Kikuo Kanda

Variable stiffness colonoscopes are associated with less pain during colonoscopy in unsedated patients

OBJECTIVES:Application of a new variable stiffness colonoscope (VSC) is expected to control loop formation and to lessen patient discomfort. The aim of this prospective study was to compare the efficacy of VSC with a conventional colonoscope (CC) in unsedated colonoscopy, based on the experience of examiners.METHODS:Four-hundred sixty-seven patients were randomly assigned to undergo colonoscopy with either VSC or CC by an endoscopist, including experienced and less-experienced examiners. The percentages of completed procedure and time to cecal intubation were recorded. Patients were asked to rate pain on a 5-point pain score.RESULTS:The percentages of completed procedure with VSC and CC were 98% and 95%, respectively, by less-experienced hands, and 99% and 98%, respectively, by experienced hands. Time for cecal intubation with VSC and CC was 15.7 and 18.5 min, respectively, by less-experienced hands, and 9.8 and 10.6 min, respectively, by experienced hands. A significantly lower mean pain score was noted in VSC patients compared with CC patients, irrespective of experience of the examiner. The percent of patients rating the procedure as moderately or severely painful was significantly lower with VSC than with CC, both in less-experienced (19% vs 40%; p < 0.01) and experienced hands (15% vs 26%; p < 0.05).CONCLUSIONS:Our results indicated that VSC allows favorable examination compared with CC regarding completeness, time to cecal intubation, and comfort of patients undergoing unsedated colonoscopy, irrespective of the examiners experience. These features suggest VSC as the preferred colonoscope for patients undergoing unsedated colonoscopy.

ENDOSCOPIC PROCEDURE UNDER IRRIGATION

Background:  Endoscopic therapy is often difficult to achieve particularly when the field of view of the lesion is poor due to contamination of mucus and blood. We developed five different types of end hoods that facilitate endoscopic procedures by simultaneously allowing various treatments and irrigation of the site.

Therapeutic experience of hyperbaric oxygenation in entero-Behcet syndrome

TO THE EDITOR: This is the first report that confirms the efficacy of hyperbaric oxygen (HBO) therapy for an ileocecal ulcer in a patient with entero-Behcet syndrome who was unresponsive to steroid therapy.