The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
Douglas K Rex - One of the best experts on this subject based on the ideXlab platform.
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impact of water filling on terminal ileum intubation with a distal tip mucosal exposure device
Gastrointestinal Endoscopy, 2020Co-Authors: Krishna C Vemulapalli, Andrew W. Sullivan, Nicholas Tippins, Rachel E Lahr, Emma Love, Connor D Mcwhinney, Merritt M Peterson, Douglas K RexAbstract:Background and Aims Endocuff improves detection at colonoscopy but seems to impede terminal ileal (TI) intubation. We assessed the impact of Endocuff Vision (EV) on TI intubation using adult or pediatric Colonoscopes and evaluated whether filling the cecum with gas versus water affected the impact of EV on TI intubation. Methods Using a prospectively recorded quality control database, we explored the impact of EV on TI intubation in ≤1 minute. We used adult and pediatric Colonoscopes and tested the effect of filling the cecum with gas versus water. If the initial attempt failed, then the alternative (water vs gas) was tried as a rescue method. Results TI intubation in ≤1 minute occurred in 91% of colonoscopies without EV versus 65% with EV, but the use of the pediatric Colonoscope with EV had a higher success rate for TI intubation in ≤1 minute compared with the adult Colonoscope with EV (73% vs 57%, P = .043). TI intubation in ≤1 minute was more successful with EV when the cecum was filled with water rather than gas (74% vs 56%, P = .019), but the benefit of water filling was limited to the adult Colonoscope with EV. When EV was in place, water filling was more successful as a rescue method of TI intubation (58% vs 21%, P = .011). Conclusions EV adversely affects TI intubation, particularly for adult Colonoscopes. Water filling of the cecum mitigates the impact of EV on TI intubation with adult Colonoscopes.
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technically difficult Colonoscope insertion tips and tricks
Digestive Endoscopy, 2019Co-Authors: Eduardo Rodriguespinto, Joel Ferreirasilva, Guilherme Macedo, Douglas K RexAbstract:Cecal intubation is a critical aspect of effective, complete colonoscopy. Difficult colonoscopy is most often considered as one in which it is challenging or impossible to reach the cecum. It may be a common occurrence due to patient and/or endoscopist factors. Incomplete colonoscopies should be avoided, since patients in this context present an important prevalence of lesions that escape examination. The approach to successful cecal intubation should depend on characterization of the problem as redundant colon or difficult sigmoid colon. Most patients with a prior incomplete colonoscopy can be Colonoscoped successfully, if careful attention is paid to technique, using a variety of scopes, colonoscopy methods and additional equipment. Sufficient time should be allotted to make the attempt.
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faster Colonoscope withdrawal time without impaired detection using endorings
PMC, 2018Co-Authors: John C Thygesen, Andrew W. Sullivan, Prasanna L Ponugoti, Jonathan R Garcia, Heather M Broadley, William W Tippins, Douglas K RexAbstract:Background and study aims Mucosal exposure devices on the Colonoscope tip have improved detection. We evaluated detection and procedure times in colonoscopies performed with EndoRings. Patients and methods We had 14 endoscopists in a university practice trial EndoRings. We compared detection and procedure times to age- and indication-matched procedures by the same endoscopists. Results There were 137 procedures with EndoRings. The adenoma detection rate was 44 % with EndoRings vs. 39 % without (P = 0.39). Mean adenomas per colonoscopy (standard deviation) was 1.2 (2.3) with EndoRings vs. 0.9 (1.6) without (P = 0.055). Mean insertion time with EndoRings was 6.2 (3.2) minutes vs. 6.6 (6.7) minutes without (P = 0.81). Mean withdrawal time with EndoRings in all patients with or without polypectomy was 12.2 (5.3) minutes and 16.1 (10.3) minutes without (P = 0.0005). Conclusion EndoRings may allow faster withdrawal during colonoscopy without any reduction in detection. Prospective trials with mucosal exposure devices targeting procedure times as primary endpoints are warranted.
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high definition colonoscopy versus endocuff versus endorings versus full spectrum endoscopy for adenoma detection at colonoscopy a multicenter randomized trial
Author, 2018Co-Authors: Douglas K Rex, Andrew W. Sullivan, Cesare Hassan, Alessandro Repici, Seth A Gross, Prasanna L Ponugoti, Jonathan R Garcia, Heather M Broadley, Jack C Thygesen, William W TippinsAbstract:Background and Aims Devices used to improve polyp detection during colonoscopy have seldom been compared with each other. Methods We performed a 3-center prospective randomized trial comparing high-definition (HD) forward-viewing colonoscopy alone to HD with Endocuff to HD with EndoRings to the full spectrum endoscopy (FUSE) system. Patients were age ≥50 years and had routine indications and intact colons. The study colonoscopists were all proven high-level detectors. The primary endpoint was adenomas per colonoscopy (APC). Results Among 1188 patients who completed the study, APC with Endocuff (APC mean ± standard deviation: 1.82 ± 2.58), EndoRings (1.55 ± 2.42), and standard HD colonoscopy (1.53 ± 2.33) were all higher than FUSE (1.30 ± 1.96; P Conclusions For high-level detectors at colonoscopy, forward-viewing HD instruments dominate the FUSE system, indicating that for these examiners image resolution trumps angle of view. Further, Endocuff is a dominant strategy over EndoRings and no mucosal exposure device on a forward-viewing HD Colonoscope. (Clinical trial registration number: NCT02345889.)
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polyp detection at colonoscopy endoscopist and technical factors
Best Practice & Research in Clinical Gastroenterology, 2017Co-Authors: Douglas K RexAbstract:The adenoma detection rate (ADR) has emerged as the most important quality measure in colonoscopy, as it predicts the risk of interval cancer after colonoscopy. Measuring and improving ADR is the central focus of the current quality movement in colonoscopy. High ADRs can be achieved by a colonoscopist with a thorough understanding of the wide range of endoscopic appearances of precancerous lesions in the colorectum, effective bowel preparation, and meticulous technique using high definition Colonoscopes. The knowledgeable and effective examiner needs no adjunctive devices or techniques to achieve master level ADRs. However, measurement reveals that many colonoscopists have ADRs that are below recommended minimum thresholds or below master levels. These colonoscopists, and even master level performers, can choose from a variety of adjunctive tools to improve ADR. This review describes these tools according to whether they are non-device methods (e.g. double right colon examination, patient position change, water exchange), mucosal exposure devices (wide angle colonoscopy, fold flattening devices), and lesion highlighting techniques (e.g. chromoendoscopy, electronic chromoendoscopy).
Kjetil Garborg - One of the best experts on this subject based on the ideXlab platform.
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gradual stiffness versus magnetic imaging guided variable stiffness Colonoscopes a randomized noninferiority trial
United European gastroenterology journal, 2017Co-Authors: Kjetil Garborg, Havard Wiig, Audun Hasund, Jon Matre, Geir Noraberg, Magnus Loberg, Oyvind Holme, Mette KalagerAbstract:BackgroundColonoscopes with gradual stiffness have recently been developed to enhance cecal intubation.ObjectiveWe aimed to determine if the performance of gradual stiffness Colonoscopes is noninferior to that of magnetic endoscopic imaging (MEI)-guided variable stiffness Colonoscopes.MethodsConsecutive patients were randomized to screening colonoscopy with Fujifilm gradual stiffness or Olympus MEI-guided variable stiffness Colonoscopes. The primary endpoint was cecal intubation rate (noninferiority limit 5%). Secondary endpoints included cecal intubation time. We estimated absolute risk differences with 95% confidence intervals (CIs).ResultsWe enrolled 475 patients: 222 randomized to the gradual stiffness instrument, and 253 to the MEI-guided variable stiffness instrument. Cecal intubation rate was 91.7% in the gradual stiffness group versus 95.6% in the variable stiffness group. The adjusted absolute risk for cecal intubation failure was 4.3% higher in the gradual stiffness group than in the variable st...
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gradual stiffness versus magnetic imaging guided variable stiffness Colonoscopes a randomized noninferiority trial
United European gastroenterology journal, 2017Co-Authors: Kjetil Garborg, Havard Wiig, Audun Hasund, Jon Matre, Geir Noraberg, Magnus Loberg, Oyvind Holme, Mette KalagerAbstract:BackgroundColonoscopes with gradual stiffness have recently been developed to enhance cecal intubation.ObjectiveWe aimed to determine if the performance of gradual stiffness Colonoscopes is noninferior to that of magnetic endoscopic imaging (MEI)-guided variable stiffness Colonoscopes.MethodsConsecutive patients were randomized to screening colonoscopy with Fujifilm gradual stiffness or Olympus MEI-guided variable stiffness Colonoscopes. The primary endpoint was cecal intubation rate (noninferiority limit 5%). Secondary endpoints included cecal intubation time. We estimated absolute risk differences with 95% confidence intervals (CIs).ResultsWe enrolled 475 patients: 222 randomized to the gradual stiffness instrument, and 253 to the MEI-guided variable stiffness instrument. Cecal intubation rate was 91.7% in the gradual stiffness group versus 95.6% in the variable stiffness group. The adjusted absolute risk for cecal intubation failure was 4.3% higher in the gradual stiffness group than in the variable st...
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reduced pain during screening colonoscopy with an ultrathin Colonoscope a randomized controlled trial
Endoscopy, 2012Co-Authors: Kjetil Garborg, Jon Matre, Mette Kalager, Magnus Loberg, Oyvind Holme, Geir Hoff, Michael BretthauerAbstract:Background and study aims: Screening colonoscopy for colorectal cancer (CRC) is recommended in several countries, but uptake rates are often low. Fear of pain and also time-consuming costly sedation are barriers for colonoscopy, and thus development of colonoscopy equipment that decreases patient discomfort is worthwhile. This randomized controlled trial investigated the performance of an ultrathin Colonoscope in CRC screening. Patients and methods: Consecutive participants in a colonoscopy screening trial were randomized to examination with an ultrathin prototype Colonoscope or a standard Colonoscope. The main outcome measure was pain during the examination. Participants rated pain (no, slight, moderate, severe) using a validated questionnaire. Results: From 187 enrolled participants (80 women [43 %]), 162 (87 %) responded to the questionnaire. The study groups were similar regarding baseline characteristics. Pain scores were significantly lower in the prototype instrument group compared with the standard group (78 % vs. 29 % of patients with no pain in prototype and standard groups, respectively; odds ratio [OR] 0.11; 95 % confidence interval [CI] 0.06 – 0.23; P Conclusion: The new ultrathin Olympus Colonoscope decreases patient pain during screening colonoscopy. This feature may improve uptake and patient satisfaction in screening colonoscopy. Further study is needed to evaluate the lower adenoma detection rate. ClinicalTrials.gov identifier: NCT01370928.
Ian M Gralnek - One of the best experts on this subject based on the ideXlab platform.
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comparison of adenoma detection and miss rates between a novel balloon Colonoscope and standard colonoscopy a randomized tandem study
Endoscopy, 2015Co-Authors: Zamir Halpern, Ian M Gralnek, Seth A Gross, Beni Shpak, Mark Pochapin, Arthur Hoffman, Meir Mizrahi, Yosef S Rochberger, Menachem MoshkowitzAbstract:Background and study aims: Although colonoscopy is the “gold standard” for colorectal cancer screening, a significant number of adenomas are still missed during standard colonoscopy, often because they are hidden behind colonic folds and flexures. The aim of this study was to assess the ability of a novel balloon Colonoscope (G-EYE endoscope; Smart Medical Systems, Ra’anana, Israel) to increase adenoma detection and reduce the miss rate compared with standard colonoscopy. Patients and methods: This was a multicenter, randomized, prospective, controlled study in patients (age ≥ 40 years) undergoing colonoscopy for screening or diagnostic work-up (including surveillance). Patients underwent same-day, back-to-back tandem colonoscopy. Patients in Group A underwent standard colonoscopy followed by balloon colonoscopy, and patients in Group B underwent balloon colonoscopy followed by the standard technique. The adenoma detection and miss rates were compared between the two colonoscopy procedures. Results: A total of 126 patients were enrolled and randomized into Group A (n = 60) or Group B (n = 66). The adenoma miss rate of balloon colonoscopy was significantly lower than that of standard colonoscopy (7.5 % vs. 44.7 %; P = 0.0002). The detection of additional adenomas by balloon colonoscopy was significant (81.0 %; P = 0.0002), in particular, the relative amount of adenomas detected in the ascending colon by balloon colonoscopy was 41 % versus 14 % for standard colonoscopy. Conclusions: A novel balloon colonoscopy technique detected significantly more adenomas than standard colonoscopy, and missed fewer adenomas. Balloon colonoscopy has the potential to increase the effectiveness of colorectal cancer screening and surveillance colonoscopy.
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emerging technological advancements in colonoscopy third eye retroscope and third eye panoramic tm fuse full spectrum endoscopy colonoscopy platform extra wide angle view Colonoscope and naviaid tm g eye tm balloon Colonoscope
Digestive Endoscopy, 2015Co-Authors: Ian M GralnekAbstract:Colonoscopy is the criterion standard for detecting colorectal adenomas and cancers. However, multiple studies have reported a significant percentage of adenomas are missed during standard, forward-viewing colonoscopy. Missed adenomas can lead to interval colorectal cancers. Aside from inadequate colon preparation, incomplete examinations (e.g. failure to intubate the cecum), short withdrawal times, and patient-related factors, the primary reason for missing colorectal adenomas and early cancers is poor visualization of the proximal aspect of colonic folds, at anatomical flexures, and in the ileocecal valve area. These anatomical sites tend to be hidden from the standard forward-viewing Colonoscope (170-degree angle of view) and can often only be seen through manipulation of the Colonoscope by the endoscopist. Thus, there is mounting evidence supporting the need to reduce the adenoma ‘miss rate’ of standard forward-viewing colonoscopy by improving upon current Colonoscope technology and its current visualization/optics limitations. Recently, there are a number of emerging technologies that may help revolutionize how colonoscopy is carried out and that will significantly reduce adenoma miss rates. These include the Third Eye® Retroscope® and Third Eye® PanoramicTM (Avantis Medical Systems, Sunnyvale, CA, USA); Fuse® Full Spectrum Endoscopy® colonoscopy platform (EndoChoice Inc., Alpharetta, GA, USA); Extra-Wide-Angle-View Colonoscope (Olympus, Tokyo, Japan), and the NaviAidTM G-EYETM balloon Colonoscope (SMART Medical Systems Ltd, Ra'anana, Israel).
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standard forward viewing colonoscopy versus full spectrum endoscopy an international multicentre randomised tandem colonoscopy trial
Lancet Oncology, 2014Co-Authors: Ian M Gralnek, Peter D Siersema, Zamir Halpern, Ori Segol, Alaa Melhem, Alain Suissa, Erwin Santo, Alan Sloyer, Jay FensterAbstract:Summary Background Although colonoscopy is the accepted standard for detection of colorectal adenomas and cancers, many adenomas and some cancers are missed. To avoid interval colorectal cancer, the adenoma miss rate of colonoscopy needs to be reduced by improvement of colonoscopy technique and imaging capability. We aimed to compare the adenoma miss rates of full-spectrum endoscopy colonoscopy with those of standard forward-viewing colonoscopy. Methods We did an international, multicentre, randomised trial at three sites in Israel, one site in the Netherlands, and two sites in the USA between Feb 1, 2012, and March 31, 2013. Patients aged 18–70 years referred for colorectal cancer screening, polyp surveillance, or diagnostic assessment underwent same-day, back-to-back tandem colonoscopy with standard forward-viewing Colonoscope and the full-spectrum endoscopy Colonoscope. The patients were randomly assigned (1:1), via computer-generated randomisation with block size of 20, to which procedure was done first. The endoscopist was masked to group allocation until immediately before the start of colonoscopy examinations; patients were not masked. The primary endpoint was adenoma miss rates. We did per-protocol analyses. This trial is registered with ClinicalTrials.gov, number NCT01549535. Findings 197 participants were enrolled. 185 participants were included in the per-protocol analyses: 88 (48%) were randomly assigned to receive standard forward-viewing colonoscopy first, and 97 (52%) to receive full-spectrum endoscopy colonoscopy first. By per-lesion analysis, the adenoma miss rate was significantly lower in patients in the full-spectrum endoscopy group than in those in the standard forward-viewing procedure group: five (7%) of 67 vs 20 (41%) of 49 adenomas were missed (p Interpretation Full-spectrum endoscopy represents a technology advancement for colonoscopy and could improve the efficacy of colorectal cancer screening and surveillance. Funding EndoChoice.
Magnus Loberg - One of the best experts on this subject based on the ideXlab platform.
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gradual stiffness versus magnetic imaging guided variable stiffness Colonoscopes a randomized noninferiority trial
United European gastroenterology journal, 2017Co-Authors: Kjetil Garborg, Havard Wiig, Audun Hasund, Jon Matre, Geir Noraberg, Magnus Loberg, Oyvind Holme, Mette KalagerAbstract:BackgroundColonoscopes with gradual stiffness have recently been developed to enhance cecal intubation.ObjectiveWe aimed to determine if the performance of gradual stiffness Colonoscopes is noninferior to that of magnetic endoscopic imaging (MEI)-guided variable stiffness Colonoscopes.MethodsConsecutive patients were randomized to screening colonoscopy with Fujifilm gradual stiffness or Olympus MEI-guided variable stiffness Colonoscopes. The primary endpoint was cecal intubation rate (noninferiority limit 5%). Secondary endpoints included cecal intubation time. We estimated absolute risk differences with 95% confidence intervals (CIs).ResultsWe enrolled 475 patients: 222 randomized to the gradual stiffness instrument, and 253 to the MEI-guided variable stiffness instrument. Cecal intubation rate was 91.7% in the gradual stiffness group versus 95.6% in the variable stiffness group. The adjusted absolute risk for cecal intubation failure was 4.3% higher in the gradual stiffness group than in the variable st...
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gradual stiffness versus magnetic imaging guided variable stiffness Colonoscopes a randomized noninferiority trial
United European gastroenterology journal, 2017Co-Authors: Kjetil Garborg, Havard Wiig, Audun Hasund, Jon Matre, Geir Noraberg, Magnus Loberg, Oyvind Holme, Mette KalagerAbstract:BackgroundColonoscopes with gradual stiffness have recently been developed to enhance cecal intubation.ObjectiveWe aimed to determine if the performance of gradual stiffness Colonoscopes is noninferior to that of magnetic endoscopic imaging (MEI)-guided variable stiffness Colonoscopes.MethodsConsecutive patients were randomized to screening colonoscopy with Fujifilm gradual stiffness or Olympus MEI-guided variable stiffness Colonoscopes. The primary endpoint was cecal intubation rate (noninferiority limit 5%). Secondary endpoints included cecal intubation time. We estimated absolute risk differences with 95% confidence intervals (CIs).ResultsWe enrolled 475 patients: 222 randomized to the gradual stiffness instrument, and 253 to the MEI-guided variable stiffness instrument. Cecal intubation rate was 91.7% in the gradual stiffness group versus 95.6% in the variable stiffness group. The adjusted absolute risk for cecal intubation failure was 4.3% higher in the gradual stiffness group than in the variable st...
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reduced pain during screening colonoscopy with an ultrathin Colonoscope a randomized controlled trial
Endoscopy, 2012Co-Authors: Kjetil Garborg, Jon Matre, Mette Kalager, Magnus Loberg, Oyvind Holme, Geir Hoff, Michael BretthauerAbstract:Background and study aims: Screening colonoscopy for colorectal cancer (CRC) is recommended in several countries, but uptake rates are often low. Fear of pain and also time-consuming costly sedation are barriers for colonoscopy, and thus development of colonoscopy equipment that decreases patient discomfort is worthwhile. This randomized controlled trial investigated the performance of an ultrathin Colonoscope in CRC screening. Patients and methods: Consecutive participants in a colonoscopy screening trial were randomized to examination with an ultrathin prototype Colonoscope or a standard Colonoscope. The main outcome measure was pain during the examination. Participants rated pain (no, slight, moderate, severe) using a validated questionnaire. Results: From 187 enrolled participants (80 women [43 %]), 162 (87 %) responded to the questionnaire. The study groups were similar regarding baseline characteristics. Pain scores were significantly lower in the prototype instrument group compared with the standard group (78 % vs. 29 % of patients with no pain in prototype and standard groups, respectively; odds ratio [OR] 0.11; 95 % confidence interval [CI] 0.06 – 0.23; P Conclusion: The new ultrathin Olympus Colonoscope decreases patient pain during screening colonoscopy. This feature may improve uptake and patient satisfaction in screening colonoscopy. Further study is needed to evaluate the lower adenoma detection rate. ClinicalTrials.gov identifier: NCT01370928.
Shai Friedland - One of the best experts on this subject based on the ideXlab platform.
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novel rigidizing overtube for Colonoscope stabilization and loop prevention with video
Gastrointestinal Endoscopy, 2021Co-Authors: Mike Tzuhen Wei, Shai Friedland, Walter G Park, Joo Ha Hwang, Rabindra R WatsonAbstract:Background and Aims Loop formation can impede endoscope advancement, destabilize the tip, and cause pain. Strategies to mitigate looping include torque-based reduction maneuvers, variable stiffness shafts, and abdominal splinting. In some cases, these strategies are insufficient, and there is need for novel instruments. Loop formation is of particular concern in colonoscopy, but it can also impact performance of other endoscopic procedures such as enteroscopy and altered-anatomy ERCP. In this case series we demonstrate the utility of a novel rigidizing overtube (Pathfinder; Neptune Medical, Burlingame, Calif, USA) in colonoscopy and other endoscopic procedures where loop management is critical. Methods We describe our initial experience with the Pathfinder overtube in 29 patients. The overtube is 85 cm long and can accommodate a pediatric Colonoscope. In its native state, the overtube is extremely flexible. Once the overtube is advanced to the desired location, application of a vacuum to the device causes the device to become 15 times stiffer. The endoscope can then be advanced through the overtube without loop formation in the region that the overtube traverses. Results The overtube was used in 29 patients to assist with difficult procedures. Patients were predominantly men (n = 18; 62.1%), with a median age of 66 years (interquartile range, 57-72). One patient received an upper endoscopy (3.4%), 24 received colonoscopy (82.8%), and 4 received enteroscopy (13.8%). The overtube was used in 12 procedures for incomplete colonoscopy (41.4%), 6 for depth (20.7%), and 11 for stability (37.9%). Colonoscopy was performed in the setting of screening (n = 3), surveillance given polyp history (n = 7), referrals for polyp removal (n = 10), workup of iron deficiency anemia (n = 2), and incomplete colonoscopy (n = 1). The lower endoscopy cases had a median cecal intubation time of 5 minutes (interquartile range, 4.25-7). Enteroscopy was performed in 4 patients: In one patient the distal 60 cm of the ileum was examined with a pediatric Colonoscope to exclude ileitis, in another the overtube was used to stabilize a 6-mm endoscope to traverse a tight Crohn’s ileocolonic stricture, in a third patient altered-anatomy ERCP was performed using an enteroscope through the overtube to reach a hepaticojejunostomy, and in the final patient upper enteroscopy was performed and the mid-jejunum was reached. We present 4 cases that demonstrate the use of the overtube. There were no adverse events. Conclusions Initial experience with a novel rigidizing overtube suggests that this tool can be useful in colonoscopy and other endoscopic procedures affected by looping.
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when experts fail use of a short turning radius Colonoscope facilitates successful completion of colonoscopy in patients with bowel fixity
Digestive Diseases and Sciences, 2020Co-Authors: Mohit Girotra, Shai Friedland, Saurabh Sethi, Monique T Barakat, Robert J Huang, Uri Ladabaum, Subhas BanerjeeAbstract:Rates of incomplete colonoscopy in non-expert settings range up to 13%. Expert colonoscopists can complete ~ 95% colonoscopies when other endoscopists fail; however, a small number remain incomplete even in expert hands, typically due to bowel fixity. Pentax Retroview™ (EC-3490TLi) is a new slim Colonoscope with a short turning radius (STR) and greater tip deflection (210°), which allows easy maneuverability across sharply angulated/fixed colonic bends. We evaluated the utility of this Colonoscope for completing colonoscopies that fail even in the hands of expert colonoscopists. Retrospective chart review was performed, and main outcomes measured included cecal intubation rate, lesions detected, dosage of sedation used, and complications. Using the STR Colonoscope, complete colonoscopy to the cecum was possible in 34/37 patients (91.9%). No loss of lumen/blind advancement was necessary in any of the procedures. No adverse events occurred. Among the completed colonoscopies, 6/34 (17.6%) patients had adenomas, all proximal to the site of prior failure, including one advanced adenoma. All failures (n = 3, 8.1%) had a history of cancer surgeries, with peritoneal carcinomatosis/extensively fixed/frozen bowel (two patients) and an additional diverticular stricture with colo-vesical fistula (one patient). STR Colonoscope facilitates completion of a high proportion (91.9%) of colonoscopies that previously failed in expert hands. Its STR allows easy maneuverability across segments of sharp angulation with bowel fixity without need for blind advancement. The use of this Colonoscope led to the detection of adenomas in 17.6% of patients, all proximal to the site of prior failed colonoscopy.
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short turn radius Colonoscope in an anatomical model retroflexed withdrawal and detection of hidden polyps
World Journal of Gastroenterology, 2015Co-Authors: Sarah K Mcgill, Shivangi Kothari, Shai Friedland, Ann Chen, Walter G Park, Subhas BanerjeeAbstract:AIM: To evaluate the new RetroView™ Colonoscope and compare its ability to detect simulated polyps “hidden” behind colonic folds with that of a conventional Colonoscope, utilizing anatomic colon models. METHODS: Three anatomic colon models were prepared, with twelve simulated polyps “hidden” behind haustral folds and five placed in easily viewed locations in each model. Five blinded endoscopists examined two colon models in random order with the conventional or RetroView™ Colonoscope, utilizing standard withdrawal technique. The third colon model was then examined with the RetroView™ Colonoscope withdrawn initially in retroflexion and then in standard withdrawal. Polyp detection rates during standard and retroflexed withdrawal of the conventional and RetroView™ Colonoscopes were determined. Polyp detection rates for combined standard and retroflexed withdrawal (combination withdrawal) with the RetroView™ Colonoscope were also determined. RESULTS: For hidden polyps, retroflexed withdrawal using the RetroView™ Colonoscope detected more polyps than the conventional Colonoscope in standard withdrawal (85% vs 12%, P = 0.0001). For hidden polyps, combination withdrawal with the RetroView™ Colonoscope detected more polyps than the conventional Colonoscope in standard withdrawal (93% vs 12%, P ≤ 0.0001). The RetroView™ Colonoscope in “combination withdrawal” was superior to other methods in detecting all (hidden + easily visible) polyps, with successful detection of 80 of 85 polyps (94%) compared to 28 (32%) polyps detected by the conventional Colonoscope in standard withdrawal (P < 0.0001) and 67 (79%) polyps detected by the RetroView™ Colonoscope in retroflexed withdrawal alone (P < 0.01). Continuous withdrawal of the Colonoscope through the colon model while retroflexed was achieved by all endoscopists. In a post-test survey, four out of five colonoscopists reported that manipulation of the Colonoscope was easy or very easy. CONCLUSION: In simulated testing, the RetroView™ Colonoscope increased detection of hidden polyps. Combining standard withdrawal with retroflexed withdrawal may become the new paradigm for “complete screening colonoscopy”.
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use of the Colonoscope training model with the Colonoscope 3d imaging probe improved trainee colonoscopy performance a pilot study
Digestive Diseases and Sciences, 2011Co-Authors: Tonya Kaltenbach, Shai Friedland, Cynthia W Leung, Kelley S Yan, Roy SoetiknoAbstract:Colonoscopy insertion is difficult to teach due to the inability of current training models to provide realistic tactile sensation with simultaneous three-dimensional (3D) Colonoscope display. To assess the influence of a simulator consisting of a colon model coupled with 3D instrument visualization on trainee colonoscopy performance. Pilot study using the simulator model with three trainees who were not proficient in colonoscopy. At random times over a 6-week period, trainees participated in an individualized half-day session using the Colonoscope Training Model and a Colonoscope equipped with a 3D magnetic probe imaging system (ScopeGuide) in six standardized cases. A blinded supervising instructor graded patient-based colonoscopy performance over the 6-week period, and we independently analyzed the 2-week period before and after the intervention. We also measured cecal intubation and withdrawal times and medication requirements. Trainees performed 86 patient-based colonoscopies. Following the intervention, the colonoscopy performance score improved from 4.4 ± 2.3 to 5.9 ± 2.4 (p = 0.005). Trainees had a 76% cecal intubation rate following the session as compared to 43% before training (p = 0.004), while utilizing less time, 14 ± 7 versus 18 ± 11 min (p = 0.056) and less medication (p > 0.05). Colonoscopy simulation using the Colonoscope Training Model and the ScopeGuide produced an immediate and large effect on trainee colonoscopy performance.
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water immersion versus standard colonoscopy insertion technique randomized trial shows promise for minimal sedation
Endoscopy, 2010Co-Authors: Cynthia W Leung, Tonya Kaltenbach, Roy Soetikno, F W Leung, Shai FriedlandAbstract:BACKGROUND AND STUDY AIMS Water immersion is an alternative colonoscopy technique that may reduce discomfort and facilitate insertion of the instrument. This was a prospective study to compare the success of colonoscopy with minimal sedation using water immersion and conventional air insufflation. PATIENTS AND METHODS A total of 229 patients were randomized to either water immersion or the standard air insertion technique. The primary outcome was success of minimal sedation colonoscopy, which was defined as reaching the cecum without additional sedation, exchange of the adult Colonoscope or hands-on assistance for trainees. Patient comfort and satisfaction were also assessed. RESULTS Successful minimal-sedation colonoscopy was achieved in 51 % of the water immersion group compared with 28 % in the standard air group (OR, 2.66; 95 % CI 1.48 - 4.79; P = 0.0004). Attending physicians had 79 % success with water immersion compared with 47 % with air insufflation (OR, 4.19; 95 % CI 1.5 - 12.17; P = 0.002), whereas trainees had 34 % success with water compared with 16 % using air (OR, 2.75; 95 % CI 1.15 - 6.86; P = 0.01). Using the water method, endoscopists intubated the cecum faster and this was particularly notable for trainees (13.0 +/- 7.5 minutes with water vs. 20.5 +/- 13.9 minutes with air; P = 0.0001). Total procedure time was significantly shorter with water for both experienced and trainee endoscopists ( P < 0.05). Patients reported less intraprocedural pain with water compared with air (4.1 +/- 2.7 vs. 5.3 +/- 2.7; P = 0.001), with a similar level of satisfaction. There was no difference in the neoplasm detection rates between the groups. CONCLUSION Colonoscopy insertion using water immersion increases the success rate of minimal sedation colonoscopy. Use of the technique leads to a decrease in discomfort, time to reach the cecum, and the amount of sedative and analgesic used, without compromising patient satisfaction.