Characterization of forces applied by endoscopists during colonoscopy by using a wireless colonoscopy force monitor

BackgroundTo perform a colonoscopy, the endoscopist maneuvers the colonoscope through a series of loops by applying force to the insertion tube. Colonoscopy insertion techniques are operator dependent but have never been comprehensively quantified.ObjectiveTo determine whether the Colonoscopy Force Monitor (CFM), a device that continually measures force applied to the insertion tube, can identify different force application patterns among experienced endoscopists.DesignObservational study of 6 experienced endoscopists performing routine diagnostic and therapeutic colonoscopy in 30 patients.SettingOutpatient ambulatory endoscopy center.PatientsAdult male and female patients between 30 and 75 years of age undergoing routine colonoscopy.InterventionsCFM monitoring of force applied to the colonoscope insertion tube during colonoscopy.Main Outcome MeasurementsMaximum and mean linear and torque force, time derivative of force, combined linear and torque vector force, and total manipulation time.ResultsThe CFM demonstrates differences among endoscopists for maximum and average push/pull and mean torque forces, time derivatives of force, combined push/torque force vector, and total manipulation time. Endoscopists could be grouped by force application patterns.LimitationsOnly experienced endoscopists using conscious sedation in the patients were studied. Sample size was 30 patients.ConclusionsThis study demonstrates that CFM allows continuous force monitoring, characterization, and display of similarities and differences in endoscopic technique. CFM has the potential to facilitate training by enabling trainees to assess, compare, and quantify their techniques and progress.