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Title: Making colonoscopy easier : advances in procedure and practice
Author: Saunders, Brian Paul
Awarding Body: University of London
Current Institution: University College London (University of London)
Date of Award: 1996
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Colonoscopy is widely accepted as the procedure of choice for investigation of the large bowel. It is unique in providing detailed views of the colonic mucosa and in allowing direct access for biopsy or therapeutic intervention. However, colonoscopy remains a technically difficult, invasive and poorly understood procedure. This thesis examines colonoscopy in detail and explores methods of making the procedure easier for the endoscopist and more acceptable to the patient. Colonic anatomy is assessed both in vivo (at laparotomy) and from barium enema series in order to define the anatomical challenge faced by the endoscopist and to appreciate the anatomical basis of difficulty during colonoscope insertion. In a series of consecutive colonoscopies, fluoroscopy is used to visualise the configuration of the colonoscope and define the causes of difficulty during colonoscope insertion. Causes of failed bowel preparation are assessed and a new mannitol/Picolax mixture is compared to two-dose polyethylene glycol-electrolyte lavage solution as bowel preparation for colonoscopy. Different methods of sedation/analgesia for colonoscopy are evaluated; the efficacy, safety and acceptability of patient-controlled inhalation with nitrous oxide/oxygen mixture is compared to conventional intravenous benzodiazepine/opiate medication and to placebo. The possible benefits to colonoscopy of premedication with intravenous anti-spasmodic are investigated in a double-blind, placebo-controlled study. Use of both nitrous oxide inhalation and intravenous anti-spasmodic medication for screening flexible sigmoidoscopy are also assessed. The development of a new, non-x-ray, magnetic method of imaging the colonoscope within the abdomen during endoscopy is described. Clinical evaluation of this imaging system is undertaken in a consecutive series of colonoscopies to assess its effect on performance and insertion technique.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available