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PubMed2001

[Hydro-MRI in inflammatory bowel diseases: a comparison with colonoscopy and histology].

PURPOSE: To compare hydro-MRI with colonoscopy and biopsy specimen regarding the assessment of inflammatory activity and the differentiation of inflammatory bowel diseases. MATERIAL AND METHODS: After an oral bowel opacification using 1000 ml of a 2.5% mannitol solution and a rectal bowel opacification using 250-500 ml of a 0.9% saline solution, axial and coronal breath-hold sequences +/- Gd-DTPA (HASTE-["half-Fourier acquisition single-shot turbo spin echo"] and dynamic FLASH-["fast low angle shot"]) were acquired in 27 patients with inflammatory bowel disease. The enhancement of the bowel wall as well as morphological MRI findings were correlated with colonoscopy and biopsy specimens. By means of the MRI findings, Crohn's disease (CD) and ulcerative colitis (UC) should be differentiated. RESULTS: In CD, a significant correlation between the contrast enhancement of the inflamed bowel wall (delta SI) and the endoscopic/histopathologic indices could be established (r = 0.52; p = 0.02 and r = 0.72; p = 0.001). In UC, no correlations between delta SI and the endoscopic/histopathologic indices could be found. The correct diagnosis of CD and UC by MRI findings was possible in 22/27 patients (81%). CONCLUSION: Hydro-MRI with dynamic studies is suitable for the assessment of disease activity in CD, but unreliable in UC. Hydro-MRI provides useful information for the differentiation of CD and UC.

Adolescent↗

PubMed2002

Increased rectal wall thickness may predict relapse in ulcerative colitis: a pilot follow-up study by ultrasonographic colonoscopy.

BACKGROUND AND STUDY AIMS: Ulcerative colitis is a chronic inflammatory bowel disease with repeated remission and relapse, although the occurrence of relapse is difficult to predict. We performed a prospective study to determine whether there is a relationship in ulcerative colitis between the inflammatory changes identified by endoscopic ultrasonography (EUS) and relapse. PATIENTS AND METHODS: Participants were 23 ulcerative colitis patients who had not suffered a relapse for 1 month, with a Seo activity index less-than-or-equal 150 and Baron grade 1 at colonoscopy. The thickness of the first to the third layer of the rectal wall in these patients was measured by EUS at the start of the study. They were subsequently followed up for 1 year to record any relapses, defined as having a Seo activity index > 150 and Baron grade greater-than-or-equal 2 at colonoscopy. RESULTS: Relapse occurred in eight patients. The mean activity index of the relapsed patients was 187.3 (95 % confidence interval (CI), 166.4 - 208.2) at the end of the study. The thickness of the first to the third layer of the rectal wall, as evaluated by EUS at the beginning of the study, was significantly larger in the relapse group (mean 2.73 mm, 95 % CI 2.13 - 3.33 mm) than in the non-relapse group (1.79 mm; 1.56 - 1.99 mm; P = 0.0001). CONCLUSIONS: Catheter probe-assisted endoluminal ultrasonography may predict the occurrence of relapse of ulcerative colitis.

Adult↗

PubMed2002

Does scant hematochezia necessitate the performance of total colonoscopy?

BACKGROUND AND STUDY AIMS: Controversy exists as to whether all patients with lower intestinal bleeding need to undergo total colonoscopy. This study compares the prevalence of colonic neoplasms in patients reporting scant hematochezia with the prevalence in controls. PATIENTS AND METHODS: Structured interviews were carried out with 4265 consecutive patients referred for colonoscopy. Of these, 468 patients had scant hematochezia, 299 had occult rectal bleeding and 57 reported dark rectal bleeding. Patients with scant hematochezia were matched for age and sex with those having no risk factors for colorectal neoplasms. For all groups, we determined the prevalence of adenomas and cancers below and above 50 cm. RESULTS: Colonic neoplasms were found in 18 % of patients with scant hematochezia and in 7.5 % of controls. However, most of these tumors were located within the reach of a sigmoidoscope. Compared with controls, patients with scant hematochezia had no increased risk for proximal neoplasms (odds ratio [OR] = 1.2), while this risk was significantly increased in patients with occult rectal bleeding (OR = 3.1) and patients who had observed maroon-colored blood in their stool (OR = 4.8). CONCLUSIONS: Flexible sigmoidoscopy appears to be a sufficient work-up for young patients who have observed trace amounts of bright red blood on the surface of their stool.

Adenoma↗

PubMed2005

Polyethylene glycol versus sodium phosphate in bowel cleansing for colonoscopy: a randomized trial.

BACKGROUND AND STUDY AIMS: There have been conflicting results regarding the adverse effects of established bowel cleansing regimens. The aim of the present study was to compare the effects of three bowel cleansing regimens on subjective well-being, electrolyte balance, cardiac arrhythmia, and the microscopic post-cleansing appearance of the colonic mucosa. PATIENTS AND METHODS: A total of 231 consecutive outpatients were randomly assigned to receive bowel preparation for colonoscopy with either 4 l polyethylene glycol (PEG; group I, n = 76); 2 l PEG plus 10 mg Bisacodyl (group II, n = 71); or 90 ml sodium phosphate (group III, n = 84). After bowel preparation, the participants completed a questionnaire on symptoms. Endoscopists blinded to the regimen used gave scores for the quality of cleansing at endoscopy, ranging from poor (0) to very good (5). Blood samples were taken before and after bowel cleansing, electrocardiographic monitoring was used during colonoscopy, and mucosal biopsy samples were taken in the sigmoid colon. RESULTS: Bowel preparation in group II was poorer (mean score 3.26) than in groups I (3.88) and III (4.01); P < 0.001 (II vs. III), P < 0.001 (I vs. II). The frequency of arrhythmias and post-cleansing mucosal inflammation was similar in all three groups. Lower serum potassium and higher serum phosphate concentrations were found in group III in comparison with the other groups ( P < 0.001). CONCLUSIONS: No differences were detected regarding the effectiveness and safety of bowel preparation with PEG alone and sodium phosphate in individuals without cardiac, renal, or hepatic failure, despite a significantly stronger alteration of the electrolyte balance with sodium phosphate.

Biopsy↗

PubMed2006

Push-and-pull enteroscopy using a single-balloon technique for difficult colonoscopy.

BACKGROUND AND STUDY AIMS: Several factors predict difficult or incomplete colonoscopy with a standard colonoscope, including female gender, low body mass index, extensive diverticulosis, and prior pelvic surgery. PATIENTS AND METHODS: A push-and-pull enteroscopy device and a single-balloon technique was used in 14 patients (six men, eight women; mean age 62 +/- 15 years) after failure of ileocolonoscopy or endoscopic therapy using either a standard or a pediatric colonoscope. The original ileocolonoscopy had been performed to investigate colon polyps (n = 6), an obscure inflammatory process in the ileocecal region (n = 6), or iron deficiency anemia with a positive fecal occult stool test (n = 2). RESULTS: Ileocolonoscopy was successfully performed using this push-and-pull technique in all 14 patients without technical problems or complications. All the endoscopic therapeutic interventions that were required were also performed without complications, with the exception of one instance of bleeding. Multiple polyps were found in six patients; a colon cancer was found in one patient; appendicitis combined with a carcinoid tumour of the appendix was diagnosed in one patient; ileocolitis was observed in two patients; one patient with Crohn's disease had stenoses in the region of an anastomosis; and in three patients no relevant pathological finding was seen. CONCLUSION: It was possible to perform ileocolonoscopy with therapeutic interventions using this new thin push-and-pull enteroscopy device with a single-balloon technique in patients who had previously undergone incomplete colonoscopy using a standard colonoscope.

Adult↗

PubMed2006

Characterization of colonic polyps at conventional (nonmagnifying) colonoscopy after spraying with 0.2 % indigo carmine dye.

BACKGROUND AND STUDY AIMS: Japanese endoscopists have devised a classification system based on mucosal crypt patterns which is helpful for distinguishing between hyperplastic polyps, adenomas, and invasive cancers at colonoscopy. The aim of this study was to assess how well the various types of colonic polyp could be distinguished using conventional colonoscopes after spraying with 0.2 % indigo carmine dye. PATIENTS AND METHODS: The endoscopic appearances of all colonic lesions were assessed in 476 unselected patients using normal-resolution, nonmagnifying colonoscopes after spraying with 0.2 % indigo carmine dye. RESULTS: A total of 709 lesions were found in the 476 patients, and histology was available for 673 of these lesions: 187 lesions were found to be non-neoplastic (128 hyperplastic, 2 juvenile, 30 inflammatory, and 27 classified as "others"); 467 lesions were adenomatous; and 19 lesions were carcinomas. Of the 467 adenomas, 377 were tubular, 77 were tubulovillous, 8 were villous and 5 were serrated; 423/467 were correctly identified (sensitivity 91 %). Of the 187 non-neoplastic lesions, 153 were correctly classified (specificity 82 %). A total of 343 of the 377 tubular lesions were correctly identified as tubular adenomas (sensitivity 90 %), and 46 of the 77 tubulovillous lesions were correctly identified. CONCLUSIONS: Standard colonoscopy with dye spraying can be used to differentiate colonic polyps. Magnification is not always necessary to distinguish neoplastic from nonneoplastic colonic lesions. This finding could result in resource savings in colonoscopic screening.

Adult↗

PubMed1995

The role of pethidine in sedation for colonoscopy.

BACKGROUND AND STUDY AIMS: As sedation with a combination of benzodiazepines and opioids has been associated with an increased risk of serious cardiorespiratory events, it is rarely used in upper gastrointestinal endoscopy. The combination is, however, still commonly used in sedation for colonscopy and endoscopic retrograde cholangiopancreatography (ERCP). This study aimed to determine the benefits and disadvantages of adding pethidine to diazepam (Diazemuls) in the sedation for colonoscopic examinations. PATIENTS AND METHODS: Seventy-one consecutive patients attending for routine colonoscopy were randomized in a double-blind, placebo-controlled manner to sedation with Diazemuls alone or Diazemuls with pethidine. The colonoscopist was at liberty to administrate any dose of Diazemuls considered appropriate for the patient's age and size, following which the patient was given an injection of pethidine 50 mg or a placebo. Both the patient and the endoscopist were blind to whether pethidine or a placebo was used. Adequacy of sedation was assessed and oxygen saturation recorded throughout the procedure. Oxygen was administered if the oxygen saturation fell below 92%. Patient satisfaction with sedation and recall of the procedure was recorded, by questionnaire, one day after examination. RESULTS: A total of 71 patients were entered into the trial. The two groups were similar with respect to age, sex, weight, alcohol intake, and state of health. An average of 18 mg of Diazemuls was given in the pethidine group and 19 mg in the placebo group. There was no statistically significant difference in the level of sedation obtained with the two regimens, although there was a tendency for the combination of Diazemuls with pethidine to give deeper sedation. Three patients were inadequately sedated with Diazemuls alone, requiring the code to be broken for pethidine to be given. Nine colonoscopies had to be abandoned due to patient intolerance in the group receiving Diazemuls, compared to five in the group receiving the combination regimen (p = 0.22). Twice as many patients receiving the combination of Diazemuls with pethidine required oxygen supplementation to maintain oxygen saturation during the procedure. This difference was highly statistically significant (p = 0.008). With the administration of supplemental oxygen, the average drop in oxygenation was similar in both groups. Satisfaction with sedation and recall for the procedure were similar in both groups. CONCLUSIONS: Although the patients had no preference for either regime, there may be an advantage in using the combination of Diazemuls and pethidine, as there was a trend for this combination to be preferred by the colonoscopists. The combination of a benzodiazepine with an opiate should be used with caution, however, as there was a greater requirement for oxygen in the group sedated by Diazemuls and pethidine.

Adolescent↗

PubMed1995

The role of colonoscopy in the differential diagnosis of acute, severe hemorrhagic colitis.

BACKGROUND AND STUDY AIMS: This study assesses the diagnostic value of colonoscopy performed at an early stage of a first attack of acute, severe hemorrhagic colitis. PATIENTS AND METHODS: One hundred fourteen consecutive patients were prospectively studied. The colonoscopic diagnosis was compared with the final diagnosis of the colitis, which was based on clinical, microbiological, endoscopic, and histological criteria during the acute illness, but also on the results of a thirty-month follow-up of the patients aiming to confirm whether the colitis was relapsing or nonrelapsing in nature. RESULTS: The colonoscopic diagnosis was ulcerative colitis (UC) in 40, Crohn's disease in four, and infective colitis (IC) in 70 patients. The endoscopic diagnosis was finally confirmed in all 40 UC patients and in 68 of 70 (97.1%) IC patients. Two patients with an initial endoscopic and histological diagnosis of IC presented with typical attacks of UC 28 and 30 months later, respectively. Prominent endoscopic appearances in IC were mucosal edema, erythematous areas, hemorrhagic spots, bleeding, microaphthoid ulcers, and luminal exudate. Although rectal sparing was occasionally seen, endoscopic lesions were continuous and severe in the distal colon, but were patchily and unevenly distributed in other parts of the colon in IC. In UC, prominent colonoscopic findings were bleeding, mucosal friability, granularity, and ulceration; lesions were continuously distributed in the involved area. CONCLUSIONS: Colonoscopy is a useful procedure in the differential diagnosis of severe bloody diarrhea of unknown cause.

Acute Disease↗

PubMed1990

Segmental tuberculosis of the colon diagnosed by colonoscopy.

We describe the case of a woman with rectorrhagia and rectal tenesmus. Colonoscopy revealed a 3-4 cm-long ulcerated lesion with a reduced colon lumen 35 cm from the anus, and multiple biopsies were obtained from the ulcerated region, but histopathology was non-specific. Biopsy culture was positive for M. tuberculosis. Anti-tuberculous chemotherapy was initiated on the diagnosis of segmental tuberculosis of the colon. Subsequent evolution was favorable, both clinically and endoscopically. Emphasis is placed on the importance of colonoscopy and biopsy in the diagnosis of tuberculosis of the colon.

Aged↗

PubMed1990

Comparison of a new colon lavage solution (Iso-Giuliani) with a standard preparation for colonoscopy: a randomized study.

Iso-Giuliani is a new improved-taste isoosmotic PEG-electrolyte solution for colon cleansing. In a randomized study, we have compared the effectiveness, tolerance and patient acceptance of 3 dosage volumes of this solution with a standard preparation in 191 patients undergoing colonoscopy. Iso-Giuliani 3 1, and 4 1 proved better colonic preparations as compared with the standard preparation (P less than 0.01). However Iso-Giuliani, 21 was sufficient for satisfactory cleansing, especially in the rectosigmoid. Patients in the standard preparation group experienced more cramps than did those in Iso-Giuliani groups. Patient acceptance was significantly better for Iso-Giuliani than for the standard preparation. The ingestion of Iso-Giuliani represents a safe, effective and well-accepted method of colon cleansing, and is our elective method of preparation for colonoscopy.

Administration, Oral↗

PubMed1986

The value of colonoscopy and ultrasonography in the diagnosis of chronic intussusception in childhood.

Ultrasonography and colonoscopy were diagnostic for chronic intussusception in a 6-year-old girl. After an episode of acute gastroenteritis the child developed non-specific recurrent abdominal symptoms, which were considered to be functional. While the ultrasonographic pattern alone was too unspecific to establish the correct diagnosis, the colonoscopic findings were diagnostic of intussusception. This case report demonstrates that ultrasonography and colonoscopy are complementary, radiation-independent but reliable diagnostic procedures for detecting organic bowel disorders in children presenting with recurrent abdominal symptoms.

Child↗

PubMed1981

Colonoscopy in infancy and childhood with special regard to patient preparation and examination technique.

Only long colonoscopes, Olympus CF-LB2 or TCF-2L, were used for the 76 pediatric colonoscopies. A combination of a thin-liquid diet and laxatives was employed for 1-2 days before all the examinations. Physiological saline enemas on the eve and the morning of the day of examination were employed as supplementary colon-cleansing measures only in larger children. A mixture consisting of chlorpromazine, promethazine and pethidine chloride supplemented with atropine sulfate was used for premedication. Diazepam and ketamine chloride given i.v., or inhalation of halothane +N2O+O2 were employed for general anesthesia. Diazepam and phentanyl citrate given intravenously were used for the sedation of older children. The "classical" and Gaisford's modification of the procedure were found to be the most suitable examination techniques in infants and children. The coecum was reached in 75% of all examinations, and we had no complications with pediatric colonoscopy.

Adolescent↗

PubMed1991

[Acupuncture to alleviate pain during colonoscopy].

36 patients (18 males and 18 females, mean age 51 [21-76] years) were prepared for colonoscopy with acupuncture (points: Hegu, Neiguan, Zusanli and Gongsun bilaterally), without acupuncture or pretend acupuncture at points not expected to bring about pain relief. In the 12 acupuncture patients mean pain sensitivity, estimated during the examination by means of a visual analog scale, was significantly (P = 0.003) lower (1.4 +/- 0.4) than in the groups without acupuncture (n = 12; 2.7 +/- 0.3) or pretend acupuncture (n = 12; 3.0 +/- 0.3). In addition, analgesics and sedatives needed to be given significantly less to those with acupuncture (one patient each; P = 0.005) than those without (analgesics to five, sedatives to eight patients) or with pretend acupuncture (analgesics to four, sedatives to five patients). These data demonstrate that pain connected with colonoscopy can be reduced by preceding acupuncture.

Acupuncture Analgesia↗

PubMed2000

Use of colonoscopy to screen asymptomatic adults for colorectal cancer. Veterans Affairs Cooperative Study Group 380.

BACKGROUND AND METHODS: The role of colonoscopy in screening for colorectal cancer is uncertain. At 13 Veterans Affairs Medical Centers, we performed colonoscopy to determine the prevalence and location of advanced colonic neoplasms and the risk of advanced proximal neoplasia in asymptomatic patients (age range, 50 to 75 years) with or without distal neoplasia. Advanced colonic neoplasia was defined as an adenoma that was 10 mm or more in diameter, a villous adenoma, an adenoma with high-grade dysplasia, or invasive cancer. In patients with more than one neoplastic lesion, classification was based on the most advanced lesion. RESULTS: Of 17,732 patients screened for enrollment, 3196 were enrolled; 3121 of the enrolled patients (97.7 percent) underwent complete examination of the colon. The mean age of the patients was 62.9 years, and 96.8 percent were men. Colonoscopic examination showed one or more neoplastic lesions in 37.5 percent of the patients, an adenoma with a diameter of at least 10 mm or a villous adenoma in 7.9 percent, an adenoma with high-grade dysplasia in 1.6 percent, and invasive cancer in 1.0 percent. Of the 1765 patients with no polyps in the portion of the colon that was distal to the splenic flexure, 48 (2.7 percent) had advanced proximal neoplasms. Patients with large adenomas (> or = 10 mm) or small adenomas (< 10 mm) in the distal colon were more likely to have advanced proximal neoplasia than were patients with no distal adenomas (odds ratios, 3.4 [95 percent confidence interval, 1.8 to 6.5] and 2.6 (95 percent confidence interval, 1.7 to 4.1], respectively). However, 52 percent of the 128 patients with advanced proximal neoplasia had no distal adenomas. CONCLUSIONS: Colonoscopic screening can detect advanced colonic neoplasms in asymptomatic adults. Many of these neoplasms would not be detected with sigmoidoscopy.

Adenoma↗

PubMed2006

Colonoscopy in colorectal-cancer screening for detection of advanced neoplasia.

BACKGROUND: Recommendations for colorectal-cancer screening are based solely on age and family history of cancer, not sex. METHODS: We performed a cross-sectional analysis of the data from a large colonoscopy-based screening program that included 50,148 participants who were 40 to 66 years of age. People 40 to 49 years of age were eligible only if they had a family history of cancer of any type. Of the 43,042 participants 50 to 66 years of age, 13.3% reported a family history of colorectal cancer, as did 66.3% of the 7106 participants who were 40 to 49 years of age. We defined advanced neoplasia as cancer or adenoma that was at least 10 mm in diameter, had high-grade dysplasia, or had villous or tubulovillous histologic characteristics, or any combination thereof. We used multivariate logistic regression to identify associations between participants' characteristics and advanced neoplasia in a primary (or derivation) data set, and we confirmed the associations in a secondary (or validation) data set. RESULTS: Advanced neoplasia was detected in 2553 (5.9%) participants 50 to 66 years of age and in 243 (3.4%) participants 40 to 49 years of age. The rate of complications during colonoscopy was 0.1%, and no participants died. In the validation set, a logistic-regression model showed that male sex was independently associated with advanced neoplasia (adjusted odds ratio, 1.73; 95% confidence interval, 1.52 to 1.98; P<0.001). In each age group (40 to 49 years, 50 to 54 years, 55 to 59 years, and 60 to 66 years), the number of persons who would have to undergo colorectal-cancer screening in order to detect one advanced neoplasia was significantly lower in men than in women (23 vs. 36, 17 vs. 28, 12 vs. 22, and 10 vs. 18, respectively). CONCLUSIONS: We detected advanced neoplasia at a significantly higher rate in men than in women, which may warrant refinement of the screening recommendations for colorectal cancer.

Adenoma↗

PubMed2001

An easy method for the intraluminal administration of peppermint oil before colonoscopy and its effectiveness in reducing colonic spasm.

BACKGROUND: Systemic administration of a cholinergic blocking agent or glucagon is used to reduce spasms, but it is inconvenient and sometimes causes side effects. This study is an evaluation of the intracolonic administration of peppermint oil during colonoscopy for the control of colonic spasm. METHODS: Each patient in the treated group (n = 409) was given approximately 200 mL of the solution (a mixture of 8 mL of peppermint oil and 0.2 mL of Tween 80 per 1 L of water with 0.04% indigo carmine) by using a hand pump attached to the accessory channel of the colonoscope. Changes in patient posture were made to distribute the solution. The patients in the control group (n = 36) were given the solution without peppermint oil. RESULTS: A satisfactory spasmolytic effect was seen in 88.5% of the treated patients and in 33.3% of those in the control group (p<0.0001). No adverse effect was observed. The mean time to onset was 21.6 +/- 15.0 seconds, and the effect continued for at least 20 minutes. In patients with irritable bowel syndrome, efficacy was significantly lower (p < 0.0001). CONCLUSIONS: The intraluminal administration of peppermint oil by using a hand pump is a simple, safe, and convenient alternative to the systemic injection of a cholinergic blocking agent or glucagon during colonoscopy.

Adult↗

PubMed2002

Relationship between age and site of colorectal cancer based on colonoscopy findings.

BACKGROUND: Colorectal cancer occurs more frequently in older people. Because the population of aged persons is increasing, a better understanding of the characteristics of colorectal cancer with respect to age would be useful. The purpose of this study was to determine whether there is any relationship between the site of colorectal adenoma and adenocarcinoma in the colon and age. METHODS: Colonoscopy was performed (September 1995 to December 1998) on 2942 consecutive patients (1907 men, 1035 women; mean age 61 years, range 11 to 95 years) with no history of colorectal adenoma, adenocarcinoma, or inflammatory bowel disease. The occurrence of colorectal neoplasia, histologically proven as adenoma or adenocarcinoma, was analyzed for a possible association between site in the colon and patient age. RESULTS: Adenocarcinoma was found in 191 patients (196 lesions). The proportion of patients with right-sided colonic adenocarcinoma increased with patient age: < 50 years, 15% (2/13); 50 to 59 years, 21% (8/39); 60 to 69 years, 32% (18/57); 70 to 79 years, 42% (25/49); > or =80 years, 57% (16/28). The proportion of patients with right-sided adenoma did not significantly differ among age groups: < 50 years, 40% (98/246); 50 to 59 years, 41% (280/678); 60 to 69 years, 46% (459/1001); 70 to 79 years, 53% (270/508); and > or =80 years, 57% (87/152). CONCLUSION: The frequency of right-sided colon cancer increases with patient age. Hence, colonoscopy may be indicated in the elderly for colorectal cancer screening. Over half of colon carcinomas may be missed if sigmoidoscopy alone is used for screening.

Adenocarcinoma↗

PubMed2002

Propofol versus midazolam/meperidine for outpatient colonoscopy: administration by nurses supervised by endoscopists.

BACKGROUND: Propofol is under evaluation as a sedative for endoscopic procedures. METHODS: Eighty outpatients (ASA Class I or II) undergoing colonoscopy were randomized to receive either propofol or midazolam plus meperidine, administered by a nurse and supervised by an endoscopist. Endpoints were patient satisfaction, procedure and recovery times, neuropsychological function, and complications. RESULTS: The mean dose of propofol administered was 218 mg; mean doses of midazolam and meperidine were, respectively, 4.7 mg and 89.7 mg. Mean time to sedation was faster in the propofol patients (2.1 min vs. 7.0 min; p < 0.0001), and depth of sedation was greater (p < 0.0001). On average, after the procedure, the propofol patients could stand at the bedside sooner (14.2 vs. 30.2 min), reached full recovery faster (14.4 vs. 33.0 min), and were discharged sooner (40.5 vs. 71.1 min) (all p < 0.0001). Patients who received propofol also expressed greater overall mean satisfaction on a 10-point visual analog scale (9.3 vs. 8.6; p < 0.05). At discharge, the propofol group had better scores on tests reflective of learning, memory, working memory span, and mental speed. Four patients in the midazolam/meperidine group developed minor complications (1 hypotension and bradycardia, 2 hypotension alone, and 1 tachycardia) and 1 patient in the propofol group had oxygen desaturation develop during an episode of epistaxis. CONCLUSION: For outpatient colonoscopy, propofol administered by nurses and supervised by endoscopists has several advantages over midazolam plus meperidine and deserves additional investigation.

Adult↗