SEARCH · PubMed Health

Results for “Colonoscopy”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 613 records · Page 34Linked to original sources

PubMed2001

Safer colonoscopy with patient-controlled analgesia and sedation with propofol and alfentanil.

BACKGROUND: The aim of this study was to assess the efficacy of patient-controlled analgesia and sedation with propofol/alfentanil for colonoscopy compared with continuous drug infusion and conventional nurse-administered medication. METHODS: One hundred fifty patients undergoing colonoscopy on an outpatient basis were randomly assigned to 1 of 3 medication regimens. To maintain blinding, all patients were connected to an infusion pump. Group I patients could self-administer boluses of 4.8 mg propofol and 125 microg alfentanil without restriction. Group II patients received a continuous infusion with 0.048 mg/kg propofol and 0.12 microg/kg alfentanil per minute. Group III patients received intravenous premedication with 0.035 mg/kg midazolam and 0.35 mg/kg meperidine. RESULTS: There were no differences between the groups with respect to pain (visual analogue scale) and procedure time. Patient-controlled analgesia and sedation with propofol/alfentanil (group I) resulted in less of an increase in the transcutaneous partial pressure of carbon dioxide (p = 0.0004) during colonoscopy and less of a decrease in mean arterial blood pressure (p = 0.0021) during recovery, as well as more complete recovery (p = 0.0019) after 45 minutes compared with conventional administration of midazolam/meperidine. Furthermore, patient-controlled analgesia and sedation yielded a higher degree of patient satisfaction than continuous infusion of propofol/alfentanil (p = 0.0033) or nurse-administered midazolam/meperidine (p = 0.0094). CONCLUSIONS: Patient-controlled administration of propofol and alfentanil for colonoscopy may provide a better margin of safety than conventional administration of midazolam and meperidine and results in a higher level of patient satisfaction and shorter recovery.

Alfentanil↗

PubMed2002

Warm water irrigation for dealing with spasm during colonoscopy: simple, inexpensive, and effective.

BACKGROUND: Colonic spasm can interfere with colonoscopy by hindering insertion of the colonoscope and by making polypectomy difficult, painful, and dangerous. Methods for dealing with colonic spasm include waiting for it to subside and administration of antispasmodic agents such as glucagon or hyoscyamine. Glucagon is expensive and hyoscyamine has side effects. This study evaluated an inexpensive technique, warm water irrigation, for overcoming colonic spasm during colonoscopy. METHODS: A prospective, randomized, controlled trial in a consecutive series of patients was conducted to compare warm water irrigation for relaxation of spasm with standard examination techniques. Patients in whom the sigmoid colon had been resected were excluded. In the test group, water from the hot water tap at approximately body temperature was instilled into the colon by means of the accessory channel of the colonoscope with a 30 mL syringe. Any irrigation, either for removal of stool or control of spasm, was performed with warm water in the test group and water at room temperature in the control group. After each colonoscopy, the level of pain experienced by the patient was recorded with a linear analog scale. RESULTS: Sixty-nine patients were randomized. The groups were similar with respect to gender distribution, age, and degree of spasm. There was no difference between groups for insertion time, total duration of colonoscopy, dose of midazolam administered, or frequency of severe spasm. Patients who had warm water irrigation had significantly less discomfort than control patients (median 2.0, interquartile range: 1-4 on a 10 point linear analog scale, vs. 4.0, interquartile range: 2-5). CONCLUSIONS: Although glucagon and hyoscyamine remain options for treatment of colonic spasm, the results of this study suggest that warm water is also effective. It has no side effects and costs practically nothing.

Aged↗

PubMed2002

A new water instillation method for colonoscopy without sedation as performed by endoscopists-in-training.

BACKGROUND: Colonoscopy may be associated with discomfort when performed without sedation. A study was conducted to determine whether instillation of water into the colon at the beginning of the procedure reduces intubation time as well as patient discomfort and pain. METHODS: Colonoscopy was performed in 259 patients by 3 endoscopists-in-training with limited experience. Patients were randomly allocated to 2 groups. In one, a technique was used in which 500 to 1000 mL of water is instilled into the colon by enema at the beginning of the procedure (instillation group, n = 130). In the other, patients underwent a conventional colonoscopy (control group, n = 129). Intubation time was measured and compared between the groups, and subjective discomfort experienced by the patients was measured upon completion of the examination. RESULTS: Success rates for insertion to the cecum were similar, (95.4%, instillation group; 96.1%, control group). Detection rates for any colorectal diseases were not different between the groups (30.0% vs. 32.6%). Mean time to cecal intubation was 10.5 minutes in the instillation group and 16.2 minutes in the control group (p < 0.0001). The proportion of patients who complained of abdominal pain during the procedure was 17.1% in the instillation group and 33.3% in the control group (p < 0.001). CONCLUSIONS: When used by endoscopists-in-training, the water-instillation colonoscopy technique was associated with less discomfort and faster cecal intubation with no decrease in the rate of detection of colorectal diseases.

Adult↗

PubMed2003

Conscious analgesia/sedation with remifentanil and propofol versus total intravenous anesthesia with fentanyl, midazolam, and propofol for outpatient colonoscopy.

BACKGROUND: This study tested the hypothesis that, for colonoscopy, analgesia/sedation with remifentanil and propofol might be more effective compared with anesthesia by intravenous administration of midazolam, fentanyl, and propofol. METHODS: In a prospective, randomized trial, 100 adult patients received either conscious analgesia/sedation (Sedation group) or total intravenous anesthesia (TIVA group). Analgesia/sedation was achieved by infusion of remifentanil (0.20 to 0.25 microg/kg/min) and propofol in titrated doses. TIVA was induced by intravenous administration of fentanyl (2 microg/kg), midazolam (0.05 mg/kg) and propofol (dosage titrated). Cardiorespiratory parameters and bispectral index were monitored and recorded. The quality of the analgesia was assessed with a Numerical Pain Rating Scale (NRS); recovery level and return of psychomotor efficiency were evaluated with, respectively, the Aldrete scale and a Modified Post Anesthesia Discharge Scoring (MPADS) system. RESULTS: Both groups of 50 patients were comparable with respect to demographic data, initial parameters, and duration of colonoscopy. All patients in the TIVA group found the colonoscopy painless (NRS score 0). In the Sedation group, the average pain intensity score was 0.4 (0.8). There was a marked difference between the Sedation and TIVA groups with respect to the time from the end of the procedure until the maximum MPADS score was reached: respectively, -6.9 (4.0) versus 25.7 (8.4) minutes (p < 0.001). In the TIVA group, changes in mean arterial pressure and heart rate and signs of respiratory depression were significant (p < 0.05). CONCLUSIONS: Combined administration of remifentanil and propofol for colonoscopy provides sufficient analgesia, satisfactory hemodynamic stability, minor respiratory depression, and rapid recovery, and allows patients to be discharged approximately 15 minutes after the procedure.

Adolescent↗

PubMed2003

Impact of colonoscopy preparation quality on detection of suspected colonic neoplasia.

BACKGROUND: Suboptimal bowel preparation for colonoscopy can lead to missed colonic lesions. The aim of this study was to describe the impact of preparation quality on detection of suspected colonic neoplasia. METHODS: Data from the Clinical Outcomes Research Initiative national endoscopic database for the period January 1, 2000 to December 31, 2001, were analyzed. Patient demographics, quality of preparation, and colonoscopy findings were abstracted from the database. RESULTS: Overall, 93,004 colonoscopies with adequate documentation were reviewed. Preparation was adequate for 71,501 (76.9%) of these procedures. On multivariate analysis, preparation adequacy was associated with colonic lesion detection, odds ratio (OR) 1.21: 95% CI [1.16, 1.25]. Adequate preparation demonstrated a closer association with identification of "nonsignificant" lesions (polyps 9 mm), OR 1.05: 95% CI [0.98, 1.11]. CONCLUSIONS: Bowel preparation is inadequate for almost a quarter of patients undergoing colonoscopy. These results suggest that inadequate preparation quality only hinders detection of smaller lesions, while having negligible impact on detection of larger lesions. These results should be confirmed in prospective studies.

Colonoscopy↗

PubMed2003

A randomized single-blind trial of whole versus split-dose polyethylene glycol-electrolyte solution for colonoscopy preparation.

BACKGROUND: Colonoscopy preparation regimens are often poorly tolerated because they require use of large-volume bowel preparation solution and diet restrictions for adequate cleansing. This study evaluated the efficacy and tolerability of a split-dose polyethylene glycol-electrolyte solution plus bisacodyl and a regular diet. METHODS: A total of 187 patients (104 men, 83 women; age range 18-91 years) were randomly assigned to receive either 3 L of polyethylene glycol-electrolyte solution (n = 96; Group A) with a liquid diet on the day before colonoscopy, or 2 L of polyethylene glycol-electrolyte solution, one tablet of bisacodyl, and a minimally restricted diet on the day before colonoscopy, and then 1 L of the same solution on the day of colonoscopy (n = 91; Group B). Acceptability, adverse events, and willingness to retake the preparation were assessed by questionnaire. The quality of the preparation was graded by an endoscopist, blinded to the type of preparation, by using a previously described scale (excellent to poor). RESULTS: There were 96 patients in Group A and 91 in Group B. Colon cleansing was significantly better in Group B with regard to the overall quality of the preparation (p lt; 0.05). Compliance was significantly higher in Group B as evidenced by the lower number of patients who discontinued the preparation (4 vs. 15; p = 0.02) because of side effects such as nausea or vomiting. The degree of discomfort, adverse events, and willingness to retake the preparation were not significantly different between the groups. CONCLUSIONS: Colonic preparation with split-dose polyethylene glycol-electrolyte provided better quality colon cleansing and higher compliance, with less dietary restrictions, than preparation with whole-dose polyethylene glycol-electrolyte.

Adolescent↗

PubMed2003

Does insertion of a rectal tube after colonoscopy reduce patient discomfort and improve satisfaction?

BACKGROUND: Distention of the colon is a major contributor to patient discomfort after colonoscopy. Some physicians and nurses believe insertion of a rectal tube relieves this discomfort and improves patient satisfaction with the procedure. This prospective, randomized, controlled trial assessed rectal tube insertion for reduction or prevention of abdominal bloating and discomfort after colonoscopy. METHODS: One hundred fifty-seven patients were prospectively randomized to groups with (n = 68) and without (n = 89) rectal tube insertion after colonoscopy. Patients were evaluated for bloating, discomfort, and pain before the procedure, at its conclusion, at discharge, and 24 hours later (by telephone). Satisfaction was also assessed at discharge and 24 hours later. RESULTS: There were no differences between groups with respect to age, gender, hospitalization status, comorbidity, or socioeconomic status. In both groups the cecum was reached in 90% of patients and procedure time was similar. There were no differences between the groups in abdominal bloating (patient and nurse assessment), abdominal discomfort, or satisfaction at any time point. There were no serious complications. The subgroup of patients who experienced more severe pain and discomfort, regardless of whether a rectal tube was inserted, was characterized by more complaints of bloating, more incomplete procedures, and a higher rate of previous abdominal operations. CONCLUSIONS: Insertion of a rectal tube after colonoscopy does not affect abdominal bloating, pain, or discomfort during recovery from the procedure or over the subsequent 24 hours, nor does it affect overall patient satisfaction.

Abdominal Pain↗

PubMed2003

A prospective study of the technical feasibility of ileoscopy at colonoscopy.

BACKGROUND: Despite a well-documented diagnostic yield, ileoscopy at colonoscopy is not performed routinely. This is due to the perceived difficulty in intubating the ileocaecal valve, added procedure time and a lack of acceptance regarding diagnostic yield. Therefore, we conducted a study to investigate the technical feasibility of ileoscopy at colonoscopy. METHODS: Ileoscopy was studied prospectively in 120 patients undergoing diagnostic colonoscopy. After identification of the caecum, ileoscopy was attempted by one of four techniques. The time taken to pass from caecum to terminal ileum, the patient position, use of Hyoscine-n-butyl bromide and any ileal abnormalities were recorded in each case. RESULTS: Ileoscopy was successful in 117/120 (97%) cases with a median time of 55 s taken to intubate the ileo-caecal valve. A 'down and left' technique was used in most cases (74.4%). Switching the patient to supine aided ileoscopy in 24 cases (20.4%) and Hyoscine-n-butyl bromide was considered helpful in 25 (21.4%). Overall, the terminal ileum was abnormal in 24 of 117 (20.5%) patients. CONCLUSIONS: Ileoscopy can be achieved in nearly all patients undergoing diagnostic colonoscopy and the added procedure time is short. Added time, technical difficulty and limited yield are not valid reasons for choosing not to perform ileoscopy.

Abdominal Pain↗

PubMed2004

Small-bowel barium follow-through is rarely required in patients with a normal ileoscopy and terminal ileal biopsy and a normal or unremarkable colonoscopy.

BACKGROUND: There is an increase of reliance on ileoscopy in preference to small-bowel barium follow-through in the diagnosis of terminal ileal Crohn disease. In this study the role of small-bowel barium follow-through after a normal or unremarkable ileocolonoscopy was investigated. METHODS: A retrospective analysis of all patients who had a colonoscopy followed by a small-bowel barium follow-through over a 7-year period was performed. Patients with a previously established diagnosis of inflammatory bowel disease and those who had colonoscopic evidence of inflammatory bowel disease were excluded. RESULTS: Of the 96 patients who had a normal ileoscopy and normal or unremarkable colonoscopy, 3 had abnormalities detected at small-bowel barium follow-through. Two patients had abnormal terminal ileal biopsies, although the terminal ileum appeared macroscopically normal. The small-bowel barium follow-through helped to establish the diagnosis of Crohn disease. The other patient presented changes consistent with a previously established diagnosis. Of the 47 patients who had a normal or unremarkable total colonoscopy without ileoscopy, I had abnormalities detected at small-bowel barium follow-through consistent with a previously established diagnosis. CONCLUSIONS: Small-bowel barium follow-through is rarely required in patients who have had a normal ileoscopy and terminal ileum biopsy and a normal or unremarkable colonoscopy. It should only be performed if there is a very high index of suspicion of small-bowel pathology. In patients with suspected Crohn disease, it is important to take terminal ileum biopsies even if the ileum appears macroscopically normal at ileoscopy.

Adolescent↗

PubMed1998

Delayed mid-ileal perforation secondary to acute-on-chronic ischaemia after a diagnostic colonoscopy.

Perforation occurring at a remote site of the bowel after diagnostic colonoscopy is rare. A 61-year-old man presenting with bloody diarrhoea underwent colonoscopy. A dynamic ileus developed in less than 1 day, and mid-ileal perforation occurred 7 days after the procedure. It is suggested that high air pressure during colonoscopy further compromised the reduced blood flow in the mid-ileum, which had underlying chronic ischaemia, leading to perforation. Our patient constitutes the first reported case of small-bowel perforation after colonoscopy due to pre-existent ileal ischaemia.

Acute Disease↗

PubMed2003

Development of appropriateness criteria for colonoscopy: comparison between a standardized expert panel and an evidence-based medicine approach.

OBJECTIVES: To assess the degree of agreement between appropriateness criteria for the use of colonoscopy developed by a standardized expert panel method and evidence from published studies. DESIGN: Descriptive, agreement study. SETTING: Multidisciplinary panel; primary care practice in Switzerland. PARTICIPANTS: Nine national experts; 577 primary care patients referred for colonoscopy, 154 published papers. INTERVENTIONS: Evaluation of the appropriateness of 402 possible clinical indications for colonoscopy, based on a comprehensive review of the literature. MAIN OUTCOMES MEASURES: Proportion of agreement (weighted kappa), between panel- and literature-based appropriateness categories (appropriate, uncertain, inappropriate) for theoretical and actual indications encountered. RESULTS: Nineteen of 402 indications rated by the panel could be based on the evidence retrieved from eight randomized clinical trials. A 68% agreement (kappa = 0.52) was found between panel- and study-based criteria. The addition of an uncontrolled trial and seven observational studies yielded a 71% agreement (kappa = 0.63). Agreement was similar when examining 577 actual cases: 69% agreement, kappa = 0.47. Agreement between panel-based indications and published evidence was not influenced by the perceived comprehensiveness and the apparent quality of the published reports. CONCLUSIONS: Evidence for the appropriateness of most indications for colonoscopy could not be derived directly from the published literature. Agreement between appropriateness criteria developed by an expert panel and evidence from published studies was moderate to good, where available. New approaches should be sought in order to systematically integrate complementary evidence obtained from clinical trials and expert panels into practice guidelines.

Clinical Trials as Topic↗

PubMed2006

Colonoscopy first for iron-deficiency anaemia: a Numbers Needed to Investigate approach.

BACKGROUND: British Society of Gastroenterology guidelines recommend that gastrointestinal investigations should be considered in males and post-menopausal women presenting with iron-deficiency anaemia (IDA). AIM: To compare the diagnostic yields and clinical effectiveness of upper and lower gastrointestinal (GI) investigation in detecting malignancy among patients presenting with IDA. DESIGN: Retrospective review of case notes, endoscopy records and radiology reports. METHODS: We reviewed the results of 3798 investigations in 2600 patients presenting to our hospital with IDA from October 1995 to December 2003. The findings of the 2318 gastroscopies were compared with those of the 896 colonoscopies and the 584 barium enemas. Patients diagnosed with GI malignancy were identified and their outcomes determined. RESULTS: Gastroscopy identified 44 patients with newly-diagnosed upper GI cancer (18 oesophageal, 26 gastric). Thus for patients being gastroscoped for IDA, the Numbers Needed to Investigate (NNI) to detect each cancer was 53. Five-year survival for these 44 patients was 10%, so the NNI to identify each curable upper GI malignancy was 527. Colonoscopy or barium enema identified 111 (7.5%) patients with newly diagnosed colorectal cancer, giving a NNI of 13. Their 5-year survival was 35%, giving a NNI to identify each curable colorectal cancer patient of 38. DISCUSSION: Potentially curable gastrointestinal malignancy was diagnosed over 13 times more commonly using colonoscopy or barium enema vs. gastroscopy. For patients presenting with IDA, our findings favour investigating the lower GI tract first, or performing both gastroscopy and colonoscopy during the same endoscopy list.

Adolescent↗

PubMed2006

Colonoscopy-associated pneumothorax: a case of tension pneumothorax and review of the literature.

A 64-year-old woman presented with severe abdominal pain and was found to have a large fecolith in the sigmoid colon with resulting bowel obstruction. During a therapeutic colonoscopy, she developed severe shortness of breath and hypoxia, and was found to have a tension pneumothorax. We review the potential mechanisms by which pneumothorax may occur following colonoscopy. In addition, the eight previously published cases are reviewed. Pneumothorax, with or without pneumomediastinum, can occur through a variety of mechanisms following colonoscopy. Although rarely reported, this may represent an underappreciated complication and should be fully investigated in the appropriate setting. Colonoscopy, an exceedingly common procedure, will continue to increase with the aging population. As a result, tension pneumothorax can have a profound effect on the patient outcome and therefore physicians, both gastroenterologists and pulmonologists, should be aware of all the potential problems with this procedure.

Colonoscopy↗

PubMed1987

The impact of colonoscopy on the early detection of colonic neoplasms in patients with rectal bleeding.

A retrospective analysis was made of 372 consecutive patients who underwent colonoscopy because of rectal bleeding. The three distinct patterns of bleeding studied were chronic (224 cases), recent major (93 cases), and acute bleeders (55 cases). In 50% of the cases, colonoscopy detected a lesion other than diverticula. These lesions consisted of several forms of colitis, arteriovenous malformations (AVMs), ulcers, and most importantly, neoplasms in 34% of the cases. In 13% of the cases, an invasive neoplasm was detected and 76% of them were early stage (Dukes A or B). A third of the neoplasms were located proximal to the splenic flexure. Among patients with a negative barium enema, 35% had a neoplasm detected on colonoscopy. These findings were similar for the three distinct patterns of rectal bleeding studied. These data support the need for colonoscopy in all types of rectal bleeders, regardless of the results obtained by BE.

Acute Disease↗

PubMed1988

Intraoperative colonoscopy.

From 1973 to 1985, we performed intraoperative colonoscopy on 68 patients with indications as follows: location of a previous polypectomy site (44%), inability to complete colonoscopy preoperatively (24%), locating nonpalpable polyps (13%), to define the source of lower gastrointestinal bleeding (4%), and to perform polypectomy (3%). Endoscopic evaluation influenced the outcome in 93% of the patients. There were two complications, both splenic capsular tears. Despite our increased ability to resolve several of the earlier indications for intraoperative colonoscopy by examination prior to celiotomy, there remains a significant role for intraoperative colonoscopy.

Colonic Neoplasms↗

PubMedDate not supplied

Evaluation of demographic, behavioral, and procedural factors on pain perception by patients undergoing colonoscopy and moderate sedation.

This prospective study collected demographic, behavioral, and procedural factors data on the pain perception of 100 patients as they were undergoing colonoscopy and moderate sedation. Patients were asked to rate pain on a 4-point categorical scale (no, slight, moderate, or severe pain) before the colonoscopy, every 5 minutes during, and after the colonoscopy. Before discharge, patients recorded overall pain control satisfaction on a 100-mm visual analog scale (0=not satisfied and 100=satisfied). The average patient age was 54.3 years, and 56% were male. A total of 59 subjects reported an averaged "no pain" or "slight pain" rating, and 41 reported moderate or severe pain. The median visual analog scale score was 92.5, demonstrating a high level of overall pain-control satisfaction. Patient reports of pain during the colonoscopy procedure may not be recalled by the moderately sedated patient, as evidenced from the high level of satisfaction of overall pain control demonstrated by the visual analog scale finding. Compared with women and non-Whites, a larger proportion (P<.05) of men and Whites reported "no" or "slight pain"; moreover, a larger proportion (P<.05) of patients experiencing no preprocedure anxiety reported "no" or "slight pain" compared with those experiencing anxiety before their procedure. Compared with other sedation groups, a larger proportion (P<.05) of patients receiving Versed + Fentanyl reported "no" or "slight pain" during their procedures. Other factors that were analyzed, including age, body mass index, history of alcohol consumption, smoking, narcotic use, length of procedure, and medical or nursing intervention, did not appear to influence the level of pain perceived by patients observed in this study.

Adult↗

PubMed1990

The value of barium enema and colonoscopy in patients infected with HIV.

Double contrast barium enema (DCBE) and colonoscopy were prospectively compared with rigid sigmoidoscopy, rectal biopsy and microbiological examination in the analysis of stool specimens in 58 HIV-1-infected patients with diarrhoea (more than three liquid motions/day for greater than 1 month). In 26 patients no cause for the diarrhoea was found. In 17 patients the cause of diarrhoea was microbiological, and in 19 rectal histology provided a specific diagnosis. In all these patients sigmoidoscopic appearances were abnormal except in those with Cryptosporidium alone. Colonoscopy provided additional information in only one individual, with cytomegalovirus ulcers of the transverse colon. DCBE was abnormal in only seven cases (cytomegalovirus in three, Kaposi's sarcoma in two, Giardia lamblia in two) and in no case provided additional information. A combination of stool microbiology and rectal histology gave a sensitivity of 97% with a positive predictive value of 100%. The sensitivities of DCBE and colonoscopy with histology were low (16 and 62%, respectively) although the specificity for each test was high, with high positive predictive values. We conclude that neither barium enema nor colonoscopy add usefully to rigid sigmoidoscopic biopsy and stool microscopy in HIV-positive patients with diarrhoea.

Barium Sulfate↗

PubMed1990

Randomized clinical trial of two colonoscopy preparation methods for elderly patients.

Colonic lavage with enemas or with Golytely are standard preparation methods for colonoscopy. Previous studies have demonstrated that Golytely has a statistically significant advantage in both adequacy of preparation and patient tolerance. To determine if these effects are present in the elderly, we performed a randomized clinical trial on 124 consecutive patients scheduled for colonoscopy who were greater than or equal to 75 years of age. Sixty-three patients were randomized to receive Golytely; 17 were inpatients, 33 were outpatients, and colonoscopy was canceled in 13. Sixty-one patients were randomized to receive the enema preparation; 17 were inpatients, 30 were outpatients, and colonoscopy was canceled in 14. For adequacy of the preparation, no differences were statistically significant, but the enema preparation was superior in outpatients while Golytely was superior in inpatients. Patients tolerated the enema preparation better, a finding present in both outpatients and inpatients. Contrary to previous reports of a significant advantage with Golytely, patients greater than or equal to 75 years old did not enjoy this advantage, but seemed to tolerate enemas better than Golytely with little difference in adequacy of the preparation.

Aged↗