New York University Langone Medical Center New York, NY, United States
Jean Wang, MD, PhD1, Seth A. Gross, MD, FACG2, David Lieberman, MD3 1Washington University School of Medicine in St. Louis, St. Louis, MO; 2New York University Langone Medical Center, New York, NY; 3Oregon Health & Science University, Portland, OR
Introduction: Looping is a primary barrier to safe and efficient colonoscopy. Common methods to address looping include staff-applied manual pressure and patient repositioning. These techniques are used frequently (52% and 34% of colonoscopies, respectively) yet are variably effective and can cause musculoskeletal disorders (MSDs) in endoscopy staff. A recent study demonstrated an association between manual pressure and post-procedure musculoskeletal pain in endoscopy personnel. Risk was maximized when long-duration pressure ( > 3 min) was needed in obese patients (BMI > 30). ColoWrap (ColoWrap, LLC, Durham, NC) is an anti-looping compression device applied during colonoscopy to decrease insertion time and the need for manual pressure and patient repositioning. We aimed to determine the extent to which the device reduces the need for manual pressure and repositioning relative to published rates.
Methods: This retrospective, multi-center, observational chart review included patients that underwent colonoscopy with the ColoWrap device between July 28, 2016 and November 11, 2020.The primary outcome was use of manual pressure. Secondary outcomes included the use of manual pressure for > 3 minutes and the use of patient repositioning.
Results: 392 procedures were included in the review. The population was predominantly male (61%), over 60 (mean age: 62.4 ± 10.2), and obese (mean BMI: 33.4 ± 8.2). 29 patients (7.4%) presented with an abdominal hernia. 65 (16.6%) had at least one prior abdominal surgery. Propofol sedation was used in the majority (59%) of procedures. Cecal intubation was achieved in 392 cases (100%). Mean cecal intubation time was 6.3 ± 5.1 (min). Manual pressure was required in 39 cases (9.9%) and only 6 procedures (1.5%) required manual pressure for > 3 min. Patient repositioning was required in 22 cases (5.6%). In a sub-population analysis of obese patients with BMI > 35 (n=134), manual pressure was required in 10 procedures (7.5%); 2 procedures (1.5%) required manual pressure > 3 min and 5 procedures (3.7%) needed patient repositioning.
Discussion: Use of the ColoWrap colonoscopy compression device significantly reduced the use of manual pressure and patient repositioning relative to published rates. The device essentially eliminated the need for long-duration manual pressure and was comparably effective in obese patients with BMI > 35.
Figure: Rates of Manual Pressure, Manual Pressure > 3 min, and Patient Repositioning During Colonoscopy. Dark blue represents published rates. Light blue represents procedures performed with colonoscopy compression device. Green represents procedures performed with colonoscopy compression device in patients with BMI > 35.
Disclosures: Jean Wang indicated no relevant financial relationships. Seth Gross: ColoWrap, LLC – Advisory Committee/Board Member. David Lieberman: ColoWrap, LLC – Advisory Committee/Board Member.
Jean Wang, MD, PhD1, Seth A. Gross, MD, FACG2, David Lieberman, MD3. P2514 - ColoWrap® Colonoscopy Compression Device Reduces Risk for Ergonomic Injury Among Endoscopy Staff, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.