title: The use of ancillary techniques to aid colonoscope insertion.
abstract: BACKGROUND
  There is more to a high-quality colonoscopy than reaching the cecum or finding adenomas. Gentle insertion involves ancillary techniques, some of which are impossible in patients receiving deep sedation. The aim of this study was to assess the importance of ancillary techniques in achieving a comfortable, complete colonoscopy.
  
  
  METHODS
  This was a prospective study of 500 consecutive outpatient colonoscopies performed by a single endoscopist. During the procedure, note was taken of various ancillary techniques used to facilitate insertion: turning the patient, patient holding their breath, abdominal pressure. The success of these techniques in helping scope advancement was also noted. After the procedure the patient was asked to rate the severity of their pain and their degree of satisfaction with the examination.
  
  
  RESULTS
  A total of 238 women and 262 men participated in the study, and colonoscopy was complete in 96.2 and 98.5%, respectively. Overall, 97% of patients received versed alone (average dose 2 mg), and 3% received a narcotic (average dose 46 U). Average pain score was 3.9 on a scale of 1 (least pain) to 10 (worst pain), and average satisfaction with the procedure as a whole was 9.5 on a similar scale. Ancillary techniques of holding breath, directed abdominal pressure, and turning to the left, right, and prone were used in 46, 56, 17, 23, and 4% of examinations, respectively. Each technique was effective in helping insertion in over 70% of cases. Turning the patient was also used to clear stool, open the colon, or facilitate polypectomy in another 33 cases. Multiple techniques were used in 49% of patients.
  
  
  CONCLUSIONS
  The use of ancillary techniques to facilitate colonoscope insertion helps avoid the expense and potential side effects of deep sedation.
authors.affiliation: Department of Colorectal Surgery, Digestive Diseases Institute, Cleveland Clinic Foundation, Desk A 30, 9500 Euclid Ave, Cleveland, OH, 44195, USA, xhajax@ccf.org.
authors.forename: Xhileta
authors.initials: X
authors.lastname: Xhaja
authors.forename: James
authors.initials: J
authors.lastname: Church
mesh_terms: D000553:Ambulatory Care / Q000379:methods*; D020685:Colonoscopes; D003113:Colonoscopy / Q000009:adverse effects / Q000379:methods*; D015179:Colorectal Neoplasms / Q000175:diagnosis; D054810:Deep Sedation; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D008297:Male; D008874:Midazolam / Q000008:administration & dosage; D008875:Middle Aged; D010146:Pain / Q000145:classification / Q000209:etiology / Q000517:prevention & control*; D010147:Pain Measurement; D011446:Prospective Studies
chemical_list: D006993:Hypnotics and Sedatives; D008874:Midazolam