Colon Tumors and Colonoscopy

Sedation and Preparation

Bowel preparation is one of the main reasons for the low acceptance of colonoscopy. Up to 20 % of colonoscopies are repeated earlier than necessary, due to poor bowel preparation [1]. In a meta-analysis, 11 randomized controlled trials comparing sodium phospate (NaP) and polyethylene glycol (PEG) were pooled, including a total of 861 patients. NaP and PEG were rated as tolerable by 84.5 % and 67.6 % of the patients, and the quality of preparation was good in 82.3 % vs. 74.9 %. The authors therefore recommend NaP [2], confirming the findings of a meta-analysis published 2 years ago [3]. An even better alternative might be a recently developed purgative tablet, which showed excellent acceptance and good preparation in an initial study [4]. The fasting hydrogen breath test may allow identification of some patients with bad preparation [5] [6] [7] , but it is doubtful whether this will become a standard method prior to colonoscopy.

Sedation is the other major factor in patient satisfaction and acceptance of colonoscopy. Propofol administered by a gastroenterologist, instead of midazolam/meperidine, is safe and improves patient satisfaction [8] [9] . In the study by Kulling et al. [8], it was found that patient-controlled sedation using propofol and alfentanil resulted in the highest level of patient satisfaction. In both studies, recovery was faster than with midazolam.

References

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• 125 Kiesslich R, von Bergh M, Hahn M, et al. Chromoendoscopy for characterization of colorectal mucosal changes [abstract].  Gastrointest Endosc. 2001;  53 AB190
• 126 Konishi K, Kaneko K, Kurahashi T, et al. Evaluation of usefulness of non-biopsy technique using magnifying colonoscopy in differentiated diagnosis of colorectal lesions: a prospective study [abstract].  Gastrointest Endosc. 2001;  53 AB191
• 127 Su M Y, Tung S Y, Lien J M, et al. Magnifying endoscopy with indigo carmine dye contrast for the differential diagnosis of neoplastic and non-neoplastic colonic polyps [abstract].  Gastrointest Endosc. 2001;  53 AB201
• 128 Eastone J A, Polish R, Butler J A, Schoenfeld P S. Using adenoma characteristics from the index colonoscopy to determine the appropriate interval between colonoscopies [abstract].  Gastroenterology. 2001;  120 (Suppl 1) A96
• 129 Nusko G, Mansmann U, Hahn E G. Effectiveness analysis for colorectal post-polypectomy surveillance using a dynamic prognostic model [abstract].  Gastroenterology. 2001;  120 (Suppl 1) A258
• 130 Bessa X, Salo J, Arcusa A, et al. Effectiveness of postoperative surveillance after radical surgery for colorectal cancer (CRC): preliminary analysis of a multicenter, randomized controlled trial [abstract].  Gastroenterology. 2001;  120 (Suppl 1) A601
• 131 Saar B, Egger K, Meining A, et al. Evaluation of virtual MR-colonography compared to colonoscopy [abstract].  Gastrointest Endosc. 2001;  53 AB72
• 132 Summers R M, Jerebko A K, Franaszek M, et al. Complementary role of computer-aided diagnostics for detecting colonic polyps with CT colonography [abstract].  Gastroenterology. 2001;  120 (Suppl 1) A600
• 133 Wax M R, Anderson J C, Kreeger K A, et al. Do we see virtually all of the colon?.  Gastroenterology. 2001;  120 (Suppl 1) A601
• 134 Lim C H, Dixon M F, Vail A, et al. Long-term outcome of ulcerative colitis patients with and without low-grade dysplasia [abstract].  Gastroenterology. 2001;  120 A141
• 135 Ullman T A, White J, Harpaz N, Itzkowitz S H. Assessment if biopsy practices in colonoscopic surveillance in ulcerative colitis [abstract].  Gastroenterology. 2001;  120 (Suppl 1) A446
• 136 Sabate J M, Villarejo J, Lemann M, et al. Hydrostatic balloon dilatation of Crohn’s strictures [abstract].  Gastroenterology. 2001;  120 (Suppl 1) A449
• 137 Hommes D W, Kate F JW, Roskam-Mul M DM, et al. Does histology predict clinical relapse in ulcerative colitis?.  Gastroenterology. 2001;  120 (Suppl 1) A275
• 138 Ochsenkuehn T, Holzknecht N, Reiser M, et al. Inflammation of the jejunum in Crohn’s disease: detection by MRI enteroclysis [abstract].  Gastroenterology. 2001;  120 (Suppl 1) A271
• 139 Ritz M A, Patak M A, Froehlich J M, et al. A novel non-invasive distension technique for magnetic resonance imaging (MRI) of the small bowel [abstract].  Gastroenterology. 2001;  120 (Suppl 1) A272
• 140 Feretis C, Benakis P, Dailianas A, et al. Endoscopic implantation of micro-balloons in the management of fecal incontinence [abstract].  Gastrointest Endosc. 2001;  53 AB57
• 141 Davis K J, Kumar D, Bland J. Results of anal injection of Duraspheres in patients with anal incontinence [abstract].  Gastroenterology. 2001;  120 (Suppl 1) A23
• 142 Bolin T D, Kneebone A, Larsson T. Sigmoidoscopic findings following radiation for prostate cancer [abstract].  Gastroenterology. 2001;  120 (Suppl 1) A284
• 143 Tam W CE, Moore J, Conroy-Hiller T A, Schoeman M N. Prospective randomized treatment trial of argon plasma coagulation and topical formalin for radiation proctitis [abstract].  Gastrointest Endosc. 2001;  53 AB184
• 144 Richards R J, Hammitt J K. Timing of prophylactic surgery for diverticulitis: a cost-effectiveness analysis [abstract].  Gastroenterology. 2001;  120 (Suppl 1) A408
• 145 Morris C R, Harvey I M, Stebbings W SL, et al. Does prescribed medication cause colonic diverticular perforation? A case-control study [abstract].  Gastroenterology. 2001;  120 (Suppl 1) A281
• 146 Kantsevoy S V, Hopkins J, Cruz-Correa M R, et al. The utility of endoscopy in the management of acute ischemic colitis [abstract].  Gastroenterology. 2001;  120 (Suppl 1) A407
• 147 Woo K E, Jung S A, Ju M, et al. The diagnosis value of colonoscopy and analysis of pathogens using biopsy specimen and intraluminal fluid in acute infectious colitis [abstract].  Gastrointest Endosc. 2001;  53 AB182