12 However, the optimal sequence of the two procedures (EGD-colonoscopy vs colonoscopy-EGD) has not been examined in detail. Anecdotal evidence from some endoscopists’ point of view suggests that the gas insufflation required when EGD is conducted before colonoscopy makes subsequent colonoscopy more difficult. As a result, bidirectional endoscopy tends to employ

colonoscopy first followed by EGD in order to avoid colonoscopy failure. However, in our practice we sometimes have observed that hyperactive bowel movement and extrinsic compression of stomach by insufflated gas during colonoscopy can lead to incomplete EGD examination in patients subjected to colonoscopy-EGD sequence. In this study, we sought to determine the superior C59 wnt concentration procedural sequence for bidirectional endoscopy without benzodiazepine and propofol sedation, through a randomized prospective study. The primary aim of this study was to compare the quality and feasibility of EGD between patient groups who received EGD before or after colonoscopy. Our secondary aim was to assess

colonoscopic parameters, particularly success rate and insertion time, as measures of procedural difficulty, in the two groups. Finally, we compared patient discomfort between groups. Between July and October 2007, 80 patients scheduled for same-day EGD and colonoscopy were enrolled at Severance Hospital (Yonsei University College of Medicine, Seoul, Korea). This study was approved by the Human Studies Committee of Yonsei University College of Medicine. Exclusion criteria included a planned therapeutic Kinase Inhibitor Library high throughput procedure, history of stomach or colorectal cancer, conscious sedation with benzodiazepine and propofol, and unwillingness by the patient to enroll in the randomized study. Enrolled patients were prospectively randomized into either a EGD-colonoscopy (Group I) or colonoscopy-EGD (Group II) sequence group based on a computer-generated list (Fig. 1). We collected patient data including age, height, weight, concomitant disease(s) and past medical and surgical history (Table 1).

Following endoscopic examination, patients completed a questionnaire designed to assess the subjective discomfort associated with endoscopy, with discomfort scored on a scale of 0–10 (0, no discomfort; 10, extreme discomfort). Florfenicol Both EGD and colonoscopy were performed after overnight fasting and a bowel cleansing, during which the patients were requested to drink 4 L of a polyethyleneglycol-electrolyte solution (Colyte; Taejun, Seoul, Korea), by at least 4 hours prior to starting endoscopic examination. A single endoscopist (S.K. Lee) performed all EGD and colonoscopic examinations in all patients using an Olympus endoscope (GIF 260, GIF 240) and colonoscope (CF 260, CF 240) after oropharyngeal topical anesthesia and standard pre-medication with 25 mg of meperidine and 20 mg of scopolamine-N-butylbromide. Once first endoscopy was finished, the subsequent endoscopy was immediately performed in both groups.