Louis Y. Korman, MD from the Metropolitan Gastroenterology Group, Chevy Chase Clinical Research, in Washington, D.C. discusses his recently published Original Article “Effect of propofol anesthesia on force application during colonoscopy.”
The focus of this study was to determine if colonoscopy technique, as measured by the amount of force applied to the insertion tube, is modified when patients receive deeper sedation with propofol.
More patients are receiving propofol anesthesia for their colonoscopy. The use of deeper sedation results in the abolition of pain feedback when compared to moderate sedation. The goal of the colonoscopist should be to the best exam possible using the least amount of force necessary. In addition, many trainees learn to perform colonoscopy with patients who receive propofol and this may affect skill acquisition. The more we understand how endoscopists use force to maneuver through the colon, the better we are able to define training methods and outcome parameters.
Colonoscopy force monitor in closed position (A) and with insertion tube attached (B).
The study was an observational cohort study of 13 expert and 12 trainee endoscopists performing colonoscopy in 114 patients. Forces were measured by using the colonoscopy force monitor, which is a wireless, handheld device that attaches to the insertion tube of the colonoscope. Axial and radial forces increase and examination time decreases significantly when propofol is used as the method of anesthesia. The study is limited because it was observational and was not randomized by method of sedation, experience, or instrument type. However, it was clear that propofol sedation is associated with a decrease in examination time and an increase in forces used to advance the colonoscope.
A randomized study should be performed among experienced and trainee endoscopists to examine the effect of anesthesia type on force application.
Read the article abstract online.
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