Effect of using personal protective equipment during the COVID-19 pandemic on the quality indicators of screening colonoscopies.

Background and Aims: Coronavirus Disease 2019 (COVID-19) has affected many facets of the practice of medicine including screening colonoscopies. Our study looks to observe if there has been an effect on the quality of colonoscopies, as indicated by quality measures such as cecal intubation rate (CIR), cecal intubation time (CIT), scope withdrawal time (SWT) and adenoma detection rate (ADR) with the adoption of standard COVID-19 precautions. Methods: We conducted a retrospective chart review to analyze the effects of the COVID-19 pandemic on screening colonoscopies. The study utilized data on CIR, CIT, SWT and ADR from outpatient, non-emergent procedures conducted at 3 endoscopy suites of St Lukes University Health Network. All inpatient and emergent procedures were excluded. Data was obtained by performing chart review on EPIC electronic health record. Results: Our study demonstrated that the total number of screening colonoscopies was decreased between 2019 to 2020 (318 in 2019 vs 157 in 2020, p= 0.005). CIT (320+/-105 seconds in 2019 vs 392+/-107 seconds in 2020, p=0.001) and SWT (706+/-232 seconds in 2019 vs 830+/-241 seconds in 2020, p=0.001) were increased while CIR (98.2% in 2019 vs 96.6% in 2020, p=0.04) was decreased between 2019 and 2020 likely due to PPE introduction. ADR was similar between the two groups (38.23 (12.50-66.66) in 2019 vs 38.18(16.66-66.00) in 2020, p=0.8). Conclusion: Our study showed that quality indices for screening colonoscopies like cecal intubation rate, cecal intubation time and scope withdrawal time were negatively impacted during the initial COVID time period compared to pre-COVID time. The study also displayed that though there was a significant decline in both screening and diagnostic colonoscopies during pandemic, adenoma detection rates were comparable. Thus, the efficiency of the procedures was affected by the use of PPE but it did not affect the colonoscopies clinical benefits.

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Effect of Using Personal Protective Equipment during the COVID-19 Pandemic on the Quality Indicators of Screening Colonoscopies

Gastroenterology Research and Practice ◽

10.1155/2021/8910004 ◽

2021 ◽

Vol 2021 ◽

pp. 1-5

Author(s):

Subin Chirayath ◽

Janak Bahirwani ◽

Parampreet Kaur ◽

Noel Martins ◽

Ronak Modi

Keyword(s):

Chart Review ◽

Retrospective Chart Review ◽

Cecal Intubation ◽

Withdrawal Time ◽

Time Period ◽

Adenoma Detection ◽

Cecal Intubation Time ◽

Practice Of Medicine ◽

Cecal Intubation Rate

Background. Coronavirus Disease 2019 (COVID-19) has affected many facets of the practice of medicine including screening colonoscopies. Aims. Our study looks to observe if there has been an effect on the quality of colonoscopies, as indicated by quality measures such as the cecal intubation rate (CIR), cecal intubation time (CIT), scope withdrawal time (SWT), and adenoma detection rate (ADR) with the adoption of standard COVID-19 precautions. Methods. We conducted a retrospective chart review to analyze the effects of the COVID-19 pandemic on screening colonoscopies. The study utilized data on CIR, CIT, SWT, and ADR from outpatient, nonemergent procedures conducted at 3 endoscopy suites of St. Luke’s University Health Network. All inpatient and emergent procedures were excluded. Results. Our study demonstrated that the total number of screening colonoscopies was decreased between 2019 and 2020 (318 in 2019 vs. 157 in 2020, p = 0.005 ). CIT ( 320 ± 105 seconds in 2019 vs. 392 ± 107 seconds in 2020, p = 0.001 ) and SWT ( 706 ± 232 seconds in 2019 vs. 830 ± 241 seconds in 2020, p = 0.001 ) were increased while CIR (98.2% in 2019 vs. 96.6% in 2020, p = 0.04 ) was decreased between 2019 and 2020 likely due to PPE introduction. ADR was similar between the two groups (38.23 (12.50-66.66) in 2019 vs. 38.18 (16.66-66.00) in 2020, p = 0.8 ). Conclusion. Our study showed that quality indices for screening colonoscopies like CIR, CIT, and SWT were negatively impacted during the COVID-19 time period. ADR, however, was similar. Thus, the efficiency of the procedures was affected by the use of PPE but it did not affect the colonoscopy’s clinical benefit.

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Cap-assisted colonoscopy: a meta-analysis of high-quality randomized controlled trials

Endoscopy International Open ◽

10.1055/a-0650-4258 ◽

2018 ◽

Vol 06 (10) ◽

pp. E1214-E1223 ◽

Cited By ~ 9

Author(s):

Venkat Nutalapati ◽

Vijay Kanakadandi ◽

Madhav Desai ◽

Mojtaba Olyaee ◽

Amit Rastogi

Keyword(s):

Meta Analysis ◽

Intubation Time ◽

Intubation Rate ◽

High Quality ◽

Cecal Intubation ◽

Randomized Controlled ◽

Adenoma Detection ◽

Cecal Intubation Time ◽

Cecal Intubation Rate ◽

Standard Colonoscopy

Abstract Background and study aims Standard colonoscopy (SC) is the preferred modality for screening for colon cancer; however, it carries a significant polyp/adenoma miss rate. Cap-assisted colonoscopy (CC) has been shown to improve polyp/adenoma detection rate, decrease cecal intubation time and increase cecal intubation rate when compared to standard colonoscopy (SC). However, data on adenoma detection rate (ADR) are conflicting. The aim of this meta-analysis was to compare the performance of CC with SC for ADR among high-quality randomized controlled trials. Patients and methods We performed an extensive literature search using MEDLINE, EMBASE, Scopus, Cochrane and Web of Science databases and abstracts published at national meetings. Only comparative studies between CC and SC were included if they reported ADR, adenoma per person (APP), cecal intubation rate, and cecal intubation time. The exclusion criterion for comparing ADR was studies with Jadad score ≤ 2. The odds ratio (OR) was calculated using Mantel-Haenszel method. I2 test was used to measure heterogeneity among studies. Results Analysis of high-quality studies (Jadad score ≥ 3, total of 7 studies) showed that use of cap improved the ADR with the results being statistically significant (OR 1.18, 95 % CI 1.03 – 1.33) and detection of 0.16 (0.02 – 0.30) additional APP. The cecal intubation rate in the CC group was 96.3 % compared to 94.5 % with SC (total of 17 studies). Use of cap improved cecal intubation (OR 1.61, 95 % CI 1.33 – 1.95) when compared to SC (P value < 0.001). Use of cap decreased cecal intubation time by an average of 0.88 minutes (95 % CI 0.37 – 1.39) or 53 seconds. Conclusions Meta-analysis of high-quality studies showed that CC improved the ADR compared to SC.

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Impact of sex and body mass index on cecal intubation time. Is it a myth that colonoscopy is easier to perform in obese than lean people?

Journal of Medical Science ◽

10.20883/183 ◽

2016 ◽

Vol 85 (4) ◽

pp. 298 ◽

Cited By ~ 1

Author(s):

Elżbieta Poniewierka ◽

Robert Dudkowiak ◽

Witold Marczyński

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Endoscopic Examination ◽

Normal Weight ◽

Intubation Time ◽

Obese People ◽

Cecal Intubation ◽

Withdrawal Time ◽

Adenoma Detection ◽

Cecal Intubation Time

Introduction. Colonoscopy is the gold standard for prevention and early diagnosis of colorectal cancer. Procedure quality is an important issue. Current quality indicators, such as cecal intubation rate, adenoma detection rate, and withdrawal time, are important, but cecum intubation time influences all of them. Factors that determine cecal intubation time (CIT) include body mass index (BMI), age, sex, history of abdominal surgery, quality of bowel preparation, and visceral adipose tissue. Among those who perform colonoscopy, it is believed that the procedure is easier to perform in obese people. Aim. To determine whether cecal intubation time depends on body mass index and sex of patients undergoing colonoscopy.Material and Methods. An analysis of the technical aspects of colonoscopy, such as the time required to intubate the cecum, with respect to BMI and sex in 100 patients.Results. The average time taken to reach the cecum or ileum was slightly longer in obese people than in people with normal weight. Average CIT was almost one minute longer in men than women. Average CIT in obese men was slightly longer than in normal weight men. There was no difference in average CIT in obese and normal weight women. The differences were not statistically significant.Conclusions. This study demonstrates that the claim that endoscopic examination of the lower gastrointestinal tract is easier to perform in obese people cannot be objectively confirmed.

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Endoscopists with Longer Cecal Intubation Time than Withdrawal Time Have Lower Adenoma Detection Rate

The American Journal of Gastroenterology ◽

10.14309/00000434-201310001-00634 ◽

2013 ◽

Vol 108 ◽

pp. S186

Author(s):

Shailendra Singh ◽

Elie Aoun ◽

Vishal Goyal ◽

Mayuri Gupta ◽

Trupti Shinde ◽

...

Keyword(s):

Detection Rate ◽

Adenoma Detection Rate ◽

Intubation Time ◽

Cecal Intubation ◽

Withdrawal Time ◽

Adenoma Detection ◽

Cecal Intubation Time

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Optimal Timing of Simethicone Supplement for Bowel Preparation: A Prospective Randomized Controlled Trial

Canadian Journal of Gastroenterology and Hepatology ◽

10.1155/2021/4032285 ◽

2021 ◽

Vol 2021 ◽

pp. 1-6

Author(s):

Zhen-wen Wu ◽

Sheng-gang Zhan ◽

Mei-feng Yang ◽

Yi-teng Meng ◽

Feng Xiong ◽

...

Keyword(s):

Bowel Preparation ◽

Controlled Trial ◽

Optimal Timing ◽

Intubation Time ◽

Right Colon ◽

Cecal Intubation ◽

Withdrawal Time ◽

Adenoma Detection ◽

Cecal Intubation Time ◽

The Right

Background and Aims. Simethicone (SIM), as an antifoaming agent, has been shown to improve bowel preparation during colonoscopy. However, the optimal timing of SIM addition remained undetermined. We aimed to investigate the optimal timing of SIM addition to polyethylene glycol (PEG) to improve bowel preparation. Methods. Eligible patients were randomly assigned to two groups: the SIM evening group (SIM addition to PEG in the evening of the day prior to colonoscopy) and the SIM morning group (SIM addition to PEG in the morning of colonoscopy). The primary outcome was Bubble Scale (BS). The secondary outcomes were Boston Bowel Preparation Scale (BBPS) and adenoma detection rate (ADR). Results. A total of 419 patients were enrolled in this study. The baseline characteristics of the patients were similar in both groups. No significant differences were observed in terms of BS (8.76 ± 0.90 vs. 8.65 ± 1.16, P = 0.81), ADR (34.1% vs. 30.8%, P = 0.47), Boston Bowel Preparation Scale (BBPS) (8.59 ± 0.94 vs. 8.45 ± 1.00, P = 0.15), and withdrawal time (8.22 ± 2.04 vs. 8.01 ± 2.51, P = 0.094) between the two groups. Moreover, safety and compliance were similar in both groups. However, the SIM evening group was associated with shorter cecal intubation time (3.80 ± 1.81 vs. 4.42 ± 2.03, P < 0.001), higher BS (2.95 ± 0.26 vs. 2.88 ± 0.38, P = 0.04) in the right colon, and diminutive ADR (62.5% vs. 38.6%, P = 0.022) in the right colon, when compared to the SIM evening group. Conclusions. The SIM addition to PEG in the evening of the day prior to colonoscopy can shorten cecal intubation time and improve BS scores and diminutive ADR of the right colon compared with the SIM addition to PEG in the morning of colonoscopy in bowel preparation.

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Evaluation of a novel colonoscope offering flexibility adjuster – a retrospective observational study

Therapeutic Advances in Gastroenterology ◽

10.1177/17562848211013494 ◽

2021 ◽

Vol 14 ◽

pp. 175628482110134

Author(s):

Christian Gerges ◽

Helmut Neumann ◽

Sauid Ishaq ◽

Visvakanth Sivanathan ◽

Peter R. Galle ◽

...

Keyword(s):

High Rate ◽

Intubation Time ◽

Cecal Intubation ◽

Withdrawal Time ◽

Patients Satisfaction ◽

Examination Time ◽

Cecal Intubation Time ◽

Total Examination Time ◽

Cecal Intubation Rate ◽

And Performance

Background: Although colonoscopy is the gold standard for colorectal cancer screening, colonic looping may make complete colonoscopy challenging. Commonly available stiffening device colonoscopy has been described as helpful but not effective enough to prevent looping. In this context the effect on cecal intubation time and rate was described differently in various studies and in some studies had no impact on cecal intubation time at all. The aim of this study was to evaluate whether a novel colonoscope with gradual stiffness (Fujifilm EC760R-V/I- flexibility adjuster, Tokyo, Japan) using four significantly different grades of stiffness can be an alternative to established devices in terms of loop prevention, cecal intubation rate and time, adverse events, and patient/examiner satisfaction. Methods: Consecutive patients without previous colorectal surgery were analyzed retrospectively. Colonoscopy was performed with the new colonoscope and performance characteristics, including time to cecum, withdrawal time, total examination time, and patient and endoscopist satisfaction were recorded. Results: Among 180 consecutive procedures, 98.3% of examinations were complete to the cecum. The endoscopic flexibility adjuster was used in 150 of 180 cases (83.3%). Overall, the device was scored by the examiner as helpful to prevent looping in 146 of the 150 cases (97.7%). Mean cecal intubation time was 6.5 min, with 35% of examination performed in under 5 min with a mean withdrawal time of 7 min. Mean total examination time was 18 min. Patient satisfaction was rated as high in all examinations performed. Conclusion: The new flexibility adjuster colonoscope was shown to be helpful in loop prevention, allowed for fast and successful cecal intubation, and led to a high rate of patients satisfaction.

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Impact of sex and body mass index on cecal intubation time. Is it a myth that colonoscopy is easier to perform in obese than lean people?

Journal of Medical Science ◽

10.20883/jms.2016.183 ◽

2016 ◽

Vol 85 (4) ◽

pp. 298-301

Author(s):

Elżbieta Poniewierka ◽

Robert Dudkowiak ◽

Witold Marczyński

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Endoscopic Examination ◽

Normal Weight ◽

Intubation Time ◽

Obese People ◽

Cecal Intubation ◽

Withdrawal Time ◽

Adenoma Detection ◽

Cecal Intubation Time

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Diagnostic application of water exchange colonoscopy: A meta-analysis of randomized controlled trials

Journal of International Medical Research ◽

10.1177/0300060518819626 ◽

2019 ◽

Vol 47 (2) ◽

pp. 515-527

Author(s):

Xiufang Xu ◽

Dongqiong Ni ◽

Yuping Lu ◽

Xuan Huang

Keyword(s):

Patient Satisfaction ◽

Detection Rate ◽

Water Exchange ◽

Meta Analysis ◽

Controlled Trials ◽

Intubation Rate ◽

Cecal Intubation ◽

Randomized Controlled ◽

Adenoma Detection ◽

Cecal Intubation Rate

Background Few well-designed studies have investigated water exchange colonoscopy (WE). We performed a meta-analysis to comprehensively evaluate the clinical utility of WE based on high-quality randomized controlled trials (RCTs) and to compare the impacts of WE, water immersion colonoscopy (WI), and gas-insufflation colonoscopy. Methods We searched the Cochrane Library, MEDLINE, Embase, PubMed, Elsevier, CNKI, VIP, and Wan Fang Data for RCTs on WE. We analyzed the results using fixed- or random-effect models according to the presence of heterogeneity. Publication bias was assessed by funnel plots. Results Thirteen studies were eligible for this meta-analysis. The colonoscopic techniques included WE as the study group, and WI and air- or CO2-insufflation colonoscopy as control groups. WE was significantly superior to the control procedures in terms of adenoma detection rate, proportion of painless unsedated colonoscopy procedures, and cecal intubation rate according to odds ratios. WE was also significantly better in terms of maximal pain score and patient satisfaction score according to mean difference. Conclusions WE can remarkably improve the adenoma detection rate, proportion of painless unsedated colonoscopy procedures, patient satisfaction, and cecal intubation rate, as well as reducing the maximal pain score in patients undergoing colonoscopy.

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