Warm water infusion during sedated colonoscopy does not decrease amount of sedation medication used.

BACKGROUND: Water infusion versus air insufflation during colonoscope insertion has been suggested to reduce patient discomfort and decrease sedation medication requirements. Warm water is thought to further facilitate colonoscopy perhaps by decreasing colon spasm. OBJECTIVE: To compare the utility of warm (35°-38°C) versus cool (20°-23°C) water infused during colonoscopic insertion by measuring patient sedation medication use and discomfort scores between the warm and cool water groups. DESIGN: Randomized, controlled, double-blinded study. SETTING: Outpatient endoscopy unit at an academic medical center. PATIENTS: A total of 175 adults. INTERVENTION: Elective outpatient sedated screening colonoscopies. MAIN OUTCOME MEASUREMENTS: Sedation medication used, pain scores, cecal intubation rate, endoscopy times, satisfaction scores, and patient willingness to repeat procedures. RESULTS: There was no significant difference in sedation medication requirement during colonoscopy with the use of warm or cool water (fentanyl 83.6 ± 29.0 µg vs 87.6 ± 39.6 µg; P = .45; midazolam 3.3 ± 1.2 mg vs 3.3 ± 1.3 mg; P = .91). There was no significant difference in patient pain scores or satisfaction scores. Cecal intubation rates (100%) were similar. There was no significant difference in cecal intubation times (6 minutes 40 seconds ± 4 minutes 9 seconds vs 7 minutes 49 seconds ± 4 minutes 0 seconds; P = .06) between the warm and cool water groups. All patients were willing to repeat the colonoscopy by using the same method in both groups. LIMITATIONS: Limited generalizability to patients undergoing screening sedated colonoscopies with good to excellent bowel preparation. CONCLUSION: Water does not need to be warmed before infusion in patients undergoing sedated colonoscopies.

A randomized controlled trial in a training institution comparing a pediatric variable stiffness colonoscope, a pediatric colonoscope, and an adult colonoscope.

BACKGROUND: There are few comparative data on the efficacy of different colonoscopes. This study compared the efficacy of a new pediatric variable stiffness colonoscope with that of standard pediatric and adult colonoscopes in the performance of routine colonoscopy. METHODS: Three hundred sixty-three consecutive patients were randomized to undergo colonoscopy with a pediatric variable stiffness (n = 122), pediatric (n = 114), or adult colonoscope (n = 127). Primary outcomes recorded were minutes to the cecum and completeness of the examination. Secondary outcomes included patient tolerance, use of abdominal compression, and endoscopists' assessment of the difficulty of the procedure. RESULTS: Cecal intubation rates were not statistically different between the groups: variable stiffness (94.3%), pediatric (96.5%), and adult (89.8%) (p = 0.099). There was no significant difference in mean insertion time, patient tolerance, use of abdominal compression, or endoscopists' global assessment or examination difficulty between groups. Overall, the initial completion rate of 93% increased to 97% on switching to a different colonoscope. Colonoscopy was unsuccessful more often and was more time consuming in women who had undergone hysterectomy. CONCLUSION: The variable stiffness colonoscope performs well, but does not appear to offer any distinct advantage over standard pediatric or adult colonoscopes for routine colonoscopy. Further study may identify subgroups of patients that benefit from this new technology.