CS groups.RESULTS The procedural time was significantly shorter in the EGDS group than in the CS group[median(range):60(20-100)vs 90(40-128)min,P value<0.01].CS was an independent factor of a longer ERCP procedural time according to the univariate and multivariate analyses(odds ratio:3.97,95%CI:1.05-15.0,P value=0.04).CONCLUSION Compared to CS,EGDS shortened the procedural time of ERCP in B-II patients.展开更多
The paper deals with active drive system for colonoscope. The system is mainly composed of soft mobile mechanism for earthworm locomotion and turning mechanism based on shape memory effect. The soft mobile mechanism c...The paper deals with active drive system for colonoscope. The system is mainly composed of soft mobile mechanism for earthworm locomotion and turning mechanism based on shape memory effect. The soft mobile mechanism contacts colon wall with air in inflatable balloons, so the robot has better soft and non invasive properties. The turning mechanism can be actively bent by shape memory alloy components. It ensures the colonoscope to adapt to the tortuous shape of colon. Some experiment results are given in the paper.展开更多
Colonoscopy sometimes causes pain during insertion,especially in difficult cases.Over-insufflation of air causes elongation or acute angulations of the colon,making passage of the scope difficult and causing pain.We p...Colonoscopy sometimes causes pain during insertion,especially in difficult cases.Over-insufflation of air causes elongation or acute angulations of the colon,making passage of the scope difficult and causing pain.We previously reported a sedative-risk-free colonoscopy insertion technique,namely,"Water Navigation Colonoscopy".Complete air suction after water infusion not only improves the vision,but also makes water flow down to the descending colon,while the sigmoid colon collapses and shortens.While non-sedative colonoscopy can be carried out without pain in most cases,some patients do complain of pain.Most of these patients have abnormal colon morphology,and the pain is caused while negotiating the "hairpin" bends of the colon.The "hairpin" bends of the colon should be negotiated by gently pushing the full-angled colonoscope.The proximal 10-20 cm from the angulated part of the conventional colonoscope is stiff,with a wide turning radius,therefore,a conventional colonoscope cannot be negotiated through the "hairpin" bends of the colon without stretching them and causing pain.The "passive-bending colonoscope" has a flexible tip with a narrow turning radius,so that the scope can be negotiated through the "hairpin" bends of the colon with a minimum turning radius and minimal discomfort.Therefore,the intubation and pain-reducing performance of the "passive-bending colonoscope" was assessed in difficult cases.展开更多
Background High success rate of intubation and short intubation time have been needed to endoscopists for a complete and comfortable coolonoscopy,if possible.The purpose of present study was to compare procedure effic...Background High success rate of intubation and short intubation time have been needed to endoscopists for a complete and comfortable coolonoscopy,if possible.The purpose of present study was to compare procedure efficiencies according to adult-colonoscope length.Methods This was a prospective,randomized,single-blinded controlled trial.A total of 239 healthy Korean subjects were randomly assigned to two groups：one group receiving intermediate-length adult-colonoscope （n=119）,and the other group receiving long-length adult-colonoscope （n=120）.Cecal intubation time and rate,and terminal ileal intubation time and rate as well as other procedure-related outcomes （adenoma detection rate,withdrawal time,and total procedure time） were evaluated.Results There were significant differences in cecal intubation time and terminal ileal intubation rate according to colonoscope length.The time of cecal intubation was shorter in the intermediate-scope group than that in the long-scope group （（222.13±101.67） s vs.（253.85±109.40） s,P=-0.014）.However,the rate of terminal ileal intubation was higher in the long-scope group than that in the intermediate-scope group （94.2％ vs.83.2％,P=-0.007）.In addition,terminal ileal intubation time was also shorter in the long-scope group than that in the intermediate-scope group （（35.21±38.89） s vs.（44.09±33.87） s,P ＜0.001）.There were no significant differences in other procedure-related outcomes between the two groups.Conclusions The intermediate-length adult-colonoscope had an advantage over the long-length adult-colonoscope regarding cecal intubation time,whereas the long-scope had an advantage over the intermediate-scope regarding the rate and time of terminal ileal intubation.These results suggest that it is rational to prepare and use these two types of colonoscope properly,instead of employing only one type of colonoscope.展开更多
BACKGROUND Bacterial contamination during colonoscopy is a significant concern,yet few studies have evaluated bacterial aerosols.This study aimed to determine whether covering the biopsy hole check valve with enzymoly...BACKGROUND Bacterial contamination during colonoscopy is a significant concern,yet few studies have evaluated bacterial aerosols.This study aimed to determine whether covering the biopsy hole check valve with enzymolysis gauze(refers to sterile gauze soaked in a multi-enzyme cleaning solution)reduces bacterial air pollution in endoscopy rooms.AIM To evaluate the efficacy of an enzymolysis gauze cover in reducing bacterial aerosols from the biopsy valve.METHODS This prospective,single-blind trial included 80 patients undergoing elective diagnostic colonoscopy.During the procedure,the biopsy hole check valve was either covered or left uncovered with enzymolysis gauze.Air samples(100 L)were collected at a distance of 30 cm from the biopsy hole check valve and approximately 140 cm above the floor using a percussive air sampling instrument.Gram-positive bacteria were cultured on standard 90 mm colimycin nalidixic agar blood plates.The primary outcome measures were bacterial load and species identification.RESULTS Covering the biopsy hole check valve with enzymolysis gauze reduced bacterial load near the check valve from 50 colony-forming unit(CFU)/m^(3)[interquartile range(IQR):30-80]to 20 CFU/m^(3)(IQR:10-20).At the end of the procedure each day,covering the valve also decreased bacterial load in the endoscopy room from 35 CFU/m^(3)(IQR:33-85)to 10 CFU/m^(3)(IQR:5-10).The predominant bacteria identified were Gram-positive cocci.CONCLUSION Applying enzymolysis gauze to cover the biopsy hole check valve significantly reduces bacterial aerosol contamination in endoscopy rooms during colonoscopy.展开更多
The advancement in endoscopic technology and techniques has increased its use in the diagnosis and treatment of gastrointestinal diseases.Reprocessing of reusable endoscopes remains a challenge.Inadequate reprocessing...The advancement in endoscopic technology and techniques has increased its use in the diagnosis and treatment of gastrointestinal diseases.Reprocessing of reusable endoscopes remains a challenge.Inadequate reprocessing leads to bacterial contamination of the endoscope,a significant cause of endoscope-related infections.To thoroughly address the complexities of cleaning a flexible endo-scope,various cleaning methods have been devised and tested across different studies.This letter evaluates one such method,spray flushing for flexible gastro-scopes,developed and tested in a randomized controlled trial by Du et al.Based on the post-processing test results for this method,Du et al conclude that there is improved cleaning efficacy and reduced damage compared to manual brush cleaning.The validity and reliability of the results could be further enhanced by carefully considering the study design and a few underlying concepts that contribute to the reprocessing quality of different types of endoscopes.展开更多
BACKGROUND Colonoscopic polypectomy is a crucial procedure for the prevention and treatment of colorectal cancer,with its success and safety largely dependent on the quality of bowel preparation.Currently,polyethylene...BACKGROUND Colonoscopic polypectomy is a crucial procedure for the prevention and treatment of colorectal cancer,with its success and safety largely dependent on the quality of bowel preparation.Currently,polyethylene glycol electrolyte solution remains the standard method for bowel preparation,but its use may cause patient discomfort and incomplete cleansing.AIM To evaluate impact of enhanced and conventional bowel preparation protocols on the outcomes of colonoscopic polypectomy.METHODS This retrospective cohort study collected data from 130 patients who underwent colonoscopic polypectomy between March 2023 and June 2024.Patients were divided into the conventional bowel preparation group(n=65)and enhanced bowel preparation group(n=65).Primary outcome measures included Boston Bowel Preparation Scale(BBPS)scores,procedure-related parameters,complication rates,and prognosis.Statistical analysis was performed using SPSS version 25.0,with P<0.05 indicating statistical significance.RESULTS The enhanced group demonstrated significant advantages over the conventional group,with higher BBPS total scores(4.2±0.7 vs 3.1±0.8,P<0.001),higher onetime complete resection rates(95.4%vs 83.1%,P=0.01),shorter operative times(23.1±4.8 vs 25.4±5.2 min,P=0.03),and lesser intraoperative blood loss(18.2±4.5 vs 20.3±5.1 mL,P=0.04).Total complication rates were significantly lower(5.9%vs 16.9%,P=0.05),particularly for bleeding(1.5%vs 16.9%,P=0.01)and infection(1.5%vs 7.7%,P=0.04).The enhanced group also showed lower 6-month recurrence rates(3.1%vs 10.8%,P=0.05)and higher patient satisfaction(87.7%vs 76.9%,P=0.04)than did the conventional group.CONCLUSION The enhanced bowel preparation protocol demonstrates significant advantages,particularly in improving surgical outcomes,reducing complications,and increasing patient satisfaction,underscoring its importance of its application during colonoscopic polypectomy.展开更多
BACKGROUND Acute colonic pseudo-obstruction(ACPO)is defined as colonic obstruction without a mechanical or extrinsic inflammatory factor.Colonic decompression is advised for patients with ACPO after the failure of con...BACKGROUND Acute colonic pseudo-obstruction(ACPO)is defined as colonic obstruction without a mechanical or extrinsic inflammatory factor.Colonic decompression is advised for patients with ACPO after the failure of conservative and medical management.AIM To systematically review and analyze the efficacy and safety of colonoscopic decompression in ACPO.METHODS A search was conducted in MEDLINE,EMBASE,and Scopus from inception to August 2024.Studies reporting the clinical success,perforation,recurrence,and need for surgery after colonoscopic decompression in ACPO were included.A random-effects inverse-variance model was used to calculate the pooled proportion.RESULTS Sixteen studies were included in the final analysis.The pooled rates of success after the first session of colonoscopic decompression and overall success were 78.8%(95%CI:72.0-85.6)and 91.5%(95%CI:87.0-96.0),respectively.The first session of colonoscopic decompression had a significantly higher success than the first dose of neostigmine with OR 3.85(95%CI:2.00-7.42).The pooled incidence of perforation was 0.9%(95%CI:0.0-2.0),while recurrence was observed in 17.1%(95%CI:12.9-21.3)of the patients after clinical success.The pooled rates of surgery in all cases undergoing colonoscopic decompression and those who had a successful procedure were 10.5%(95%CI:5.0-15.9)and 3.7%(95%CI:0.3-7.1),respectively.Subgroup analysis,excluding the low-quality studies,did not significantly change the event rates.CONCLUSION Colonoscopic decompression for ACPO is associated with a clinical success rate of>90%with a perforation rate of<1%,demonstrating high efficacy and safety.展开更多
BACKGROUND Rectal foreign bodies,though uncommon,present diagnostic and therapeutic challenges,particularly when they result from accidental ingestion.The non-specific symptoms and the potential for serious complicati...BACKGROUND Rectal foreign bodies,though uncommon,present diagnostic and therapeutic challenges,particularly when they result from accidental ingestion.The non-specific symptoms and the potential for serious complications necessitate a thorough and methodical approach to diagnosis and treatment.This case report aims to highlight the diagnostic complexities and management strategies involved in treating a patient with a rectal foreign body,focusing on the use of advanced imaging techniques and the importance of a multidisciplinary approach.CASE SUMMARY A 48-year-old male with a history of hypertension presented with a one-year history of post-defecation anorectal pain and mild post-defecation rectorrhagia.Initial evaluation revealed hemodynamic stability and a tender,non-mucosal lesion in the anterior left rectal region.Imaging studies,including colonoscopy,magnetic resonance imaging,and endosonography,identified an erythematous,exophytic lesion and a perirectal abscess containing a foreign body.Surgical inter-vention revealed necrotic tissue and purulent material,along with two solid foreign body fragments(bone or plant matter).Postoperative follow-up showed the patient in good condition,and pathology confirmed the fragments as mature bone.CONCLUSION This case underscores the diagnostic challenges posed by rectal foreign bodies with nonspecific symptoms and no clear history of ingestion.展开更多
AIM:To assess the theoretical advantages of magnetic endoscope imaging(MEI)over standard colonoscopies(SCs)and to compare their efficacies.METHODS:Electronic databases,including PubMed,EMBASE,the Cochrane library and ...AIM:To assess the theoretical advantages of magnetic endoscope imaging(MEI)over standard colonoscopies(SCs)and to compare their efficacies.METHODS:Electronic databases,including PubMed,EMBASE,the Cochrane library and the Science Citation Index,were searched to retrieve relevant trials.In addition,abstracts from papers presented at professional meetings and the reference lists of retrieved articles were reviewed to identify additional studies.The metaanalyses were performed using RevMan 5.1.A random effect model with the Mantel-Haenszel method was used for pooling dichotomous and continuous data.A sensitivity analysis was performed by excluding the trials with a small number of patients and by excluding the trials performed by inexperienced providers.RESULTS:Eight randomized controlled trials(RCTs),including 2967 patients,were included in the metaanalysis to compare cecal intubation rates and times,sedation dose,abdominal pain scores and the use of ancillary maneuvers between MEI and SC.The overall OR was 1.92(95%CI:1.13-3.27,eight RCTs),as indicated by the cecal intubation rate of MEI compared with SC,but MEI did not have any distinct advantage over SC for cecal intubation time(MD=-0.07,95%CI:-0.16-0.02;three RCTs).MEI did not generally result in lower pain scores.Outcomes were also analyzed for the two subgroups based on the endoscopists’experience level to evaluate cecal intubation rates.MEI presented better outcomes for non-experienced colonoscopists than experienced colonoscopists.CONCLUSION:The real-time magnetic imaging system is of benefit in training and educating inexperienced endoscopists and improves the cecal intubation rate for experienced and inexperienced endoscopists.展开更多
AIM: To investigate when and why a colonoscopist should discontinue incomplete colonoscopy by himself.METHODS: In this cross-sectional study, 517 difficult colonoscope insertions(Grade C, Kudo's difficulty classif...AIM: To investigate when and why a colonoscopist should discontinue incomplete colonoscopy by himself.METHODS: In this cross-sectional study, 517 difficult colonoscope insertions(Grade C, Kudo's difficulty classification) screened from 37800 colonoscopy insertions were collected from April 2004 to June 2014 by three 4th-level(Kudo's classification) colonoscopists. The following common factors for the incomplete insertion were excluded: structural obstruction of the colon or rectum, insufficient colon cleansing, discontinuation due to patient's discomfort or pain, severe colon disease with a perforation risk(e.g., severe ischemic colonopathy). All the excluded patients were re-scheduled if permission was obtained from the patients whose intubation had failed. If the repeat intubations were still a failure because of the difficult operative techniques, those patients were also included in this study. The patient's age, sex, anesthesia and colonoscope type were recorded before colonoscopy. During the colonoscopic examination, the influencing factors of fixation, tortuosity, laxity and redundancy of the colon were assessed, and the insertion time(> 10 min or ≤ 10 min) were registered. The insertion time was analyzed by t-test, and other factors were analyzed by univariate and multivariate logistic regression.RESULTS: Three hundred and twenty-two(62.3%) of the 517 insertions were complete in the colonoscope insertion into the ileocecum, but 195(37.7%) failed in the insertion. Fixation, tortuosity, laxity or redundancy occurred during the colonoscopic examination. Multivariate logistic regression analysis revealed that fixation(OR = 0.06, 95%CI: 0.03-0.16, P < 0.001) and tortuosity(OR = 0.04, 95%CI: 0.02-0.08, P < 0.001) were significantly related to the insertion into the ileocecum in the left hemicolon; multivariate logistic regression analysis also revealed that fixation(OR = 0.16, 95%CI: 0.06-0.39, P < 0.001), tortuosity(OR0.23, 95%CI: 0.13-0.43, P < 0.001), redundancy(OR = 0.12, 95%CI: 0.05-0.26, P < 0.001) and sex(OR = 0.35, 95%CI: 0.20-0.63, P < 0.001) were significantly related to the insertion into the ileocecum in the right hemicolon. Prolonged insertion time(> 10 min) was an unfavorable factor for the insertion into the ileocecum.CONCLUSION: Colonoscopy should be discontinued if freedom of the colonoscope body's insertion and rotation is completely lost, and the insertion time is prolonged over 30 min.展开更多
Despite recent advances in medicine,colorectal cancer (CRC)remains one of the greatest hazards for public health worldwide and especially the industrialized world.It has been well documented with concrete data that re...Despite recent advances in medicine,colorectal cancer (CRC)remains one of the greatest hazards for public health worldwide and especially the industrialized world.It has been well documented with concrete data that regular screening colonoscopy aimed at early detection of precancerous polyps can help decrease the incidence of CRC.However,the adherence of the general population to such screening programs has been shown to be lower than that expected,thus allowing CRC to remain a major threat for public health.Various reasons have been suggested to explain the disappointing compliance of the population to CRC screening programs,some of them associated with colonoscopy per se,which is viewed by many people as an unpleasant examination.Governments,medical societies,individual gastroenterologists,as well as the medical industry are working in order to improve endoscopic devices and/or to improve standard colo-noscopy.The aim is to improve the acceptance of the population for this method of CRC screening,by providing a painless and reliable examination of the colon.This review focuses on some of the latest improve-me-nts in this fie-ld.展开更多
AIM: To evaluate the full-spectrum endoscopy(FUSE) colonoscopy system as the first report on the utility thereof in a Korean population.METHODS: We explored the efficacy of the FUSE colonoscopy in a retrospective, sin...AIM: To evaluate the full-spectrum endoscopy(FUSE) colonoscopy system as the first report on the utility thereof in a Korean population.METHODS: We explored the efficacy of the FUSE colonoscopy in a retrospective, single-center feasibility study performed between February 1 and July 20, 2015. A total of 262 subjects(age range: 22-80) underwent the FUSE colonoscopy for colorectal cancer screening, polyp surveillance, or diagnostic evaluation. The cecal intubation success rate, the polyp detection rate(PDR), the adenoma detection rate(ADR), and the diverticulum detection rate(DDR), were calculated. Also, the success rates of therapeutic interventions were evaluated with biopsy confirmation.RESULTS: All patients completed the study and the success rates of cecal and terminal ileal intubation were 100% with the FUSE colonoscope; we found 313 polyps in 142 patients and 173 adenomas in 95. The overall PDR, ADR and DDR were 54.2%, 36.3%, and 25.2%, respectively, and were higher in males, and increased with age. The endoscopists and nurses involved considered that the full-spectrum colonoscope improved navigation and orientation within the colon.No colonoscopy was aborted because of colonoscope malfunction.CONCLUSION: The FUSE colonoscopy yielded a higher PDR, ADR, DDR than did traditional colonoscopy, without therapeutic failure or complications, showing feasible, effective, and safe in this first Korean trial.展开更多
The moving principle of a colonoscopic robot is presented in this paper. The robot mainly consists of soft mobile mechanism for earthworm locomotion and turning mechanism based on shape memory effect. The soft mobile ...The moving principle of a colonoscopic robot is presented in this paper. The robot mainly consists of soft mobile mechanism for earthworm locomotion and turning mechanism based on shape memory effect. The soft mobile mechanism contacts colon wall with air in inflatable balloons, so the robot has better soft and non invasive properties. The turning mechanism can be actively bent by shape memory alloy components. It ensures the robot to adapt to the tortuous shape of colon. Therefore, the colonoscopic robot has good safety, lower working strength of surgeon and higher efficiency of colonooscopy.展开更多
Colonoscopy is the gold standard for colorectal cancer prevention; however, it is still an imperfect modality. Precancerous lesions can be lost during screening examinations, thus increasing the risk of interval cance...Colonoscopy is the gold standard for colorectal cancer prevention; however, it is still an imperfect modality. Precancerous lesions can be lost during screening examinations, thus increasing the risk of interval cancer. A variety of factors either patient-, or endoscopist dependent or even the procedure itself may contribute to loss of lesions. Sophisticated modalities including advanced technology endoscopes and add-on devices have been developed in an effort to eliminate colonoscopy's drawbacks and maximize its ability to detect potentially culprit polyps. Novel colonoscopes aim to widen the field of view. They incorporate more than one cameras enabling simultaneous image transmission. In that way the field of view can expand up to 330°. On the other hand a plethora of add-on devices attachable on the standard colonoscope promise to detect lesions in the proximal aspect of colonic folds either by offering a retrograde view of the lumen or by straightening the haustral folds during withdrawal. In this minireview we discuss how these recent advances affect colonoscopy performance by improving its quality indicators(cecal intubation rate, adenoma detection rate) and other metrics(polyp detection rate, adenomas per colonoscopy, polyp/adenoma miss rate) associated with examination's outcomes.展开更多
This review discusses the incidence,risk factors,management and outcome of colonoscopic perforation(CP).The incidence of CP ranges from 0.016% to 0.2% following diagnostic colonoscopies and could be up to 5% following...This review discusses the incidence,risk factors,management and outcome of colonoscopic perforation(CP).The incidence of CP ranges from 0.016% to 0.2% following diagnostic colonoscopies and could be up to 5% following some colonoscopic interventions.The perforations are frequently related to therapeutic colonoscopies and are associated with patients of advanced age or with multiple comorbidities.Management of CP is mainly based on patients' clinical grounds and their underlying colorectal diseases.Current therapeutic approaches include conservative management(bowel rest plus the administration of broadspectrum antibiotics),endoscopic management,and operative management(open or laparoscopic approach).The applications of each treatment are discussed.Overall outcomes of patients with CP are also addressed.展开更多
AIM: To assess the incidence and risk factors associated with colonic perforation due to colonoscopy. METHODS: This was a retrospective cross-sectional study. Patients were retrospectively eligible for inclusion if th...AIM: To assess the incidence and risk factors associated with colonic perforation due to colonoscopy. METHODS: This was a retrospective cross-sectional study. Patients were retrospectively eligible for inclusion if they were 18 years and older and had an inpatient or outpatient colonoscopy procedure code in any facility within the Geisinger Health System during the period from January 1, 2002 to August 25, 2010. Data are presented as median and inter-quartile range, for continuous variables, and as frequency and percentage for categorical variables. Baseline comparisons across those with and without a perforation were made using the two-sample t -test and Pearson's χ2 test, as appropriate.RESULTS: A total of 50 perforations were diagnosed out of 80118 colonoscopies, which corresponded to an incidence of 0.06% (95%CI: 0.05-0.08) or a rate of 6.2 per 10000 colonoscopies. All possible risk factors associated with colonic perforation with a P -value < 0.1 were checked for inclusion in a multivariable logbinomial regression model predicting 7-d colonic perforation. The final model resulted in the following risk factors which were significantly associated with risk of colonic perforation: age, gender, body mass index, albumin level, intensive care unit (ICU) patients, inpatient setting, and abdominal pain and Crohn's disease as indications for colonoscopy. CONCLUSION: The cumulative 7 d incidence of colonic perforation in this cohort was 0.06%. Advanced age and female gender were significantly more likely to have perforation. Increasing albumin and BMI resulted in decreased risk of colonic perforation. Having a colonoscopy indication of abdominal pain or Crohn's disease resulted in a higher risk of colonic perforation. Colonoscopies performed in inpatients and particularly the ICU setting had substantially greater odds of perforation. Biopsy and polypectomy did not increase the risk of perforation and only three perforations occurred with screening colonoscopy.展开更多
AIM:To evaluate and compare the clinical outcomes of prophylactic submucosal saline-epinephrine injection and saline injection alone for large colon polyps by conventional polypectomy. METHODS:A prospective study was ...AIM:To evaluate and compare the clinical outcomes of prophylactic submucosal saline-epinephrine injection and saline injection alone for large colon polyps by conventional polypectomy. METHODS:A prospective study was conducted from July 2003 to July 2004 at 11 tertiary endoscopic centers. Large colon polyps (> 10 mm in diameter) wererandomized to undergo endoscopic polypectomy with submucosal saline-epinephrine injection (epinephrine group) or normal saline injection (saline group). Endoscopic polypectomy was performed by the conventional snare method,and early (< 12 h) and late bleeding complications (12 h-30 d) were observed. RESULTS:A total of 561 polyps in 486 patients were resected by endoscopic polypectomy. Overall,bleeding complications occurred in 7.6% (37/486) of the patients,including 4.9% (12/244) in the epinephrine group,and 10.3% (25/242) in the saline group. Early and late postpolypectomy bleeding (PPB) occurred in 6.6% (32/486) and 1% (5/486) of the patients,respectively,including 4.5% (11/244),0.4% (1/244) in the epinephrine group,and 8.7% (21/242),1.7% (4/242) in the saline group. No significant differences in the rates of overall,early and late PPB were observed between the 2 groups. Multivariate stepwise logistic regression analysis revealed that large size (> 2 cm) and neoplastic polyps were independently and significantly associated with the presence of PPB. CONCLUSION:The prophylactic submucosal injection of diluted epinephrine does not appear to provide an additional advantage over the saline injection alone for the prevention of PPB.展开更多
基金Sasagawa Medical Scholarship Foundation(from 1999-2000)
文摘AIM It is well known that colonoscopy can bedifficult due to abdominal pain induced duringcolonoscope insertion,if sedative agents are notgiven.Recently,an extra-flexible,small-diameter colonoscope(CF-SV,Olympus Inc.,Japan)was developed in order to improve safetyand comfort.The aim of this study was toaccess the usefulness of the CF-SV.METHODS One hundred patients undergoingsigmoidoscopy were recruited and colonoscopywas performed by one experiencedcolonoscopist.First,a routine-type colonoscope(CF-2301)was inserted into the colon withoutsedation.When the patient complained ofabdominal pain(even if mild),the scope wasnot advanced further and was withdrawn afterthe anatomic location of its tip was determinedfluoroscopically.Then,the CF-SV was inserteduntil it reached the cecun or the site whereabdominal pain occurred.Previous abdominalsurgery and abdominal disease were consideredas unfavorable factors(UF)and the relationshipbetween abdominal pain and UF,age and genderwere investigated.Furthermore,the colonicinsertion pressures in 36 patients with abdominalpain were measured with a force gauge.RESULTS Thirty-four cases(34%)felt no painwith the CF-2301 and successful pancolon-0scopies to the cecum were performed.Sixty-six cases(66%)complained of abdominal pain.The procedure was painless for 47% of men and24% of women,respectively.The CF-2301 scopefailed to reach the sigmoid-descending colon junctions in 59(89.4%)of the 66 patientscomplaining of abdominal pain.However,CF-SVreached proximal area in 94.9% of those whofailed with CF-2301.The median pressure forpain-inducing was 700 g/cm^2.CONCLUSION Unsedated patients with UFwere prone to complain of pain when thestandard-type CF-2301 scope was used.Thenewly developed extra-flexible CF-SV is usefulfor the aged and for those with UF or being proneto suffer from abdominal pain.Sedative agentsmay be unnecessary if this new type ofcolonoscope is used.
基金supported by grants from the National Key Research and Development Program of China(No.2016YFC0107005)National Natural Science Foundation of China(No.81470818)+1 种基金Beijing Municipal Science&Technology Commission(No.D101100050010037)Research Project of the General Hospital of Air Force,PLA(No.kz2014020 and No.kz2015026)
文摘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 placement 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.
文摘BACKGROUND Recently,with the advent of more advanced devices and endoscopic techniques,endoscopic retrograde cholangiopancreatography(ERCP)in Billroth II(B-II)patients has been increasingly performed.However,the procedures are difficult,and the techniques and strategies have not been defined.AIM To reveal the appropriate scope for ERCP in B-II patients.METHODS Sixty ERCP procedures were performed on B-II patients between June 2005 and May 2018 at Fukushima Medical University Hospital,and in 44 cases,this was the first ERCP procedure performed by esophagogastroduodenoscopy(EGDS)or colonoscopy(CS)after B-II gastrectomy.These cases were divided into two groups:17 cases of ERCP performed by EGDS(EGDS group)and 27 cases of ERCP performed by CS(CS group).The patient characteristics and ERCP procedures were compared between the EGDS and CS groups.RESULTS The procedural time was significantly shorter in the EGDS group than in the CS group[median(range):60(20-100)vs 90(40-128)min,P value<0.01].CS was an independent factor of a longer ERCP procedural time according to the univariate and multivariate analyses(odds ratio:3.97,95%CI:1.05-15.0,P value=0.04).CONCLUSION Compared to CS,EGDS shortened the procedural time of ERCP in B-II patients.
文摘The paper deals with active drive system for colonoscope. The system is mainly composed of soft mobile mechanism for earthworm locomotion and turning mechanism based on shape memory effect. The soft mobile mechanism contacts colon wall with air in inflatable balloons, so the robot has better soft and non invasive properties. The turning mechanism can be actively bent by shape memory alloy components. It ensures the colonoscope to adapt to the tortuous shape of colon. Some experiment results are given in the paper.
文摘Colonoscopy sometimes causes pain during insertion,especially in difficult cases.Over-insufflation of air causes elongation or acute angulations of the colon,making passage of the scope difficult and causing pain.We previously reported a sedative-risk-free colonoscopy insertion technique,namely,"Water Navigation Colonoscopy".Complete air suction after water infusion not only improves the vision,but also makes water flow down to the descending colon,while the sigmoid colon collapses and shortens.While non-sedative colonoscopy can be carried out without pain in most cases,some patients do complain of pain.Most of these patients have abnormal colon morphology,and the pain is caused while negotiating the "hairpin" bends of the colon.The "hairpin" bends of the colon should be negotiated by gently pushing the full-angled colonoscope.The proximal 10-20 cm from the angulated part of the conventional colonoscope is stiff,with a wide turning radius,therefore,a conventional colonoscope cannot be negotiated through the "hairpin" bends of the colon without stretching them and causing pain.The "passive-bending colonoscope" has a flexible tip with a narrow turning radius,so that the scope can be negotiated through the "hairpin" bends of the colon with a minimum turning radius and minimal discomfort.Therefore,the intubation and pain-reducing performance of the "passive-bending colonoscope" was assessed in difficult cases.
文摘Background High success rate of intubation and short intubation time have been needed to endoscopists for a complete and comfortable coolonoscopy,if possible.The purpose of present study was to compare procedure efficiencies according to adult-colonoscope length.Methods This was a prospective,randomized,single-blinded controlled trial.A total of 239 healthy Korean subjects were randomly assigned to two groups：one group receiving intermediate-length adult-colonoscope （n=119）,and the other group receiving long-length adult-colonoscope （n=120）.Cecal intubation time and rate,and terminal ileal intubation time and rate as well as other procedure-related outcomes （adenoma detection rate,withdrawal time,and total procedure time） were evaluated.Results There were significant differences in cecal intubation time and terminal ileal intubation rate according to colonoscope length.The time of cecal intubation was shorter in the intermediate-scope group than that in the long-scope group （（222.13±101.67） s vs.（253.85±109.40） s,P=-0.014）.However,the rate of terminal ileal intubation was higher in the long-scope group than that in the intermediate-scope group （94.2％ vs.83.2％,P=-0.007）.In addition,terminal ileal intubation time was also shorter in the long-scope group than that in the intermediate-scope group （（35.21±38.89） s vs.（44.09±33.87） s,P ＜0.001）.There were no significant differences in other procedure-related outcomes between the two groups.Conclusions The intermediate-length adult-colonoscope had an advantage over the long-length adult-colonoscope regarding cecal intubation time,whereas the long-scope had an advantage over the intermediate-scope regarding the rate and time of terminal ileal intubation.These results suggest that it is rational to prepare and use these two types of colonoscope properly,instead of employing only one type of colonoscope.
基金Supported by the Construction Fund of Key Medical Disciplines of Hangzhou,No.2025HZGF05the Key R and D Program of Zhejiang Province,No.2023C03054 and No.2024C03048+1 种基金the Key Discipline of Integrated Chinese and Western Medicine(Digestive Diseases)in Zhejiang Province,No.2024-XK-61the Zhejiang Province Medical and Health Science and Technology Plan Project,No.2021KY848.
文摘BACKGROUND Bacterial contamination during colonoscopy is a significant concern,yet few studies have evaluated bacterial aerosols.This study aimed to determine whether covering the biopsy hole check valve with enzymolysis gauze(refers to sterile gauze soaked in a multi-enzyme cleaning solution)reduces bacterial air pollution in endoscopy rooms.AIM To evaluate the efficacy of an enzymolysis gauze cover in reducing bacterial aerosols from the biopsy valve.METHODS This prospective,single-blind trial included 80 patients undergoing elective diagnostic colonoscopy.During the procedure,the biopsy hole check valve was either covered or left uncovered with enzymolysis gauze.Air samples(100 L)were collected at a distance of 30 cm from the biopsy hole check valve and approximately 140 cm above the floor using a percussive air sampling instrument.Gram-positive bacteria were cultured on standard 90 mm colimycin nalidixic agar blood plates.The primary outcome measures were bacterial load and species identification.RESULTS Covering the biopsy hole check valve with enzymolysis gauze reduced bacterial load near the check valve from 50 colony-forming unit(CFU)/m^(3)[interquartile range(IQR):30-80]to 20 CFU/m^(3)(IQR:10-20).At the end of the procedure each day,covering the valve also decreased bacterial load in the endoscopy room from 35 CFU/m^(3)(IQR:33-85)to 10 CFU/m^(3)(IQR:5-10).The predominant bacteria identified were Gram-positive cocci.CONCLUSION Applying enzymolysis gauze to cover the biopsy hole check valve significantly reduces bacterial aerosol contamination in endoscopy rooms during colonoscopy.
文摘The advancement in endoscopic technology and techniques has increased its use in the diagnosis and treatment of gastrointestinal diseases.Reprocessing of reusable endoscopes remains a challenge.Inadequate reprocessing leads to bacterial contamination of the endoscope,a significant cause of endoscope-related infections.To thoroughly address the complexities of cleaning a flexible endo-scope,various cleaning methods have been devised and tested across different studies.This letter evaluates one such method,spray flushing for flexible gastro-scopes,developed and tested in a randomized controlled trial by Du et al.Based on the post-processing test results for this method,Du et al conclude that there is improved cleaning efficacy and reduced damage compared to manual brush cleaning.The validity and reliability of the results could be further enhanced by carefully considering the study design and a few underlying concepts that contribute to the reprocessing quality of different types of endoscopes.
基金Supported by Jiaxing Science and Technology Projects,No.2023AD31041。
文摘BACKGROUND Colonoscopic polypectomy is a crucial procedure for the prevention and treatment of colorectal cancer,with its success and safety largely dependent on the quality of bowel preparation.Currently,polyethylene glycol electrolyte solution remains the standard method for bowel preparation,but its use may cause patient discomfort and incomplete cleansing.AIM To evaluate impact of enhanced and conventional bowel preparation protocols on the outcomes of colonoscopic polypectomy.METHODS This retrospective cohort study collected data from 130 patients who underwent colonoscopic polypectomy between March 2023 and June 2024.Patients were divided into the conventional bowel preparation group(n=65)and enhanced bowel preparation group(n=65).Primary outcome measures included Boston Bowel Preparation Scale(BBPS)scores,procedure-related parameters,complication rates,and prognosis.Statistical analysis was performed using SPSS version 25.0,with P<0.05 indicating statistical significance.RESULTS The enhanced group demonstrated significant advantages over the conventional group,with higher BBPS total scores(4.2±0.7 vs 3.1±0.8,P<0.001),higher onetime complete resection rates(95.4%vs 83.1%,P=0.01),shorter operative times(23.1±4.8 vs 25.4±5.2 min,P=0.03),and lesser intraoperative blood loss(18.2±4.5 vs 20.3±5.1 mL,P=0.04).Total complication rates were significantly lower(5.9%vs 16.9%,P=0.05),particularly for bleeding(1.5%vs 16.9%,P=0.01)and infection(1.5%vs 7.7%,P=0.04).The enhanced group also showed lower 6-month recurrence rates(3.1%vs 10.8%,P=0.05)and higher patient satisfaction(87.7%vs 76.9%,P=0.04)than did the conventional group.CONCLUSION The enhanced bowel preparation protocol demonstrates significant advantages,particularly in improving surgical outcomes,reducing complications,and increasing patient satisfaction,underscoring its importance of its application during colonoscopic polypectomy.
文摘BACKGROUND Acute colonic pseudo-obstruction(ACPO)is defined as colonic obstruction without a mechanical or extrinsic inflammatory factor.Colonic decompression is advised for patients with ACPO after the failure of conservative and medical management.AIM To systematically review and analyze the efficacy and safety of colonoscopic decompression in ACPO.METHODS A search was conducted in MEDLINE,EMBASE,and Scopus from inception to August 2024.Studies reporting the clinical success,perforation,recurrence,and need for surgery after colonoscopic decompression in ACPO were included.A random-effects inverse-variance model was used to calculate the pooled proportion.RESULTS Sixteen studies were included in the final analysis.The pooled rates of success after the first session of colonoscopic decompression and overall success were 78.8%(95%CI:72.0-85.6)and 91.5%(95%CI:87.0-96.0),respectively.The first session of colonoscopic decompression had a significantly higher success than the first dose of neostigmine with OR 3.85(95%CI:2.00-7.42).The pooled incidence of perforation was 0.9%(95%CI:0.0-2.0),while recurrence was observed in 17.1%(95%CI:12.9-21.3)of the patients after clinical success.The pooled rates of surgery in all cases undergoing colonoscopic decompression and those who had a successful procedure were 10.5%(95%CI:5.0-15.9)and 3.7%(95%CI:0.3-7.1),respectively.Subgroup analysis,excluding the low-quality studies,did not significantly change the event rates.CONCLUSION Colonoscopic decompression for ACPO is associated with a clinical success rate of>90%with a perforation rate of<1%,demonstrating high efficacy and safety.
文摘BACKGROUND Rectal foreign bodies,though uncommon,present diagnostic and therapeutic challenges,particularly when they result from accidental ingestion.The non-specific symptoms and the potential for serious complications necessitate a thorough and methodical approach to diagnosis and treatment.This case report aims to highlight the diagnostic complexities and management strategies involved in treating a patient with a rectal foreign body,focusing on the use of advanced imaging techniques and the importance of a multidisciplinary approach.CASE SUMMARY A 48-year-old male with a history of hypertension presented with a one-year history of post-defecation anorectal pain and mild post-defecation rectorrhagia.Initial evaluation revealed hemodynamic stability and a tender,non-mucosal lesion in the anterior left rectal region.Imaging studies,including colonoscopy,magnetic resonance imaging,and endosonography,identified an erythematous,exophytic lesion and a perirectal abscess containing a foreign body.Surgical inter-vention revealed necrotic tissue and purulent material,along with two solid foreign body fragments(bone or plant matter).Postoperative follow-up showed the patient in good condition,and pathology confirmed the fragments as mature bone.CONCLUSION This case underscores the diagnostic challenges posed by rectal foreign bodies with nonspecific symptoms and no clear history of ingestion.
基金Supported by The National Natural Science Foundation of China,No.81172374Sichuan Provincial Science and Technology Department Application Infrastructure Plan,No.2013JY0154
文摘AIM:To assess the theoretical advantages of magnetic endoscope imaging(MEI)over standard colonoscopies(SCs)and to compare their efficacies.METHODS:Electronic databases,including PubMed,EMBASE,the Cochrane library and the Science Citation Index,were searched to retrieve relevant trials.In addition,abstracts from papers presented at professional meetings and the reference lists of retrieved articles were reviewed to identify additional studies.The metaanalyses were performed using RevMan 5.1.A random effect model with the Mantel-Haenszel method was used for pooling dichotomous and continuous data.A sensitivity analysis was performed by excluding the trials with a small number of patients and by excluding the trials performed by inexperienced providers.RESULTS:Eight randomized controlled trials(RCTs),including 2967 patients,were included in the metaanalysis to compare cecal intubation rates and times,sedation dose,abdominal pain scores and the use of ancillary maneuvers between MEI and SC.The overall OR was 1.92(95%CI:1.13-3.27,eight RCTs),as indicated by the cecal intubation rate of MEI compared with SC,but MEI did not have any distinct advantage over SC for cecal intubation time(MD=-0.07,95%CI:-0.16-0.02;three RCTs).MEI did not generally result in lower pain scores.Outcomes were also analyzed for the two subgroups based on the endoscopists’experience level to evaluate cecal intubation rates.MEI presented better outcomes for non-experienced colonoscopists than experienced colonoscopists.CONCLUSION:The real-time magnetic imaging system is of benefit in training and educating inexperienced endoscopists and improves the cecal intubation rate for experienced and inexperienced endoscopists.
文摘AIM: To investigate when and why a colonoscopist should discontinue incomplete colonoscopy by himself.METHODS: In this cross-sectional study, 517 difficult colonoscope insertions(Grade C, Kudo's difficulty classification) screened from 37800 colonoscopy insertions were collected from April 2004 to June 2014 by three 4th-level(Kudo's classification) colonoscopists. The following common factors for the incomplete insertion were excluded: structural obstruction of the colon or rectum, insufficient colon cleansing, discontinuation due to patient's discomfort or pain, severe colon disease with a perforation risk(e.g., severe ischemic colonopathy). All the excluded patients were re-scheduled if permission was obtained from the patients whose intubation had failed. If the repeat intubations were still a failure because of the difficult operative techniques, those patients were also included in this study. The patient's age, sex, anesthesia and colonoscope type were recorded before colonoscopy. During the colonoscopic examination, the influencing factors of fixation, tortuosity, laxity and redundancy of the colon were assessed, and the insertion time(> 10 min or ≤ 10 min) were registered. The insertion time was analyzed by t-test, and other factors were analyzed by univariate and multivariate logistic regression.RESULTS: Three hundred and twenty-two(62.3%) of the 517 insertions were complete in the colonoscope insertion into the ileocecum, but 195(37.7%) failed in the insertion. Fixation, tortuosity, laxity or redundancy occurred during the colonoscopic examination. Multivariate logistic regression analysis revealed that fixation(OR = 0.06, 95%CI: 0.03-0.16, P < 0.001) and tortuosity(OR = 0.04, 95%CI: 0.02-0.08, P < 0.001) were significantly related to the insertion into the ileocecum in the left hemicolon; multivariate logistic regression analysis also revealed that fixation(OR = 0.16, 95%CI: 0.06-0.39, P < 0.001), tortuosity(OR0.23, 95%CI: 0.13-0.43, P < 0.001), redundancy(OR = 0.12, 95%CI: 0.05-0.26, P < 0.001) and sex(OR = 0.35, 95%CI: 0.20-0.63, P < 0.001) were significantly related to the insertion into the ileocecum in the right hemicolon. Prolonged insertion time(> 10 min) was an unfavorable factor for the insertion into the ileocecum.CONCLUSION: Colonoscopy should be discontinued if freedom of the colonoscope body's insertion and rotation is completely lost, and the insertion time is prolonged over 30 min.
文摘Despite recent advances in medicine,colorectal cancer (CRC)remains one of the greatest hazards for public health worldwide and especially the industrialized world.It has been well documented with concrete data that regular screening colonoscopy aimed at early detection of precancerous polyps can help decrease the incidence of CRC.However,the adherence of the general population to such screening programs has been shown to be lower than that expected,thus allowing CRC to remain a major threat for public health.Various reasons have been suggested to explain the disappointing compliance of the population to CRC screening programs,some of them associated with colonoscopy per se,which is viewed by many people as an unpleasant examination.Governments,medical societies,individual gastroenterologists,as well as the medical industry are working in order to improve endoscopic devices and/or to improve standard colo-noscopy.The aim is to improve the acceptance of the population for this method of CRC screening,by providing a painless and reliable examination of the colon.This review focuses on some of the latest improve-me-nts in this fie-ld.
文摘AIM: To evaluate the full-spectrum endoscopy(FUSE) colonoscopy system as the first report on the utility thereof in a Korean population.METHODS: We explored the efficacy of the FUSE colonoscopy in a retrospective, single-center feasibility study performed between February 1 and July 20, 2015. A total of 262 subjects(age range: 22-80) underwent the FUSE colonoscopy for colorectal cancer screening, polyp surveillance, or diagnostic evaluation. The cecal intubation success rate, the polyp detection rate(PDR), the adenoma detection rate(ADR), and the diverticulum detection rate(DDR), were calculated. Also, the success rates of therapeutic interventions were evaluated with biopsy confirmation.RESULTS: All patients completed the study and the success rates of cecal and terminal ileal intubation were 100% with the FUSE colonoscope; we found 313 polyps in 142 patients and 173 adenomas in 95. The overall PDR, ADR and DDR were 54.2%, 36.3%, and 25.2%, respectively, and were higher in males, and increased with age. The endoscopists and nurses involved considered that the full-spectrum colonoscope improved navigation and orientation within the colon.No colonoscopy was aborted because of colonoscope malfunction.CONCLUSION: The FUSE colonoscopy yielded a higher PDR, ADR, DDR than did traditional colonoscopy, without therapeutic failure or complications, showing feasible, effective, and safe in this first Korean trial.
文摘The moving principle of a colonoscopic robot is presented in this paper. The robot mainly consists of soft mobile mechanism for earthworm locomotion and turning mechanism based on shape memory effect. The soft mobile mechanism contacts colon wall with air in inflatable balloons, so the robot has better soft and non invasive properties. The turning mechanism can be actively bent by shape memory alloy components. It ensures the robot to adapt to the tortuous shape of colon. Therefore, the colonoscopic robot has good safety, lower working strength of surgeon and higher efficiency of colonooscopy.
文摘Colonoscopy is the gold standard for colorectal cancer prevention; however, it is still an imperfect modality. Precancerous lesions can be lost during screening examinations, thus increasing the risk of interval cancer. A variety of factors either patient-, or endoscopist dependent or even the procedure itself may contribute to loss of lesions. Sophisticated modalities including advanced technology endoscopes and add-on devices have been developed in an effort to eliminate colonoscopy's drawbacks and maximize its ability to detect potentially culprit polyps. Novel colonoscopes aim to widen the field of view. They incorporate more than one cameras enabling simultaneous image transmission. In that way the field of view can expand up to 330°. On the other hand a plethora of add-on devices attachable on the standard colonoscope promise to detect lesions in the proximal aspect of colonic folds either by offering a retrograde view of the lumen or by straightening the haustral folds during withdrawal. In this minireview we discuss how these recent advances affect colonoscopy performance by improving its quality indicators(cecal intubation rate, adenoma detection rate) and other metrics(polyp detection rate, adenomas per colonoscopy, polyp/adenoma miss rate) associated with examination's outcomes.
基金Supported by Faculty of Medicine,Siriraj Hospital,Mahidol University,Bangkok,Thailand
文摘This review discusses the incidence,risk factors,management and outcome of colonoscopic perforation(CP).The incidence of CP ranges from 0.016% to 0.2% following diagnostic colonoscopies and could be up to 5% following some colonoscopic interventions.The perforations are frequently related to therapeutic colonoscopies and are associated with patients of advanced age or with multiple comorbidities.Management of CP is mainly based on patients' clinical grounds and their underlying colorectal diseases.Current therapeutic approaches include conservative management(bowel rest plus the administration of broadspectrum antibiotics),endoscopic management,and operative management(open or laparoscopic approach).The applications of each treatment are discussed.Overall outcomes of patients with CP are also addressed.
文摘AIM: To assess the incidence and risk factors associated with colonic perforation due to colonoscopy. METHODS: This was a retrospective cross-sectional study. Patients were retrospectively eligible for inclusion if they were 18 years and older and had an inpatient or outpatient colonoscopy procedure code in any facility within the Geisinger Health System during the period from January 1, 2002 to August 25, 2010. Data are presented as median and inter-quartile range, for continuous variables, and as frequency and percentage for categorical variables. Baseline comparisons across those with and without a perforation were made using the two-sample t -test and Pearson's χ2 test, as appropriate.RESULTS: A total of 50 perforations were diagnosed out of 80118 colonoscopies, which corresponded to an incidence of 0.06% (95%CI: 0.05-0.08) or a rate of 6.2 per 10000 colonoscopies. All possible risk factors associated with colonic perforation with a P -value < 0.1 were checked for inclusion in a multivariable logbinomial regression model predicting 7-d colonic perforation. The final model resulted in the following risk factors which were significantly associated with risk of colonic perforation: age, gender, body mass index, albumin level, intensive care unit (ICU) patients, inpatient setting, and abdominal pain and Crohn's disease as indications for colonoscopy. CONCLUSION: The cumulative 7 d incidence of colonic perforation in this cohort was 0.06%. Advanced age and female gender were significantly more likely to have perforation. Increasing albumin and BMI resulted in decreased risk of colonic perforation. Having a colonoscopy indication of abdominal pain or Crohn's disease resulted in a higher risk of colonic perforation. Colonoscopies performed in inpatients and particularly the ICU setting had substantially greater odds of perforation. Biopsy and polypectomy did not increase the risk of perforation and only three perforations occurred with screening colonoscopy.
基金a grant from the Korean Association for the Study of Intestinal Diseases
文摘AIM:To evaluate and compare the clinical outcomes of prophylactic submucosal saline-epinephrine injection and saline injection alone for large colon polyps by conventional polypectomy. METHODS:A prospective study was conducted from July 2003 to July 2004 at 11 tertiary endoscopic centers. Large colon polyps (> 10 mm in diameter) wererandomized to undergo endoscopic polypectomy with submucosal saline-epinephrine injection (epinephrine group) or normal saline injection (saline group). Endoscopic polypectomy was performed by the conventional snare method,and early (< 12 h) and late bleeding complications (12 h-30 d) were observed. RESULTS:A total of 561 polyps in 486 patients were resected by endoscopic polypectomy. Overall,bleeding complications occurred in 7.6% (37/486) of the patients,including 4.9% (12/244) in the epinephrine group,and 10.3% (25/242) in the saline group. Early and late postpolypectomy bleeding (PPB) occurred in 6.6% (32/486) and 1% (5/486) of the patients,respectively,including 4.5% (11/244),0.4% (1/244) in the epinephrine group,and 8.7% (21/242),1.7% (4/242) in the saline group. No significant differences in the rates of overall,early and late PPB were observed between the 2 groups. Multivariate stepwise logistic regression analysis revealed that large size (> 2 cm) and neoplastic polyps were independently and significantly associated with the presence of PPB. CONCLUSION:The prophylactic submucosal injection of diluted epinephrine does not appear to provide an additional advantage over the saline injection alone for the prevention of PPB.
