title: A Novel Hands-Free Abdominal Compression Device for Colonoscopy Significantly Decreases Cecal Intubation Time: A Prospective Single-Blinded Pilot Study.
abstract: BACKGROUND
  Colonoscopy outcome is limited by endoscope looping, which leads to patient discomfort, prolonged procedure, and increased sedation requirement. Traditional manual abdominal pressure is imprecise and manually intensive. A hands-free abdominal compression device (ACD) may improve colonoscopy outcome. We aimed to assess the effect of a novel ACD on colonoscopy outcomes compared to manual pressure.
  
  
  METHODS
  This was a prospective single-blinded study of patients undergoing outpatient colonoscopy. The ACD (N-Doe Pillow™) was applied on 50 consecutive patients. Endoscopists were blinded to device usage. Control cases using manual pressure were randomly selected in a 2:1 manner. Primary outcome was cecal intubation time. Secondary outcomes included sedation requirement and complications. Subgroup analyses evaluated ACD effect on endoscopists with different experiences and patients at higher risk of difficult colonoscopy. Fisher's exact and Student's t-tests were performed for univariate analyses. Multivariate analysis was performed using generalized linear regression.
  
  
  RESULTS
  Fifty patients undergoing colonoscopy with ACD assistance were compared to 100 matched controls. Mean cecal intubation time was significantly reduced in the ACD group compared to controls (6.38 minutes versus 11.8 minutes, P < .0001). Multivariate analysis showed that ACD use was independently associated with reduction in cecal intubation time (β-coeff: -4.11, P = .007). Subgroup analyses revealed a trend toward increased improvement in cecal intubation time among junior endoscopists and obese patients.
  
  
  CONCLUSIONS
  A novel, hands-free ACD significantly decreased cecal intubation time in this prospective, single-blinded, match-controlled study. A trend toward more improvement was seen among junior faculty, suggesting an application for trainees and/or endoscopists with smaller case volumes.
authors.affiliation: 1 Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital , Boston, Massachusetts.|2 Harvard Medical School , Boston, Massachusetts.
authors.forename: Allison R
authors.initials: AR
authors.lastname: Schulman
authors.affiliation: 1 Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital , Boston, Massachusetts.|2 Harvard Medical School , Boston, Massachusetts.
authors.forename: Marvin
authors.initials: M
authors.lastname: Ryou
authors.affiliation: 1 Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital , Boston, Massachusetts.|2 Harvard Medical School , Boston, Massachusetts.
authors.forename: Walter W
authors.initials: WW
authors.lastname: Chan
mesh_terms: D002432:Cecum; D003110:Colonic Neoplasms / Q000473:pathology*; D003113:Colonoscopy / Q000295:instrumentation* / Q000379:methods; D054810:Deep Sedation; D005260:Female; D006801:Humans; D006874:Hydrostatic Pressure; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D007441:Intubation, Gastrointestinal; D008297:Male; D008874:Midazolam / Q000008:administration & dosage; D008875:Middle Aged; D015999:Multivariate Analysis; D010865:Pilot Projects; D011446:Prospective Studies; D016037:Single-Blind Method; D013647:Task Performance and Analysis; D016896:Treatment Outcome
chemical_list: D006993:Hypnotics and Sedatives; D008874:Midazolam
keywords: abdominal compression device; abdominal pressure; cecal intubation time; colonoscopy; sedation requirement