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Segmental increases in force application during colonoscope insertion: quantitative analysis using force monitoring technology - 17/09/12

Doi : 10.1016/j.gie.2012.05.030 
Louis Y. Korman, MD 1, ⁎, Lawrence J. Brandt, MD 2, David C. Metz, MD 3, Nadim G. Haddad, MD 4, Stanley B. Benjamin, MD 4, Susan K. Lazerow, MD 5, Hannah L. Miller, MD 5, David A. Greenwald, MD 2, Sameer Desale, MS 6, Milind Patel, MS 7, Armen Sarvazyan, PhD 7
1 Chevy Chase Clinical Research, Chevy Chase, Maryland 
2 Division of Gastroenterology, Montefiore Medical Center, Albert Einstein School of Medicine, Bronx, New York 
3 Division of Gastroenterology, Hospital University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 
4 Division of Gastroenterology, Georgetown University Hospital, Georgetown University School of Medicine, Washington DC 
5 Gastroenterology Division, Department of Veterans Affairs Medical Center, Washington, DC 
6 Department of Biostatistics and Epidemiology, MedStar Health Research Institute, Washington, DC 
7 Artann Laboratories, Trenton, New Jersey, USA 

Reprint requests: Louis Y. Korman, MD, Chevy Chase Clinical Research, 5550 Friendship Boulevard, Chevy Chase, MD 20815

Resumen

Background

Colonoscopy is a frequently performed procedure that requires extensive training and a high skill level.

Objective

Quantification of forces applied to the external portion of the colonoscope insertion tube during the insertion phase of colonoscopy.

Design

Observational cohort study of 7 expert and 9 trainee endoscopists for analysis of colonic segment force application in 49 patients. Forces were measured by using the colonoscopy force monitor, which is a wireless, handheld device that attaches to the insertion tube of the colonoscope.

Setting

Academic gastroenterology training programs.

Patients

Patients undergoing routine screening or diagnostic colonoscopy with complete segment force recordings.

Main Outcome Measurements

Axial and radial force and examination time.

Results

Both axial and radial force increased significantly as the colonoscope was advanced from the rectum to the cecum. Analysis of variance demonstrated highly significant operator-independent differences between segments of the colon (zones) in all axial and radial forces except average torque. Expert and trainee endoscopists differed only in the magnitude of counterclockwise force, average push/pull force rate used, and examination time.

Limitations

Small study, observational design, effect of prototype device on insertion tube manipulation.

Conclusion

Axial and radial forces used to advance the colonoscope increase through the segments of the colon and are operator independent.

El texto completo de este artículo está disponible en PDF.

Abbreviation : CFM


Esquema


 DISCLOSURE: The following author disclosed financial relationships relevant to this publication: Dr Korman: consultant and patent coholder, Artann Labs. The other authors disclosed no financial relationships relevant to this publication. Supported by grant NIDDK 2R44 DK068936-02A1.
 If you would like to chat with an author of this article, you may contact Dr Korman at [email protected].


© 2012  American Society for Gastrointestinal Endoscopy. Publicado por Elsevier Masson SAS. Todos los derechos reservados.
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