Oncology Portuguese Institute of Porto
Oncology Portuguese Institute of Porto
Triantafyllou K.,National and Kapodistrian University of Athens |
Polymeros D.,National and Kapodistrian University of Athens |
Apostolopoulos P.,417 Army Veterans Hospital |
Lopes Brandao C.,Oncology Portuguese Institute of Porto |
And 7 more authors.
Endoscopy | Year: 2017
Background and study aims The Endocuff (ARC Medical Design, Leeds, UK) is a device that, when mounted on the tip of an endoscope, may assist with inspection of a greater surface of the colonic mucosa by pulling backwards, flattening, and stretching the colonic folds as the endoscope is gradually withdrawn. We aimed to compare the adenoma miss rates of Endocuff-assisted colonoscopy with those of conventional colonoscopy. Patients and methods The included patients underwent same-day, back-to-back, (Endocuff-assisted colonoscopy as the index procedure followed by conventional colonoscopy or vice versa, randomly assigned 1:1) colonoscopies, performed by six endoscopists with documented adenoma detection rates?>?35?%, in four tertiary endoscopy facilities. Results We randomized 200 patients (mean age 61.2 years [standard deviation 9.8]; 86.5?% colorectal cancer screening surveillance cases). Overall, there were seven incomplete examinations using Endocuff and one with conventional colonoscopy ( P =?0.03). Times for endoscope insertion (5.0 minutes [0.8?–?21.0] vs. 5.0 minutes [1.0?–?16.0]; P =?0.49) and withdrawal (6.0 minutes [3.2?–?29.0] vs. 6.0 minutes [3.1?–?17.0]; P =?0.06) were similar for Endocuff-assisted and conventional colonoscopy. We detected one cancer and 195 adenomas; 84 in the proximal colon. Endocuff-assisted colonoscopy showed significantly lower overall and proximal colon adenoma miss rates compared with conventional colonoscopy (14.7?% [8.0?%?–?21.0?%] vs. 38.4?% [28.1?%?–?48.6?%] and 10.4?% [1.8?%?–?19.1?%] vs. 38.9?% [23.0?%?–?54.8?%], respectively). No difference between the two arms was shown regarding advanced adenoma miss rates, either overall or in the proximal colon. There were no serious adverse events related to the procedures. Conclusions In comparison with conventional colonoscopy, Endocuff-assisted colonoscopy has a significantly lower adenoma miss rate when performed by high-detector endoscopists. However, the incomplete colonoscopy rate with Endocuff is higher. ClinicalTrials.gov Identifier: NCT02340065. Copyright © 2017, Georg Thieme Verlag KG. All rights reserved.
Ferreira A.O.,Centro Hospitalar Do Algarve Portimao Unit |
Ferreira A.O.,Hospital Beatriz Angelo |
Torres J.,Hospital Beatriz Angelo |
Dinis-Ribeiro M.,Oncology Portuguese Institute of Porto |
Cravo M.,Hospital Beatriz Angelo
European Journal of Gastroenterology and Hepatology | Year: 2015
BACKGROUND: National surveys have been used to obtain information on sedation and monitoring practices in endoscopy in several countries. AIMS: To provide data from Portugal and query the Portuguese endoscopists on nonanesthesiologist administration of propofol. MATERIALS AND METHODS: A 31-item web survey was sent to all 490 members of the Portuguese Society of Gastroenterology. RESULTS: A total of 129 members (26%) completed the questionnaire; 57% worked in both public and private practice. Most performed esophagogastroduodenoscopy without sedation (public - 70%; private - 57%) and colonoscopies with sedation (public - 64%; private - 69%). Propofol was the most commonly used agent for colonoscopy, especially in private practice (52 vs. 33%), and it provided the best satisfaction (mean 9.6/10). A total of 94% chose propofol as the preferred sedation for routine colonoscopy. Nonanesthesiologist administration of propofol was performed only by four respondents; however, 71% reported that they would consider its use, given adequate training. Pulse oximetry is monitored routinely (99%); oxygen supplementation is administered by 81% with propofol and 42% with traditional sedation. Most (82%) believed that propofol sedation may increase the uptake of endoscopic screening for colorectal cancer. CONCLUSION: The use of sedation is routine practice in colonoscopy, but not esophagogastroduodenoscopy. The preferred agent is propofol and it is used almost exclusively by anesthesiologists.. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.