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Quality colonoscopy

Chi-Liang Cheng, Nai-Jen Liu, Jui-Hsiang Tang, Yen-Lin Kuo, Hsiang-Ling Hung, Yi-Ning Tsui, Bai-Ping Lee, Cheng-Hui Lin
BACKGROUND: A 3-l polyethylene glycol (PEG) solution provided better bowel cleansing quality than a 2-l solution for outpatient colonoscopy. Predictors of suboptimal preparation using a 3-l PEG have not been previously reported. AIMS: To investigate the possible predictors of suboptimal bowel preparation using 3-l of PEG. METHODS: We analyzed a database of 1404 consecutive colonoscopies during a 27-month period at a community hospital. A split-dose PEG regimen was provided for morning colonoscopies, and a same-day PEG regimen was provided for afternoon colonoscopies...
October 21, 2016: Digestive Diseases and Sciences
Elisabeth Waldmann, Georg Heinze, Arnulf Ferlitsch, Irina GessI, Daniela Sallinger, Philip Jeschek, Martha Britto-Arias, Petra Salzl, Elisabeth Fasching, Bernd Jilma, Michael Kundi, Michael Trauner, Monika Ferlitsch
BACKGROUND: Prevalence of (pre)cancerous colorectal lesions are higher in men than in women, although transition rates from advanced lesions to cancer is similar in both sexes. Our aim was to investigate whether the sex-specific difference in incidence of premalignant colorectal lesions might be explained by the impact of risk factors. METHODS: A cross-sectional study analysing health check-up examinations and screening colonoscopies performed within a national quality assurance program...
October 20, 2016: British Journal of Cancer
Duk Hwan Kim, Soo Jung Park, Jae Hee Cheon, Tae Il Kim, Won Ho Kim, Sung Pil Hong
OBJECTIVES: The objective of this study was to determine whether a pre-training program influences the entire learning process and overall proficiency of colonoscopy during fellowship. METHODS: From March 2011 to February 2013, a total of 28 first-year gastrointestinal fellows were trained in colonoscopy at a single tertiary center. Before entering their fellowship training, all fellows were board certified in internal medicine, but had no experience performing a full colonoscopy...
2016: PloS One
Sean C Rice, Tina Higginbotham, Melanie J Dean, James C Slaughter, Patrick S Yachimski, Keith L Obstein
OBJECTIVES: Successful outpatient colonoscopy (CLS) depends on many factors including the quality of a patient's bowel preparation. Although education on consumption of the pre-CLS purgative can improve bowel preparation quality, no study has evaluated dietary education alone. We have created an educational video on pre-CLS dietary instructions to determine whether dietary education would improve outpatient bowel preparation quality. METHODS: A prospective randomized, blinded, controlled study of patients undergoing outpatient CLS was performed...
October 18, 2016: American Journal of Gastroenterology
David Pace, Mark Borgaonkar, Brad Evans, Curtis Marcoux, Muna Lougheed, Vanessa Falk, Nikita Hickey, Meghan O'Leary, Jerry McGrath, Darrel Boone
INTRODUCTION: To determine whether the annual case volume of general surgeons (greater or less than 200 colonoscopies) is associated with quality outcomes. METHODS: This retrospective cohort study involved all adults who underwent colonoscopy by a surgeon in the city of St. John's, NL, during the first 6 months of 2012. Subjects were identified through records from the health authority, and data were recorded on a standardized data sheet. Univariate analysis followed by stepwise multivariable logistic regression was performed to determine whether there was an association between quality outcomes (colonoscopy completion rate, adenoma detection rate) and predictors of these outcomes including annual colonoscopy volume, patient age, gender, indication for colonoscopy, and ASA score...
October 17, 2016: Surgical Endoscopy
Jui-Hsiang Tang, Chi-Liang Cheng, Yen-Lin Kuo, Yi-Ning Tsui
BACKGROUND/AIMS: Same-day bidirectional endoscopy (BDE) is a commonly performed procedure, but the optimal sequence of the procedure with carbon dioxide insufflation is not well established. In this study, we investigated the optimal sequence for same-day BDE without polypectomy under moderate sedation and carbon dioxide insufflation in terms of sedation doses and colonoscopy performance. PATIENTS AND METHODS: We performed a prospective observational study of 63 asymptomatic patients who were admitted for physical check-ups...
September 2016: Saudi Journal of Gastroenterology: Official Journal of the Saudi Gastroenterology Association
Anthony Razzak, Dineen Smith, Maliha Zahid, Georgios Papachristou, Asif Khalid
Background and aims: Adenoma detection rate (ADR) and cecal withdrawal time (CWT) have been identified as measures of colonoscopy quality. This study evaluates the impact of monitoring these measures on provider performance. Methods: Six blinded gastroenterologists practicing at a Veterans Affairs Medical Center were prospectively monitored over 9 months. Data for screening, adenoma surveillance, and fecal occult blood test positive (FOBT +) indicated colonoscopies were obtained, including exam preparation quality, cecal intubation rate, CWT, ADR, adenomas per colonoscopy (APC), and adverse events...
October 2016: Endoscopy International Open
Jacob E Kurlander, Arjun R Sondhi, Akbar K Waljee, Stacy B Menees, Cathleen M Connell, Philip S Schoenfeld, Sameer D Saini
BACKGROUND: Bowel preparation is inadequate in a large proportion of colonoscopies, leading to multiple clinical and economic harms. While most patients receive some form of education before colonoscopy, there is no consensus on the best approach. AIMS: This systematic review aimed to evaluate the efficacy of patient education interventions to improve bowel preparation. METHODS: We searched the Cochrane Database, CINAHL, EMBASE, Ovid, and Web of Science...
2016: PloS One
Rupa Banerjee, Hrushikesh Chaudhari, Nirish Shah, Arjunan Saravanan, Manu Tandan, D Nageshwar Reddy
BACKGROUND: Adequate bowel preparation is an essential prerequisite for complete mucosal visualization during colonoscopy. Polyethylene glycol (PEG) solutions are commonly used. However the large volume of the solution is often poorly tolerated. Addition of Lubiprostone (LB) could improve the adequacy of standard PEG preparation & reduce requirement. The aims to assess adequacy of PEG preparation with addition of single dose LB (24mcg) vs placebo and efficacy of reduced dose PEG + LB compared with full dose PEG + LB...
October 13, 2016: BMC Gastroenterology
Theodor Voiosu, Alina Tanțău, A Voiosu, Andreea Benguș, Cristina Mocanu, Bianca Smarandache, C Baicuș, Ioana Vișovan, B Mateescu
BACKGROUND: Optimal bowel preparation is one of the most important factors affecting the quality of colonoscopy. Several patient-related factors are known to influence the quality of bowel cleansing but randomized trials in this area are lacking. We aimed to compare an individualized bowel prep strategy based on patient characteristics to a standard preparation regimen. MATERIAL AND METHODS: We conducted an endoscopist-blinded multicenter randomized control-trial...
October 13, 2016: Romanian Journal of Internal Medicine, Revue Roumaine de Médecine Interne
Robert J Hilsden, Ronald Bridges, Catherine Dube, S Elizabeth McGregor, Christopher Naugler, Sarah M Rose, Alaa Rostom, Steven J Heitman
OBJECTIVES: Although there is an accepted benchmark for adenoma detection rate (ADR) in average risk screening colonoscopy, a benchmark for ADR or the associated quality indicator, adenomas per colonoscopy (APC), for colonoscopies performed for a positive fecal immunochemical test (FIT+) has not been established. The purpose of this study was to propose methods for establishing a benchmark ADR and APC for FIT+ patients. METHODS: In this historical cohort study, we included 15,329 patients aged 50-74 years who underwent a colonoscopy at Alberta Health Services' Colon Cancer Screening Centre, Calgary, Canada, from 1 January 2014 to 30 June 2015 for either investigation of a positive FIT or average risk screening...
October 11, 2016: American Journal of Gastroenterology
Fiona Webster, Jigisha Patel, Kathleen Rice, Nancy Baxter, Lawrence Paszat, Linda Rabeneck, Jill Tinmouth
Background. Audit and feedback (A/F) reports are one of the few knowledge translation activities that can effect change in physician behavior. In this study, we pilot-tested an endoscopist A/F report to elicit opinions about the proposed report's usability, acceptability and usefulness, and implications for knowledge translation. Methods. Semi-structured qualitative interviews were conducted with eleven endoscopists in Ontario, Canada. We tested an A/F report template comprising 9 validated, accepted colonoscopy quality indicators populated with simulated data...
2016: Canadian Journal of Gastroenterology & Hepatology
Francesc Casellas, Claudia Herrera-de Guise, Virginia Robles, Ester Navarro, Natalia Borruel
BACKGROUND: There is currently little evidence about what treatment objectives most interest patients with inflammatory bowel disease (IBD). AIMS: To determine patient preferences regarding IBD treatment objectives, specially the attributes they value most and the symptoms to be controlled as a priority. METHODS: Prospective, observational, anonymous study conducted in 117 outpatients with Crohn's disease or ulcerative colitis. RESULTS: The most important treatment objectives from the patients' perspective were: improving quality of life (40...
September 21, 2016: Digestive and Liver Disease
Alexander Lee, Christopher D Jensen, Amy R Marks, Wei K Zhao, Chyke A Doubeni, Ann G Zauber, Virginia P Quinn, Theodore R Levin, Douglas A Corley
BACKGROUND AND AIMS: Endoscopist fatigue may impact colonoscopy quality, but prior studies conflict, and minimal data exist from community-based practices where most colonoscopies are performed. METHODS: Within a large, community-based integrated healthcare system, we evaluated the associations among 4 measures of endoscopist fatigue and colonoscopic adenoma detection during the years 2010 to 2013. Fatigue measures included afternoon versus morning colonoscopy and the number of GI procedures performed before a given colonoscopy, including consideration of prior procedure complexity...
October 1, 2016: Gastrointestinal Endoscopy
Emanuele Rondonotti, Alida Andrealli, Arnaldo Amato, Silvia Paggi, Clara Benedetta Conti, Giancarlo Spinzi, Franco Radaelli
Adenoma detection rate (ADR) is the most robust colonoscopy quality metric and clinical studies have adopted it as the ideal method to assess the impact of technical interventions. Areas covered: We reviewed papers focusing on the impact of colonoscopy technical issues on ADR, including withdrawal time and technique, second evaluation of the right colon, patient positional changes, gastrointestinal assistant participation during colonoscopy, water-aided technique, optimization of bowel preparation and antispasmodic administration...
October 5, 2016: Expert Review of Gastroenterology & Hepatology
Jonah Cohen, Douglas Grunwald, Laurie B Grossberg, Mandeep S Sawhney
BACKGROUND: Although colonoscopy with polypectomy can prevent up to 80% of colorectal cancers, a significant adenoma miss rate still exists, particularly in the right colon. Previous studies addressing right colon retroflexion have revealed discordant evidence regarding the benefit of this maneuver on adenoma detection with concomitant concerns about safety and rates of maneuver success. In this meta-analysis, we sought to determine the effect of right colon retroflexion on improving adenoma detection compared with conventional colonoscopy without retroflexion, as well as determine the rates of retroflexion maneuver success and adverse events...
September 28, 2016: Journal of Clinical Gastroenterology
John B Ortolani, Daniel R Tershak, John J Ferrara, Charles J Paget
The American Society for Gastrointestinal Endoscopy (ASGE)/American College of Gastroenterology Task Force (ACGTF) on Quality in Endoscopy released updated quality benchmarks for colonoscopy in 2015. Our initial study concluded that surgery residents could perform safe and competent screening colonoscopy within a structured endoscopy curriculum. In this follow-up study, we sought to determine whether surgery residents could achieve the increased adenoma detection rate (ADR) benchmarks endorsed by the ASGE/ACGTF...
September 2016: American Surgeon
Shail M Govani, Eric E Elliott, Stacy B Menees, Stephanie L Judd, Sameer D Saini, Constantinos P Anastassiades, Annette L Urganus, Suzanna J Boyce, Philip S Schoenfeld
AIM: To identify risk factors for a suboptimal preparation among a population undergoing screening or surveillance colonoscopy. METHODS: Retrospective review of the University of Michigan and Veteran's Administration (VA) Hospital records from 2009 to identify patients age 50 and older who underwent screening or surveillance procedure and had resection of polyps less than 1 cm in size and no more than 2 polyps. Patients with inflammatory bowel disease or a family history of colorectal cancer were excluded...
September 16, 2016: World Journal of Gastrointestinal Endoscopy
Andrew Hill, Mark S Horswill, Annaliese M Plooy, Marcus O Watson, Lachlan N Rowlands, Guy M Wallis, Stephan Riek, Robin Burgess-Limerick, David G Hewett
BACKGROUND: The quality of colonoscopy is known to vary. The extent to which colonoscopists can recognize the presence of subtle colorectal lesions by visually distinguishing them from the surrounding mucosa (i.e., polyp recognition skill) may be one of several attributes that influence polyp detection rates. The aim of the present study was to develop and validate the first objective test of polyp recognition skill. METHODS: Validation study. Twenty-eight experienced colonoscopists and eighty novices took a preliminary 280-item computer-based polyp recognition test...
September 20, 2016: Surgical Endoscopy
Elizabeth Sheena John, Ann M John, David R Hansberry, Prashant J Thomas, Prateek Agarwal, Christopher Deitch, Sita Chokhavatia
PURPOSE: Patients screened for colorectal cancer (CRC) frequently turn to the Internet to improve their understanding of tests used for detection, including colonoscopy, flexible sigmoidoscopy, fecal occult blood test (FOBT), and CT colonography. It was of interest to determine the quality and readability levels of online health information. METHODS: The screening tools were googled, and the top 20 results of each test were analyzed for readability, accessibility, usability, and reliability...
September 20, 2016: International Journal of Colorectal Disease
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