A linear sigmoid colon passage method in colonoscopy · 2014. 10. 13. · 1 1 A linear sigmoid...
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1 A linear sigmoid colon passage method in colonoscopy 1 2 Satoshi Awazu, Risa Araki, Toshihiko Awazu 3 4 Awazu Hospital, Nagasaki, Japan 5 6 Address correspondence to Satoshi Awazu, Awazu Hospital, Nagasaki 851-0251, Japan. Phone: 7 +81-95-826-9088. E-mail: [email protected]. 8 9 10 ABSTRACT 11 12 A previous study revealed loop formation of the colonoscope in the sigmoid colon in 13 79% of patients. Colonoscope looping in the sigmoid colon is considered to cause 14 abdominal pain and intestinal perforation. We discovered a phenomenon whereby the 15 rectosigmoid junction becomes linear when the patient is moved from a left lateral to left 16 semiprone position and the colonoscope tip can be readily inserted into the sigmoid colon. 17 Therefore, this phenomenon was applied to our conventional insertion method to determine 18 whether the colonoscope looping rate in the sigmoid colon can be reduced. Thus our new 19 insertion method could reduce the colonoscope looping rate in the sigmoid colon. Our new 20 insertion method may allow safer colonoscope insertion than our conventional insertion 21 method. 22 23 24 INTRODUCTION 25 26 A previous study revealed loop formation of the colonoscope in the sigmoid colon in 27 79% of patients (Shah et al., 2000). Colonoscope looping in the sigmoid colon is 28 considered to cause abdominal pain and intestinal perforation (Lüning et al., 2007). 29 We previously reported that the colonoscope can be readily inserted through the 30 sigmoid-descending colon junction in a left semiprone position (Awazu, Araki & Awazu, 31 2012). Therefore, we considered that the colonoscope can be readily inserted through the 32 rectosigmoid junction in a left semiprone position. 33 In fact, we discovered a phenomenon (Fig. 1) whereby the rectosigmoid junction 34 becomes linear when the patient is moved from a left lateral to left semiprone position and 35 the colonoscope tip can be readily inserted into the sigmoid colon by pushing. Therefore, 36 this phenomenon was applied to our conventional insertion method to determine whether 37 the colonoscope looping rate in the sigmoid colon can be reduced. 38 39 40 41 42 43 44 PeerJ PrePrints | http://dx.doi.org/10.7287/peerj.preprints.535v1 | CC-BY 4.0 Open Access | rec: 13 Oct 2014, publ: 13 Oct 2014 PrePrints
Transcript of A linear sigmoid colon passage method in colonoscopy · 2014. 10. 13. · 1 1 A linear sigmoid...
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A linear sigmoid colon passage method in colonoscopy 1
2 Satoshi Awazu, Risa Araki, Toshihiko Awazu 3 4 Awazu Hospital, Nagasaki, Japan 5 6 Address correspondence to Satoshi Awazu, Awazu Hospital, Nagasaki 851-0251, Japan. Phone: 7 +81-95-826-9088. E-mail: [email protected]. 8 9 10 ABSTRACT 11 12 A previous study revealed loop formation of the colonoscope in the sigmoid colon in 13 79% of patients. Colonoscope looping in the sigmoid colon is considered to cause 14 abdominal pain and intestinal perforation. We discovered a phenomenon whereby the 15 rectosigmoid junction becomes linear when the patient is moved from a left lateral to left 16 semiprone position and the colonoscope tip can be readily inserted into the sigmoid colon. 17 Therefore, this phenomenon was applied to our conventional insertion method to determine 18 whether the colonoscope looping rate in the sigmoid colon can be reduced. Thus our new 19 insertion method could reduce the colonoscope looping rate in the sigmoid colon. Our new 20 insertion method may allow safer colonoscope insertion than our conventional insertion 21 method. 22 23 24 INTRODUCTION 25 26 A previous study revealed loop formation of the colonoscope in the sigmoid colon in 27 79% of patients (Shah et al., 2000). Colonoscope looping in the sigmoid colon is 28 considered to cause abdominal pain and intestinal perforation (Lüning et al., 2007). 29 We previously reported that the colonoscope can be readily inserted through the 30 sigmoid-descending colon junction in a left semiprone position (Awazu, Araki & Awazu, 31 2012). Therefore, we considered that the colonoscope can be readily inserted through the 32 rectosigmoid junction in a left semiprone position. 33 In fact, we discovered a phenomenon (Fig. 1) whereby the rectosigmoid junction 34 becomes linear when the patient is moved from a left lateral to left semiprone position and 35 the colonoscope tip can be readily inserted into the sigmoid colon by pushing. Therefore, 36 this phenomenon was applied to our conventional insertion method to determine whether 37 the colonoscope looping rate in the sigmoid colon can be reduced. 38 39 40 41 42 43 44
PeerJ PrePrints | http://dx.doi.org/10.7287/peerj.preprints.535v1 | CC-BY 4.0 Open Access | rec: 13 Oct 2014, publ: 13 Oct 2014
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1 Figure 1. The phenomenon we discovered. The colonoscope tip reached the rectosigmoid junction. When the 2 endoscopist moved the patient from a left lateral to left semiprone position with the colonoscope slightly 3 pushed with twisting to the left, the visual field broadened, both the rectosigmoid junction and colonoscope 4 simultaneously became linear, and the colonoscope tip was readily inserted into the sigmoid colon. 5 Rectosigmoid junction (▲). 6 7 8 MATERIALS & METHODS 9 10 The Pentax EC-3830MK (HOYA, Akishima, Tokyo) was used, and the neutral position 11 of the colonoscope was determined as shown in Fig. 2. Our new insertion method is shown 12 in Fig. 3, and our conventional insertion method is shown in Fig. 4. 13
14 Figure 2. The neutral position of the colonoscope in our new insertion method. The patient is placed in a left 15 semiprone position, and the colonoscope is unbent with its tip directed toward the sigmoid-descending colon 16 junction. 17 18 19
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1 Figure 3. Our new insertion method. The shape of the colonoscope and movements of its tip are observed 2 using fluoroscopy. Step 1. The patient is placed in a left lateral position, the colonoscope tip reaches the 3 rectosigmoid junction, and the colonoscope is slightly pushed with twisting to the left. Step 2. The assistant 4 moves the patient from a left lateral to left semiprone position. Step 3. In some cases, the visual field broadens, 5 and the colonoscope tip is readily inserted into the sigmoid colon by pushing. If this does not occur (colon 6 bending is considered to be present), in the same body position, the colonoscope is pushed with twisting to the 7 left, beyond 1-2 fold, which results in advancement of the colonoscope tip into the sigmoid colon. The 8 colonoscope is unbent with its tip directed toward the sigmoid-descending colon junction. Step 4. When the 9 lumen of the sigmoid colon is observed in the left or front direction, the colonoscope is pushed with twisting 10 to the left (Step 4a). When the lumen of the sigmoid colon is observed in the right direction, the colonoscope 11 is pushed with twisting to the right (Step 4b, left), which causes colonoscope bending. To correct bending, the 12 colonoscope is returned to the neutral position by twisting to the left (Step 4b, right). Excessively advancing 13 the colonoscope with twisting to the right should be avoided. However, when such advancement is 14 unavoidable, the colonoscope is pulled while being returned to the neutral position by twisting to the left with 15 caution not to displace the colonoscope tip. Step 5. Step 4 is repeated. Step 6. The colonoscope tip is inserted 16 into the descending colon. Rectosigmoid junction (▲), splenic flexure (◇), colonoscope manipulation and 17 movements of colonoscope tip (brown arrows and point). 18 19
20 Figure 4. Our conventional insertion method. The shape of the colonoscope and movements of its tip were 21 observed using fluoroscopy. The patient was placed in a left lateral position, and the colonoscope tip reached 22 the rectosigmoid junction. The colonoscope was pushed with twisting to the right or left, which results in 23 colonoscope looping in the sigmoid colon. After arrival of the colonoscope tip at the descending colon, the 24 colonoscope loop was resolved, and the sigmoid colon and colonoscope were straightened together. 25 Rectosigmoid junction (▲), splenic flexure (◇), colonoscope manipulation and movements of colonoscope 26 tip (brown arrows and point). 27
PeerJ PrePrints | http://dx.doi.org/10.7287/peerj.preprints.535v1 | CC-BY 4.0 Open Access | rec: 13 Oct 2014, publ: 13 Oct 2014
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RESULTS 1 2 The colonoscope looping rate in the sigmoid colon was 59% (267 of the 452 patients) 3 using our conventional insertion method but 14% (34 of the 238 patients) using our new 4 insertion method. Thus, our new insertion method could reduce the colonoscope looping 5 rate in the sigmoid colon. And no major complications were associated with our new 6 insertion method. 7 Our new insertion method may allow safer colonoscope insertion than our conventional 8 insertion method. 9 10 11 DISCUSSION 12 13 We consider that all physicians who read this manuscript can confirm the reproducibility 14 of this phenomenon irrespective of their skill level. We have confirmed this phenomenon by 15 using fluoroscopy. However, for confirmation of its reproducibility, the use of magnetic 16 endoscope imaging (Shah et al., 2002) is recommended to avoid x-ray exposure. 17 We also consider that this phenomenon is applicable to all insertion methods (Anderson 18 et al., 2007; Leung et al., 2009; Morgan et al., 2011). With the use of any insertion method, 19 it is rational to insert the colonoscope with the patient in a position that brings the 20 colonoscope tip to the highest position when it passes the rectosigmoid junction. 21 22 23 REFERENCES 24 25 Anderson JC, Walker G, Birk JW, Alpern Z, Von Althen I. 2007. Tapered colonoscope per- 26 forms better than the pediatric colonoscope in female patients: a direct comparison throu- 27 gh tandem colonoscopy. Gastrointestinal Endoscopy 65:1042-1047. 28 Awazu S, Araki R, Awazu T. 2012. A method of linear passage through the sigmoid colon 29 in colonoscopy. Gastrointestinal Endoscopy 75:702-704. 30 Leung JW, Mann SK, Siao-Salera R, Ransibrahmanakul K, Lim B, Cabrera H, Canete W, 31 Barredo P, Gutierrez R, Leung FW. 2009. A randomized, controlled comparison of warm 32 water infusion in lieu of air insufflation versus air insufflation for aiding colonoscopy in- 33 sertion in sedated patients undergoing colorectal cancer screening and surveillance. Gast- 34 rointestinal Endoscopy 70:505-510. 35 Lüning TH, Keemers-Gels ME, Barendregt WB, Tan AC, Rosman C. 2007. Colonoscopic 36 perforations: a review of 30,366 patients. Surgical Endoscopy 21:994-997. 37 Morgan J, Thomas K, Lee-Robichaud H, Nelson RL. 2011. Transparent cap colonoscopy 38 versus standard colonoscopy for investigation of gastrointestinal tract conditions. Coch- 39 rane Database of Systematic Reviews 16: CD008211. 40 Shah SG, Saunders BP, Brooker JC, Williams CB. 2000. Magnetic imaging of colonosco- 41 py: an audit of looping, accuracy and ancillary maneuvers. Gastrointestinal Endoscopy 42 52:1-8. 43 Shah SG, Brooker JC, Thapar C, Suzuki N, Williams CB, Saunders BP. 2002. Effect of ma- 44 gnetic endoscope imaging on patient tolerance and sedation requirements during colono- 45 scopy: a randomized controlled trial. Gastrointestinal Endoscopy 55:832-837. 46
PeerJ PrePrints | http://dx.doi.org/10.7287/peerj.preprints.535v1 | CC-BY 4.0 Open Access | rec: 13 Oct 2014, publ: 13 Oct 2014
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