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

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.

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

2021 ◽  
Author(s):  
Subin G Chirayath ◽  
Janak Bahirwani ◽  
Parampreet Kaur ◽  
Noel Martins ◽  
Ronak Modi
Keyword(s):  
Chart Review ◽  
Retrospective Chart Review ◽  
Intubation Time ◽  
Intubation Rate ◽  
Cecal Intubation ◽  
Withdrawal Time ◽  
Detection Rates ◽  
Adenoma Detection ◽  
Cecal Intubation Time ◽  
Cecal Intubation Rate

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.

scholarly journals The Quality of Screening Colonoscopies in an Office-Based Endoscopy Clinic

2009 ◽  
Vol 23 (1) ◽  
pp. 41-47 ◽  
Author(s):  
Douglas Bair ◽  
Joe Pham ◽  
M Bianca Seaton ◽  
Naveen Arya ◽  
Michelle Pryce ◽  
...  
Keyword(s):  
Academic Community ◽  
Screening Colonoscopy ◽  
Polyp Detection ◽  
Cecal Intubation ◽  
Withdrawal Time ◽  
Adenoma Detection ◽  
Adequate Sedation ◽  
Cecal Intubation Rate ◽  
Hospital Practices

BACKGROUND: Wait times for hospital screening colonoscopy have increased dramatically in recent years, resulting in an increase in patient referrals to office-based endoscopy clinics. There is no formal regulation of office endoscopy, and it has been suggested that the quality of service in some office locations may be inferior to hospital procedures.OBJECTIVE: To compare the quality of office-based screening colonos-copies at a clinic in Oakville, Ontario, with published benchmarks for cecal intubation, withdrawal times, polyp detection, adenoma detection, cancer detection and patient complications.METHODS: Demographic information on consecutive patients and colonoscopy reports by all nine gastroenterologists at the Oakville Endoscopy Centre between August 2006 and December 2007 were prospectively obtained.RESULTS: A total of 3741 colonoscopies were analyzed. The mean age of patients was 57.1 years and 51.9% were women. The cecal intubation rate was 98.98% with an average withdrawal time of 9.75 min. A total of 3857 polyps were retrieved from 1725 patients (46.11%), and 1721 adenomas were detected in 953 patients (25.47%). A total of 126 patients (3.37%) had advanced polyps and 18 (0.48%) were diagnosed with colon cancer. One patient (0.027%) had a colonic perforation and two patients had postpolypectomy bleeding (0.053%). These results meet or exceed published benchmarks for quality colonoscopy.CONCLUSIONS: The Oakville Endoscopy Centre data demonstrate that office-based colonoscopies, performed by well-trained physicians using adequate sedation and hospital-grade equipment, result in outcomes at least equal to or better than those of published academic/community hospital practices and are therefore a viable option for the future of screening colonoscopy in Canada.

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?

10.20883/183 ◽  
2016 ◽  
Vol 85 (4) ◽  
pp. 298 ◽  
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.

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

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

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

2018 ◽  
Vol 06 (10) ◽  
pp. E1214-E1223 ◽  
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.

scholarly journals Colonoscopy quality across Europe: a report of the European Colonoscopy Quality Investigation (ECQI) Group

2021 ◽  
Vol 09 (10) ◽  
pp. E1456-E1462
Author(s):  
Cristiano Spada ◽  
Anastasios Koulaouzidis ◽  
Cesare Hassan ◽  
Pedro Amaro ◽  
Anurag Agrawal ◽  
...  
Keyword(s):  
Bowel Preparation ◽  
Detection Rate ◽  
Gastrointestinal Endoscopy ◽  
Polyp Detection ◽  
Cecal Intubation ◽  
Withdrawal Time ◽  
Polyp Detection Rate ◽  
Adenoma Detection ◽  
Cecal Intubation Rate ◽  
Colonoscopy Quality

Abstract Background and study aims The European Colonoscopy Quality Investigation (ECQI) Group comprises expert colonoscopists and investigators with the aim of raising colonoscopy standards. We assessed the levels of monitoring and achievement of European Society of Gastrointestinal Endoscopy (ESGE) performance measures (PMs) across Europe using responses to the ECQI questionnaires. Methods The questionnaire comprises three forms: institution and practitioner questionnaires are completed once; a procedure questionnaire is completed on multiple occasions for individual total colonoscopies. ESGE PMs were approximated as closely as possible from the data collected via the procedure questionnaire. Procedure data could provide rate of adequate bowel preparation, cecal intubation rate (CIR), withdrawal time, polyp detection rate (PDR), and tattooing resection sites. Results We evaluated ECQI questionnaire data collected between June 2016 and April 2018, comprising 91 practitioner and 52 institution questionnaires. A total of 6445 completed procedure forms were received.Institution and practitioner responses indicate that routine recording of PMs is not widespread: adenoma detection rate (ADR) is routinely recorded in 29 % of institutions and by 34 % of practitioners; PDR by 42 % and 47 %, CIR by 62 % and 64 %, bowel preparation quality by 56 % and 76 %, respectively.Procedure data showed a rate of adequate bowel preparation of 84.2 %, CIR 73.4 %, PDR 40.5 %, mean withdrawal time 7.8 minutes and 12.2 % of procedures with possible removal of a non-pedunculated lesion ≥ 20 mm reporting tattooing. Conclusions Our findings clearly show areas in need of quality improvement and the importance of promoting quality monitoring throughout the colonoscopy procedure.

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

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.

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

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.

scholarly journals The Impact of Sedation on Adenoma Detection Rate and Cecal Intubation Rate in Colonoscopy

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Qiongmei Zhang ◽  
Zhiyu Dong ◽  
Yuanxi Jiang ◽  
Tingting Zhan ◽  
Junwen Wang ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Model ◽  
Detection Rate ◽  
Logistic Regression Model ◽  
Independent Factor ◽  
Intubation Rate ◽  
Cecal Intubation ◽  
Adenoma Detection ◽  
Cecal Intubation Rate

Purpose. To explore the effect of sedation on the quality of colonoscopy. Methods. The data collected from the Digestive Endoscopy Center of Shanghai Tongji Hospital from March 2012 to June 2019 were retrospectively analyzed. The rate of sedation and quality metrics of colonoscopy such as adenoma detection rate (ADR) and cecal intubation rate (CIR) were calculated. The logistic regression model was used to explore the relationship between sedation and quality metrics of colonoscopy. The interaction effects between experience of endoscopists and sedation on quality of colonoscopy was also investigated in subgroups stratified by total number of colonoscopies during career using the logistic regression model. Results. A total of 63,417 colonoscopies including 11,417 colonoscopies without sedation and 52,000 colonoscopies with sedation were enrolled in our study. The proportion of colonoscopy with sedation was 82.0%. The ADR and CIR were all significantly higher in cases with sedation compared with cases without sedation (ADR, 22.5% vs. 17.0%, p < 0.001 ; CIR, 94.7% vs. 91.2%, p < 0.001 ). Multivariate analysis showed that the sedation was an independent factor associated with adenoma detection ( OR = 1.448 , 95% CI: 1.372~1.529, p < 0.001 ) and cecal intubation ( OR = 1.560 , 95% CI: 1.446~1.683, p < 0.001 ). A total of 14 endoscopists with complete colonoscopy data in our database and corresponding 20,949 colonoscopies data were enrolled for further analysis. The logistic regression model yielded a similar result that sedation was an independent factor on adenoma detection and cecal intubation when the factor, experience of endoscopists, was also entered into the model as a confounder (adenoma detection, OR = 1.408 , 95% CI: 1.333~1.487, p < 0.001 ; cecal intubation, OR = 1.601 , 95% CI: 1.482-1.729, p < 0.001 ). Conclusion. Colonoscopy with sedation has a positive effect on ADR and CIR in all endoscopists with different experience of colonoscopy, which makes the quality of colonoscopy better.

scholarly journals Weekend and evening planned colonoscopy activity: a safe and effective way to meet demands

2021 ◽  
Vol 09 (07) ◽  
pp. E1026-E1031
Author(s):  
Shimaa A. Afify ◽  
Omnia M. Abo-Elazm ◽  
Ishak I. Bahbah ◽  
Mo H. Thoufeeq
Keyword(s):  
Performance Indicators ◽  
Gastrointestinal Endoscopy ◽  
Working Hours ◽  
Key Performance Indicators ◽  
Advisory Group ◽  
Cecal Intubation ◽  
Related Data ◽  
Adenoma Detection ◽  
Cecal Intubation Rate

Abstract Background and study aims Colonoscopy is the “gold standard” investigation for assessment of the large bowel that detects and prevents colorectal cancer, as well as non-neoplastic conditions. The Joint Advisory Group (JAG) on Gastrointestinal Endoscopy recommends monitoring key performance indicators such as cecal intubation rate (CIR) and adenoma detection rate (ADR). We aimed to investigate the quality of colonoscopies carried out during evening and Saturday lists in our unit and compare them against JAG standards of quality for colonoscopies. Patients and methods We retrospectively collected and analyzed demographical and procedure-related data for non-screening colonoscopies performed between January 2016 and November 2018. Evenings and Saturdays were defined as the out-of-hour (OOH) period. We compared the outcomes of the procedures done in these against the working hours of the weekdays. We also wanted to explore whether the outcomes were different among certain endoscopists. Other factors that could affect the KPIs, such as endoscopist experience and bowel preparation, were also analyzed. Results There were a total of 17634 colonoscopies carried out; 56.9 % of the patients (n = 10041) < 70 years old. Key Performance Indicators (KPIs) of weekday, evening, and Saturday colonoscopies regarding the CIR and ADR met the JAG standards as they were above 93 % and 24 %, respectively. Advanced colonoscopists had better KPIs when compared to the non-advanced colonoscopists, with CIR at 97.6 % vs. 93.2 % and ADR at 40.8 % vs. 26 %, respectively. Conclusions JAG standards were maintained during colonoscopies done on weekdays, evenings, and Saturdays. Advanced colonoscopists had higher CIR and ADRs.

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