Abstract
Colonoscopy tends to be more difficult to perform in women. Women also experience more pain during flexible sigmoidoscopy, and the mean insertion distance of the instrument is less than in men. The ‘Bladen system’, first described in 1993, is a non-radiological method of continuously visualising the path of the endoscope using magnetic drive coils under the patient and a chain of sensors up the biopsy channel of the instrument. In 1998, results were published that used a novel computer graphics system (the ‘RMR system’), in which a much more realistic endoscope could be produced using the stored positional data from the Bladen system. The RMR computer graphics system has been further refined to enable measurement of the anatomical lengths of different parts of the large intestine to an accuracy of greater than 5 mm. The system is used to analyse the results obtained in 232 patients undergoing a total colonoscopy. In women, the colonoscope tends to form loops in the sigmoid colon more readily than in men (p<0.05). When the first 50 cm of the endoscope are inserted for the first time, the tip passes either up to or beyond the splenic flexure in 40/116, or 34.5%, of males, compared with 24/117, or 20.5%, of females (p=0.0137). It is demonstrated that women have longer transverse colons than men, and the differences are especially apparent when a stiffening tube is used to splint the left side of the colon (p<0.0001). The possible relevance of these observations to biomedical engineers and those manufacturing and assessing prototype endoscopes is discussed.
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References
Baillie, J. (1999): ‘The reach of flexible sigmoidoscopy-not enough?’,Endoscopy 31, pp. 269–270
Bell, G. D., Rowland, R. S., Rutter, M., Abu-Sada, M., Dogramadzi, S., andAllen, C. (1999a): ‘Colonoscopy aided by magnetic 3D imaging: assessment of the routine use of a stiffening tube to speed up the procedure’,Med. Biol. Eng. Comput.,37, pp. 605–611
Bell, G. D., Painter, J., Rowland, R. S., Atkin, W. S., Dogramadzi, S., andAllen, C. (1999b): ‘Preliminary experience comparing two longer thinner prototype Olympus endoscopes with a standard 60 cm flexible sigmoidoscope’,Gut,44, (suppl. 1), p. A22
Bladen, J. S., Anderson, A. P., Bell, G. D., Rameh, B., andEvans, B. (1993): ‘Non-radiological technique for three dimensional imaging of intestinal endoscopes’,Lancet,341, pp. 719–722
Bladen, J. S. (1995): ‘Imaging medical endoscopes in three dimensions using magnetic fields’, PhD thesis, University of Sheffield, UK
Brooker, J. C., Saunders, B. P., andWilliams, C. B. (1999): ‘A new variable-stiffness colonoscope makes insertion quicker and may reduce patient discomfort’,Gut,44, (suppl. 1), p. A21
Gray (1962):Davies, D. V., andDavies, F. (Eds.): ‘Gray's anatomy. 33rd edn.’ (University Press, Glasgow), pp. 1457–1471
Hull, T. L., Church, J. M., Milson, J. W., andOakley, J. R. (1994): ‘Colonoscopy: How difficult? How painful?’ (Abstract),Dis. Colon Rectum,35, p. 43.
Hunt, R. H. (1981): ‘Colonoscopy intubation techniques with fluoroscopy —8.4.2. The sigmoid splint/stiffening sleeve’in Hunt, R. H., andWaye, J. D. (Eds.): ‘Colonoscopy techniques, clinical practice and colour atlas’ (Chapman and Hall Ltd, London, ISBN 0 412 22710X), chap. 8, pp. 128–130
Marshall, J. B. (1996): ‘Use of a pediatric colonoscope improves the success of total colonoscopy in selected adult patients’,Gastrointest. Endosc.,44, pp. 675–678
Maule, W. F. (1994): ‘Screening for colorectal cancer by nurse endoscopists’,N. Engl. J. Med.,330, pp. 183–187
Mosse, C. A., Mills, T. N., Bell, G. D., andSwain, P. (1998): ‘A device for measuring the forces exerted on the shaft of an endoscope during colonoscopy’,Med. Biol. Eng. Comput.,36, pp. 186–190
Newcommer, M. K., Jowell, P. S., Williams, D. M., Presad, S. M., andCotton, P. B. (1994): ‘Determination of work time lost following outpatient colonoscopy (Abstract)’,Gastrointest. Endosc.,40, p. 30
Painter, J., Saunders D. B., Bell, G. D., Williams, C. B., Pitt, R., andBladen, J. (1999): ‘Depth of insertion at flexible sigmoidoscopy: implications for colorectal cancer screening and instrument design’,Endoscopy,31, pp. 227–231
Rowland, R. S., andBell, G. D. (1998): ‘Non-radiological technique for 3D imaging of intestinal endoscopes: computerised graphical 3D representation of endoscope and skeleton’,Med. Biol. Eng. Comput.,36, pp. 285–290
Rowland, R. S., Bell, G. D., Dogramadzi, S., andAllen, C. (1999): ‘Validation of a 3-D method of accurately measuring the insertion depth of different anatomical sections of the colon during flexible endoscopy’,Gut,44, (suppl 1), p. A 22
Sadahiro, S., Ohmura, T., andYamada, Y. (1992): ‘Analysis of length and surface area of each segment of the large intestine according to age, sex, and physique’,Surg. Radiol. Anat.,14, pp. 251–257
Sakai, Y. (1987): ‘Techniques in colonoscopy’, inSivak, M., Jr. (Ed.): ‘Gastroenterological endoscopy’ (W. B. Saunders, Philadelphia), pp. 840–867
Saunders, B. P., Bladen, J. S., Williams, C. B., andBell, G. D. (1995a): ‘First clinical results with a real-time, electronic imager as an aid to colonoscopy’,Gut,36, pp. 913–917
Saunders, B. P., Philips, R. K. S., andWilliams, C. B. (1995b): ‘Intraoperative measurements of colonic anatomy and attachments with relevance to colonoscopy’,Br. J. Surg.,82, pp. 1491–1493
Saunders, B. P., Fukumoto, M., Halligan, S., Jobling, C., Mussa, M. E., Bartram, C. I., andWilliams, C. B. (1996): ‘Why is colonoscopy more difficult in women?’,Gastrointest. Endosc.,43, pp. 124–126
Schmitt, C. M., Schultz, S. M., Lee, J. G., andBaillie, J. (1994): ‘The association between gender and difficult colonoscopy (Abstract)’,Gastrointest. Endosc.,40, p. 46
Wehrmeyer, J. A., Barthel, J. A., Roth, J. P., andSaifuddin, T. (1998): ‘Colonoscope flexural rigidity measurement’,Med. Biol. Eng. Comput.,36, pp. 475–479
Williams, C. B., Guy, C., Gillies, D. F., andSaunders, B. P. (1993): ‘Electronic three-dimensional imaging of intestinal endoscopy’,Lancet,341, pp. 724–725
Williams, C. B. (1996a): ‘Colonoscopy and flexible sigmoidoscopy-Handling the colonoscope’in Cotton, P. B., andWilliams, C. B. (Eds.): ‘Practical gastrointestinal endoscopy, 4th edn.’ (Blackwell Science Ltd., Oxford, ISBN 0-86542-851-4), chap. 9, pp. 215–217
Williams, C. B. (1996b): ‘Colonoscopy and flexible sigmoidoscopy—The stiffening or ‘overtube’,in Cotton, P. B., andWilliams, C. B. (Eds.): ‘Practical gastrointestinal endoscopy, 4th edn.’ (Blackwell Science Ltd., Oxford, ISBN 0-86542-851-4), chap. 9, pp. 246–247
Williams, C. B., Saunders, B. P., Bell, G. D. Bladen, J. S., Gillies, D. F., andGuy, C. M. (1997): ‘Real-time magnetic three-dimensional imaging of flexible endoscopy’in Rex, D. K. (Ed.): ‘Gastrointestinal endoscopy clinics of North America. Evolving issues in colon endoscopy’, Vol. 7, No. 3, pp. 469–476
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Rowland, R.S., Bell, G.D., Dogramadzi, S. et al. Colonoscopy aided by magnetic 3D imaging: is the technique sufficiently sensitive to detect differences between men and women?. Med. Biol. Eng. Comput. 37, 673–679 (1999). https://doi.org/10.1007/BF02513366
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DOI: https://doi.org/10.1007/BF02513366