Improved Colonoscopy Techniques Increase Patient Comfort

LOS ANGELES—Increasing patient comfort may translate into higher screening rates for colon cancer, researchers said at Digestive Disease Week 2006. A new colonoscopy system promises a gentler procedure (abstract 719) and an alternative sedation method allows a quicker recovery time (abstract 645).

"One of the reasons we are not performing enough colonoscopies is the reluctance of many patients to undergo the procedure, and one of the major causes of the discomfort with regular colonoscopy is loop formation" said Jacques Van Dam, MD, PhD.

Computer-Assisted Colonoscope

Dr. Van Dam, clinical chief, Division of Gastroenterology and Hepatology, and director of endoscopy, Stanford University School of Medicine, and his team from Stanford and Klinikum Ludwigshafen in Germany evaluated the NeoGuide Endoscopy System (see figure), a computer-assisted colonoscope that is designed to avoid the looping or "bunching up" of the flexible colonoscope as it is inserted into the colon.

The NeoGuide System builds a three-dimensional map of the colon as the tip is inserted and then directs the tube that follows to adhere to the bends and curves of the colon. "It's like a snake following its head," Dr. Van Dam said. The system allows for all standard therapies to be administered during the procedure including biopsies and removal of polyps.

In 10 patient volunteers, colonoscopy with the NeoGuide System was successful, with the colonoscope reaching the cecum in 10 patients and going as far as the ileum in 9. Evaluations at discharge, 48 hours, and 30 days after the procedure showed no complications or adverse effects. All patients said they would be willing to undergo the procedure again.

Inhaled Sedation

Most patients who undergo colonoscopy require some sort of pain relief and/or sedation. Intravenous sedation is the most frequently used, but it may be associated with cardiorespiratory complications, delayed recovery, and prolonged drowsiness, said Sushil Maslekar, MD, a researcher at the University of Hull in Cottingham, England. Dr. Maslekar and colleagues investigated whether Entonox, an inhaled mixture of nitrous oxide and oxygen, would provide as much pain relief and allow a quicker recovery time as the commonly used IV sedative midazolam/fentanyl.

For the study, 131 patients who were undergoing elective colonoscopy were randomized to receive either Entonox or the IV sedative. Each patient completed a letter-cancellation test and an anxiety and pain questionnaire at discharge and 24 hours after the procedure.

The Entonox patients had a significantly higher satisfaction rate (98 vs 80), reported significantly less pain post-procedure, and were discharged within 26 minutes of the procedure vs 44 minutes for the IV group (P = .004). "Entonox shows significant value in improving patient satisfaction after colonoscopy, better accommodating patient lifestyles by enabling them to drive home after the procedure and, perhaps, making them less apprehensive about undergoing the procedure again," Dr. Maslekar said.