Skinny Scopes Better for Women Requesting Unsedated Colonoscopy
Douglas K. Rex, MD, MASGE, reviewing Hamada Y, et al. Endosc Int Open 2021 Jul.
On average, colonoscope insertion is considered more difficult in women than men, and most colonoscopists meet patients, including women, who request an attempt at unsedated procedures. In a randomized controlled trial comparing outcomes, 220 Japanese women underwent unsedated colonoscopy with a small-caliber colonoscope that is 9.2 mm in diameter and 168 cm in length or with a standard colonoscope that is 12.2 mm in diameter and 133 cm in length. The small-caliber scope has the passive bending and high-force transmission elements introduced with the Olympus 190 series scopes (Olympus Medical Systems, Tokyo, Japan).
The small-caliber scope resulted in a higher cecal intubation rate (99% vs 93%), and all patients who could not tolerate the standard scope underwent successful colonoscopy with the small-caliber instrument. Overall pain, according to a visual analog scale, was lower with the small-caliber scope than the standard scope (score, 20.0 vs 32.4; P<.0001), and maximum pain was lower at 28.9 vs 47.2, respectively (P<.0001).
COMMENTFor most American colonoscopists, often the best business practice is to let patients choose their approach to sedation. This study suggests that there are advantages to using the small-caliber scope over the standard colonoscope in unsedated colonoscopy performed in women. It would be interesting to see comparisons in the West, where colons are longer and patients may not be as tolerant. Certainly, the slim or ultrathin colonoscope is a very useful option in patients who are known to have severely angulated sigmoids.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
CITATION(S)
Hamada Y, Tanaka K, Katsurahara M, et al. Efficacy of a small-caliber colonoscope for pain in female patients during unsedated colonoscopy: a randomized controlled study. Endosc Int Open 2021;09:E1055-E1061. (https://doi.org/10.1055/a-1464-0780)
