Blanco, Paola, MD

Essrani, Rajesh, MD

Hickey, Patrick, DO

Shah, Hiral N, MD

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksDepartment of MedicineInitial Experience of a CommunityGastroenterology Practice With Ultra-SlimColonoscopy: A Case Series.Rajesh Essrani MDLehigh Valley Health Network, Rajesh.Essrani@lvhn.orgPatrick Hickey DOLehigh Valley Health Network, Patrick.Hickey@lvhn.orgHiral N. Shah MDLehigh Valley Health Network, hiral_n.shah@lvhn.orgPaola Blanco MDLehigh Valley Health Network, Paola_G.Blanco@lvhn.orgFollow this and additional works at: https://scholarlyworks.lvhn.org/medicinePart of the Gastroenterology Commons, Internal Medicine Commons, and the Medical SciencesCommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtEssrani, R. Hickey, P. Shah, H. N., Blanco, P. (2017, October 17). Initial Experience of a Community Gastroenterology Practice WithUltra-slim Colonoscopy: A Case Series. poster Presented at: The World Congress Of Gastroenterology at ACG, Orlando, Florida.© 2017 Lehigh Valley Health NetworkThe PCF-PH190L/I is among the new endoscopes Olympus has recently introduced as part of their EVIS EXERA III system. The ultra-slim colonoscope has an outer diameter of 9.7 mm and a 3.2 mm working channel width. Its advantages include reduced physician fatigue and patient discomfort1. Cecal intubation rates are high with low mean cecal intubation times. It has enhanced optical system with greater brightness, viewing angle and ultra-high definition imaging quality. It has a responsive insertion technology (RIT) technology with passive bending which allows easier movement through acute bends in the colon which improves operator control for both pushing and twisting maneuvers. It can be used in patients with previous incomplete colonoscopies with less or no sedation. The purpose of this study is to review a series of patients who underwent colonoscopy with a newly acquired ultra-slim colonoscope (Olympus PCF-PH190L/I) in a community ambulatory endoscopy center.Initial Experience of a Community Gastroenterology Practice with Ultra-Slim Colonoscopy:A Case SeriesReferences:1.  K. K. Garborg, M. Loberg, J. Matre, O. Holme, M. Kalager, G. Hoff, M. Bretthauer. Reduced pain during screening colonoscopy with an ultrathin colonoscope: a randomized controlled trial. Endoscopy 2012; 44(08): 740-746. 2.  Sofi AA, Nawras A, Khan MA, Howden CW, Lee WM. Meta-analysis of the performance of ultrathin vs. standard colonoscopes. Endoscopy. 2017 Apr;49(4):351-358.3.  Töx U, Schumacher B, Toermer T, Terheggen G, Mertens J, Holzapfel B, Lehmacher W, Goeser T, Neuhaus H. Propofol sedation for colonoscopy with a new ultrathin or a standard endoscope: a prospective randomized controlled study. Endoscopy. 2013 Jun;45(6):439-44.A total of 13 colonoscopies were performed on 13 patients (10 women and 3 men), with a mean age of 64.5 years by five different providers.  Common indications for colonoscopy were screening for colorectal cancer (38.4%), history of colon polyps (38.4%).  The most common reason for ultra-slim colonoscope use were patient comfort (84.6 %), fixed sigmoid preventing passage of pediatric colonoscope (7.7%) and prior failed colon (7.7%).  Results showed diverticulosis (76.9%), internal hemorrhoids (46.1%), polyps (30.7%), rectal gastrointestinal stromal tumor (7.6%) only one normal colonoscopy (7.6%).Our study showed use of an ultra-slim colonoscope had a cecal intubation rate of 92.3%.  Patients with prior failed colonoscopy had successful cecal intubation. A large number of patients were selected to have colonoscopy with an ultra-slim scope for patient and provider comfort.  Ultra-slim colonoscopy is reportedly preferred by patients for comfort and reduced sedation requirements making it an ideal choice for community gastroenterologists2,3. It is used at many practices as a rescue in situations where standard colonoscopes have failed.  Our study highlights the use of an ultra-slim scope in both rescue situations, and as the initial colonoscope of choice in an ambulatory endoscopy center.  Further studies are needed to evaluate the use of ultra-slim colonoscopy and its indications and advantages.Lehigh Valley Health Network, Allentown, PennsylvaniaRajesh Essrani, MD1, Patrick Hickey, DO2, Hiral Shah, MD3, Paola Blanco, MD4DISCUSSIONBACKGROUNDTable 1.  Results of a Case Series on an Initial Experience of a Community Gastroenterology Practice with Ultra-Slim ColonoscopyPatient # Gender Age ProviderCecum ReachedPrior Failed ColonIndication Stated?(If so what) AdenomaReason for Ultra-Thin Findings1Female 62 1 No No Change in bowel habits, weight loss No Fixed sigmoid prevenging passage of pediatric colonoscopePossible rectosigmoid junction tumor ingrowth with polypoid lesion (lymphoid aggregates, no neoplasia/dysplasia), diverticulosis, internal hemorrhoids2 Female 66 2 Yes Yes Abnormal CT Scan No Prior failed colon Normal Colonoscopy3Male 76 3 Yes No Heme-Positive Stools Yes Patient Comfort Pedunculated Polyp, Necrotic Appearing Area (biopsy with granulation tissue)4 Female 69 2 Yes No Screening for colorectal cancer No Patient Comfort Severe sigmoid diverticulosis, Internal Hemorrhoids5 Female 62 2 Yes No History Colon Polyps No Patient Comfort Tortuous sigmoid colon, sigmoid diverticulosis6 Female 69 4 Yes No History Colon Polyps Yes Patient Comfort Rectal gastrointestinal stromal tumor, Sigmoid Polyp, Sigmoid Diverticulosis7 Female 64 4 Yes No Screening for colorectal cancer No Patient Comfort Diverticulosis8 Male 62 4 Yes No Screening for colorectal cancer No Patient Comfort Sigmoid Diverticulosis, Internal/External Hemorrhoids9 Female 56 2 Yes No History Colon Polyps Yes Patient Comfort Ascending Colon Sessile Serrated Adenoma, Diverticulosis, Internal Hemorrhoids10 Male 74 3 Yes No Screening for colorectal cancer No Patient Comfort Severe Diverticulosis11 Female 65 2 Yes No History Colon Polyps No Patient Comfort Severe Diverticulosis, Internal Hemorrhoids12 Female 51 2 Yes No Screening for colorectal cancer Yes Patient Comfort Cecal Polyp, Internal Hemorrhoids13 Female 63 5 Yes No History Colon Polyps No Patient Comfort Severe DiverticulosisRESULTSFigure 1: showing EVIS EXERA III PCF-PH190L/I 

Initial Experience of a Community Gastroenterology Practice With Ultra-Slim Colonoscopy: A Case Series.

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Initial Experience of a Community Gastroenterology Practice With Ultra-Slim Colonoscopy: A Case Series.

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