The impact of advances in instrumentation and techniques of colonoscopy from 1988 to 2008 on inpatient colonoscopy performance at a high volume endoscopy unit in the United States: significantly shorter procedure time, higher completion rate, performance on sicker inpatients, and near disappearance of flexible sigmoidoscopy.

摘要

BACKGROUND AND AIMS: Colonoscopy instrumentation and technique have improved from 1988 to 2008. We analyze whether these improvements have resulted in improved colonoscopy performance. METHODS: This was a retrospective study of 50 consecutive inpatients in 1988 vs. 1998 vs. 2008 undergoing intended colonoscopy at a teaching hospital. Patient APACHE score, cecal and terminal ileal intubation rates, procedure time, and colonoscopic diagnoses were compared for the three different years. RESULTS: Changes in practice of inpatient colonoscopy in 2008 from 1988 include (1) remarkably sicker inpatients undergoing colonoscopy in 2008, as indicated by: significantly higher mean APACHE II score (11.0 +/- 6.6 vs. 5.9 +/- 4.1, P < 0.00001), significantly more frequent monitored bed status (58% vs. 10%, OR = 12.4; 95%-ORCI: 4.31-35.4, P < 0.00001), and significantly higher rates of several chronic diseases (e.g. CHF, 24% vs. 6%, P = 0.02); (2) significantly higher colonoscopy completion rate in 2008 (88% vs. 64%; OR = 4.13, 95%-ORCI: 1.51-11.2, P = 0.009); (3) significantly higher terminal ileum intubation rate in 2008 (44% vs. 14%, OR = 4.83, 95%-ORCI: 1.85-12.5, P = 0.002); and (4) significantly shorter mean procedure time in 2008 (26.3 +/- 7.9 min vs. 48.0 +/- 20.3 min, P < 0.00001). The ratio of intended colonoscopy/flexible sigmoidoscopy was significantly higher in 2008 vs. 1988 (OR = 7.50, 95%-ORCI: 2.56-21.8, P < 0.00001). Internal hemorrhoids were significantly more frequently diagnosed by colonoscopy in 2008 (44% vs. 12%, OR = 5.76, 95%-ORCI: 2.12-15.5, P = 0.001), attributed to increased rectal retroflexion. CONCLUSIONS: Due to improved instrumentation and technique, colonoscopy has dramatically changed from 1988 to become a clinically more valuable test in 2008 as manifested by a higher completion rate, greater clinical applicability, and shorter procedure time. Colonoscopy is supplanting flexible sigmoidoscopy.