A prospective trial of variable stiffness pediatric vs. standard instrument colonoscopy.
BACKGROUND
The pediatric variable stiffness colonoscope is believed to have theoretical advantages over the standard colonoscope, however a systematic evaluation of this instrument in routine clinical practice involving adult patients is lacking.


METHODS
Consecutive patients (blinded) undergoing colonoscopy in an outpatient endoscopy center by one of 4 experienced colonoscopists had the procedure performed with a standard colonoscope (n=384) or pediatric variable stiffness colonoscope (n=413). Failure to negotiate the sigmoid colon within 10 minutes was regarded as a failure and, if suitable, the patient was crossed over to colonoscopy with the alternative instrument.


RESULTS
Median (95% CI) time to the cecum was significantly faster in the pediatric variable stiffness colonoscope group (odds ratio 5.0: 95% CI[4.7,5.3] minutes) compared with the standard colonoscope group (odds ratio 5.5: 95% CI[5.2,5.8] minutes, p=0.01). There were 22 failures overall (2.8%), 14 in the standard colonoscope group (3.6%) and 8 in the pediatric variable stiffness colonoscope group (1.9%; p=0.1). With regard to the 14 failures in the standard colonoscope group, colonoscopy was attempted with the pediatric variable stiffness colonoscope in 13 and completed successfully in 12 (92%). The pediatric variable stiffness colonoscope was superior in cases of severe stenosing diverticular disease; two of 27 examinations with the pediatric variable stiffness colonoscope were rated as failed vs. 12 of 18 with the standard colonoscope (p<0.001).


CONCLUSIONS
Intubation time was faster with the pediatric variable stiffness colonoscope, but use of this instrument was not associated with a superior cecal intubation rate compared with the standard colonoscope. However, in patients with severe stenosing diverticular disease, the intubation rate with the pediatric variable stiffness colonoscope was superior.
Kaffes
Arthur John
AJ
Department of Gastroenterology and Hepatology, Westmead Hospital, City West Endoscopy, Westmead, Australia.
Mishra
Animesh
A
Ding
Steven Leslie
SL
Hope
Rick
R
Williams
Stephen John
SJ
Gillespie
Peter Edward
PE
Bourke
Michael John
MJ
D002429:Cecal Diseases / Q000175:diagnosis; D002432:Cecum; D020685:Colonoscopes; D043963:Diverticulosis, Colonic / Q000175:diagnosis; D004868:Equipment Failure; D005260:Female; D006801:Humans; D007441:Intubation, Gastrointestinal; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors