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
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 determine the incidence of colonoscopic perforation （CP）, and evaluate clinical findings, management and outcomes of patients with CP from the World Gastroenterology Organization （WGO） Endoscopy Training ...AIM： To determine the incidence of colonoscopic perforation （CP）, and evaluate clinical findings, management and outcomes of patients with CP from the World Gastroenterology Organization （WGO） Endoscopy Training Center in Thailand. METHODS： All colonoscopies and sigmoidoscopies performed between 1999 and 2007 in the Endoscopic unit, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok were reviewed. Incidence of CP, patients＇ characteristics, endoscopic information, intraoperative findings, management and outcomes were analyzed. RESULTS： A total of 17357 endoscopic procedures of the colon （13 699 colonoscopies and 3658 flexible sigmoidoscopies） were performed in Siriraj hospital over a 9-year period. Fifteen patients （0.09%） had CP： 14 from colonoscopy and 1 from sigmoidoscopy. The most common site of perforation was in the sigmoid colon （80%）, followed by the transverse colon （13%）. Perforations were caused by direct trauma from either the shaft or the tip of the endoscope （n = 12,80%） and endoscopic polypectomy （n = 3, 20%）. All patients with CP underwent surgical management： primary repair （27%） and bowel resection （73%）. The mortality rate was 13% and postoperative complication rate was 53%. CONCLUSION： CP is a rare but serious complication following colonoscopy and sigmoidoscopy, with high rates of morbidity and mortality. Incidence of CP was 0.09%. Surgery is still the mainstay of CP management.展开更多
Introduction: Laparoscopic assisted colonoscopic polypectomies have been well described in the literature and are well established in surgical practice, for removal of large, inaccessible, or flat based polyps. Laparo...Introduction: Laparoscopic assisted colonoscopic polypectomies have been well described in the literature and are well established in surgical practice, for removal of large, inaccessible, or flat based polyps. Laparoscope allows the endoscopist a serosal viewpoint and thus clear indication of perforation, in addition to enhancing endoscopic positioning through colonic mobilisation, facilitating polypectomy. We describe a previously rarely published technique, in which the colonoscope directs the surgeon to polyps and laparoscopy enables wedge resection of benign polyps using Endo GIA staplers. Using this method, the colonoscope provides an intra-luminal view ensuring adequate excision with margins whilst the laparoscope provides intra-peritoneal access for the wedge resection. Methods: This is a case series of 12 patients with large tubulovillous adenomas, found and biopsied at colonoscopy. Under a general anaesthetic, an on table colonoscopy was performed to identify and reassess the polyp, whilst a laparoscopy was performed to excise the polyp via wedge resection, using the endoscopic view as guidance. Results: The polyp was identified and completely resected in our 12 patients. All patients were discharged on the first post-operative day. Of the polyps excised, a focus of adenocarcinoma was detected in one and an adjacent endocrine tumour was found in another patient in histology along with tubulovillous adenoma. Rest were all tubulovillous adenomas only. Conclusion: We propose that this technique should be regarded as an alternative to Right hemicolectomies and difficult endoscopic mucosal resections for large adenomas, and be regarded as a definitive and safe procedure in its own right.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
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
Colonoscopic evaluation is an important tool in the evaluation of ulcerative colitis(UC).UC is divided by disease extent into proctitis,proctosigmoiditis,left-sided colitis,and pan-colitis.In addition,a cecal or peri-...Colonoscopic evaluation is an important tool in the evaluation of ulcerative colitis(UC).UC is divided by disease extent into proctitis,proctosigmoiditis,left-sided colitis,and pan-colitis.In addition,a cecal or peri-appendiceal patch and backwash ileitis are associated with UC.The extent and behavior of UC has been characterized further using various indices and scoring systems;among these systems is the Mayo Score,which is widely used in current clinical trials for new medications.As these medical therapies for UC have developed,achieving mucosal healing with medications has become an important therapeutic objective.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 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
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
Colitis-associated colorectal cancer(CAC)is defined as a specific cluster of colorectal cancers that develop as a result of prolonged colitis in patients with inflammatory bowel disease(IBD).Patients with IBD,includin...Colitis-associated colorectal cancer(CAC)is defined as a specific cluster of colorectal cancers that develop as a result of prolonged colitis in patients with inflammatory bowel disease(IBD).Patients with IBD,including ulcerative colitis and Crohn’s disease,are known to have an increased risk of developing CAC.Although the incidence of CAC has significantly decreased over the past few decades,individuals with CAC have increased mortality compared to individuals with sporadic colorectal cancer,and the incidence of CAC increases with duration.Chronic inflammation is generally recognized as a major contributor to the pathogenesis of CAC.CAC has been shown to progress from colitis to dysplasia and finally to carcinoma.Accumulating evidence suggests that multiple immune-mediated pathways,DNA damage pathways,and pathogens are involved in the pathogenesis of CAC.Over the past decade,there has been an increasing effort to develop clinical approaches that could help improve outcomes for CAC patients.Colonoscopic surveillance plays an important role in reducing the risk of advanced and interval cancers.It is generally recommended that CAC patients undergo endoscopic removal or colectomy.This review summarizes the current understanding of CAC,particularly its epidemiology,mechanisms,and management.It focuses on the mechanisms that contribute to the development of CAC,covering advances in genomics,immunology,and the microbiome;presents evidence for management strategies,including endoscopy and colectomy;and discusses new strategies to interfere with the process and development of CAC.These scientific findings will pave the way for the management of CAC in the near future.展开更多
AIM: To identify the diagnostic value of colonoscopy for diverticulosis as determined by barium enema. METHODS: A total of 65 patients with hematochezia who underwent colonoscopy and barium enema were analyzed, and th...AIM: To identify the diagnostic value of colonoscopy for diverticulosis as determined by barium enema. METHODS: A total of 65 patients with hematochezia who underwent colonoscopy and barium enema were analyzed, and the diagnostic value of colonoscopy for diverticula was assessed. The receiver operating characteristic area under the curve was compared in relation to age (< 70 or ≥ 70 years), sex, and colon location. The number of diverticula was counted, and the detection ratio was calculated. RESULTS: Colonic diverticula were observed in 46 patients with barium enema. Colonoscopy had a sensitivity of 91% and specificity of 90%. No significant differences were found in the receiver operating characteristic area under the curve (ROC-AUC) for age group or sex. The ROC-AUC of the left colon was significantly lower than that of the right colon (0.81 vs 0.96, P=0.02). Colonoscopy identified 486 colonic diverticula, while barium enema identified 1186. The detection ratio for the entire colon was therefore 0.41 (486/1186). The detection ratio in the left colon (0.32, 189/588) was significantly lower than that of the right colon (0.50, 297/598) (P < 0.01). CONCLUSION: Compared with barium enema, only half the number of colonic diverticula can be detected by colonoscopy in the entire colon and even less in the left colon.展开更多
BACKGROUND Although the usefulness of endoscopic scores,such as the Mayo Endoscopic Subscore(MES),Ulcerative Colitis Endoscopic Index of Severity(UCEIS),and Ulcerative Colitis Colonoscopic Index of Severity(UCCIS),and...BACKGROUND Although the usefulness of endoscopic scores,such as the Mayo Endoscopic Subscore(MES),Ulcerative Colitis Endoscopic Index of Severity(UCEIS),and Ulcerative Colitis Colonoscopic Index of Severity(UCCIS),and biomarkers such as fecal calprotectin(FC)for predicting relapse in ulcerative colitis(UC)has been reported,few studies have included endoscopic scores for evaluating the entire colon.AIM To compare the usefulness of FC value and MES,UCEIS,and UCCIS for predicting relapse in patients with UC in clinical remission.METHODS In total,75 patients with UC in clinical and endoscopic remission who visited our institution between February 2019 and March 2022 were enrolled.The diagnosis of UC was confirmed based on the clinical presentation,endoscopic findings,and histology,according to the current established criteria for UC.Fecal samples were collected the day before or after the colonoscopy for measurement of FC.Endoscopic evaluations were performed using MES,UCEIS,and UCCIS.The primary outcome measure of this study was the assessment of the association between relapse within 12 mo and MES,UCEIS,UCCIS,and FC.The secondary outcome was the comparison between endoscopic scores and biomarkers in en-rolled patients with UC with mucosal healing.RESULTSFC and UCCIS showed a significant correlation with UCEIS (r = 0.537, P < 0.001 and r = 0.957, P < 0.001, respectively).Receiver-operating characteristic analysis for predicting MES 0 showed that the area under the curve ofUCCIS was significantly higher than that of FC (P < 0.01). During the 1-year observation period, 18 (24%) patientsexperienced a relapse, and both the FC and UCCIS of the relapse group were significantly higher than that of theremission group. The cut-off values for predicting relapse were set at FC = 323 mg/kg and UCCIS = 10.2. The areaunder the curve of the receiver-operating characteristic analysis for predicting relapse did not show a significantdifference between FC and UCCIS. The accuracy of the endoscopic scores and biomarkers in predicting relapse was86.7% for UCCIS, 85.3% for UCEIS, 76.0% for FC, and 73.3% for MES.CONCLUSIONThe three endoscopic scores and FC may predict UC relapse during clinical remission. Among these scores, UCEISmay be the most useful in terms of ease of evaluation and accuracy.展开更多
Intestinal pseudo-obstruction (IPO) either acute or chronic is a condition including features of intestinal ileus in absence of mechanical obstruction. Our paper presents such a rare case of idiopathic IPO in a 53-yea...Intestinal pseudo-obstruction (IPO) either acute or chronic is a condition including features of intestinal ileus in absence of mechanical obstruction. Our paper presents such a rare case of idiopathic IPO in a 53-year-old male patient with recurrent episodes of pseudo-obstruction, which were successfully resolved by anticholinesterase agents, motilin agonists or colonic decompression. However, the patient finally underwent total colectomy. Huge colonic dilatation was identified intraoperatorily, while histology showed a neuropathic variant of chronic intestinal pseudo-obstruction. Etiologic mechanisms and current therapeutic methods are reviewed in this paper, which concludes that IPO is a condition in which conservative treatment usually fails. Total colectomy with ileoanal pouch may be the only solution in these situations.展开更多
Objective:To investigate the clinical efficacy of transcutaneous electrical acupoint stimulation combined with propofol infusion during the treatment of patients under colonoscopy.Methods:A total of 90 patients receiv...Objective:To investigate the clinical efficacy of transcutaneous electrical acupoint stimulation combined with propofol infusion during the treatment of patients under colonoscopy.Methods:A total of 90 patients received painless colonoscopy were randomly divided into three groups:transcutaneous electrical acupoint stimulation combined with propofol group(group T),sufentanil combined with propofol group(group S)and propofol group(group P),with 30 cases in each group.The patients in group T were anesthetized with propofol after transcutaneous electrical acupoint stimulation of 30min at Hegu(LI4),Neiguan(PC6),Zusanli(ST36),Shangjuxu(ST37)and Sanyinjiao(SP6)on both sides,and the electrical stimulation lasted until the end of the operation.Group S and group P were pasted electrode slices at the same acupoint with group T,but no electrical stimulation was given.The other treatments were the same as those in group T.Group S was given sufentanil 0.1ug/kg at the beginning of anesthesia.The levels of blood pressure(MAP),heart rate(HR)and pulse oxygen saturation(SpO2)were continuously monitored at time points of entering operating room(T0),disappearance of eyelash reflex(T1),during operation(through the liver region T2)and immediately after operation(T3),and the total dosage of propofol,awakening time and incidence of adverse reactions in each group were recorded.Results:Compared with group P,the blood pressure and heart rate of the patients at T1 and T2 in group T were more stable(P<0.05),the awakening time after operation was significantly shorter(P<0.05),and the dosage of propofol was significantly lower than that in group P(P<0.05).The incidence of bradycardia,hypotension and respiratory depression decreased significantly(P<0.05).Compared with group S,the postoperative awakening time of group T was significantly shorter(P<0.05),and there was no significant difference in other indexes.Conclusion:Transcutaneous electrical acupoint stimulation is effective during the treatment of analgesia under colonoscopy.It can reduce the dosage of anesthetics,reduce the incidence of postoperative adverse reactions and shorten the awakening time of patients.展开更多
TO THE EDITORIn the UK, clear guidelines exist as to the expected level of competence an individual endoscopist should achieve.This is of utmost importance given the variance in practice among endoscopic departments a...TO THE EDITORIn the UK, clear guidelines exist as to the expected level of competence an individual endoscopist should achieve.This is of utmost importance given the variance in practice among endoscopic departments as highlighted by the National Colonoscopy audit in 2002. The audited variables included sedation practice, caecal completion and complication rates, but not the type of instrument used.展开更多
Colonoscopic polypectomy is extremely effective in protecting against colorectal cancers,and recognition of adenomas by colonoscopy is of paramount importance in preventing colorectal cancer(CRC)and CRC-associated mor...Colonoscopic polypectomy is extremely effective in protecting against colorectal cancers,and recognition of adenomas by colonoscopy is of paramount importance in preventing colorectal cancer(CRC)and CRC-associated mortality.Incomplete polyp resection(IPR)occurs routinely in medical practice following polypectomy.We conducted a comprehensive literature search to identify studies that reported on the potential risk factors for IPR using MEDLINE,EMBASE,and PubMed.Publication time was limited between January 2004 and July 2021.Our search revealed assessments of the position,morphology,and histologic variation of the polypsdas well as the relevant skills that may interfere with IPR.The included studies showed that colonic polyps with a diameter>20 mm and proximal in location should be dealt with cautiously.For smaller polyps,cold-snare polypectomy appeared to be the most effective method used to accomplish comprehensive polyp removal.In addition,endoscopist experience in narrow-band imaging in polyp detection were also associated with IPR.Therefore,polypectomy should be performed cautiously if the polyp growth is expected to be cancerous and situated in the proximal portion of the colon or rectum,and modalities should be standardized so as to lower the potential risk for IPR.展开更多
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.
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.
文摘AIM： To determine the incidence of colonoscopic perforation （CP）, and evaluate clinical findings, management and outcomes of patients with CP from the World Gastroenterology Organization （WGO） Endoscopy Training Center in Thailand. METHODS： All colonoscopies and sigmoidoscopies performed between 1999 and 2007 in the Endoscopic unit, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok were reviewed. Incidence of CP, patients＇ characteristics, endoscopic information, intraoperative findings, management and outcomes were analyzed. RESULTS： A total of 17357 endoscopic procedures of the colon （13 699 colonoscopies and 3658 flexible sigmoidoscopies） were performed in Siriraj hospital over a 9-year period. Fifteen patients （0.09%） had CP： 14 from colonoscopy and 1 from sigmoidoscopy. The most common site of perforation was in the sigmoid colon （80%）, followed by the transverse colon （13%）. Perforations were caused by direct trauma from either the shaft or the tip of the endoscope （n = 12,80%） and endoscopic polypectomy （n = 3, 20%）. All patients with CP underwent surgical management： primary repair （27%） and bowel resection （73%）. The mortality rate was 13% and postoperative complication rate was 53%. CONCLUSION： CP is a rare but serious complication following colonoscopy and sigmoidoscopy, with high rates of morbidity and mortality. Incidence of CP was 0.09%. Surgery is still the mainstay of CP management.
文摘Introduction: Laparoscopic assisted colonoscopic polypectomies have been well described in the literature and are well established in surgical practice, for removal of large, inaccessible, or flat based polyps. Laparoscope allows the endoscopist a serosal viewpoint and thus clear indication of perforation, in addition to enhancing endoscopic positioning through colonic mobilisation, facilitating polypectomy. We describe a previously rarely published technique, in which the colonoscope directs the surgeon to polyps and laparoscopy enables wedge resection of benign polyps using Endo GIA staplers. Using this method, the colonoscope provides an intra-luminal view ensuring adequate excision with margins whilst the laparoscope provides intra-peritoneal access for the wedge resection. Methods: This is a case series of 12 patients with large tubulovillous adenomas, found and biopsied at colonoscopy. Under a general anaesthetic, an on table colonoscopy was performed to identify and reassess the polyp, whilst a laparoscopy was performed to excise the polyp via wedge resection, using the endoscopic view as guidance. Results: The polyp was identified and completely resected in our 12 patients. All patients were discharged on the first post-operative day. Of the polyps excised, a focus of adenocarcinoma was detected in one and an adjacent endocrine tumour was found in another patient in histology along with tubulovillous adenoma. Rest were all tubulovillous adenomas only. Conclusion: We propose that this technique should be regarded as an alternative to Right hemicolectomies and difficult endoscopic mucosal resections for large adenomas, and be regarded as a definitive and safe procedure in its own right.
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.
文摘Colonoscopic evaluation is an important tool in the evaluation of ulcerative colitis(UC).UC is divided by disease extent into proctitis,proctosigmoiditis,left-sided colitis,and pan-colitis.In addition,a cecal or peri-appendiceal patch and backwash ileitis are associated with UC.The extent and behavior of UC has been characterized further using various indices and scoring systems;among these systems is the Mayo Score,which is widely used in current clinical trials for new medications.As these medical therapies for UC have developed,achieving mucosal healing with medications has become an important therapeutic objective.
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.
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.
基金Supported by the National Key Research and Development Program,No.2022YFC2504003Young Scholar Independent Innovation Science Fund of Chinese PLA General Hospital,No.22QNCZ020Medical Science and Technology Young Scholar Fostering Fund,No.21QNPY109.
文摘Colitis-associated colorectal cancer(CAC)is defined as a specific cluster of colorectal cancers that develop as a result of prolonged colitis in patients with inflammatory bowel disease(IBD).Patients with IBD,including ulcerative colitis and Crohn’s disease,are known to have an increased risk of developing CAC.Although the incidence of CAC has significantly decreased over the past few decades,individuals with CAC have increased mortality compared to individuals with sporadic colorectal cancer,and the incidence of CAC increases with duration.Chronic inflammation is generally recognized as a major contributor to the pathogenesis of CAC.CAC has been shown to progress from colitis to dysplasia and finally to carcinoma.Accumulating evidence suggests that multiple immune-mediated pathways,DNA damage pathways,and pathogens are involved in the pathogenesis of CAC.Over the past decade,there has been an increasing effort to develop clinical approaches that could help improve outcomes for CAC patients.Colonoscopic surveillance plays an important role in reducing the risk of advanced and interval cancers.It is generally recommended that CAC patients undergo endoscopic removal or colectomy.This review summarizes the current understanding of CAC,particularly its epidemiology,mechanisms,and management.It focuses on the mechanisms that contribute to the development of CAC,covering advances in genomics,immunology,and the microbiome;presents evidence for management strategies,including endoscopy and colectomy;and discusses new strategies to interfere with the process and development of CAC.These scientific findings will pave the way for the management of CAC in the near future.
基金Supported by A grant from the National Center for Global Health and Medicine
文摘AIM: To identify the diagnostic value of colonoscopy for diverticulosis as determined by barium enema. METHODS: A total of 65 patients with hematochezia who underwent colonoscopy and barium enema were analyzed, and the diagnostic value of colonoscopy for diverticula was assessed. The receiver operating characteristic area under the curve was compared in relation to age (< 70 or ≥ 70 years), sex, and colon location. The number of diverticula was counted, and the detection ratio was calculated. RESULTS: Colonic diverticula were observed in 46 patients with barium enema. Colonoscopy had a sensitivity of 91% and specificity of 90%. No significant differences were found in the receiver operating characteristic area under the curve (ROC-AUC) for age group or sex. The ROC-AUC of the left colon was significantly lower than that of the right colon (0.81 vs 0.96, P=0.02). Colonoscopy identified 486 colonic diverticula, while barium enema identified 1186. The detection ratio for the entire colon was therefore 0.41 (486/1186). The detection ratio in the left colon (0.32, 189/588) was significantly lower than that of the right colon (0.50, 297/598) (P < 0.01). CONCLUSION: Compared with barium enema, only half the number of colonic diverticula can be detected by colonoscopy in the entire colon and even less in the left colon.
文摘BACKGROUND Although the usefulness of endoscopic scores,such as the Mayo Endoscopic Subscore(MES),Ulcerative Colitis Endoscopic Index of Severity(UCEIS),and Ulcerative Colitis Colonoscopic Index of Severity(UCCIS),and biomarkers such as fecal calprotectin(FC)for predicting relapse in ulcerative colitis(UC)has been reported,few studies have included endoscopic scores for evaluating the entire colon.AIM To compare the usefulness of FC value and MES,UCEIS,and UCCIS for predicting relapse in patients with UC in clinical remission.METHODS In total,75 patients with UC in clinical and endoscopic remission who visited our institution between February 2019 and March 2022 were enrolled.The diagnosis of UC was confirmed based on the clinical presentation,endoscopic findings,and histology,according to the current established criteria for UC.Fecal samples were collected the day before or after the colonoscopy for measurement of FC.Endoscopic evaluations were performed using MES,UCEIS,and UCCIS.The primary outcome measure of this study was the assessment of the association between relapse within 12 mo and MES,UCEIS,UCCIS,and FC.The secondary outcome was the comparison between endoscopic scores and biomarkers in en-rolled patients with UC with mucosal healing.RESULTSFC and UCCIS showed a significant correlation with UCEIS (r = 0.537, P < 0.001 and r = 0.957, P < 0.001, respectively).Receiver-operating characteristic analysis for predicting MES 0 showed that the area under the curve ofUCCIS was significantly higher than that of FC (P < 0.01). During the 1-year observation period, 18 (24%) patientsexperienced a relapse, and both the FC and UCCIS of the relapse group were significantly higher than that of theremission group. The cut-off values for predicting relapse were set at FC = 323 mg/kg and UCCIS = 10.2. The areaunder the curve of the receiver-operating characteristic analysis for predicting relapse did not show a significantdifference between FC and UCCIS. The accuracy of the endoscopic scores and biomarkers in predicting relapse was86.7% for UCCIS, 85.3% for UCEIS, 76.0% for FC, and 73.3% for MES.CONCLUSIONThe three endoscopic scores and FC may predict UC relapse during clinical remission. Among these scores, UCEISmay be the most useful in terms of ease of evaluation and accuracy.
文摘Intestinal pseudo-obstruction (IPO) either acute or chronic is a condition including features of intestinal ileus in absence of mechanical obstruction. Our paper presents such a rare case of idiopathic IPO in a 53-year-old male patient with recurrent episodes of pseudo-obstruction, which were successfully resolved by anticholinesterase agents, motilin agonists or colonic decompression. However, the patient finally underwent total colectomy. Huge colonic dilatation was identified intraoperatorily, while histology showed a neuropathic variant of chronic intestinal pseudo-obstruction. Etiologic mechanisms and current therapeutic methods are reviewed in this paper, which concludes that IPO is a condition in which conservative treatment usually fails. Total colectomy with ileoanal pouch may be the only solution in these situations.
基金National Natural Science Foundation of China(Project No.81860233)。
文摘Objective:To investigate the clinical efficacy of transcutaneous electrical acupoint stimulation combined with propofol infusion during the treatment of patients under colonoscopy.Methods:A total of 90 patients received painless colonoscopy were randomly divided into three groups:transcutaneous electrical acupoint stimulation combined with propofol group(group T),sufentanil combined with propofol group(group S)and propofol group(group P),with 30 cases in each group.The patients in group T were anesthetized with propofol after transcutaneous electrical acupoint stimulation of 30min at Hegu(LI4),Neiguan(PC6),Zusanli(ST36),Shangjuxu(ST37)and Sanyinjiao(SP6)on both sides,and the electrical stimulation lasted until the end of the operation.Group S and group P were pasted electrode slices at the same acupoint with group T,but no electrical stimulation was given.The other treatments were the same as those in group T.Group S was given sufentanil 0.1ug/kg at the beginning of anesthesia.The levels of blood pressure(MAP),heart rate(HR)and pulse oxygen saturation(SpO2)were continuously monitored at time points of entering operating room(T0),disappearance of eyelash reflex(T1),during operation(through the liver region T2)and immediately after operation(T3),and the total dosage of propofol,awakening time and incidence of adverse reactions in each group were recorded.Results:Compared with group P,the blood pressure and heart rate of the patients at T1 and T2 in group T were more stable(P<0.05),the awakening time after operation was significantly shorter(P<0.05),and the dosage of propofol was significantly lower than that in group P(P<0.05).The incidence of bradycardia,hypotension and respiratory depression decreased significantly(P<0.05).Compared with group S,the postoperative awakening time of group T was significantly shorter(P<0.05),and there was no significant difference in other indexes.Conclusion:Transcutaneous electrical acupoint stimulation is effective during the treatment of analgesia under colonoscopy.It can reduce the dosage of anesthetics,reduce the incidence of postoperative adverse reactions and shorten the awakening time of patients.
文摘TO THE EDITORIn the UK, clear guidelines exist as to the expected level of competence an individual endoscopist should achieve.This is of utmost importance given the variance in practice among endoscopic departments as highlighted by the National Colonoscopy audit in 2002. The audited variables included sedation practice, caecal completion and complication rates, but not the type of instrument used.
基金supported by the National Natural Science Foundation of China(No.81703076 and No.82072628).
文摘Colonoscopic polypectomy is extremely effective in protecting against colorectal cancers,and recognition of adenomas by colonoscopy is of paramount importance in preventing colorectal cancer(CRC)and CRC-associated mortality.Incomplete polyp resection(IPR)occurs routinely in medical practice following polypectomy.We conducted a comprehensive literature search to identify studies that reported on the potential risk factors for IPR using MEDLINE,EMBASE,and PubMed.Publication time was limited between January 2004 and July 2021.Our search revealed assessments of the position,morphology,and histologic variation of the polypsdas well as the relevant skills that may interfere with IPR.The included studies showed that colonic polyps with a diameter>20 mm and proximal in location should be dealt with cautiously.For smaller polyps,cold-snare polypectomy appeared to be the most effective method used to accomplish comprehensive polyp removal.In addition,endoscopist experience in narrow-band imaging in polyp detection were also associated with IPR.Therefore,polypectomy should be performed cautiously if the polyp growth is expected to be cancerous and situated in the proximal portion of the colon or rectum,and modalities should be standardized so as to lower the potential risk for IPR.
