Douglas K Rex

..To evaluate the safety and efficacy of two reduced dosing regimens of sodium phosphate tablets (Visicol, InKine Pharmaceutical Co. Inc., Blue Bell, PA, USA) for colon cleansing prior to colonoscopy...

..To review dosing considerations and other treatment recommendations to maximize the efficacy, tolerability, and safety of sodium phosphate (NaP) preparations...

..The aim of this study was to describe the approach used by a gastroenterologist with special interest in colonoscopy to perform colonoscopy in patients with a prior incomplete colonoscopy...

..Moderate sedation is typically accepted in the anaesthesia community as an appropriate target for sedation by non-anaesthesiologists...

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..Its administration by anesthesia specialists is associated with high cost. Administration by nonanesthesiologists is controversial because of concerns about safety, particularly respiratory depression...

..This inactive ingredient produces a residue that obscures mucosal visualization and is time-consuming to remove during colonoscopy...

..The object may directly extend from the stomach or duodenum into the liver, or rarely, the object may perforate the bowel distal to the duodenum and indirectly extend to the liver leading to the formation of an abscess...

..For each of these approaches to colonoscopy, the advantages and disadvantages also are listed and discussed...

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..Endoscopist-directed propofol sedation (EDP) remains controversial. We sought to update the safety experience of EDP and estimate the cost of using anesthesia specialists for endoscopic sedation...

..Colonoscopy provides imperfect protection against colorectal cancer and is operator dependent. Colonoscopies typically are poorly documented. We aimed to determine whether videorecording impacts short-term performance of colonoscopy...

..This study evaluated the ability of the Olympus Exera 180 high-definition colonoscope (Olympus America, Inc, Center Valley, PA), with narrow-band imaging, to predict colorectal polyp histology...

..Specific training is needed to undertake gastroenterologist directed propofol administration...

..The population prevalence of Barrett's esophagus (BE) is uncertain. Our aim was to describe the prevalence of BE in a volunteer population...

..These guidelines are summarized and evaluated as they pertain to colorectal cancer screening...

..As these strategies emerge, monitoring their effects on adherence, cancer prevention, and procedural complications will be needed to optimize their roles relative to primary colonoscopy screening...

..Variable-stiffness colonoscopes allow passage of the rectosigmoid colon in a flexible mode, followed by stiffening to prevent looping. This feature might allow faster cecal intubation...

..Candidate patients for oral NaP solution should be assessed for eligibility and preparation instructions should adhere to the current recommendations for maximizing the safety of oral NaP...

..However, the absence of an evidence base supporting a need for MAC to deliver propofol, combined with its high cost, suggests that alternatives to MAC to deliver propofol deserve fair and balanced evaluation...

..Propofol offers advantages over meperidine/midazolam in cirrhotic patients...

..3 vs. 9.4, P>0.5). CONCLUSIONS: Nurse-administered propofol resulted in several advantages for outpatient colonoscopy compared with midazolam plus fentanyl, but did not improve patient satisfaction...

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..It has been shown that the first screening colonoscopy and polypectomy produces the greatest effects on reducing the incidence of colorectal cancer in patients with adenomatous polyps...

..A controlled trial of whether BIS values can assist in avoiding unnecessary propofol dosing during the maintenance phase of sedation appears warranted...

..Some physicians believe that split-dose preparations would be unpopular with patients scheduled for early morning colonoscopies...

..Emerging technologies, such as stool DNA tests and virtual colonoscopy, hold promise for the future but cannot be recommended for screening at present...

..The aim of the study was to determine the impact of ACR recommendations on resection of high-risk adenoma findings using an endoscopic polyp/histology database...

..The potential for improvements in the technology are substantial, and data from second-generation assays have already been reported. The cost-effectiveness of new strategies needs further evaluation...

..Colonoscopy with narrow-band imaging can allow real-time determination of polyp histology...

..This double-blind, multicenter study evaluated the safety and efficacy of intravenous fospropofol (6.5 mg/kg vs. 2 mg/kg) for moderate sedation in patients undergoing colonoscopy...

..The aim of this study was to see if a 170 degrees angle of view (wide angle [WA]) colonoscope allowed faster withdrawal without decreasing adenoma detection...

..Oral sodium phosphate solution (OSPS) has been associated with acute renal failure when used as a bowel preparation for colonoscopy...

..There is variation between endoscopists in their detection of colorectal adenomas. There is less understanding of variation between endoscopists in detection and management of nonadenomas...

..We sought to determine whether a retrospective case-control study could identify risk factors for sporadic CRC and advanced adenomatous polyps (together known as sporadic colorectal neoplasia [CRN])...

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..High-definition chromoscopy is used to increase the yield of colonoscopy for flat and depressed neoplasms; however, its role in average-risk patients undergoing routine screening remains uncertain...

..We investigated the prevalence and endoscopist detection rates of proximal serrated polyps in a large cohort of average risk patients undergoing screening colonoscopy...

..The aim of this study was to describe the resource use of endoscopic resection of large sessile colon polyps compared with small polyps with respect to physician time and equipment use...

..No clinically important role for BIS monitoring as an adjunct to NAPS has yet been established...

..To evaluate how proximal colon polyps interpreted as hyperplastic polyps in 2001 would be interpreted by expert pathologists in 2007...

..In this study, we assessed the adenoma detection rates of nine endoscopists performing colonoscopy and the effects of endoscopist on adenoma detection compared with the established predictors of advancing age and male gender...

..Colonoscopy is used widely for colorectal cancer (CRC) screening; however, its long-term impact on the incidence and mortality of CRC is not known...

..Guidelines recommend inspection of the polypectomy site 3 to 6 months after resection. Some patients with a negative examination at 3 to 6 months have a subsequent "late" recurrence...

..Wide angle colonoscopy has the potential to reduce examination time and improve visualization of the periphery of the endoscopic field of view, but improvements in resolution are needed...

..98). CONCLUSIONS: The use of the WA colonoscope was associated with a reduction in insertion time to the cecum, as well as examination time during withdrawal. No evidence was found that the accuracy of the two colonoscopes differs...

..In this article, the authors examine the quality indicators for colonoscopy, present the reasons for interval cancers, and discuss the relation between NP-CRNs and quality colonoscopy...

..NAPS is in its infancy, but this method of sedation shows considerable promise for improving patient satisfaction with, and thereby the reputation of, endoscopic procedures...

..Effective examination should be demonstrated by meeting recommended targets for adenoma detection...

..Colonoscopy is less effective in the proximal compared with the distal colon...

..An exception to this approach is patients with rectal cancer operated by traditional blunt dissection techniques, for which there is a rationale for interval flexible sigmoidoscopy and/or rectal ultrasound to look for local recurrences...

..Failures of adenoma detection diminish the effectiveness of colonoscopy...

..High risk is still based primarily on family history, and the guidelines are fairly consistent in adjusting screening modality and intervals according to family history...

..Maintaining a high standard of performance is critical with regard to achieving the highest level of effectiveness possible...

..This article reviews the rationale, efficacy, and clinical challenges associated with one of the most promising devices for improvement of mucosal exposure during colonoscopy, the Third Eye Retroscope (Avantis Medical, Sunnyvale, CA)...

..The gastroenterology and anesthesia communities should work together to explore mechanisms to expand propofol use or an alternative for endoscopy in a safe and cost-effective manner...

..There are few data evaluating how accurately patients can predict the quality of their colonoscopy preparation...

..Interventions to bridge the gap between efficacy and effectiveness are lacking, yet they should emphasize quality measurement and operate at various levels within the health system to motivate change in endoscopist behavior...

..To find if patients are interested in obtaining a video recording of their colonoscopy procedure...

..2% and there were no perforations. CONCLUSION: Nurse-administered propofol sedation is safe and simplifies the technical performance of colonoscopy compared to midazolam/narcotic sedation...

..CONCLUSIONS: At present, polypectomy technique among clinical gastroenterologists is highly variable. Some newer ancillary techniques have had extremely limited use thus far...

..A pediatric colonoscope with short bending in only two directions had good function for both cecal insertion and proximal colon retroflexion...

..CONCLUSIONS: Propofol can be given safely by appropriately trained nurses under supervision by endoscopists. Technology that allows immediate detection of apnea would likely further improve its safety...

..Physician education and widespread implementation of continuous quality improvement programs are required to bridge the gap between the guidelines and their clinical application...

..As leaders in the prevention and early diagnosis of colorectal cancer in the United States, clinical gastroenterologists can play an important role in promoting colorectal cancer awareness and the need for screening in African Americans...

..CONCLUSION: The prevalence of adenomatous foci in proximal colon polyps with endoscopic features of hyperplastic polyps is low. Whether endoscopic resection of polyps with these features is warranted remains uncertain...

..This review focuses on modern imaging techniques and their role in both the diagnosis and treatment of patients with SBO...

..Detection of adenomas is an important goal of colonoscopy. Narrow band imaging (NBI) might highlight adenomas and lead to higher rates of adenoma detection...

..The role of anti-tumor necrosis factor (TNF) antibody therapy in the treatment of IBD continues to be investigated...

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..These results do not support the addition of routine right colon retroflexion to colonoscopy...

..Synchronous polyps were those removed at the colonoscopy that discovered the large sessile adenoma or at any follow-up endoscopic examination within 12 months of discovery of the large sessile adenoma...

..The role of nurses in endoscopic sedation and monitoring continues to develop, and we are enthusiastic about an active role for nurses...

..The use of screening colonoscopy is expected to increase. Gastroenterologists will play the central role in ensuring the safe and cost-effective application of colonoscopy to screening and surveillance...

..Adenoma detection rates are an important measure of the quality of colonoscopy and should be reported to endoscopists in quality improvement programs in colonoscopy...

..Factors that interfere with detection of neoplasia during colonoscopy, as well as technologic advances that can improve both neoplasia detection and real-time determination of polyp histology, are reviewed...

..More information is needed on how training nurses and endoscopists should proceed to give propofol, as well as the optimal level of monitoring to ensure the safety of nurse-administered propofol...

..We conclude that in a group of unsedated subjects scheduled for flexible sigmoidoscopy after a sigmoidoscopy prep, the use of instruments longer than 60 cm gives very little additional yield...

..However, initial colonoscopy is more cost effective for those aged greater than or equal to 55 yr...

..Cost-effective selection of imaging strategies in this population can be based on demographic factors such as age and sex, which are better predictors of the presence of adenomas than are symptoms...

..Our aims were to determine the normal distribution of in vivo colorectal anatomy and to investigate the effect of age, sex, and body mass index (BMI) on colorectal length...

..After the clearing colonoscopy, subsequent examinations can be performed based on the associated adenoma findings...

..These issues include informed consent, documentation of cecal intubation, appropriate description of preparation, documentation of examination time and technique, and attention to potential atypical neoplasms...

..We conclude that when colonoscopy using air insufflation is incomplete because of looping or angulation, air contrast barium enema can be done the same day without impairing the quality of the barium study...

..Further interventions should target individual, organizational, and health system factors which influence physician behavior...

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..The use of retroflexion can increase the fraction of proximal sessile colon polyps amenable to endoscopic resection...

..This report describes the design and operation of a new device that addresses this problem, together with preliminary preclinical experience with this use of this shape-locking guide (SG-1)...

..CONCLUSION: For outpatient colonoscopy, propofol administered by nurses and supervised by endoscopists has several advantages over midazolam plus meperidine and deserves additional investigation...

..Nurse-administered propofol sedation in an ambulatory surgery center was safe and resulted in high levels of patient satisfaction and rapid postprocedure recovery and discharge...