Authors: Varayu Prachayakul Pitulak Aswakul Julajak Limsrivilai Soros Anuchapreeda Patommatat Bhanthumkomol Pimsiri Sripongpun Tanyawat Prangboonyarat Udom Kachintorn
Publish Date: 2011/11/01
Volume: 26, Issue: 4, Pages: 1041-1046
Abstract
The attachment of a transparent hood to the colonoscope tip has been reported to offer some benefits such as enabling the endoscopist to perform the colonoscopy more easily and to save time However there have been no randomized controlled trials concerning these benefits nor have any reports been published regarding the use of hoods for the purpose of training colonoscopists Therefore we conducted this study to evaluate the possible benefits of the transparent soft short hood when used by both experienced and trainee endoscopist groupsThis randomized controlled trial to assess the results of using a transparent soft short hood attached to the tip of the colonoscope was undertaken by two groups of investigators experienced endoscopists and gastroenterologist trainees The cecal and ileal intubation times as well as the doses of sedative medication required were analyzedA total of 112 patients 65 of whom were female underwent colonoscopy by 2 endoscopists and 5 gastroenterologist trainees Colonoscopy was complete in 100 of the patients The study showed significant shortening of the cecal intubation time when using the soft short hood in both the endoscopist and gastroenterologist trainee groups 68/461 min P = 0006 and 936/736 min P = 003 The ileal intubation time had a trend to be significantly less when using the transparent hood in the trainee group 1264/529 s although this was not statistically significant P = 008 The average dose of propofol when using the transparent hood was significantly lower in the endoscopist group 180/120 mg P = 0001 No significant complications occurred in the hood or nonhood groupsThe transparent soft short hood shortened the cecal intubation time in both the experienced endoscopist and gastroenterologist trainee groups as well as reducing the dose of sedative medication required in the experienced endoscopist group Interestingly it also reduced the trainee ileal intubation time The attachment of this type of hood enabled both the experienced endoscopists and gastroenterological trainees to perform colonoscopy more quickly and easily without any complicationsColonoscopy is one of the most common endoscopic procedures and is undertaken for many reasons Recent recommendations regarding colon cancer screening have led to an upsurge in requests However this can be a lengthy and difficult procedure to perform especially for inexperienced colonoscopists There also is concern regarding the risk of serious complications Another factor is that the longer the average time taken to perform colonoscopy the longer the time spent by patients on the waiting list becomes which can result in delayed definitive diagnosis potentially adversely affecting those with serious illnessAuxiliary devices and techniques that improve skill levels are therefore to be welcomed Recent studies have reported on the use of devices attached to the colonoscope to allow endoscopists to perform this procedure more easily Harada et al 1 described the apparent benefit of transparent hoods hard and long in shortening the cecal intubation time even though this was without statistical significance A reduction in patient discomfort also was noted Kondo et al 2 reported that a soft hood reduced the cecal intubation time and enhanced the success rate of colonoscopy especially for trainee endoscopistsWe conducted this study to identify the potential benefits of this specific type of the hood in terms of cecal intubation time ileal intubation time colonoscopy success rate complications and amount of sedative medication required In addition we wished to establish whether this device could improve colonoscopy trainingFrom August 2010 to October 2010 the patients in the age range 18–90 years who were scheduled for elective colonoscopy based on a wide variety of indications were invited to participate in this study at our center Those who expressed interest received an oral and written explanation of the purpose and procedures of the trial and were asked to give their written informed consent Computerized random number assignment to the different groups was employed
Keywords: