CC BY-NC-ND 4.0 · Journal of Digestive Endoscopy 2020; 11(04): 253-257
DOI: 10.1055/s-0040-1721223
Research Article

Perception and Practices of Colonoscopy Procedure: A Nationwide Survey of Indian Gastroenterologists

Jitendra Mohan Jha
1   Department of Medical Gastroenterology, KIMS, Secunderabad, Telangana, India
,
Sethu Babu
1   Department of Medical Gastroenterology, KIMS, Secunderabad, Telangana, India
› Author Affiliations

Abstract

Introduction There is a lack of data and consensus about the practices and policies regarding performing colonoscopy in India. We surveyed gastroenterologists to assess their practices and policies of performing colonoscopy.

Methodology A questionnaire was presented to gastroenterologists all over India regarding their preference of bowel preparation and method of sedation, completeness of cecal and ileal intubation rates, preferences for inflation, use of carbon dioxide and nitrous oxide, and complications faced.

Results Of the 350 surveys, 307 had completely responded (88%). Only 18% of the centers were conducting more than 100 colonoscopies a month and 46% denied following a colon cancer screening policy. Two bottles of liquid polyethylene glycol were the most preferred preparation. A total of 21% did not prefer any sedation at all. Nitrous oxide was used by only 5.6% of doctors. Ileal intubation rate was >96% in 34% of centers and cecal intubation rate >96% in 58% of centers. Air was used for inflation by 58%, while 39% used CO2. A total of 40% of the respondents believe CO2 inflation would improve cecal intubation rate, while 9.4% believed otherwise. While one third found CO2 inflation unnecessary and 14% not cost-effective, three fourths were still interested in setting up a CO2 facility. Reasons for not using nitrous oxide were practical/administrative difficulty (46.6%), side effects (20%), and cost (16%). Still more than half surveyed would consider using Entonox in future. Perforation was the most noted complication faced by respondents.

Conclusions This survey of real-world clinical practices will help to formulate practice guideline regarding colonoscopy in India.



Publication History

Article published online:
31 December 2020

© 2020. Society of Gastrointestinal Endoscopy of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 Wernli KJ, Brenner AT, Rutter CM, Inadomi JM. Risks associated with anesthesia services during colonoscopy. Gastroenterology 2016; 150 (04) 888-894, quiz e18
  • 2 Lüning TH, Keemers-Gels ME, Barendregt WB. Tan AC, Rosman C. Colonoscopic perforations: a review of 30,366 patients. Surg Endosc 2007; 21 (06) 994-997
  • 3 Adeyemo A, Bannazadeh M, Riggs T, Shellnut J, Barkel D, Wasvary H. Does sedation type affect colonoscopy perforation rates?. Dis Colon Rectum 2014; 57 (01) 110-114
  • 4 Katherine MH, Jennifer LH, Glenn ME. More large polyps are seen on screening colonoscopy with deep sedation compared with moderate conscious sedation. Gastrointest Endosc 2009; 69: AB119-AB20
  • 5 Falt P, Liberda M, Smajstrla V. et al. Combination of water immersion and carbon dioxide insufflation for minimal sedation colonoscopy: a prospective, randomized, single-center trial. Eur J Gastroenterol Hepatol 2012; 24 (08) 971-977
  • 6 Porostocky P, Chiba N, Colacino P, Sadowski D, Singh H. A survey of sedation practices for colonoscopy in Canada. Can J Gastroenterol 2011; 25 (05) 255-260
  • 7 Cohen LB, Wecsler JS, Gaetano JN. et al. Endoscopic sedation in the United States: results from a nationwide survey. Am J Gastroenterol 2006; 101 (05) 967-974
  • 8 Heuss LT, Froehlich F, Beglinger C. Changing patterns of sedation and monitoring practice during endoscopy: results of a nationwide survey in Switzerland. Endoscopy 2005; 37 (02) 161-166
  • 9 Leung FW, Aljebreen AM, Brocchi E. et al. Sedation-risk-free colonoscopy for minimizing the burden of colorectal cancer screening. World J Gastrointest Endosc 2010; 2 (03) 81-89
  • 10 Løberg M, Furholm S, Hoff I, Aabakken L, Hoff G, Bretthauer M. Nitrous oxide for analgesia in colonoscopy without sedation. Gastrointest Endosc 2011; 74 (06) 1347-1353
  • 11 Maslekar S, Balaji P, Gardiner A, Culbert B, Monson JR, Duthie GS. Randomized controlled trial of patient-controlled sedation for colonoscopy: Entonox vs modified patient-maintained target-controlled propofol. Colorectal Dis 2011; 13 (01) 48-57
  • 12 Baxter NN, Sutradhar R, Forbes SS, Paszat LF, Saskin R, Rabeneck L. Analysis of administrative data finds endoscopist quality measures associated with postcolonoscopy colorectal cancer. Gastroenterology 2011; 140 (01) (Suppl. 40) 65-72
  • 13 Rex DK, Schoenfeld PS, Cohen J. et al. Quality indicators for colonoscopy. Gastrointest Endosc 2015; 81 (01) 31-53
  • 14 von Karsa L, Patnick J, Segnan N. et al. European Colorectal Cancer Screening Guidelines Working Group. European guidelines for quality assurance in colorectal cancer screening and diagnosis: overview and introduction to the full supplement publication. Endoscopy 2013; 45 (01) 51-59
  • 15 Hussein AM, Bartram CI, Williams CB. Carbon dioxide insufflation for more comfortable colonoscopy. Gastrointest Endosc 1984; 30 (02) 68-70
  • 16 Sajid MS, Caswell J, Bhatti MI, Sains P, Baig MK, Miles WF. Carbon dioxide insufflation vs conventional air insufflation for colonoscopy: a systematic review and meta-analysis of published randomized controlled trials. Colorectal Dis 2015; 17 (02) 111-123
  • 17 Lindblom A, Jansson O, Jeppsson B, Törnebrandt K, Benoni C, Hedenbro JL. Nitrous oxide for colonoscopy discomfort: a randomized double-blind study. Endoscopy 1994; 26 (03) 283-286
  • 18 Aboumarzouk OM, Agarwal T, Syed Nong Chek SA, Milewski PJ, Nelson RL. Nitrous oxide for colonoscopy. Cochrane Database Syst Rev 2011; (08) CD008506
  • 19 Ball AJ, Campbell JA, Riley SA. Nitrous oxide use during colonoscopy: a national survey of English screening colonoscopists. Frontline Gastroenterol 2014; 5 (04) 254-259
  • 20 Kim SY, Kim HS, Park HJ. Adverse events related to colonoscopy: Global trends and future challenges. World J Gastroenterol 2019; 25 (02) 190-204