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Canadian Journal of Gastroenterology
Volume 27, Issue 5, Pages 293-302
http://dx.doi.org/10.1155/2013/353760
Review

Mechanical Analysis of Insertion Problems and Pain During Colonoscopy: Why Highly Skill-Dependent Colonoscopy Routines are Necessary in the First Place... and How They May be Avoided

Arjo J Loeve,1 Paul Fockens,2 and Paul Breedveld1

1Department of BioMechanical Engineering, Faculty 3mE – Mechanical, Maritime and Materials Engineering, Delft University of Technology, Delft, Netherlands
2Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands

Received 4 October 2012; Accepted 5 November 2012

Copyright © 2013 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

BACKGROUND: Colonoscopy requires highly skill-dependent manoeuvres that demand a significant amount of training, and can cause considerable discomfort to patients, which increases the use of sedatives. Understanding the underlying fundamental mechanics behind insertion difficulties and pain during colonoscopy may help to simplify colonoscopy and reduce the required extent of training and reliance on sedatives.

METHODS: A literature search, anatomical studies, models of the colon and colonoscope, and bench tests were used to qualitatively analyze the fundamental mechanical causes of insertion difficulties and pain. A categorized review resulted in an overview of potential alternatives to current colonoscopes.

RESULTS: To advance a colonoscope through the colon, the colon wall, ligaments and peritoneum must be stretched, thus creating tension in the colon wall, which resists further wall deformation. This resistance forces the colonoscope to bend and follow the curves of the colon. The deformations that cause insertion difficulties and pain (necessitating the use of complex conventional manoeuvres) are the stretching of ligaments, and stretching of colon wall in the transverse and longitudinal directions, and the peritoneum.

CONCLUSIONS: Four fundamental mechanical solutions to prevent these deformations were extracted from the analysis. The current results may help in the development of new colonoscopy devices that reduce – or eliminate – the necessity of using highly skill-dependent manoeuvres, facilitate training and reduce the use of sedatives.