Abstract
Introduction Colonoscopy practice in the UK has improved over the past decade.1,2There remains, however, a small but significant failure rate and the use of sedation and analgesia remains the norm. There is a clear clinical need for alternatives to traditional colonoscopy. An automatic self-propelled, user-guided colonoscope has been developed that abolishes the need for sedation or analgesia in the vast majority of cases, even where traditional colonoscopy has failed or may incur excess risks.3The new model colonoscope also has a 3.1 mm working channel for diagnostic and some therapeutic options. Given that the apparatus is operated by a controller resembling those used in gaming consoles, we hypothesised that it would take little time to become familiar with controls and achieve efficient colonic intubation. Method Using an animal explant model (Erlangen-type; porcine colon) we asked a variety of operators to achieve a timed caecal intubation (total colon length 1.65 m). The Endotics colonoscopy system mark II (ECS-II) was used. Two CMT-grade doctors, two 'JAG-independent' SpRs, an Endoscopy nurse (non-Endoscopist), a consultant Colorectal surgeon and a Consultant Gastroenterologist were asked to try to match the performance of an expert operator (from the manufacturers). A short tutorial on the controls was given to each operator and they were allowed to intubate the simulated sigmoid-descending junction before withdrawing and conducting a timed intubation. Results The expert operator set a time of 6:21 min to reach the caecum. The experienced colonoscopists achieved a median time of 6:28 (range 6:21-6:56) with their first attempt. Subsequent attempts were not deemed necessary to improve on this. The Endoscopy nurse achieved 6:26 on first attempt. The two CMT doctors recorded times of 9:44 and 8:02 on their first attempt, then 6:48 and 6:22 on their second and 6:33 and 6:23 on their third. Withdrawal of the scope was qualitatively assessed but not timed. All operators were satisfied with image resolution. Conclusion The acquisition of operator skills to use the ECS-II was rapid and was not limited, nor hindered, by previous colonoscopy experience. Human studies have been conducted in the EU with success4,5and we expect the first UK studies to be completed soon, focussing on clinically-relevant performance indicators. Disclosure of interest None Declared. References Bowles CJ, et al. Gut 2004;53:277-83 Gavin DR, et al. Gut 2013;62:242-9 Pallotta S, et al. Poster, SIGE; 2011 Tumino E, et al. World J Gastroenterol. 2010;16:5452-6 Perri F, et al. Dig Liver Dis. 2010;42:839-43