Download PDF
Endoscopy 2012; 44(4): 444-451
DOI: 10.1055/s-0032-1306690
SEED Guidelines

© Georg Thieme Verlag KG Stuttgart · New York

Clinical practice Guidelines: quality of colonoscopy in colorectal cancer screening

On behalf of the SPANISH SOCIETY OF GASTROINTESTINAL ENDOSCOPY and the SPANISH ASSOCIATION OF GASTROENTEROLOGY.R.  Jover1 , M.  Herráiz1 , O.  Alarcón1 , E.  Brullet1 , L.  Bujanda1 , M.  Bustamante1 , R.  Campo1 , R.  Carreño1 , A.  Castells1 , J.  Cubiella1 , P.  García-Iglesias1 , A.  J.  Hervás1 , P.  Menchén1 , A.  Ono1 , A.  Panadés1 , A.  Parra-Blanco1 , M.  Pellisé1 , M.  Ponce1 , E.  Quintero1 , J.  M.  Reñé1 , A.  Sánchez del Río1 , A.  Seoane1 , A.  Serradesanferm1 , A.  Soriano Izquierdo1 , E.  Vázquez Sequeiros1
  • 1Spanish Society of Gastroenterology (AEG) and Spanish Society of Gastrointestinal Endoscopy (SEED) Working Group.
Further Information

Publication History

Publication Date:
21 March 2012 (online)

Also available at
   Permissions and Reprints

Goals of this clinical practice guidline:

Collecting the evidence about the quality of colonoscopy screening for colorectal cancer (CRC) in order to serve as a tool for screening programs, endoscopy units and endoscopists that perform screening colonoscopies. Defining and establishing quality indicators and minimum requirements based on available evidence that endoscopy units and endoscopists involved in CRC screening programs should meet. Providing evidence about procedures that may improve the quality of colonoscopy.

References

  • 1 Paterson W G, Depew W T, Pare P et al. Canadian consensus on medically acceptable wait times for digestive health care.  Can J Gastroenterol. 2006;  20(6) 411-423
    Google Scholar
  • 2 Hui A J, Wong R M, Ching J Y et al. Risk of colonoscopic polypectomy bleeding with anticoagulants and antiplatelet agents: analysis of 1657 cases.  Gastrointest Endosc. 2004;  59(1) 44-48
    Google Scholar
  • 3 Shiffman M L, Farrel M T, Yee Y S. Risk of bleeding after endoscopic biopsy or polypectomy in patients taking aspirin or other NSAIDS.  Gastrointest Endosc. 1994;  40(4) 458-462
    Google Scholar
  • 4 Yousfi M, Gostout C J, Baron T H et al. Postpolypectomy lower gastrointestinal bleeding: potential role of aspirin.  Am J Gastroenterol. 2004;  99(9) 1785-1789
    Google Scholar
  • 5 Friedland S, Soetikno R. Colonoscopy with polypectomy in anticoagulated patients.  Gastrointest Endosc. 2006;  64(1) 98-100
    Google Scholar
  • 6 Singh M, Mehta N, Murthy U K et al. Postpolypectomy bleeding in patients undergoing colonoscopy on uninterrupted clopidogrel therapy.  Gastrointest Endosc. 2010;  71(6) 998-1005
    Google Scholar
  • 7 Kim H S, Kim T I, Kim W H et al. Risk factors for immediate postpolypectomy bleeding of the colon: a multicenter study.  Am J Gastroenterol. 2006;  101(6) 1333-1341
    Google Scholar
  • 8 Sawhney M S, Salfiti N, Nelson D B et al. Risk factors for severe delayed postpolypectomy bleeding.  Endoscopy. 2008;  40(2) 115-119
    Google Scholar
  • 9 Belsey J, Epstein O, Heresbach D. Systematic review: oral bowel preparation for colonoscopy.  Aliment Pharmacol Ther. 2007;  25(4) 373-384
    Google Scholar
  • 10 Froehlich F, Wietlisbach V, Gonvers J J et al. Impact of colonic cleansing on quality and diagnostic yield of colonoscopy: the European Panel of Appropriateness of Gastrointestinal Endoscopy European multicenter study.  Gastrointest Endosc. 2005;  61(3) 378-384
    Google Scholar
  • 11 Harewood G C, Sharma V K, de Garmo P. Impact of colonoscopy preparation quality on detection of suspected colonic neoplasia.  Gastrointest Endosc. 2003;  58(1) 76-79
    Google Scholar
  • 12 Rex D K, Imperiale T F, Latinovich D R, Bratcher L L. Impact of bowel preparation on efficiency and cost of colonoscopy.  Am J Gastroenterol. 2002;  97(7) 1696-1700
    Google Scholar
  • 13 Adler M, Quenon M, Even-Adin D et al. Whole gut lavage for colonoscopy--a comparison between two solutions.  Gastrointest Endosc. 1984;  30(2) 65-67
    Google Scholar
  • 14 DiPalma J A, Brady C E, III , Stewart D L et al. Comparison of colon cleansing methods in preparation for colonoscopy.  Gastroenterology. 1984;  86(5 Pt 1) 856-860
    Google Scholar
  • 15 Ell C, Fischbach W, Bronisch H J et al. Randomized trial of low-volume PEG solution versus standard PEG + electrolytes for bowel cleansing before colonoscopy.  Am J Gastroenterol. 2008;  103(4) 883-893
    Google Scholar
  • 16 Marschall H U, Bartels F. Life-threatening complications of nasogastric administration of polyethylene glycol-electrolyte solutions (Golytely) for bowel cleansing.  Gastrointest Endosc. 1998;  47(5) 408-410
    Google Scholar
  • 17 Love J, Bernard E J, Cockeram A et al. A multicentre, observational study of sodium picosulfate and magnesium citrate as a precolonoscopy bowel preparation.  Can J Gastroenterol. 2009;  23(10) 706-710
    Google Scholar
  • 18 Aoun E, Abdul-Baki H, Azar C et al. A randomized single-blind trial of split-dose PEG-electrolyte solution without dietary restriction compared with whole dose PEG-electrolyte solution with dietary restriction for colonoscopy preparation.  Gastrointest Endosc. 2005;  62(2) 213-218
    Google Scholar
  • 19 Parra-Blanco A, Nicolas-Perez D, Gimeno-Garcia A et al. The timing of bowel preparation before colonoscopy determines the quality of cleansing, and is a significant factor contributing to the detection of flat lesions: a randomized study.  World J Gastroenterol. 2006;  12(38) 6161-6166
    Google Scholar
  • 20 Rostom A, Jolicoeur E, Dube C et al. A randomized prospective trial comparing different regimens of oral sodium phosphate and polyethylene glycol-based lavage solution in the preparation of patients for colonoscopy.  Gastrointest Endosc. 2006;  64(4) 544-552
    Google Scholar
  • 21 Sabri M, di Lorenzo C, Henderson W et al. Colon cleansing with oral sodium phosphate in adolescents: dose, efficacy, acceptability, and safety.  Am J Gastroenterol. 2008;  103(6) 1533-1539
    Google Scholar
  • 22 Church J M. Effectiveness of polyethylene glycol antegrade gut lavage bowel preparation for colonoscopy--timing is the key!.  Dis Colon Rectum. 1998;  41(10) 1223-1225
    Google Scholar
  • 23 Poon C M, Lee D W, Mak S K et al. Two liters of polyethylene glycol-electrolyte lavage solution versus sodium phosphate as bowel cleansing regimen for colonoscopy: a prospective randomized controlled trial.  Endoscopy. 2002;  34(7) 560-563
    Google Scholar
  • 24 Aronchick C A. Bowel preparation scale.  Gastrointest Endosc. 2004;  60(6) 1037-1038
    Google Scholar
  • 25 Lai E J, Calderwood A H, Doros G et al. The Boston bowel preparation scale: a valid and reliable instrument for colonoscopy-oriented research.  Gastrointest Endosc. 2009;  69(3 Pt 2) 620-625
    Google Scholar
  • 26 Rostom A, Jolicoeur E. Validation of a new scale for the assessment of bowel preparation quality.  Gastrointest Endosc. 2004;  59(4) 482-486
    Google Scholar
  • 27 Bretagne J F, Ponchon T. Do we need to embrace adenoma detection rate as the main quality control parameter during colonoscopy?.  Endoscopy. 2008;  40(6) 523-528
    Google Scholar
  • 28 Pinsky P F, Schoen R E, Weissfeld J L et al. Variability in flexible sigmoidoscopy performance among examiners in a screening trial.  Clin Gastroenterol Hepatol. 2005;  3(8) 792-797
    Google Scholar
  • 29 Rex D K. Maximizing detection of adenomas and cancers during colonoscopy.  Am J Gastroenterol. 2006;  101(12) 2866-2877
    Google Scholar
  • 30 Kaminski M F, Regula J, Kraszewska E et al. Quality indicators for colonoscopy and the risk of interval cancer.  N Engl J Med. 2010;  362(19) 1795-1803
    Google Scholar
  • 31 Faivre J, Dancourt V, Lejeune C et al. Reduction in colorectal cancer mortality by fecal occult blood screening in a French controlled study.  Gastroenterology. 2004;  126(7) 1674-1680
    Google Scholar
  • 32 Kronborg O, Fenger C, Olsen J et al. Randomised study of screening for colorectal cancer with faecal-occult-blood test.  Lancet. 1996;  348(9040) 1467-1471
    Google Scholar
  • 33 Manfredi S, Piette C, Durand G et al. Colonoscopy results of a French regional FOBT-based colorectal cancer screening program with high compliance.  Endoscopy. 2008;  40(5) 422-427
    Google Scholar
  • 34 Steele R J, McClements P L, Libby G et al. Results from the first three rounds of the Scottish demonstration pilot of FOBT screening for colorectal cancer.  Gut. 2009;  58(4) 530-535
    Google Scholar
  • 35 Harewood G C. Relationship of colonoscopy completion rates and endoscopist features.  Dig Dis Sci. 2005;  50(1) 47-51
    Google Scholar
  • 36 Radaelli F, Meucci G, Sgroi G, Minoli G. Technical performance of colonoscopy: the key role of sedation/analgesia and other quality indicators.  Am J Gastroenterol. 2008;  103(5) 1122-1130
    Google Scholar
  • 37 Wexner S D, Garbus J E, Singh J J. A prospective analysis of 13,580 colonoscopies. Reevaluation of credentialing guidelines.  Surg Endosc. 2001;  15(3) 251-261
    Google Scholar
  • 38 Bressler B, Paszat L F, Chen Z et al. Rates of new or missed colorectal cancers after colonoscopy and their risk factors: a population-based analysis.  Gastroenterology. 2007;  132(1) 96-102
    Google Scholar
  • 39 Rabeneck L, Paszat L F, Saskin R. Endoscopist specialty is associated with incident colorectal cancer after a negative colonoscopy.  Clin Gastroenterol Hepatol. 2010;  8(3) 275-279
    Google Scholar
  • 40 Fracchia M, Senore C, Armaroli P et al. Assessment of the multiple components of the variability in the adenoma detection rate in sigmoidoscopy screening, and lessons for training.  Endoscopy. 2010;  42(6) 448-155
    Google Scholar
  • 41 Dellon E S, Lippmann Q K, Galanko J A et al. Effect of GI endoscopy nurse experience on screening colonoscopy outcomes.  Gastrointest Endosc. 2009;  70(2) 331-343
    Google Scholar
  • 42 van Putten P G, van Leerdam M E, Kuipers E J. The views of gastroenterologists about the role of nurse endoscopists, especially in colorectal cancer screening.  Aliment Pharmacol Ther. 2009;  29(8) 892-897
    Google Scholar
  • 43 Rex D K, Petrini J L, Baron T H et al. Quality indicators for colonoscopy.  Gastrointest Endosc. 2006;  63(4) 16-28
    Google Scholar
  • 44 Johnson D A, Gurney M S, Volpe R J et al. A prospective study of the prevalence of colonic neoplasms in asymptomatic patients with an age-related risk.  Am J Gastroenterol. 1990;  85(8) 969-74
    Google Scholar
  • 45 Marshall J B, Barthel J S. The frequency of total colonoscopy and terminal ileal intubation in the 1990 s.  Gastrointest Endosc. 1993;  39(4) 518-520
    Google Scholar
  • 46 Anderson J C, Messina C R, Cohn W et al. Factors predictive of difficult colonoscopy.  Gastrointest Endosc. 2001;  54(5) 558-562
    Google Scholar
  • 47 Kim W H, Cho Y J, Park J Y et al. Factors affecting insertion time and patient discomfort during colonoscopy.  Gastrointest Endosc. 2000;  52(5) 600-605
    Google Scholar
  • 48 Shah H A, Paszat L F, Saskin R et al. Factors associated with incomplete colonoscopy: a population-based study.  Gastroenterology. 2007;  132(7) 2297-2303
    Google Scholar
  • 49 Rex D K. Achieving cecal intubation in the very difficult colon.  Gastrointest Endosc. 2008;  67(6) 938-944
    Google Scholar
  • 50 Baumann U A. Water intubation of the sigmoid colon: water instillation speeds up left-sided colonoscopy.  Endoscopy. 1999;  31(4) 314-317
    Google Scholar
  • 51 Leung F W, Aharonian H S, Leung J W et al. Impact of a novel water method on scheduled unsedated colonoscopy in U.S. veterans.  Gastrointest Endosc. 2009;  69(3 Pt 1) 546-550
    Google Scholar
  • 52 Witte T N, Enns R. The difficult colonoscopy.  Can J Gastroenterol. 2007;  21(8) 487-490
    Google Scholar
  • 53 Barclay R L, Vicari J J, Doughty A S et al. Colonoscopic withdrawal times and adenoma detection during screening colonoscopy.  N Engl J Med. 2006;  355(24) 2533-2541
    Google Scholar
  • 54 The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002.  Gastrointest Endosc. 2003;  58(6 Suppl) 3-43
    Google Scholar
  • 55 Riley S. Colonoscopic polypectomy and endoscopic mucosal resection: a practical guide. http://www bsg org uk/pdf_word_docs/polypectomy_08 pdf 2008
    Google Scholar
  • 56 Moran S S, Torrella E, Esteban D P et al. Colonoscopy quality assessment.  Rev Esp Enferm Dig. 2009;  101(2) 107-6
    Google Scholar
  • 57 Levy M J, Anderson M A, Baron T H et al. Position statement on routine laboratory testing before endoscopic procedures.  Gastrointest Endosc. 2008;  68(5) 827-832
    Google Scholar
  • 58 Carpenter S, Petersen B T, Chuttani R et al. Polypectomy devices.  Gastrointest Endosc. 2007;  65(6) 741-749
    Google Scholar
  • 59 Chino A, Karasawa T, Uragami N et al. A comparison of depth of tissue injury caused by different modes of electrosurgical current in a pig colon model.  Gastrointest Endosc. 2004;  59(3) 374-379
    Google Scholar
  • 60 Mann N S, Mann S K, Alam I. The safety of hot biopsy forceps in the removal of small colonic polyps.  Digestion. 1999;  74-6 Ref Type: Generic
    Google Scholar
  • 61 Uraoka T, Fujii T, Saito Y et al. Effectiveness of glycerol as a submucosal injection for EMR.  Gastrointest Endosc. 2005;  61(6) 736-740
    Google Scholar
  • 62 di Giorgio P, de Luca L, Calcagno G. Detachable snare versus epinephrine injection in the prevention of postpolypectomy bleeding: a randomized and controlled study.  Endoscopy. 2004;  860-863 Ref Type: Generic
    Google Scholar
  • 63 Paspatis G A, Paraskeva K, Theodoropoulou A et al. A prospective, randomized comparison of adrenaline injection in combination with detachable snare versus adrenaline injection alone in the prevention of postpolypectomy bleeding in large colonic polyps.  Am J Gastroenterol. 2006;  101(12) 2805
    Google Scholar
  • 64 Brooker J C, Saunders B P, Shah S G et al. Treatment with argon plasma coagulation reduces recurrence after piecemeal resection of large sessile colonic polyps: a randomized trial and recommendations.  Gastrointest Endosc. 2002;  55(3) 371-375
    Google Scholar
  • 65 Miller K, Waye J D. Polyp retrieval after colonoscopic polypectomy: use of the Roth Retrieval Net.  Gastrointest Endosc. 2001;  54(4) 505-507
    Google Scholar
  • 66 Banez A V, Bozek S A, Simon R F. A double endoscope method for multiple colonic polypectomy.  Gastrointest Endosc. 1987;  33(1) 30-32
    Google Scholar
  • 67 Waye J. It ain't over til it's over: retrieval of polyps after colonoscopic polypectomy.  Gastrointest Endosc. 2005;  62(2) 257-259
    Google Scholar
  • 68 Rex D K, Bond J H, Winawer S et al. Quality in the technical performance of colonoscopy and the continuous quality improvement process for colonoscopy: recommendations of the U.S. Multi-Society Task Force on Colorectal Cancer.  Am J Gastroenterol. 2002;  97(6) 1296-1308
    Google Scholar
  • 69 Patnick J, Segnan N, von Karsa L. European Guidelines for Quality Assurance in Colorectal Cancer Screening 2010. 
    Google Scholar
  • 70 Ko C W, Riffle S, Michaels L et al. Serious complications within 30 days of screening and surveillance colonoscopy are uncommon.  Clin Gastroenterol Hepatol. 2010;  8(2) 166-173
    Google Scholar
  • 71 Rathgaber S W, Wick T M. Colonoscopy completion and complication rates in a community gastroenterology practice.  Gastrointest Endosc. 2006;  64(4) 556-562
    Google Scholar
  • 72 Arora G, Mannalithara A, Singh G et al. Risk of perforation from a colonoscopy in adults: a large population-based study.  Gastrointest Endosc. 2009;  69(3 Pt 2) 654-664
    Google Scholar
  • 73 Park D I, Kim H J, Park J H et al. Factors affecting abdominal pain during colonoscopy.  Eur J Gastroenterol Hepatol. 2007;  19(8) 695-699
    Google Scholar
  • 74 Dobrowolski S, Dobosz M, Babicki A et al. Blood supply of colorectal polyps correlates with risk of bleeding after colonoscopic polypectomy.  Gastrointest Endosc. 2006;  63(7) 1004-1009
    Google Scholar
  • 75 Heldwein W, Dollhopf M, Rosch T et al. The Munich Polypectomy Study (MUPS): prospective analysis of complications and risk factors in 4000 colonic snare polypectomies.  Endoscopy. 2005;  37(11) 1116-1122
    Google Scholar
  • 76 Lorenzo-Zuniga V, Moreno de Vega V, Domenech E et al. Endoscopist experience as a risk factor for colonoscopic complications.  Colorectal Dis. 2010;  12 273-277
    Google Scholar
  • 77 Rabeneck L, Paszat L F, Hilsden R J et al. Bleeding and perforation after outpatient colonoscopy and their risk factors in usual clinical practice.  Gastroenterology. 2008;  135(6) 1899-906,1906
    Google Scholar
  • 78 Dobrowolski S, Dobosz M, Babicki A et al. Prophylactic submucosal saline-adrenaline injection in colonoscopic polypectomy: prospective randomized study.  Surg Endosc. 2004;  18(6) 990-993
    Google Scholar
  • 79 Folwaczny C, Heldwein W, Obermaier G et al. Influence of prophylactic local administration of epinephrine on bleeding complications after polypectomy.  Endoscopy. 1997;  29(1) 31-33
    Google Scholar
  • 80 Hsieh Y H, Lin H J, Tseng G Y et al. Is submucosal epinephrine injection necessary before polypectomy? A prospective, comparative study.  Hepatogastroenterology. 2001;  48(41) 1379-1382
    Google Scholar
  • 81 Lee S H, Lee K S, Park Y S et al. Submucosal saline-epinephrine injection in colon polypectomy: appropriate indication.  Hepatogastroenterology. 2008;  55(86 – 87) 1589-1593
    Google Scholar
  • 82 Shirai M, Nakamura T, Matsuura A et al. Safer colonoscopic polypectomy with local submucosal injection of hypertonic saline-epinephrine solution.  Am J Gastroenterol. 1994;  89(3) 334-338
    Google Scholar
  • 83 Kouklakis G, Mpoumponaris A, Gatopoulou A et al. Endoscopic resection of large pedunculated colonic polyps and risk of postpolypectomy bleeding with adrenaline injection versus endoloop and hemoclip: a prospective, randomized study.  Surg Endosc. 2009;  23 2732-2737
    Google Scholar
  • 84 Dominitz J A, Eisen G M, Baron T H et al. Complications of colonoscopy.  Gastrointest Endosc. 2003;  57(4) 441-445
    Google Scholar
  • 85 Morris M L, Tucker R D, Baron T H. Electrosurgery in gastrointestinal endoscopy: principles to practice.  Am J Gastroenterol. 2009;  104(6) 1563-1574
    Google Scholar
  • 86 Waye J D, Lewis B S, Yessayan S. Colonoscopy: a prospective report of complications.  J Clin Gastroenterol. 1992;  15(4) 347-351
    Google Scholar
  • 87 Early D S, Saifuddin T, Johnson J C et al. Patient attitudes toward undergoing colonoscopy without sedation.  Am J Gastroenterol. 1999;  94(7) 1862-1865
    Google Scholar
  • 88 Rex D K, Imperiale T F, Portish V. Patients willing to try colonoscopy without sedation: associated clinical factors and results of a randomized controlled trial.  Gastrointest Endosc. 1999;  49(5) 554-559
    Google Scholar
  • 89 Wehrmann T, Riphaus A. Sedation, surveillance, and preparation.  Endoscopy. 2009;  41(1) 86-90
    Google Scholar
  • 90 The u se. Council on Scientific Affairs, American Medical Association.  JAMA. 1993;  270(12) 1463-1468
    Google Scholar
  • 91 Vargo J J, Cohen L B, Rex D K, Kwo P Y. Position statement: nonanesthesiologist administration of propofol for GI endoscopy.  Gastrointest Endosc. 2009;  70(6) 1053-1059
    Google Scholar
  • 92 Wang A, Hoda K M, Holub J L, Eisen G M. Does level of sedation impact detection of advanced neoplasia?.  Dig Dis Sci. 2010;  55(8) 2337-2343
    Google Scholar
  • 93 Shumaker D A, Zaman A, Katon R M. Use of a variable-stiffness colonoscope allows completion of colonoscopy after failure with the standard adult colonoscope.  Endoscopy. 2002;  34(9) 711-714
    Google Scholar
  • 94 Campillo-Soto A, Pellicer-Franco E, Parlorio-Andres E et al. [CT colonography vs. barium enema for the preoperative study of colorectal cancer in patients with incomplete colonoscopy].  Med Clin (Barc ). 2007;  129(19) 725-728
    Google Scholar
  • 95 Rosman A S, Korsten M A. Meta-analysis comparing CT colonography, air contrast barium enema, and colonoscopy.  Am J Med. 2007;  120(3) 03-210
    Google Scholar
  • 96 Sosna J, Sella T, Sy O et al. Critical analysis of the performance of double-contrast barium enema for detecting colorectal polyps ≥ 6 mm in the era of CT colonography.  AJR Am J Roentgenol. 2008;  190(2) 374-385
    Google Scholar
  • 97 Johnson C D, Chen M H, Toledano A Y et al. Accuracy of CT colonography for detection of large adenomas and cancers.  N Engl J Med. 2008;  359(12) 1207-1217
    Google Scholar
  • 98 Kim D H, Pickhardt P J, Taylor A J et al. CT colonography versus colonoscopy for the detection of advanced neoplasia.  N Engl J Med. 2007;  357(14) 1403-1412
    Google Scholar
  • 99 Pickhardt P J, Choi J R, Hwang I et al. Computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults.  N Engl J Med. 2003;  349(23) 2191-2200
    Google Scholar
  • 100 Ajaj W, Lauenstein T C, Pelster G et al. MR colonography in patients with incomplete conventional colonoscopy.  Radiology. 2005;  234(2) 452-9
    Google Scholar
  • 101 Hartmann D, Bassler B, Schilling D et al. Incomplete conventional colonoscopy: magnetic resonance colonography in the evaluation of the proximal colon.  Endoscopy. 2005;  37(9) 816-820
    Google Scholar
  • 102 Wong T Y, Lam W W, So N M et al. Air-inflated magnetic resonance colonography in patients with incomplete conventional colonoscopy: Comparison with intraoperative findings, pathology specimens, and follow-up conventional colonoscopy.  Am J Gastroenterol. 2007;  102(1) 6-63
    Google Scholar
  • 103 Nelson D B. Infectious disease complications of GI endoscopy: part II, exogenous infections.  Gastrointest Endosc. 2003;  57(6) 695-711
    Google Scholar
  • 104 Multi-society guideline for reprocessing flexible gastrointestinal endoscopes.  Gastrointest Endosc. 2003;  58(1) 1-8
    Google Scholar
  • 105 Cronmiller J R, Nelson D K, Salman G et al. Antimicrobial efficacy of endoscopic disinfection procedures: a controlled, multifactorial investigation.  Gastrointest Endosc. 1999;  50(2) 152-158
    Google Scholar
  • 106 Fraser V J, Zuckerman G, Clouse R E et al. A prospective randomized trial comparing manual and automated endoscope disinfection methods.  Infect Control Hosp Epidemiol. 1993;  14(7) 383-389
    Google Scholar
  • 107 Ortiz V, Sala T, Arguello L et al. [Comparison of the efficacy of cleaning and disinfection of videoscopes: mechanized versus manual].  Gastroenterol Hepatol. 2000;  23(9) 412-415
    Google Scholar
  • 108 Santolaria S, Ducons J, Bordas J M. [Cleaning and disinfection in gastrointestinal endoscopy].  Gastroenterol Hepatol. 2007;  30(1) 25-35
    Google Scholar
  • 109 Beilenhoff U, Neumann C S, Biering H et al. ESGE/ESGENA guideline for process validation and routine testing for reprocessing endoscopes in washer-disinfectors, according to the European Standard prEN ISO 15 883 parts 1, 4 and 5.  Endoscopy. 2007;  39(1) 85-94
    Google Scholar
  • 110 Beilenhoff U, Neumann C S, Rey J F et al. ESGE-ESGENA guideline for quality assurance in reprocessing: microbiological surveillance testing in endoscopy.  Endoscopy. 2007;  39(2) 175-181
    Google Scholar
  • 111 Radaelli F, Meucci G, Terruzzi V et al. Single bolus of midazolam versus bolus midazolam plus meperidine for colonoscopy: a prospective, randomized, double-blind trial.  Gastrointest Endosc. 2003;  57(3) 329-335
    Google Scholar
  • 112 Willey J, Vargo J J, Connor J T et al. Quantitative assessment of psychomotor recovery after sedation and analgesia for outpatient EGD.  Gastrointest Endosc. 2002;  56(6) 810-816
    Google Scholar
  • 113 Simon M A, Bordas J M, Campo R et al. [Consensus document of the Spanish Association of Gastroenterology on sedoanalgesia in digestive endoscopy].  Gastroenterol Hepatol. 2006;  29(3) 131-149
    Google Scholar
  • 114 Bretthauer M, Hoff G, Severinsen H et al. [Systematic quality control programme for colonoscopy in an endoscopy centre in Norway].  Tidsskr Nor Laegeforen. 2004;  124(10) 1402-1405
    Google Scholar
  • 115 Johanson J F, Schmitt C M, Deas T M et al. Quality and outcomes assessment in Gastrointestinal Endoscopy.  Gastrointest Endosc. 2000;  52(6 Pt 1) 827-830
    Google Scholar
  • 116 Cohen L B, Delegge M H, Aisenberg J et al. AGA Institute review of endoscopic sedation.  Gastroenterology. 2007;  133(2) 675-701
    Google Scholar
      >