Impact of a responsive insertion technology (RIT) on reducing discomfort during colonoscopy – randomized clinical trial

Artur Pasternak, MD, PhD, Miroslaw Szura, MD, PhD, Rafal Solecki, MD, PhD, Andrzej Matyja, MD, PhD, Professor. 1st Department of General, Oncological and GI Surgery, Jagiellonian University Medical College, Krakow, Poland

In many countries, colonoscopies for colorectal cancer screening, due to the costs are performed without sedation. Changes in the structure of the endoscopes are designed to facilitate the colonoscopic examination, shorten the time and improve the imaging of the intestinal lumen. Variable stiffness of the endoscope and recently introduced responsive insertion technology (RIT) are aimed to ease colonoscope insertion and reduce discomfort and pain during examination.

The aim of the study is to analyze the frequency of auxiliary maneuvers during endoscopy depending on the structure of endoscopic armor tube, and a subjective assessment of patient discomfort during the examination.

Material and methods: The analysis included 647 patients who underwent complete colonoscopy in the screening program. All colonoscopies were performed without sedation. Olympus series 180 and 190 endoscopes equipped with a magnetic positioning system were used. Group I included patients who were examined using variable stiffness endoscopes and group II included patients examined using variable stiffness endoscopes with RIT. Main objective was to evaluate the cecal intubation time, the rate of loop formation, the need to change the patient position, the requirement to apply manual pressure to different areas of the abdomen and degree of discomfort and pain on a VAS . ClinicalTrials.gov number, NCT01688557

Results: Group I consisted of 329 patients and group II – 318. The mean age of the patients was 58.4 years (SD ± 4.21). Both groups were compared in terms of age, sex, BMI and frequency of previous abdominal procedures. The mean cecal intubation time was 209 seconds in group I and 224 seconds in group II (p<0.05). Increased loop formation was observed on endoscope insertion in group II (1.7 vs 1.35) (p < 0.05 ), and required more manual pressures to the abdomen (2.2 vs. 1.7) ( p = 0.001). In group I, there was less discomfort and pain graded on a VAS – 2.3, in group II – 2.6.

Conclusions: The implementation of responsive insertion technology facilitated shortening of the cecal intubation time. Modified structure of the endoscope made the colonoscopic examination easier by reducing loop formation on insertion with subsequent lower rate of auxiliary maneuvers.

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