ONE-MAN METHOD VS. TWO-MAN METHOD FOR COLONOSCOPE INSERTION: A RANDOMIZED CONTROLLED TRIAL

Aims The one-man method for colonoscope insertion is recommended by professional societies and is regarded as the standard practice. However, two-man method has shown several advantages over one-man method. The aim of this study is to evaluate the performance of two-man compared to one-man method.

Methods In this prospective study, consecutive individuals undergoing outpatient colonoscopy were randomized to undergo colonoscopy by either one-man or two-man method. Colonoscopy examinations were performed by three senior and three junior endoscopists. The primary end-point was adenoma detection rate. Secondary outcome measures included cecal intubation rate, cecal insertion time, total colonoscopy time, procedure related complications, mean doses of sedatives, and procedure tolerability as assessed by either the endoscopy assistant or the patient.

Results 204 subjects (117 males, mean age 52.4 [17-87]) were randomized to one-man (n= 102) or two-man method (n=102). The adenoma detection rate was 40.2% in one-man method and 42.2% in two-man method. (p=0.82). No significant differences between the two groups were found regarding cecal intubation rate (98/102 vs 98/102), cecal insertion time (411sec vs 381sec), total examination time (1426sec vs 1296sec), and sedative dose (midazolam; 3.5mg vs 3.2mg, propofol; 88mg vs 79.3mg). However, individuals undergoing two-man method had lower pain score than one-man method (3.29 vs 2.15, p= 0.03; 0 for painless to 10 for maximal pain). Endoscopists’ fatigue measured using FACIT-F was significantly lower in two-man method group.

Conclusions Two-man method for colonoscopy showed similar technical and clinical outcomes compared to one-man method, but resulted in better patient tolerance and reduction in endoscopists’ fatigue.