Endoscopy teams' judgment of discomfort among patients undergoing colonoscopy: "How bad was it really?".

QUESTIONS UNDER STUDY / PRINCIPLES: Colonoscopies are complex procedures that depend greatly on the patient's cooperation and on the correct judgment of a tolerable amount of discomfort by the endoscopy team, even in sedated patients. Little is known regarding the accuracy of the patient comfort level assessments made by medical staff. METHODS: We prospectively evaluated the degree of agreement between the assessments made by the endoscopists and endoscopy nurses and the assessments made by patients regarding their comfort level during the procedure. A total of 222 patients scheduled for routine colonoscopies assessed their preprocedural anxiety and the tolerability of the procedure. Endoscopists and nurses assessed the difficulty of the examination and the patient's level of discomfort. Assessments were performed using a 100-mm VAS. RESULTS: Overall, patients rated the procedure as tolerable. For 12% (27/222) of the patients, the examination was less tolerable (VAS >50 mm). The patients' judgment of tolerability was not related to the initial level of anxiety (r = 0.15). The scores of the endoscopists and nurses were better correlated with each other (r = 0.58) than with the patients' self-assessments (r = 0.37 and 0.35, respectively). Both endoscopists and nurses tended to overestimate the patients' discomfort. However, in 9% (19/222) of cases, the level of patient discomfort was considerably underestimated by at least one member of the team. CONCLUSION: Our study shows that the estimation of a patient's discomfort during a colonoscopy is difficult and that the comfort level may not be accurately determined in a considerable number of patients, including sedated patients.

Ileocecal valve as substitute for the missing pyloric sphincter after partial distal gastrectomy.

OBJECTIVES: Accelerated gastric emptying (including dumping syndrome) occurs frequently after gastric resections, largely resulting from rapid entry of meal contents into the small intestine. The authors hypothesized that an ileocecal segment used as an interpositional graft placed between the remaining part of the stomach and the small intestine would slow down food transit and thus replace pyloric function. METHODS: Thirty Göttingen minipigs were randomized into three groups. Group 1: partial gastrectomy and Roux-en-Y reconstruction; Group 2: partial gastrectomy and ileocecal interpositional graft; and Group 3: sham laparotomy. Gastric emptying in the nonsedated animals was quantified using radioscintigraphy at 3 and 6 months postoperatively. The animals ingested 300 grams of soft food containing 99mTc labeled resin- pellets using a technique previously described. Data were analyzed using ANOVA. RESULTS: Three months postoperatively, the ileocecal group had a significantly prolonged gastric emptying time compared with the Roux-en-Y group, but gastric emptying time was also significantly faster compared to the control group (sham laparotomy). After 6 months no significant difference was seen between the ileocecal group and the controls, while emptying rates were still significantly faster in the Roux-en-Y group. CONCLUSIONS: Reconstruction of the gastric reservoir with an ileocecal segment largely restores gastric emptying patterns of food in minipigs. Six months postoperatively, gastric emptying time is similar to that of controls, and significantly slower when compared with the group with Roux-en-Y reconstruction. These results suggest that the ileocecal interposition graft could offer specific advantages over current reconstruction procedures.