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Zorlu Kolonoskopi Uygulamalasında Su Yardımlı Kolonoskopi Yöntemi

Yıl 2018, Cilt: 9 Sayı: 33, 8 - 13, 31.01.2018
https://doi.org/10.17944/mkutfd.375837

Öz
















Amaç: Güvenli ve ucuz bir yöntem olarak, su yardımlı kolonoskopi yöntemi,  kolonoskop ile eişimi zor kolona giderken karşılaşılan güçlükleri gidermek için endoskopi yapan cerraha benzersiz bir yöntem sunmaktadır. Su yardımlı uygulamanın bir diğer yararı da sedasyon için kullanılan ilaçların gereksinimini azaltmasıdır. Su yardımlı yöntemlerin gerçek yararı hakkında hala çok sayıda tartışma olmasına karşın az sayıda klinik yayın mevcuttur. Bu çalışmada, zorlu geçmesi öngörülen vakalarda, konvansiyonel hava insuflasyonu ile yapılan kolonoskopileri, hava insuflasyonu yerine su zerk edilerek yapılan kolonoskopilerle çekum entübasyon başarısı ve hızı, ağrı skoru ve işlem sonrası analjezik ihtiyacı açısından karşılaştımayı amaçladık.


Gereç ve Yöntemler: Zorlu kolonoskopi öngörülen hastalar ve/veya geçirilmiş abdomino-pelvik cerrahi öyküsü olan toplam 40 hasta çalışmaya dahil edildi. İşlem öncesi veya esnasında herhangi bir sedasyon uygulanmadı. Hastalar randomize olarak su ve hava grubu olarak iki gruba ayrıldı. Çekum entübasyon süresi ve başarısı, hastalara tekrar kolonoskopi gerektiğinde sedayonsuz uygulama redetme oranı, abdominal ağrı skoru ve işlem sonrası analjezik ihtiyacı incelendi.


Bulgular: Yaş ve beden kitle indeksi açısından her iki grup açısından istatiksel fark yoktu. Abdominal ağrı skoru istatiksel olarak anlamlı düzeyde su grubunda daha az olarak bulundu (p<0.05). Su grubunda 1 hastanın (%5) hava grubunda 7 hastanın (%35) narkotik ajan ihtiyacı oldu. İki grup arasındaki fark istatiksel olarak anlamlıydı (p:0.004). Sedasyon olmaksızın tekrar kolonoskopi yaptırmayı redetme oranı su grubunda 2 hastada (%10) hava grubunda 10 hastada (%50) saptandı ve fark istatiksel olarak anlamlıydı (p:0.001). Her iki grup arasında çekum entübasyon süresi ve başarısı açısından herhangi bir fark tespit edilmedi.


Sonuç: Konvansiyonel hava insuflasyonu ile yapılan kolonoskopiler yerine zorlu olgularda su ile yapılan kolonoskopi yöntemi çekum entübasyon hızını ve sıklığını azaltmadan abdominal ağrıyı azaltma açısından avantajlı görülmektedir.

Kaynakça

  • 1.Stoop EM, de Haan MC, de Wijkerslooth TR, Bossuyt PM, van Ballegooijen M, Nio CY, et al. Participation and yield of colonoscopy versus non-cathartic CT colonography in population-based screening for colorectal cancer: a randomised controlled trial. The Lancet Oncology. 2012;13(1):55-64.
  • 2.Bretthauer M, Kaminski MF, Loberg M, Zauber AG, Regula J, Kuipers EJ, et al. Population-Based Colonoscopy Screening for Colorectal Cancer: A Randomized Clinical Trial. JAMA internal medicine. 2016;176(7):894-902.
  • 3.Leung JW, Mann SK, Siao-Salera R, Ransibrahmanakul K, Lim B, Cabrera H, et al. A randomized, controlled comparison of warm water infusion in lieu of air insufflation versus air insufflation for aiding colonoscopy insertion in sedated patients undergoing colorectal cancer screening and surveillance. Gastrointestinal Endoscopy. 2009;70(3):505-10.
  • 4.Rabenstein T, Radaelli F, Zolk O. Warm water infusion colonoscopy: a review and meta-analysis. Endoscopy. 2012;44(10):940-51.
  • 5.Leung FW, Leung JW, Siao-Salera R, Mann SK. The water method significantly enhances proximal diminutive adenoma detection rate in unsedated patients. Journal of Interventional Gastroenterology. 2011;1(1):9-13.
  • 6.Hu D, Xu Y, Sun Y, Zhu Q. Water infusion versus air insufflation for colonoscopy: a meta-analysis of randomized controlled trials. Techniques in coloproctology. 2013;17(5):487-96.
  • 7.Leung FW, Aharonian HS, Leung JW, Guth PH, Jackson G. Impact of a novel water method on scheduled unsedated colonoscopy in U.S. veterans. Gastrointestinal Endoscopy. 2009;69(3):546-50.
  • 8.Radaelli F, Paggi S, Amato A, Terruzzi V. Warm water infusion versus air insufflation for unsedated colonoscopy: a randomized, controlled trial. Gastrointestinal Endoscopy. 2010;72(4):701-9.
  • 9.Rex DK. Editorial: Water Exchange vs. Water Immersion During Colonoscope Insertion. The American Journal of Gastroenterology. 2014;109(9):1401-3.
  • 10.Leung FW, Harker JO, Jackson G, Okamoto KE, Behbahani OM, Jamgotchian NJ, et al. A proof-of-principle, prospective, randomized, controlled trial demonstrating improved outcomes in scheduled unsedated colonoscopy by the water method. Gastrointestinal Endoscopy. 2010;72(4):693-700.
  • 11.Hsieh Y-H, Koo M, Leung FW. A Patient-Blinded Randomized, Controlled Trial Comparing Air Insufflation, Water Immersion and Water Exchange During Minimally Sedated Colonoscopy. The American Journal of Gastroenterology. 2014;109(9):1390-400.

Water-Assisted Colonoscopy Method in the Application of Forced Colonoscopy

Yıl 2018, Cilt: 9 Sayı: 33, 8 - 13, 31.01.2018
https://doi.org/10.17944/mkutfd.375837

Öz

Aim: A water-assisted colonoscopy, a safe and cheap method, offers the endoscopist a unique method for addressing challenges in navigating the colonoscope through difficult colons. One benefit of the water technique is the reduction of the requirement for medications used for sedation. Although there is still much contention among endoscopists regarding the true benefit of the water-assisted methods, a few clinical study was reported on that issue. In this study, we aimed to compare the colonoscopy with conventional air insufflation and the colonoscopes with water inserted instead of air insufflation in terms of the cecum intubation success and speed, the pain score and the post-procedural analgesic requirements in the arduous cases.

Material and Method: A total of 40 patients with suspected colonoscopy and/or previous history of abdominal-pelvic surgery were included in the study. No sedation was applied before or during the procedure. The patients were randomly divided into two groups as water and air groups. Cecum intubation duration and success, rejection rate when the patient was required to undergo colonoscopy again, abdominal pain score, and postoperative analgesic requirement were all assessed.

Results: There was no statistical difference between the two groups in terms of age and body mass index. The abdominal pain score was statistically lower in the water group (p<0.05). One patient (5%) in the water group and 7 (35%)  in the air group needed a narcotic agent. The difference between the two groups was statistically significant (p: 0.004). The rate of rejection of colonoscopy without sedation was found in 2 patients (10%) of the water group and in 10 patients (50%) of the air group, and this difference had significance (p: 0.001). There was no difference between the two groups in terms of duration of tracheal intubation and success.

Conclusion: The choice of colonoscopy with water instead of colonoscopy with conventional air insufflation seems to be advantageous in terms of abdominal pain reduction without reducing the rate and frequency of intubation.

Kaynakça

  • 1.Stoop EM, de Haan MC, de Wijkerslooth TR, Bossuyt PM, van Ballegooijen M, Nio CY, et al. Participation and yield of colonoscopy versus non-cathartic CT colonography in population-based screening for colorectal cancer: a randomised controlled trial. The Lancet Oncology. 2012;13(1):55-64.
  • 2.Bretthauer M, Kaminski MF, Loberg M, Zauber AG, Regula J, Kuipers EJ, et al. Population-Based Colonoscopy Screening for Colorectal Cancer: A Randomized Clinical Trial. JAMA internal medicine. 2016;176(7):894-902.
  • 3.Leung JW, Mann SK, Siao-Salera R, Ransibrahmanakul K, Lim B, Cabrera H, et al. A randomized, controlled comparison of warm water infusion in lieu of air insufflation versus air insufflation for aiding colonoscopy insertion in sedated patients undergoing colorectal cancer screening and surveillance. Gastrointestinal Endoscopy. 2009;70(3):505-10.
  • 4.Rabenstein T, Radaelli F, Zolk O. Warm water infusion colonoscopy: a review and meta-analysis. Endoscopy. 2012;44(10):940-51.
  • 5.Leung FW, Leung JW, Siao-Salera R, Mann SK. The water method significantly enhances proximal diminutive adenoma detection rate in unsedated patients. Journal of Interventional Gastroenterology. 2011;1(1):9-13.
  • 6.Hu D, Xu Y, Sun Y, Zhu Q. Water infusion versus air insufflation for colonoscopy: a meta-analysis of randomized controlled trials. Techniques in coloproctology. 2013;17(5):487-96.
  • 7.Leung FW, Aharonian HS, Leung JW, Guth PH, Jackson G. Impact of a novel water method on scheduled unsedated colonoscopy in U.S. veterans. Gastrointestinal Endoscopy. 2009;69(3):546-50.
  • 8.Radaelli F, Paggi S, Amato A, Terruzzi V. Warm water infusion versus air insufflation for unsedated colonoscopy: a randomized, controlled trial. Gastrointestinal Endoscopy. 2010;72(4):701-9.
  • 9.Rex DK. Editorial: Water Exchange vs. Water Immersion During Colonoscope Insertion. The American Journal of Gastroenterology. 2014;109(9):1401-3.
  • 10.Leung FW, Harker JO, Jackson G, Okamoto KE, Behbahani OM, Jamgotchian NJ, et al. A proof-of-principle, prospective, randomized, controlled trial demonstrating improved outcomes in scheduled unsedated colonoscopy by the water method. Gastrointestinal Endoscopy. 2010;72(4):693-700.
  • 11.Hsieh Y-H, Koo M, Leung FW. A Patient-Blinded Randomized, Controlled Trial Comparing Air Insufflation, Water Immersion and Water Exchange During Minimally Sedated Colonoscopy. The American Journal of Gastroenterology. 2014;109(9):1390-400.
Toplam 11 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm Original Articles
Yazarlar

Aziz Arı 0000-0002-7806-2354

Kenan Büyükaşık Bu kişi benim

Yayımlanma Tarihi 31 Ocak 2018
Gönderilme Tarihi 9 Ocak 2018
Kabul Tarihi 17 Temmuz 2018
Yayımlandığı Sayı Yıl 2018 Cilt: 9 Sayı: 33

Kaynak Göster

Vancouver Arı A, Büyükaşık K. Zorlu Kolonoskopi Uygulamalasında Su Yardımlı Kolonoskopi Yöntemi. mkutfd. 2018;9(33):8-13.