How Big Is A Colonoscopy Camera

World J Gastroenterol. 2000 Oct 15; 6(5): 659–663.

Does flexible minor-bore colonoscope reduce insertion pain during colonoscopy?

Received 2000 May 6; Revised 2000 May 25; Accepted 2000 Jun 2.

Abstract

AIM: It is well known that colonoscopy tin be difficult due to abdominal pain induced during colonoscope insertion, if sedative agents are not given. Recently, an extra-flexible, small-diameter colonoscope (CF-SV, Olympus Inc., Japan) was developed in social club to ameliorate safety and comfort. The aim of this study was to access the usefulness of the CF-SV.

METHODS: Ane hundred patients undergoing sigmoidoscopy were recruited and colonoscopy was performed by 1 experienced colonoscopist. First, a routine-type colonoscope (CF-230I) was inserted into the colon without sedation. When the patient complained of intestinal pain (even if balmy), the scope was not advanced farther and was withdrawn after the anatomic location of its tip was determined fluoroscopically. Then, the CF-SV was inserted until information technology reached the cecun or the site where abdominal pain occurred. Previous abdominal surgery and a bdominal disease were considered as unfavorable factors (UF) and the relationship between abdominal hurting and UF, age and gender were investigated. Furthermore, the colonic insertion pressures in 36 patients with intestinal pain were measured with a force gauge.

RESULTS: Thirty-four cases (34%) felt no pain with the CF-230I and successful pancolon-oscopies to the cecum were performed. Sixty-6 cases (66%) complained of abdominal pain. The procedure was painless for 47% of men and 24% of women, respectively. The CF-230I scope failed to attain the sigmoid-descending colon junctions in 59 (89.4%) of the 66 patients complaining of abdominal pain. Even so, CF-SV reached proximal area in 94.9% of those who failed with CF-230I. The median pressure for pain-inducing was 700 one thousand/cm².

Conclusion: Unsedated patients with UF were prone to complain of pain when the standard-type CF-230I scope was used. The newly developed extra-flexible CF-SV is useful for the aged and for those with UF or being decumbent to suffer from intestinal pain. Allaying agents may exist unnecessary if this new type of colonoscope is used.

Keywords: colonoscopy, abdominal hurting, flexible colonoscope, insertion pressure level, unfavorable factors, sigmoidoscopy

INTRODUCTION

Colonoscopy for patients who have undergone previous abdominal surgery, those with diverticular disease, women equally well as the aged is technically difficult, fifty-fifty in good hands[1-8], and usually induces abdominal pain if sedative agents are not administered. One way of preventing pain during colonoscopy is to use a scope that is more flexible and thinner than the conventional scopes. It has been reported that success rate of colonoscopy could be significantly improved when a pediatric colonoscope was used instead of routine-type instrument for adults when stricture, fixation or painful looping was encountered[ix]. Kozarek et al[10] accomplished a similar increase in the success rate by using a pocket-size-quotient upper endoscope for colonoscopy in similar circumstance. In 1997, the softest and most flexible colonoscope (CF-SV, Olympus Inc., and 9.6 mm in diameter with a 103 cm working length) so far was developed[11,12]. Moreover, a comparative study showed that fewer unsedated patients felt hurting during colonoscopy with the CF-SV than with a conventional colonoscope[11]. The aim of this self-controlled, prospective written report was to evaluate whether less pain is experienced during colonoscopy with the CF-SV than with a routine-blazon colon oscope.

SUBJECTS AND METHODS

The study was approved by the ethics commission of Hirosaki Academy Infirmary. I hundred consecutive patients of this hospital undergoing sigmoidoscopy over a 6-week flow were recruited. For the purpose of scientific comparison all of the functioning of colonoscopy was done exclusively by Dr. Uno who has performed over 5000 colonoscopies.

Relationship between insertion pain and unfavorable factors (UF)

Each patient was placed on the X-ray table in the left lateral position. No sedating agent was given, but the anus was treated with xylocaine jelly, and a routine-type colonoscope CF-230I (Figure ​ one) (Olympus Inc. 13.half-dozen mm in bore with a 130 cm working-length) was inserted. As soon every bit the patient complained of intestinal hurting, even it was balmy, the colonoscope was accelerate d no further, the patient was moved to supine position and the anatomic location of the tip of the scope was determined by fluoroscopy. And so, the scope was pulled out and the air in the lumen was let out. The colonoscopist knew nothing about the patients' historic period, past history of surgery or intestinal diseases considered as UF of the patients until the process had been completed.

The standard colonoscope (CF-230 I) is shown on the top, the CF-SV is on, the bottom.

Re-insertion of CF-SV

The patients who suffered from abdominal pain with CF-230I were checked with CF-SV five minutes after CF-230I was withdrawn. When the patient complained abdominal pain of similar severity as that with CF-230I, the proximal location of the scope tip was confirmed fluoroscopically with the patient in supine position and the procedure was discontinued. If the patient did not complain of pain, insertion of the scope was continued until up to the cecum or the 103 cm working length of the shaft had been inserted. Then, the proximal location of the tip was determined fluoroscopically and the procedure was terminated.

Measurement of the pain-inducing pressure level during insertion

The first sequent 36 patients who complained of hurting during colonoscopy with CF-230I were investigated. The hurting inducing pressure (g/cm²) initiated by the manus of the colonoscopist was measured with a force judge, and the relation ship between the insertion force and location of the hurting was evaluated.

Statistics

All statistical analyses were performed using either Chi-squared test or differences at P values of less than 0.05 were regarded equally significant.

RESULTS

Thirty-four patients (34%) were free of abdominal hurting during colonoscopy with CF-230I and the scope was inserted up to the cecum. More of these pain-free subjects were male (21 cases, 61.8%) than female (13 cases, 38.ii%) (Table ​ ane). At that place was no meaning difference (P < 0.05) between the boilerplate ages of the males who did non mutter of hurting (60.one years) and those who did (59.0 years), but the average ages of the corresponding female groups (55.4 yr. and 60.7 yr., respectively) were significantly different (P < 0.05), which suggests that crumbling females may be prone to pain during colonoscope insertion. There was no pregnant departure between the boilerplate ages of the males and females who did not mutter of hurting.

Table 1

Relationship betwixt insertion-induced pain, gender, age and UF

	Insertion induced pain	Number of cases	Age (year) 10- ± s	UF-positive
				No.	%
Male	Negative	21	60.1 ± 11.2	1	4.viii
	Positive	24	59.0 ± xiv.8	17	70.8
Female	Negative	13	55.iv ± eleven.2	3	23.ane
	Positive	42	60.7 ± thirteen.nine	31	73.8

Relationship between insertion pain and UF

Xviii male patients had past histories of surgery or intestinal diseases: seven (38.ix%) had undergone appendectomy; 3 (16.seven%) had cholecystectomy; ii (11.1%) of each had gastrectomy, Crohn's disease and ileus; one (five.6%) of each had diverticulitis, cancer of bladder, trauma, and a previous intestinal functioning for an unknown reason. One of these patients had two UFs. Seventeen of these eighteen patients with UF complained of abdominal pain during colonoscopy.

Thirty-four females had UF: 10 (29.4%) had cancer of the uterus; 8 (23.5%) h ad undergone appendectomy; 7 (20.6%) had hysterectomy for myoma uteri; 5 (14.7 %) had ovarian neoplasms; 3 (viii.viii%) of each had undergone cholecystectomy and had peritonitis; 2 (5.9%) had carcinoma of the tummy or float, and 1 (two.ix%) had ileus. Seven of these 34 patients had 2 of UFs. Thirty-1 patients (91.1%) complained of no abdominal pain during colonoscopy with CF-SV. Simply one (4.8%) of the 21 males who did non complain of pain had UF (Table ​ 1). Seventeen (70.8%) of the 24 male patients with abdominal hurting had UF (Table ​ 1) and 7 (29.2%) did not. Three (23.1%) of the 13 females whose procedures were painless were UF-positive, whereas 31 (73.viii%) of the 42 females with abdominal pain were UF-positive (Table ​ ane) and 11 (26.2%) were UF-negative. There was meaning difference (P < 0.05) between the numbers of UF-positive patients receiving painless and painful colonoscopy.

Reinsertion of CF-SV

The anatomic location of the intestinal pain induced in 61 of the 64 patients with CF-230I was the sigmoid segment. Yet, in 59 of these 61 (96.7%) the CF-SV was successfully inserted proximal to sigmoid segment without causing abdominal pain (Figure ​ 2). The remaining ii patients who complained of intestinal pain during re-insertion of CF-SV were female and very short in stature. Amidst the 59 patients in whom the CF-230I was failed to laissez passer through the sigmoid-descending colon junction, when re-inserted with CF-SV, it was passed in 56 (94.9%); transverse colon was passed in 30 (49.2%) and the ascending colon was reached in fourteen (23.7%). Only one man (8.3%) and 6 women (17.6%) complained of intestinal hurting with CF-SV, which was not inserted beyond the descending colon.

Anatomic depths of penetration of both colonoscopes, gender, patients' ages and unfavorable factors (UF). ▲: The location of insertion-induced abdominal pain with CF-230 I; ●: The location of insertion-induced abdominal pain with CF-SV; ○: Proximal surface area reached when re-inserted with CF-SV.

Measurement of the pain-inducing pressure during insertion of colonoscope

The pain-inducing pressure level during insertion ranged from 300 to 1200 g/cm² (Effigy ​ iii) and the median was 700 g/cm^two. In 24 of 36 patients (66.seven%), the range was 500-700 g/cm². Merely one patient, a 56-yr one-time woman with a history of hysterectomy and abdominal radiations therapy complained of a bdominal hurting even when the insertion force per unit area was as low as 300 g/cmⁱⁱ, and the anatomic location of the pain was around the upper rectum with the CF-230I and the rectosigmoid junction with CF-SV. Abdominal pain was induced at a pressure of 400 g/cm² just in three females: ane is a 35-yr-old immature lady suffering from a giant ovarian tumor; the other ii patients, fifty-fifty the CF-SV scope could not exist advanced to the proximal segment (the reason remains unknown). Two patients, both were 61 years old male, did not complain of intestinal pain fifty-fifty when the pressure level exceeded up to m 1000/cm². Interestingly, one of them was UF-negative, but the other had undergone appendectomy previously.

The pressure level associated with insertion-induced intestinal pain during colonoscopy.

DISCUSSION

The Japanese Society of Gastrointestinal Endoscopy has investigated, by conveying out questionnaire surveys, and reported the incidence of complications during endoscopy every 5 years since 1983. Co-ordinate to their data, from 1983 to 1992, the estimated incidence of colonic perforation during diagnostic and therapeutic colonoscopy was 0.04%[xiii], which is far lower than that in other countries[fourteen-16]. Even so, the incidence did not modify during this period which means that if the number of colonoscopic exam increases, the accented number of cases of perforation will inevitably goes upwardly. In Japan, the number of colonoscopies performed each year has been estimated to be over 3 millions. Therefore, over 600 perforation will occur per year, i-2 cases per day[17]. If perforation tin can be prevented, colonoscopy volition exist performed far more ofttimes.

When the tip or bend of a colonoscope presses difficult against the colonic mucosa, a seromuscular tear volition probably occur, fifty-fifty when there is no muscularis injury[xviii], and clinically, more than damage occurs before the symptoms of perforation appear. In lodge to avert such injuries, it is very important that colonoscopists undergo special grooming to improve their skill. The problem of perforation might be resolved if the procedure is piece of cake to perform and contained of experience and/or expertise.

In 1957, the "sigmoid camera" was developed in our institution (Hirosak University, Nippon)[19,twenty]. Examined with camera, it was not necessary to use sedation. Since then, colonoscopy without sedation had been performed till several years agone. In social club to minimize abdominal hurting during colonoscope insertion, the loop maneuver technique was introduced[21]. However, in some patients with UF, although the maneuver was performed, the scope could not be inserted more proximally considering of astringent insertion-induced abdominal pain. Therefore, no wadays, in our institution, at that place are 2 indications for colonoscopy nether sedation: when a patient complains of severe insertion-induced intestinal pain during the procedure; the patient prefers to be sedated.

In Japan, based on extensive experience, "Abdominal pain is a bespeak for some unsafe conditions" has become one of the nearly of import precepts. In our written report, the pressure to induce insertion-related abdominal pain was not college than 1200 g/cm². An in vitro experiment on perforation of the man colon[eighteen] showed that perforation occurred when the pressure reached upwards to 2-three kg/cmⁱⁱ. Therefore, the precept of our institution is true. Recently, colonoscopy without sedation and with selective sedation has been investigated in institutes in which colonoscopy under sedation used to exist a routine procedure[22-24]. Furthermore, the toll and complications may be reduced when colonoscopy is performed without sedation. According to King[25], the success rate of unsedated colonoscopy has uniformly been reported to be high in a pocket-size number of American reports, although the patients announced to have been selected. For example, in one study, attempted unsedated colonoscopy but in volunteers consisting of most 30% of sequent patients undergoing colonoscopy. In another study, colonoscopy was performed in consecutive male veterans.

In Japan, colonoscopy without sedation has too been reported but the subjects were young males undergoing a health check-up and did non include elderly subjects or those with UF. In fact, nosotros found that abdominal pain during colonoscope insertion ordinarily occurred in patients who were elderly or UF-positive. The sigmoid colon was the area where hurting occurred in most of the subjects undergoing colonoscopy without sedation[26]. In patients who are very young, very sometime, accept diverticular disease, a stock-still colon due to previous abdominal surgery, underwent previous pelvic radiation, have ovarian neoplasms besides as other kinds of abdominal pathological disorders, colonoscope advocacy to the transverse colon was difficult considering of making loops re-course in the sigmoid colon. This problem might be solved by introducing a potent wire into the instrument channel to stiffen the colonoscope after it has been straightened[27,28]. Recently, a new type of colonoscope with a shaft of variable stiffness has been developed [29].

Footnotes

Supported partially by Sasagawa Medical Scholarship Foundation (from 1999-2000)

Edited by Y'all DY Proofread by Zhu LH and Ma JY

References

1. Nivatvougs S, Fryd DS, Fang D. How difficult is colonoscopy (Abstract)? Gastrointest Endosc. 1982;28:140. [Google Scholar]

2. Ravi J, Brodmerkel GJ Jr, Agrawal RM, Gregory DH, Ashok PS. Does prior abdominal or pelvic surgery bear on the length of insertion of the colonoscope (Abstruse) Endoscopy. 1988;twenty:43. [Google Scholar]

three. Saunders BP, Marcrae F, Williams CB. What makes colonoscopy difficult (Abstract) Cut. 1993;34:S46. [Google Scholar]

four. Schmidt CM, Schultz SM, Lee JG, Baillie J. The association exist-tween gender and difficult colonoscopy (Abstruse) Gastrointest Endosc. 1994;forty:46. [Google Scholar]

v. Waye JD, Bashkoff Due east. Total colonoscopy: is information technology always possible? Gastrointest Endosc. 1991;37:152–154. [PubMed] [Google Scholar]

6. Church JM. Complete colonoscopy: How ofttimes. And if not, why not. Am J Gastroenterol. 1994;89:556–560. [PubMed] [Google Scholar]

7. Hull TL, Church JM, Milson JW, Oakley JR. Colonoscopy: How difficult. How painful (Abstract) Dis Colon Rectum. 1994;35:43. [Google Scholar]

8. Saunders BP, Fukumoto M, Halligan S, Jobling C, Moussa ME, Bartram CI, Williams CB. Why is colonoscopy more hard in women? Gastrointest Endosc. 1996;43:124–126. [PubMed] [Google Scholar]

9. Bat L, Williams CB. Usefulness of pediatric colonoscopes in adult colonoscopy. Gastrointest Endosc. 1989;35:329–332. [PubMed] [Google Scholar]

10. Kozarek RA, Botoman VA, Patterson DJ. Prospective evaluation of a small caliber upper endoscope for colonoscopy after unsuccessful standard examination. Gastrointest Endosc. 1989;35:333–335. [PubMed] [Google Scholar]

11. Tada G. Clinical evaluation of a newly devised sigmoidoscope, Type CF-SV. (In Japanese) Nippon J Med Instrume. 1997;67:127–130. [Google Scholar]

12. Tada Chiliad, Fujita North, Mori Y, Moriya A. Usefulness of a small caliber colonoscope, blazon CF-SV, for screening colorectal cancer. (In Japanese) J Gastro enterol Mass Survey. 1997;35:692–697. [Google Scholar]

xiii. Kaneko E. Fact-findings of complication during colorectal endoscopy (In Japanese) Clin Gastroenterol. 1996;11:1667–1672. [Google Scholar]

14. Kavin H, Sinicrope F, Esker AH. Management of perforation of the colon at colonoscopy. Am J Gastroenterol. 1992;87:161–167. [PubMed] [Google Scholar]

15. Orsoni P, Berdah S, Verrier C, Caamano A, Sastre B, Boutboul R, Grimaud JC, Picaud R. Colonic perforation due to colonoscopy: a retrospective study of 48 cases. Endoscopy. 1997;29:160–164. [PubMed] [Google Scholar]

xvi. Gilbert DA, Hallstrom AP, Shaneyfelt SL, Mahler AK, Silverstein Iron. The national ASGE colonoscopy survey complications of colonoscopy. Gastrointest Endosc. 1984;xxx:156. [Google Scholar]

17. Uno Y. Modest caliber flexible colonoscopy. Proceedings of the 23rd Seminar of the Japanese Society for Gastroenterological Endoscopy (Kanazawa, Japan), 1999: 28-30 [Google Scholar]

18. Uno Y, Morita T. Colonic perforation and serosal tears associated with colonoscopy. Lancet. 1997;349:1888. [PubMed] [Google Scholar]

xix. Morrissey JF. Progress in gastroenterology gastrointestinal endoscopy. Gastroenterol. 1972;62:1241–1267. [PubMed] [Google Scholar]

20. Edmonson JM. History of the instruments for gastrointestinal endoscopy. Gastrointest Endosc. 1991;37:S27–S56. [PubMed] [Google Scholar]

21. Matsunaga F. Colonoscopy. Proceedings of the 2nd World congress of Gastrointestinal Endoscopy (Roma and Copenhagen), 1970: 93-99 [Google Scholar]

22. Cataldo PA. Colonoscopy without sedation. Dis Colon Rectum. 1996;39:257–261. [PubMed] [Google Scholar]

23. Rex DK, Imperiale TF, Portish V. Patients willing to try colonoscopy without sedation: associated clinical factors and results of a randomized controlled trial. Gastrointest Endosc. 1999;49:554–559. [PubMed] [Google Scholar]

24. Seow-Choen F, Leong AF, Tsang C. Selective sedation for colonoscopy. Gastrointest Endosc. 1994;40:661–664. [PubMed] [Google Scholar]

25. King DK. Sedation for colonoscopy: Routine, Nitrous, or Nothing? Syllaous book of the 15th Acting Postgraduate grade of ASGE (NY) 1999: 7-ix [Google Scholar]

26. Hawes RH, Lehman GA, O'Connor KW, Kopecky KK, Lappas JC. Effect of instrument bore on the depth of penetration of fiberoptic sigmoidoscopes. Gastrointest Endosc. 1988;34:28–31. [PubMed] [Google Scholar]

27. Deyle P. Flexible steel wire for the maintenance of the straightening of the sigmoid and transverse colon during colonoscopy. Endoscopy. 1972;four:36–38. [Google Scholar]

28. Gabrielesson Due north, Granqvist Due south, Ohlsen H. Colonoscopy with the assistance of a steel wire to stiffen the fiberscope. Endoscopy. 1972;4:217–218. [Google Scholar]

29. Omasa R, Fujisaki J, Ando H, Kimoto A, Katsura S, Koizumi T. Experiences of use and usefulness of a new variable stiffness type colonoscope (Abstract) Gastrointest Endosc. 1999;49:AB130(305). [Google Scholar]

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4688839/

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