title: 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.
abstract: 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.
authors.affiliation: Division of Gastroenterology, Department of Medicine, William Beaumont Hospital, MOB 233, 3535 W Thirteen Mile Road, Royal Oak, MI 48073, USA. mscappell@yahoo.com
authors.forename: Mitchell S
authors.initials: MS
authors.lastname: Cappell
authors.forename: Rami
authors.initials: R
authors.lastname: Abboud
mesh_terms: 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
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