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Effect of magnetic endoscope imaging on patient tolerance and sedation requirements during colonoscopy: a randomized
Syed G Shah1, Jim C Brooker, Catherine Thapar
1Wolfson Unit for Endoscopy, St. Mark's Hospital, Harrow, Middlesex, London, United Kingdom.
Background:
Pain during colonoscopy is primarily related to mesenteric stretching from looping of the colonoscope insertion tube. Prompt recognition and removal of loops reduces patient discomfort and may lessen sedation requirements. Magnetic endoscope imaging allows real-time visualization of the colonoscope during insertion. The effect of magnetic endoscope imaging on patient pain and sedation requirements was assessed in a prospective randomized controlled trial.
Methods:
A total of 122 consecutive patients undergoing routine colonoscopy by a single experienced endoscopist were randomized to have the procedure performed either with the endoscopist viewing the imager display (n = 62), or without the imager view (n = 60). Procedures began with administration of hyoscine-N-butylbromide alone, and sedative medications (midazolam and meperidine) were self-administered by the patient with a patient-controlled analgesia pump. Cardiorespiratory parameters were recorded and patient pain was assessed with a 100-mm visual analogue scale.
Results:
The number of attempts at straightening the colonoscope was fewer (median 8 [0-66] vs. 15 [0-87], p = 0.0076) and the duration of looping less (median 4.5 min [0-27.3 min] vs. 6.4 min [0-29.4 min]), when the endoscopist was able to see the imager view. The total number of patient demands (by patient-controlled analgesia) for medication (median 1 vs. 2.5) and total doses of midazolam (median 0.44 mg vs. 0.88 mg) and meperidine (median 16.75 mg vs. 32.5 mg) administered did not significantly differ between patients examined with or without the imager. Patient pain scores were also similar.
Conclusions:
Magnetic endoscope imaging allows accurate assessment and straightening of loops during colonoscopy, but without a significant reduction in patient requirements for sedative medication or improvement in patient tolerance. However, the dosages of sedation drugs used were small.
Insights
Magnetic endoscope imaging aids colonoscope loop management but did not significantly reduce patient pain or sedation needs. This technology improves loop assessment during colonoscopy procedures.
Area of Science:
- Gastroenterology
- Medical Imaging
- Endoscopy
Background:
- Colonoscopy pain is often caused by mesenteric stretching from colonoscope looping.
- Early detection and correction of loops can decrease patient discomfort and sedation needs.
- Magnetic endoscope imaging offers real-time visualization of the colonoscope during insertion.
Purpose of the Study:
- To evaluate the impact of magnetic endoscope imaging on patient pain during colonoscopy.
- To assess if magnetic endoscope imaging reduces the need for sedative medications.
Main Methods:
- A prospective randomized controlled trial involving 122 patients undergoing routine colonoscopy.
- Patients were randomized into two groups: one with endoscopist viewing the imager display, and one without.
- Patient-controlled analgesia with midazolam and meperidine was used, with pain assessed via a visual analogue scale.
Main Results:
- Fewer attempts to straighten the colonoscope and less time spent with loops were observed when using the imager.
- No significant differences were found in patient demands for medication or total doses of midazolam and meperidine administered.
- Patient pain scores remained similar between the groups.
Conclusions:
- Magnetic endoscope imaging enables accurate assessment and straightening of loops during colonoscopy.
- The technology did not lead to a significant reduction in sedative medication requirements or improved patient tolerance.
- The study utilized relatively low dosages of sedation drugs.