Use of a variable-stiffness colonoscope decreases the dose of patient-controlled sedation during colonoscopy: a randomized comparison of 3 colonoscopes.
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.
Lee
Danny W H
DW
Departments of Surgery and Anesthesiology, North District Hospital and Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, China.
Li
Anthony C N
AC
Ko
Chi-wah
CW
Chu
David W
DW
Chan
Kang-chung
KC
Poon
Chi-ming
CM
Sin
Kwok-sang
KS
Leung
Kam-fung
KF
Sze
Tak-suen
TS
Chan
Angus C W
AC
Chung
Sydney C S
SC
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
D018686:Anesthetics, Intravenous; D015760:Alfentanil; D015742:Propofol