Operation sequence of bidirectional endoscopy with topical anesthesia affected colonoscopy performance: a randomized...

Area of Science:

• Gastroenterology
• Endoscopic Procedures
• Clinical Quality Improvement

Background:

• Variability in operation sequence for bidirectional endoscopy with topical anesthesia impacts clinical procedures.
• Standardizing the sequence is crucial for improving bidirectional endoscopy performance.

Purpose of the Study:

• To investigate the influence of different operation sequences on quality indicators in bidirectional endoscopy.
• To optimize the performance of bidirectional endoscopy procedures.

Main Methods:

• A randomized trial comparing colonoscopy-first versus esophagogastroduodenoscopy-first sequences.
• Topical anesthesia (dyclonine hydrochloride mucilage, oxybuprocaine hydrochloride gel) was administered.
• Quality indicators were compared between the two randomized groups.

Main Results:

• No significant differences in cecal intubation rate, esophagogastroduodenoscopy discomfort, examination scores, or polyp detection rates.
• The colonoscopy-first group showed significantly lower colonic spasm incidence (30.3% vs. 66.0%) and higher comfort rates (85.6% vs. 72.5%).
• Colonoscopy-first also resulted in shorter cecal intubation times (211 s vs. 254 s) and demonstrated a significant correlation between operation sequence, colonic spasm, cecal intubation time, and patient discomfort.

Conclusions:

• Performing colonoscopy first in bidirectional endoscopy with topical anesthesia may enhance colonoscopy performance.
• This sequence optimization does not appear to negatively affect esophagogastroduodenoscopy examination quality.
• Findings suggest a potential improvement in patient experience and procedural efficiency through optimized sequencing.