Maximizing the general success of cecal intubation during propofol sedation in a multi-endoscopist academic centre

BMC Gastroenterology

Research Article

Elena Pinetti¹  Fabrizio Cardin²  Bruno Martella²  Oreste Terranova²  Federico Campigotto³  Alessandra Andreotti³  Nadia Minicuci³  Barbara M Donà⁴ 

[1] Department of Pharmacology and Anesthesiology, Anesthesia and Intensive Care Unit, Padova, Italy;Geriatrics Department, Geriatric Surgery Unit, General Hospital, Padova, Italy;National Research Council, Institute of Neuroscience, Padova Section, Italy;Veneto Oncologic Institute, IRCCS, Padova, Italy;

关键词: Bowel Preparation;    Deep Sedation;    Cecal Intubation;    Favourable Situation;    Incomplete Colonoscopy;   

DOI  :  10.1186/1471-230X-10-123

 received in 2010-06-24, accepted in 2010-10-20,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundAchieving the target of 95% colonoscopy completion rate at centres conducting colorectal screening programs is an important issue. Large centres and teaching hospitals employing endoscopists with different levels of training and expertise risk achieving worse results. Deep sedation with propofol in routine colonoscopy could maximize the results of cecal intubation.MethodsThe present study on the experience of a single centre focused on estimating the overall completion rate of colonoscopies performed under routine propofol sedation at a large teaching hospital with many operators involved, and on assessing the factors that influence the success rate of the procedure and how to improve this performance, analyzing the aspects relating to using of deep sedation. Twenty-one endoscopists, classified by their level of specialization in colonoscopic practice, performed 1381 colonoscopies under deep sedation. All actions needed for the anaesthesiologist to restore adequate oxygenation or hemodynamics, even for transient changes, were recorded.ResultsThe "crude" overall completion rate was 93.3%. This finding shows that with routine deep sedation, the colonoscopy completion rate nears, but still does not reach, the target performance for colonoscopic screening programs, at centers where colonoscopists of difference experience are employed in such programs.Factors interfering with cecal intubation were: inadequate colon cleansing, endoscopists' expertise in colonoscopic practice, patients' body weight under 60 kg or age over 71 years, and the need for active intervention by the anaesthesiologist. The most favourable situation - a patient less than 71 years old with a body weight over 60 kg, an adequate bowel preparation, a "highly experienced specialist" performing the test, and no need for active anaesthesiological intervention during the procedure - coincided with a 98.8% probability of the colonoscopy being completed.ConclusionsWith routine deep sedation, the colonoscopy completion rate nears the target performance for colonoscopic screening programs, at centers where colonoscopists of difference experience are employed in such programs. Organizing the daily workload to prevent negative factors affecting the success rate from occurring in combination may enable up to 85% of incomplete procedures to be converted into successful colonoscopies.

【 授权许可】

CC BY   
© Cardin et al; licensee BioMed Central Ltd. 2010