title: Use of a variable-stiffness colonoscope decreases the dose of patient-controlled sedation during colonoscopy: a randomized comparison of 3 colonoscopes.
abstract: BACKGROUND
  The variable-stiffness colonoscope incorporates different degrees of stiffness of the insertion tube, which can be adjusted during the examination. Whether its use can lead to reduced procedure-related pain and sedative use is unknown.
  
  
  OBJECTIVE
  Our purpose was to compare the use of 3 types of colonoscope with different shaft stiffnesses in relation to procedure-related pain and sedative consumption.
  
  
  METHODS
  Prospective randomized trial.
  
  
  METHODS
  Endoscopy unit of a university-affiliated hospital.
  
  
  METHODS
  Consecutive patients undergoing ambulatory colonoscopy.
  
  
  METHODS
  Random assignment was made of patients into 3 groups to receive colonoscopic examinations by one of the 3 types of colonoscope: conventional standard adult size, 1.3-m; 1.6-m; and the new variable-stiffness adult size, full-length (1.6-m) colonoscope. A mixture of propofol and afentanil, delivered by a patient-controlled syringe pump, was used for sedation in all groups.
  
  
  METHODS
  Outcome measures included dose of patient-controlled sedation consumed, pain score, cecal intubation rate, cecal intubation time, requirement of abdominal pressure and change of patients' positions during colonoscopy, and endoscopists and patients' satisfaction scores according to a visual analog scale.
  
  
  RESULTS
  A total of 335 patients were randomized. Patients in group 3 used significantly less propofol (in milligrams per kilograms, mean [SD]) compared with the other 2 groups (group 1: 1.00 [0.75], group 2: 0.93 [0.62], and group 3: 0.75 [0.65]; P = .02; 1-way analysis of variance). The mean (SD) pain score was also lower in group 3.
  
  
  CONCLUSIONS
  The endoscopists were not blinded.
  
  
  CONCLUSIONS
  The use of the new variable-stiffness adult-size colonoscope significantly reduced procedure-related pain and doses of sedative medications during colonoscopy.
authors.affiliation: Departments of Surgery and Anesthesiology, North District Hospital and Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, China.
authors.forename: Danny W H
authors.initials: DW
authors.lastname: Lee
authors.forename: Anthony C N
authors.initials: AC
authors.lastname: Li
authors.forename: Chi-wah
authors.initials: CW
authors.lastname: Ko
authors.forename: David W
authors.initials: DW
authors.lastname: Chu
authors.forename: Kang-chung
authors.initials: KC
authors.lastname: Chan
authors.forename: Chi-ming
authors.initials: CM
authors.lastname: Poon
authors.forename: Kwok-sang
authors.initials: KS
authors.lastname: Sin
authors.forename: Kam-fung
authors.initials: KF
authors.lastname: Leung
authors.forename: Tak-suen
authors.initials: TS
authors.lastname: Sze
authors.forename: Angus C W
authors.initials: AC
authors.lastname: Chan
authors.forename: Sydney C S
authors.initials: SC
authors.lastname: Chung
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015760:Alfentanil / Q000008:administration & dosage*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D020685:Colonoscopes; D003113:Colonoscopy / Q000379:methods*; D016292:Procedural Sedation / Q000379:methods*; D004305:Dose-Response Relationship, Drug; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D017060:Patient Satisfaction; D015742:Propofol / Q000008:administration & dosage*; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D018686:Anesthetics, Intravenous; D015760:Alfentanil; D015742:Propofol