The impact of advances in instrumentation and techniques of colonoscopy from 1988 to 2008 on inpatient colonoscopy performance at a high volume endoscopy unit in the United States: significantly shorter procedure time, higher completion rate, performance on sicker inpatients, and near disappearance of flexible sigmoidoscopy.
OBJECTIVE
Colonoscopy instrumentation and technique have improved from 1988 to 2008. We analyze whether these improvements have resulted in improved colonoscopy performance.


METHODS
This was a retrospective study of 50 consecutive inpatients in 1988 vs. 1998 vs. 2008 undergoing intended colonoscopy at a teaching hospital. Patient APACHE score, cecal and terminal ileal intubation rates, procedure time, and colonoscopic diagnoses were compared for the three different years.


RESULTS
Changes in practice of inpatient colonoscopy in 2008 from 1988 include (1) remarkably sicker inpatients undergoing colonoscopy in 2008, as indicated by: significantly higher mean APACHE II score (11.0 ± 6.6 vs. 5.9 ± 4.1, P < 0.00001), significantly more frequent monitored bed status (58% vs. 10%, OR = 12.4; 95%-ORCI: 4.31-35.4, P < 0.00001), and significantly higher rates of several chronic diseases (e.g. CHF, 24% vs. 6%, P = 0.02); (2) significantly higher colonoscopy completion rate in 2008 (88% vs. 64%; OR = 4.13, 95%-ORCI: 1.51-11.2, P = 0.009); (3) significantly higher terminal ileum intubation rate in 2008 (44% vs. 14%, OR = 4.83, 95%-ORCI: 1.85-12.5, P = 0.002); and (4) significantly shorter mean procedure time in 2008 (26.3 ± 7.9 min vs. 48.0 ± 20.3 min, P < 0.00001). The ratio of intended colonoscopy/flexible sigmoidoscopy was significantly higher in 2008 vs. 1988 (OR = 7.50, 95%-ORCI: 2.56-21.8, P < 0.00001). Internal hemorrhoids were significantly more frequently diagnosed by colonoscopy in 2008 (44% vs. 12%, OR = 5.76, 95%-ORCI: 2.12-15.5, P = 0.001), attributed to increased rectal retroflexion.


CONCLUSIONS
Due to improved instrumentation and technique, colonoscopy has dramatically changed from 1988 to become a clinically more valuable test in 2008 as manifested by a higher completion rate, greater clinical applicability, and shorter procedure time. Colonoscopy is supplanting flexible sigmoidoscopy.
Cappell
Mitchell S
MS
Division of Gastroenterology, Department of Medicine, William Beaumont Hospital, MOB 233, 3535 W Thirteen Mile Road, Royal Oak, MI 48073, USA. mscappell@yahoo.com
Abboud
Rami
R
D018806:APACHE; D000328:Adult; D000368:Aged; D002983:Clinical Competence; D020685:Colonoscopes; D003113:Colonoscopy / Q000295:instrumentation / Q000379:methods / Q000592:standards / Q000639:trends*; D015897:Comorbidity; D005260:Female; D006304:Health Status; D006333:Heart Failure / Q000453:epidemiology; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012812:Sigmoidoscopy / Q000706:statistics & numerical data*; D014481:United States
Gastroenterology. 2007 Jun;132(7):2297-303
17570204
Am J Gastroenterol. 2000 May;95(5):1184-7
10811325
Am Fam Physician. 1999 Jan 15;59(2):313-24, 327-8
9930126
Gastrointest Endosc. 2008 May;67(6):938-44
18440383
Endoscopy. 1999 Sep;31(7):522-7
10533735
Gastrointest Endosc. 1994 Sep-Oct;40(5):544-6
7988815
J Gastroenterol Hepatol. 2005 Dec;20(12):1873-9
16336447
Clin Gastroenterol Hepatol. 2008 Jan;6(1):109-14
18065277
Rev Gastroenterol Disord. 2008 Fall;8(4):223-32
19107096
Gastroenterol Clin North Am. 2000 Mar;29(1):169-87, vii
10752021
Gastrointest Endosc. 2009 Mar;69(3 Pt 1):503-8
19152904
Gastrointest Endosc. 2009 Mar;69(3 Pt 2):681-7
19251010
Am J Gastroenterol. 2004 Nov;99(11):2138-42
15554993
Am J Gastroenterol. 2006 Apr;101(4):873-85
16635231
Gastrointest Endosc. 1984 Feb;30(1):1-5
6706081
Gastroenterol Clin North Am. 2000 Mar;29(1):223-63, viii
10752023
Gastrointest Endosc Clin N Am. 2006 Jan;16(1):1-31
16546020
Digestion. 2009;80(4):267-70
19923819
Am J Gastroenterol. 2006 Apr;101(4):721-31
16494586
Gastroenterol Clin North Am. 1998 Dec;27(4):827-60, vi
9890115
Clin Pharm. 1985 Jul-Aug;4(4):414-24
3899470
Gastrointest Endosc Clin N Am. 1994 Jul;4(3):623-38
8069479
Crit Care Med. 1985 Oct;13(10):818-29
3928249
Eur J Gastroenterol Hepatol. 2005 Aug;17(8):785-92
16003125
Clin Gastroenterol Hepatol. 2004 Jan;2(1):72-7
15017635
N Engl J Med. 2006 Dec 14;355(24):2533-41
17167136
Minerva Gastroenterol Dietol. 2009 Dec;55(4):505-6
19942833
J Gen Intern Med. 2005 Jan;20(1):81-90
15693933
Curr Drug Targets. 2005 Nov;6(7):741-4
16305451
Gastrointest Endosc. 1996 Dec;44(6):675-8
8979056
Am J Kidney Dis. 2000 Jan;35(1):146-9
10620557
Gastroenterology. 2007 Jul;133(1):42-7
17631129