Sedation-Free Colonoscopy Tolerable and Effective With Upper Endoscope

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Sedation-Free Colonoscopy Tolerable and Effective With Upper Endoscope

NEW YORK (Reuters Health) Dec 25 - A small-caliber upper endoscope for sedation-free colonoscopy is tolerable and effective, particularly in patients with a low BMI, according to a report in the American Journal of Gastroenterology for November.

Compared with use of a standard colonoscope, use of an endoscope results in less pain and may actually improve visualization of the entire colon, note lead author Dr. Chang-Hwan Park and colleagues, from the Chonnam National University Medical School in Gwangju, South Korea.

The present randomized trial involved 244 patients who underwent sedation-free colonoscopy with either an upper endoscope (9.2 mm) or with a standard colonoscope (12.2 mm). Patients in each group had similar clinical characteristics.

The cecal intubation rate in each group was identical-91%, the authors report. However, in patients with a BMI < 22, the upper endoscope was more likely to reach the cecum (97.7% vs. 79.4%) and the difficult cecal intubation rate was lower (9.3% vs. 32.4%).

The self-assessed pain score on a 4-point scale (4 = greatest pain) was significantly lower in the endoscope group: 1.44 vs. 2.08 with a colonoscope (p < 0.001). Similarly, the endoscopist-assessed patient pain scores were also lower with the endoscope: 1.27 vs. 1.58.

Polyp detection and complication rates were comparable with either type of colon evaluation, the researchers note.

"The present study demonstrates that small-caliber upper endoscopes are promising instruments for improving total colonic evaluation, either as a primary colonoscope or as a backup for the standard colonoscope in patients with incomplete colonoscopy," Dr. Park's team writes.

"Sedation-free colonoscopy using an upper endoscope is feasible with less patient pain and discomfort compared with a standard colonoscope," they conclude.

Am J Gastroenterol 2006;101:2504-2510.

http://www.medscape.com/viewarticle/549871?src=mp