Colonoscopy techniques combining or replacing air insufflation with water infusion are becoming increasinglypopular.They were originally designed to reduce colonic spasms,facilitate cecal intubation,and lower patient ...Colonoscopy techniques combining or replacing air insufflation with water infusion are becoming increasinglypopular.They were originally designed to reduce colonic spasms,facilitate cecal intubation,and lower patient discomfort and the need for sedation.These maneuvers straighten the rectosigmoid colon and enable the colonoscope to be inserted deeply without causing looping of the colon.Water-immersion colonoscopy minimizes colonic distension and improves visibility by introducing a small amount of water.In addition,since pain during colonoscopy indicates risk of bowel perforation and sedation masks this important warning,this method has the potential to be the favored insertion technique because it promotes patient safety without sedation.Recently,this water-immersion method has not only been used for colonoscope insertion,but has also been applied to therapy for sigmoid volvulus,removal of lesions,lower gastrointestinal bleeding,and therapeutic diagnosis of abnormal bowel morphology and irritable bowel syndrome.Although a larger sample size and prospective head-to-head-designed studies will be needed,this review focuses on the usefulness of waterimmersion colonoscopy for diagnostic and therapeutic applications.展开更多
National data show that in China mainland unsedated gastrointestinal （GI） endoscopy has been applied in most hospitals for clinical examination, while sedated GI endoscopy is only performed in some hospitals. The pu...National data show that in China mainland unsedated gastrointestinal （GI） endoscopy has been applied in most hospitals for clinical examination, while sedated GI endoscopy is only performed in some hospitals. The purpose of this study was to compare sedated versus unsedated GI endoscopy regarding cost, safety, degree of comfort, tolerance level and overall satisfaction of patients over a 6-month period investigation. From March to September 2011, a questionnaire survey was performed on 1800 patients and 30 physicians at Zhongnan Hospital of Wuhan University and Wuhan General Hospital of Guangzhou Military Command. The patients fell into two groups according to their own de- cisions： the unsedated group （n=1000） and the sedated group （n=800）. After examination, the patients and the physicians were required to fill in a questionnaire form. All the data were analyzed statistically. The results showed that the main factors the patients took for consideration between sedated and unse- dated procedures included economy, comfort and safety. The income levels between the sedated and unsedated groups showed significant difference （P〈0.01）. Most patients in the unsedated group had lower income and were covered by less medical insurance. The tolerance rate was 92.4% vs. 65.5% be- tween the sedated and unsedated group, respectively. 95.5% patients in the sedated group and 72.1% pa- tients in the unsedated group chose the same endoscopy procedure for repeat examination. The survey data from endoscopists suggested the sedated procedure was more comfortable but less safe than the unsedated procedure （P〈0.01 ）. In China, unsedated GI endoscopy is now widely accepted by the major- ity of patients due to low cost and safety. Compared to unsedated GI endoscopy, sedated GI endoscopy is less painful, but more expensive and less safe. With the rapid improvement of people＇s living stan- dard and the reliability of sedation technology, we expect sedated GI endoscopy will be gradually ac- cepted by more patien展开更多
AIM:To compare sedated to unsedated colonoscopy in terms of duration,pain and the patient’s willingness to repeat the procedure.METHODS:Consecutive patients who underwent colonoscopies over a 2-year period were invit...AIM:To compare sedated to unsedated colonoscopy in terms of duration,pain and the patient’s willingness to repeat the procedure.METHODS:Consecutive patients who underwent colonoscopies over a 2-year period were invited to participate.All patients who were to undergo our endoscopy unit were offered sedation with standard intravenous sedatives and analgesics,or an unsedated colonoscopy was attempted.Demographic details were recorded.The patient anxiety level prior to the procedure,time to reach the cecum,total discharge time,patient and endoscopist pain assessments,satisfaction after the examination and the patient’s willingness to return for the same procedure in the future were recorded.RESULTS:Among the 403 observed patients,more males were observed in the unsedated group(66.2%vs 55.2%,P=0.04).Additionally,the unsedated group patients were less anxious prior to the procedure(5.1vs 6.0,P<0.01).The colonoscopy completion rates were comparable between the 2 groups(85.9%vs84.2%,P=0.66).The time to reach the cecum was also comparable(12.2 min vs 11.8 min);however,the total discharge times were shorter in the unsedated group(20.7 min vs 83.0 min,P<0.01).Moreover,the average patient pain score(3.4 vs 5.7,P<0.01)was lower in the sedated group,while the satisfaction score(8.8 vs 7.8,P<0.01)was significantly higher.There was no significant difference,however,between the groups in terms of willingness to repeat the procedure if another was required in the future(83.3%vs 77.3%,P=0.17).CONCLUSION:Unsedated colonoscopy is feasible in willing patients.The option saves the endoscopy units up to one hour per patient and does not affect the patient willingness to return to the same physician again for additional colonoscopies if a repeated procedure is needed.展开更多
AIM To compare colonoscopy quality with nitrous oxide gas(Entonox?) against intravenous conscious sedation using midazolam plus opioid.METHODS A retrospective analysis was performed on a prospectively held database of...AIM To compare colonoscopy quality with nitrous oxide gas(Entonox?) against intravenous conscious sedation using midazolam plus opioid.METHODS A retrospective analysis was performed on a prospectively held database of 18608 colonoscopies carried out in Lothian health board hospitals between July 2013 and January 2016.The quality of colonoscopies performed with Entonox was compared to intravenous conscious sedation(abbreviated in this article as IVM).Furthermore,the quality of colonoscopies performed with an unmedicated group was compared to IVM.The study used the following key markers of colonoscopy quality:(1) patient comfort scores;(2) caecal intubation rates(CIRs); and (3) polyp detection rates (PDRs).We used binary logistic regression to model the data.RESULTS There was no difference in the rate of moderate-toextreme discomfort between the Entonox and IVM groups (17.9% vs 18.8%; OR = 1.06,95%CI: 0.95-1.18,P = 0.27).Patients in the unmedicated group were less likely to experience moderate-to-extreme discomfort than those in the IVM group(11.4% vs 18.8%; OR = 0.71,95%CI: 0.60-0.83,P < 0.001).There was no difference in caecal intubation between the Entonox and IVM groups(94.4% vs 93.7%; OR = 1.08,95%CI: 0.92-1.28,P = 0.34).There was no difference in caecal intubation between the unmedicated and IVM groups (94.2% vs 93.7%; OR = 0.98,95%CI: 0.79-1.22,P = 0.87).Polyp detection in the Entonox group was not different from IVM group (35.0% vs 33.1%; OR = 1.01,95%CI: 0.93-1.10,P = 0.79).Polyp detection in the unmedicated group was not significantly different from the IVM group (37.4% vs 33.1%; OR = 0.97,95%CI: 0.87-1.08,P = 0.60).CONCLUSION The use of Entonox was not associated with lower colonoscopy quality when compared to intravenous conscious sedation using midazolam plus opioid.展开更多
Unsedated colonoscopy is available worldwide,but is not a routine option in the United States(US).We conducted a literature review supplemented by our experience and expert commentaries to provide data to support the ...Unsedated colonoscopy is available worldwide,but is not a routine option in the United States(US).We conducted a literature review supplemented by our experience and expert commentaries to provide data to support the use of unsedated colonoscopy for colorectal cancer screening.Medline data from 1966 to 2009 were searched to identify relevant articles on the subject.Data were summarized and co-authors provided critiques as well as accounts of unsedated colonoscopy for screening and surveillance.Diagnostic colonoscopy was initially dev eloped as an unsedated procedure.Procedure-re lated discomfort led to wide adoption of sedation in the US,although unsedated colonoscopy remains the usual practice elsewhere.The increased use of colonoscopy for colorectal cancer screening in healthy,asymptomatic individuals suggests a reass-essment of the burden of sedation in colonoscopy for screening is appropriate in the US for lowering costs and minimizing complications for patients.A water method developed to minimize discomfort has shown promise to enhance outcomes of unsedated colonoscopy.The use of scheduled,unsedated colono scopy in the US appears to be feasible for colorectal cancer screening.Studies to assess its applicability in diverse practice settings deserve to be conducted and supported.展开更多
Transnasal endoscopy(TNE) is an upper endoscopy method which is performed by the nasal route using a thin endoscope less than 6 mm in diameter. The primary goal of this method is to improve patient tolerance and conve...Transnasal endoscopy(TNE) is an upper endoscopy method which is performed by the nasal route using a thin endoscope less than 6 mm in diameter. The primary goal of this method is to improve patient tolerance and convenience of the procedure. TNE can be performed without sedation and thus eliminates the risks associated with general anesthesia. In this way,TNE decreases the cost and total duration of endoscopic procedures, while maintaining the image quality of standard caliber endoscopes, providing good results for diagnostic purposes. However, the small working channel of the ultra-thin endoscope used for TNE makes it difficult to use for therapeutic procedures except in certain conditions which require a thinner endoscope.Biopsy is possible with special forceps less than 2 mm in diameter. Recently, TNE has been used for screening endoscopy in Far East Asia, including Japan. In most controlled studies, TNE was found to have better patient tolerance when compared to unsedated endoscopy. Nasal pain is the most significant symptom associated with endoscopic procedures but can be reduced with nasal pretreatment. Despite the potential advantage of TNE, it is not common in Western countries, usually due to a lack of training in the technique and a lack of awareness of its potential advantages. This paper briefly reviews the technical considerations as well as the potential advantages and limitations of TNE with ultra-thin scopes.展开更多
Although sedation and analgesia for patients undergoing colonoscopy is the standard practice in Western countries, unsedated colonoscopy is still routinely provided in Europe and the Far East. This variation in sedat... Although sedation and analgesia for patients undergoing colonoscopy is the standard practice in Western countries, unsedated colonoscopy is still routinely provided in Europe and the Far East. This variation in sedation practice relies on the different cultural attitudes of both patients and endoscopists across these countries. Data from the literature consistently report that, in unsedated patients, the use of alternative techniques, such as warm water irrigation or carbon dioxide insufflation, can allow a high quality and well tolerated examination.展开更多
文摘Colonoscopy techniques combining or replacing air insufflation with water infusion are becoming increasinglypopular.They were originally designed to reduce colonic spasms,facilitate cecal intubation,and lower patient discomfort and the need for sedation.These maneuvers straighten the rectosigmoid colon and enable the colonoscope to be inserted deeply without causing looping of the colon.Water-immersion colonoscopy minimizes colonic distension and improves visibility by introducing a small amount of water.In addition,since pain during colonoscopy indicates risk of bowel perforation and sedation masks this important warning,this method has the potential to be the favored insertion technique because it promotes patient safety without sedation.Recently,this water-immersion method has not only been used for colonoscope insertion,but has also been applied to therapy for sigmoid volvulus,removal of lesions,lower gastrointestinal bleeding,and therapeutic diagnosis of abnormal bowel morphology and irritable bowel syndrome.Although a larger sample size and prospective head-to-head-designed studies will be needed,this review focuses on the usefulness of waterimmersion colonoscopy for diagnostic and therapeutic applications.
文摘National data show that in China mainland unsedated gastrointestinal （GI） endoscopy has been applied in most hospitals for clinical examination, while sedated GI endoscopy is only performed in some hospitals. The purpose of this study was to compare sedated versus unsedated GI endoscopy regarding cost, safety, degree of comfort, tolerance level and overall satisfaction of patients over a 6-month period investigation. From March to September 2011, a questionnaire survey was performed on 1800 patients and 30 physicians at Zhongnan Hospital of Wuhan University and Wuhan General Hospital of Guangzhou Military Command. The patients fell into two groups according to their own de- cisions： the unsedated group （n=1000） and the sedated group （n=800）. After examination, the patients and the physicians were required to fill in a questionnaire form. All the data were analyzed statistically. The results showed that the main factors the patients took for consideration between sedated and unse- dated procedures included economy, comfort and safety. The income levels between the sedated and unsedated groups showed significant difference （P〈0.01）. Most patients in the unsedated group had lower income and were covered by less medical insurance. The tolerance rate was 92.4% vs. 65.5% be- tween the sedated and unsedated group, respectively. 95.5% patients in the sedated group and 72.1% pa- tients in the unsedated group chose the same endoscopy procedure for repeat examination. The survey data from endoscopists suggested the sedated procedure was more comfortable but less safe than the unsedated procedure （P〈0.01 ）. In China, unsedated GI endoscopy is now widely accepted by the major- ity of patients due to low cost and safety. Compared to unsedated GI endoscopy, sedated GI endoscopy is less painful, but more expensive and less safe. With the rapid improvement of people＇s living stan- dard and the reliability of sedation technology, we expect sedated GI endoscopy will be gradually ac- cepted by more patien
基金Supported by Partially by College of Medicine Research Center,Deanship of Scientific Research,King Saud University
文摘AIM:To compare sedated to unsedated colonoscopy in terms of duration,pain and the patient’s willingness to repeat the procedure.METHODS:Consecutive patients who underwent colonoscopies over a 2-year period were invited to participate.All patients who were to undergo our endoscopy unit were offered sedation with standard intravenous sedatives and analgesics,or an unsedated colonoscopy was attempted.Demographic details were recorded.The patient anxiety level prior to the procedure,time to reach the cecum,total discharge time,patient and endoscopist pain assessments,satisfaction after the examination and the patient’s willingness to return for the same procedure in the future were recorded.RESULTS:Among the 403 observed patients,more males were observed in the unsedated group(66.2%vs 55.2%,P=0.04).Additionally,the unsedated group patients were less anxious prior to the procedure(5.1vs 6.0,P<0.01).The colonoscopy completion rates were comparable between the 2 groups(85.9%vs84.2%,P=0.66).The time to reach the cecum was also comparable(12.2 min vs 11.8 min);however,the total discharge times were shorter in the unsedated group(20.7 min vs 83.0 min,P<0.01).Moreover,the average patient pain score(3.4 vs 5.7,P<0.01)was lower in the sedated group,while the satisfaction score(8.8 vs 7.8,P<0.01)was significantly higher.There was no significant difference,however,between the groups in terms of willingness to repeat the procedure if another was required in the future(83.3%vs 77.3%,P=0.17).CONCLUSION:Unsedated colonoscopy is feasible in willing patients.The option saves the endoscopy units up to one hour per patient and does not affect the patient willingness to return to the same physician again for additional colonoscopies if a repeated procedure is needed.
文摘AIM To compare colonoscopy quality with nitrous oxide gas(Entonox?) against intravenous conscious sedation using midazolam plus opioid.METHODS A retrospective analysis was performed on a prospectively held database of 18608 colonoscopies carried out in Lothian health board hospitals between July 2013 and January 2016.The quality of colonoscopies performed with Entonox was compared to intravenous conscious sedation(abbreviated in this article as IVM).Furthermore,the quality of colonoscopies performed with an unmedicated group was compared to IVM.The study used the following key markers of colonoscopy quality:(1) patient comfort scores;(2) caecal intubation rates(CIRs); and (3) polyp detection rates (PDRs).We used binary logistic regression to model the data.RESULTS There was no difference in the rate of moderate-toextreme discomfort between the Entonox and IVM groups (17.9% vs 18.8%; OR = 1.06,95%CI: 0.95-1.18,P = 0.27).Patients in the unmedicated group were less likely to experience moderate-to-extreme discomfort than those in the IVM group(11.4% vs 18.8%; OR = 0.71,95%CI: 0.60-0.83,P < 0.001).There was no difference in caecal intubation between the Entonox and IVM groups(94.4% vs 93.7%; OR = 1.08,95%CI: 0.92-1.28,P = 0.34).There was no difference in caecal intubation between the unmedicated and IVM groups (94.2% vs 93.7%; OR = 0.98,95%CI: 0.79-1.22,P = 0.87).Polyp detection in the Entonox group was not different from IVM group (35.0% vs 33.1%; OR = 1.01,95%CI: 0.93-1.10,P = 0.79).Polyp detection in the unmedicated group was not significantly different from the IVM group (37.4% vs 33.1%; OR = 0.97,95%CI: 0.87-1.08,P = 0.60).CONCLUSION The use of Entonox was not associated with lower colonoscopy quality when compared to intravenous conscious sedation using midazolam plus opioid.
基金Supported in part by Veterans Affairs Clinical Merit Medical Research Funds,the ASGE Career Development Award (FWL1985)American College of Gastroenterology Clinical Research Award(FWL 2009)
文摘Unsedated colonoscopy is available worldwide,but is not a routine option in the United States(US).We conducted a literature review supplemented by our experience and expert commentaries to provide data to support the use of unsedated colonoscopy for colorectal cancer screening.Medline data from 1966 to 2009 were searched to identify relevant articles on the subject.Data were summarized and co-authors provided critiques as well as accounts of unsedated colonoscopy for screening and surveillance.Diagnostic colonoscopy was initially dev eloped as an unsedated procedure.Procedure-re lated discomfort led to wide adoption of sedation in the US,although unsedated colonoscopy remains the usual practice elsewhere.The increased use of colonoscopy for colorectal cancer screening in healthy,asymptomatic individuals suggests a reass-essment of the burden of sedation in colonoscopy for screening is appropriate in the US for lowering costs and minimizing complications for patients.A water method developed to minimize discomfort has shown promise to enhance outcomes of unsedated colonoscopy.The use of scheduled,unsedated colono scopy in the US appears to be feasible for colorectal cancer screening.Studies to assess its applicability in diverse practice settings deserve to be conducted and supported.
文摘Transnasal endoscopy(TNE) is an upper endoscopy method which is performed by the nasal route using a thin endoscope less than 6 mm in diameter. The primary goal of this method is to improve patient tolerance and convenience of the procedure. TNE can be performed without sedation and thus eliminates the risks associated with general anesthesia. In this way,TNE decreases the cost and total duration of endoscopic procedures, while maintaining the image quality of standard caliber endoscopes, providing good results for diagnostic purposes. However, the small working channel of the ultra-thin endoscope used for TNE makes it difficult to use for therapeutic procedures except in certain conditions which require a thinner endoscope.Biopsy is possible with special forceps less than 2 mm in diameter. Recently, TNE has been used for screening endoscopy in Far East Asia, including Japan. In most controlled studies, TNE was found to have better patient tolerance when compared to unsedated endoscopy. Nasal pain is the most significant symptom associated with endoscopic procedures but can be reduced with nasal pretreatment. Despite the potential advantage of TNE, it is not common in Western countries, usually due to a lack of training in the technique and a lack of awareness of its potential advantages. This paper briefly reviews the technical considerations as well as the potential advantages and limitations of TNE with ultra-thin scopes.
文摘 Although sedation and analgesia for patients undergoing colonoscopy is the standard practice in Western countries, unsedated colonoscopy is still routinely provided in Europe and the Far East. This variation in sedation practice relies on the different cultural attitudes of both patients and endoscopists across these countries. Data from the literature consistently report that, in unsedated patients, the use of alternative techniques, such as warm water irrigation or carbon dioxide insufflation, can allow a high quality and well tolerated examination.
