scholarly journals Efficacy of Macrogol 4000 Plus Electrolytes in Bowel Preparation for Colonoscopy in Patients with Chronic Constipation

2021 ◽  
Author(s):  
Ryoji Ichijima ◽  
Sho Suzuki ◽  
Mitsuru Esaki ◽  
Tomomi Sugita ◽  
Kanako Ogura ◽  
...  
Keyword(s):  
Adverse Events ◽  
Bowel Preparation ◽  
Chronic Constipation ◽  
Detection Rate ◽  
Observation Time ◽  
Insertion Time ◽  
Polyp Detection ◽  
Cecal Intubation ◽  
Polyp Detection Rate ◽  
Adenoma Detection

Abstract Background: Chronic constipation is a significant factor in poor bowel preparation for colonoscopy. Macrogol 4000 plus electrolytes (Movicol, EA Pharma, Tokyo, Japan), containing polyethylene glycol (PEG) and electrolytes, have been used recently to treat patients with constipation. However, prospective studies on the use of macrogol 4000 for bowel cleansing for colonoscopy are lacking. This study aimed to investigate the efficacy and safety of macrogol 4000 in addition to PEG administered in patients with chronic constipation.Methods: This single-center, single-arm prospective study enrolled patients with chronic constipation who were scheduled to undergo colonoscopy. The primary endpoint was the proportion of good bowel preparation assessed using the Boston Bowel Preparation Scale (BBPS) (6 or more points). The secondary endpoints were the time from when pPEG (MoviPrep, EA Pharma, Tokyo, Japan) was taken until colonoscopy could be started, amount of PEG taken, number of defecations, whether additional PEG doses were taken, and adverse events. Endoscopy-related endpoints included cecal intubation rate, insertion time, observation time, adenoma detection rate (ADR), and polyp detection rate (PDR). The tolerability of PEG and macrogol 4000 was assessed using a questionnaire.Results: Forty patients were included in the analysis. The median BBPS was 7 (range, (3–9)) and ³6 points in 37 cases (92.5%). The median time until colonoscopy can be started was 210 min (90–360 min), the median volume of PEG taken was 1500 mL (1000–2000 mL), and the median number of defecations was 7 (3-20). No adverse events were observed. Fourteen patients required an additional dose of PEG. Cecal intubation was achieved in all cases, the median insertion time was 6.0 min (range, 2.3–22 min), and the median observation time was 8.8 min (range, 4.0–16.0 min). The ADR and PDR were 60.0% and 75.0%, respectively. A greater proportion of patients rated the tolerability of macrogol 4000 as good compared with that of PEG (95.0% vs. 50.0%, p < 0.01).Conclusions: Intake of macrogol 4000 in addition to PEG is effective and safe for colonoscopy in patients with chronic constipation.

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 A120 NO EVIDENCE OF A FRIDAY EFFECT ON COLONOSCOPY QUALITY OUTCOMES

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 101-102
Author(s):  
Z Hindi ◽  
L Guizzetti ◽  
S cocco ◽  
M Brahmania ◽  
A Wilson ◽  
...  
Keyword(s):  
Detection Rate ◽  
Hospital Setting ◽  
Polyp Detection ◽  
Cecal Intubation ◽  
Detection Rates ◽  
Adjusted Risk ◽  
Polyp Detection Rate ◽  
Adenoma Detection ◽  
Significant Difference ◽  
Colonoscopy Quality

Abstract Background Colonoscopy quality may be influenced by operator fatigue. Prior studies have shown lower adenoma detection rates for procedures performed at the end of the day. However, it is unknown if colonoscopy quality is impaired at the end of the work week. Aims We investigated whether colonoscopy quality-related metrics differ at the end of the work week using the South West Ontario Colonoscopy Cohort. Methods Between April 2017 to February 2018, 45,510 consecutive colonoscopies from 20 academic and community hospitals in our health region were captured to form the cohort. In Canada, outpatient endoscopies are generally performed between Monday to Friday, taking Friday, or the last business day, as the last day of the work week compared to the rest of the work week. When a statutory holiday occurred on a Friday, Thursday was designated the last day of the work week. The primary outcome was adenoma detection rate (ADR), and secondary outcomes were sessile serrated polyp detection rate (ssPDR), polyp detection rate (PDR), and failed cecal intubation. Outcomes were presented as unadjusted and adjusted risk ratios derived from modified Poisson regression and adjusting for physician-level clustering, and characteristics of the patient (age, sex, severity), procedure (hospital setting, trainee presence, indication, sedation, bowel preparation quality) and physician (experience and specialty). Results During the observation period, 9,132 colonoscopies were performed on the last day of the work week compared to 36,378 procedures during the rest of the work week. No significant difference was observed for ADR (26.4% vs. 26.6%, p=0.75), ssPDR (4.5% vs. 5.0%, p=0.12), PDR (44.1% vs. 43.1%, p=0.081), or failed cecal intubation (2.8% vs. 2.9%, p=0.51) for colonoscopies performed on the last day of the work week compared to the rest of the week, respectively. After adjusting for potential confounders, there were no significant differences in the ADR (RR 1.01, 95% CI [0.88, 1.15], p=0.94), ssPDR (RR 0.90, 95% CI [0.70, 1.14], p=0.38), PDR (RR 1.00, 95% CI [0.92, 1.09], p=0.94), or failed cecal intubation (RR 0.92, 95% CI [0.72, 1.18], p=0.51) for colonoscopies performed on the last day of the work week compared to the rest of week, respectively. Conclusions Colonoscopy quality metrics, including ADR, ssPDR, PDR, and failed cecal intubation are not significantly different at the end of the week. Funding Agencies None

scholarly journals Cap-assisted endoscopy: Do we have enough evidence?

2018 ◽  
Vol 06 (10) ◽  
pp. E1224-E1226 ◽  
Author(s):  
Thomas Frieling
Keyword(s):  
Clinical Practice ◽  
Detection Rate ◽  
Meta Analysis ◽  
Intubation Time ◽  
Polyp Detection ◽  
Cecal Intubation ◽  
Polyp Detection Rate ◽  
Adenoma Detection ◽  
Clinical Benefits ◽  
Transparent Cap

AbstractSo, is there enough evidence to incorporate CC in clinical practice? If we interpret the literature and the meta-analysis by Nutalapati et al., the answer for the clinically-focused endoscopist, with regard to adenoma detection rate (ADR), at present, may be “no”. Significant differences do not necessarily imply clinical benefits and translation into clinical practice. The answer for the improvement of cecal intubation frequency and intubation time by the cap depends on the focus of training commitment, because these effects of the cap may be beneficial, especially for unexperienced endoscopists. It is obvious that further studies are needed. In this line, it is interesting to know, that in a recent meta-analysis of prospective studies, the length of the transparent cap had opposite effects on investigation time and polyp detection rate. Whereas, the anal to cecal time was significantly shortened by a cap length of > 7 mm and a polyp detection rate was significantly improved by a cap length of < 4 mm.

Cuff-assisted versus cap-assisted colonoscopy for adenoma detection: results of a randomized study

Endoscopy ◽  
2019 ◽  
Vol 51 (08) ◽  
pp. 742-749 ◽  
Author(s):  
Javier Sola-Vera ◽  
Lourdes Catalá ◽  
Francisco Uceda ◽  
María Dolores Picó ◽  
Estefanía Pérez Rabasco ◽  
...  
Keyword(s):  
Detection Rate ◽  
Removal Rate ◽  
Randomized Study ◽  
Intubation Rate ◽  
Device Removal ◽  
Polyp Detection ◽  
Cecal Intubation ◽  
Polyp Detection Rate ◽  
Adenoma Detection ◽  
Cecal Intubation Rate

Abstract Background The adenoma detection rate (ADR) is the most important marker of colonoscopy quality. Devices to improve adenoma detection have been developed, such as the Endocuff and transparent cap. The aim of the current study was to examine whether there was a difference in ADR between Endocuff-assisted (EAC) and cap-assisted colonoscopy (CAC). Methods A randomized prospective trial was conducted. Eligible patients included adults ≥ 18 years referred because of symptoms, surveillance, or colonoscopies as part of the Bowel Cancer Screening Programme (BCSP). The primary outcome measure was ADR. Secondary outcomes included mean number of adenomas, mean number of polyps, polyp detection rate, cecal intubation rate, and time to cecal intubation. Procedural measures, device removal rate, and adverse events were also recorded. Results A total of 711 patients (51.1 % men; median age 63 years) were included, of whom 357 patients were randomized to EAC and 354 patients to CAC. In the intention-to-treat analysis, the ADR was similar in both groups: EAC 50.4 % (95 % confidence interval [CI] 45.1 – 55.7) vs. CAC 50.6 % (95 %CI 45.2 – 55.9). Similar results were obtained in the per-protocol analysis: EAC 51.6 % (95 %CI 46.2 – 57) vs. CAC 51.4 % (95 %CI 46 – 56.8). There were no differences between the two devices in ADR according to the mean number of adenomas and polyps per procedure, polyp detection rate, cecal intubation rate, and time to cecal intubation. Device removal rate and adverse events were also similar. Conclusion In this randomized study, no differences in ADR were found between Endocuff- and cap-assisted colonoscopy.

scholarly journals A108 ARE INPATIENTS STILL MORE LIKELY TO FAIL BOWEL PREPARATION IN THE SPLIT-DOSE ERA? FINDINGS FROM 47, 292 COLONOSCOPIES IN THE SOUTHWEST ONTARIO COLONOSCOPY COHORT

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 85-86
Author(s):  
M Sey ◽  
A Wong ◽  
C McDonald ◽  
E Y Liu ◽  
B Yan
Keyword(s):  
Bowel Preparation ◽  
Detection Rate ◽  
High Rate ◽  
Ordinal Scale ◽  
Polyp Detection ◽  
Split Dose ◽  
Polyp Detection Rate ◽  
Adenoma Detection ◽  
Inadequate Bowel Preparation ◽  
The Impact

Abstract Background Prior studies before the widespread use of split-dose bowel preparation have shown a high rate of inadequate bowel preparation in hospitalized patients. Whether this is still true in the era of split-dose bowel preparation is unknown. Aims To determine the impact of inpatient status on bowel preparation quality in the contemporary era of split-dose bowel preparation. Methods The Southwest Ontario Colonoscopy cohort consists of all inpatient and outpatient colonoscopies performed between April 2017 and Oct 2018 at 21 hospitals serving a large geographic health region. Procedures done in patients &lt; 18 years of age or by an endoscopist performing &lt;50 colonoscopies/year were excluded. Data were collected through a mandatory quality assurance form that was completed by the endoscopist after each procedure. Pathology reports were manually reviewed. The primary outcome was adequate bowel preparation, defined on an ordinal scale as “good” or “fair” rather than “poor”. Secondary outcomes included adenoma detection rate (ADR), sessile serrated polyp detection rate (ssPDR), polyp detection rate (PDR), and cecal intubation rate (CIR). Results A total of 47,292 colonoscopies were performed by 75 physicians (36.2% by gastroenterologists, 60% by general surgeons, 4% others), of which 1,690 were inpatients (3.6%). Inpatients were older (mean 66.8 years vs 60.2 years, p&lt;0.0001), more co-morbid (≥ASA grade 3, 53.6% vs 23.7%, p&lt;0.0001), performed for symptomatic indications (95.7% vs 48.6%, p&lt; 0.0001), have trainee involvement (47% vs 11.6% p&lt;0.001), and less likely to receive split-dose bowel preparation (71.7% vs 91.6% p&lt;0.001). On crude analysis, inpatients were less likely to have adequate bowel preparation (86.2% vs 97.6% p&lt;0.001). On multi-variable analysis, inpatients had lower odds of achieving adequate bowel preparation (OR=0.41, 95% CI 0.33 - 0.50, p&lt;0.001), lower ADR (OR=0.47, 95% CI 0.40 - 0.55, p&lt;0.001), lower PDR (OR=0.54, 95% CI 0.47 - 0.61 p&lt;0.001) and lower CIR (OR = 0.43, 95% CI 0.35 - 0.54, p&lt;0.001). Conclusions In the era of split-dose bowel preparation, inpatient status is still an important predictor of inadequate bowel preparation with resultant lower quality outcome metrics. Funding Agencies None

scholarly journals PROPOSED SCORE FOR THE SELF-ASSESSMENT OF AN ENDOSCOPY DEPARTMENT PERFORMANCE IN COLONOSCOPY SCREENING

2016 ◽  
Vol 90 (1) ◽  
pp. 28-32
Author(s):  
Ioan Sporea ◽  
Alina Popescu ◽  
Roxana Sirli ◽  
Oliviu Pascu ◽  
Cristina Cijevschi Prelipcean ◽  
...  
Keyword(s):  
Bowel Preparation ◽  
Detection Rate ◽  
Quality Parameter ◽  
Intubation Rate ◽  
Polyp Detection ◽  
Self Assessment ◽  
Cecal Intubation ◽  
Highest Weight ◽  
Polyp Detection Rate

The aim of the paper was to propose a score for performance evaluation in colonoscopy units.Method. We proposed a score (CDCD score - Cecal intubation, polyp Detection rate, Cleansing and Documentation of cecal intubation) based on the following parameters that  assess the quality of colonoscopy units: total colonoscopies rate, polyp detection rate, rate of cecal intubation photo record, rate of recorded Boston bowel preparation scale (BBPS) (rated 1 to 5 stars). The mean score obtained based on the above mentioned criteria was used as a quality parameter of the endoscopy unit.We  applied and calculated this score in all screening colonoscopies performed in our Endoscopy Department during the last 4 years.Results. The study group included 856 screening colonoscopies. The rate of total colonoscopies was 92.1% (789/856 cases) and the polyp detection rate was 23.9%. Regarding the quality of bowel preparation, the BBPS was recorded in 51.1% cases. The cecal intubation was photo recorded in 44% of cases.We considered that of the 4 parameters, the highest weight for an excellent quality belonged to the cecal intubation rate, followed by the polyp detection rate, because they evaluate the endoscopic technique, while the other 2 are more administrative. Thus, for the unit’s assessment we used the following equation: UNIT’S QUALITY CDCD SCORE = (3xcecal intubation rate+3xpolyp detection rate+1xphoto documentation+1xBBPS documentation)/8. Thus, the CDCD Score for our unit was ≈4 stars (3.7 stars).Conclusion. the proposed CDCD score may be an objective tool for the quality assessment in different endoscopy units. 

scholarly journals A117 PROPOFOL SEDATION DOES NOT IMPROVE MEASURES OF COLONOSCOPY QUALITY – FINDINGS FROM THE SOUTHWEST ONTARIO COLONOSCOPY COHORT

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 97-98
Author(s):  
M Sey ◽  
B Yan ◽  
Z Hindi ◽  
M Brahmania ◽  
J C Gregor ◽  
...  
Keyword(s):  
Detection Rate ◽  
Conscious Sedation ◽  
Intubation Rate ◽  
Polyp Detection ◽  
Cecal Intubation ◽  
Propofol Sedation ◽  
Serrated Polyp ◽  
Polyp Detection Rate ◽  
Cecal Intubation Rate ◽  
Colonoscopy Quality

Abstract Background The use of propofol during colonoscopy has gained increased popularity due to deeper anesthesia compared to conscious sedation. Prior studies examining the use of propofol sedation during colonoscopy have primarily focused on anesthesia outcomes. Whether propofol sedation is associated with improvements in colonoscopy outcomes is uncertain. Aims The primary outcome was adenoma detection rate (ADR). Secondary outcomes were the detection of any adenoma (conventional adenoma, sessile serrated polyp, and traditional serrated adenoma), sessile serrated polyp detection rate, polyp detection rate, cecal intubation rate, and perforation rate. Methods The Southwest Ontario Colonoscopy cohort consists of all patients who underwent colonoscopy between April 2017 and Oct 2018 at 21 hospitals serving a large geographic area in Southwest Ontario. Procedures performed in patients less than 18 years of age or by endoscopist who perform &lt;50 colonoscopies/year were excluded. Data were collected through a mandatory quality assurance form that was completed by the endoscopist after each procedure. Pathology reports were manually reviewed. Results A total of 46,634 colonoscopies were performed by 75 physicians (37.5% by gastroenterologists, 60% by general surgeons, 2.5% others) of which 16,408 (35.2%) received propofol and 30,226 (64.8%) received conscious sedation (e.g. combination of a benzodiazepine and a narcotic). Patients who received propofol were likely to have a screening indication (49.2% vs 45.5%, p&lt;0.0001), not have a trainee endoscopist present and be performed at a non-academic centre (32.2% vs 44.6%, p&lt;0.0001). Compared to conscious sedation, use of propofol was associated with a lower ADR (24.6% vs. 27.0%, p&lt;0.0001) and detection of any adenoma (27.7% vs. 29.8%, p&lt;0.0001); no difference was observed in the detection ofsessile serrated polyps (5.0% vs. 4.7%, p=0.26), polyp detection rate (41.2% vs 41.2%, p=0.978), cecal intubation rate (97.1% vs. 96.8%, p=0.15) or perforation rate (0.04% vs. 0.06%,p=0.45). On multi-variable analysis, the use of propofol was not significantly associated with any improvement in ADR (RR=0.90, 95% CI 0.74–1.10, p=0.30), detection of any adenoma (RR=0.93, 95% CI 0.75–1.14, p=0.47), sessile serrated polyp detection rate (RR=1.20, 95%CI 0.90–1.60, p=0.22), polyp detection rate (RR=1.00, 95% CI 0.90–1.11, p=0.99), or cecal intubation rate (RR=1.00, 95%CI 0.80–1.26, p=0.99). Conclusions The use of propofol sedation does not improve colonoscopy quality metrics. Funding Agencies None

scholarly journals A113 ANNUAL COLONOSCOPY VOLUME IS NOT PREDICTIVE OF COLONOSCOPY QUALITY - FINDINGS FROM THE SOUTHWEST ONTARIO COLONOSCOPY COHORT

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 92-93
Author(s):  
M Sey ◽  
O Siddiqi ◽  
C McDonald ◽  
S cocco ◽  
Z Hindi ◽  
...  
Keyword(s):  
Predictive Value ◽  
Detection Rate ◽  
Primary Outcome ◽  
Case Mix ◽  
Operating Characteristics ◽  
Polyp Detection ◽  
Cecal Intubation ◽  
Polyp Detection Rate ◽  
Secondary Outcomes ◽  
Colonoscopy Quality

Abstract Background Performing a minimum number of colonoscopies annually has been proposed by some jurisdictions as a requirement for maintaining privileges. However, this practice is supported by limited evidence. Aims The objective of this study was to determine if annual colonoscopy volume was associated with colonoscopy quality metrics. Methods A population-based study was performed using the Southwest Ontario Colonoscopy cohort, which consists of all adult patients who underwent colonoscopy between April 2017 and Oct 2018 at 21 academic and community hospitals within the health region. Data were collected through a mandatory quality assurance form completed after each procedure and pathology reports were manually reviewed. Physician annualized colonoscopy volumes were compared by correlation analysis to each quality-related outcome, by means of the area under the receiver operating characteristics curve (AUROC), and logistic regression. The prognostic value of colonoscopy volume was also adjusted for case-mix and potential confounders in separate regression analyses for each outcome. The primary outcome was ADR. Secondary outcomes were polyp detection rate (PDR), sessile serrated polyp detection rate (SSPDR), and cecal intubation. Results A total of 47,195 colonoscopies were performed by 75 physicians (37.5% by gastroenterologists, 60% by general surgeons, 2.5% others). There were no clear relationships between annual colonoscopy volumes and study outcomes. Colonoscopy volume was not associated with ADR (OR 1.03, 95% CI 0.96–1.10, p=0.48) and corresponded to an AUROC not significantly different from the null (AUROC 0.52, 95% CI 0.43–0.61, p=0.65). Multi-variable regression adjusting for case-mix also demonstrated no predictive value of annual colonoscopy volume for the primary outcome (OR 1.03, 95% CI 0.94–1.12, p=0.55). Similarly, analyses of secondary outcomes failed to find an association between colonoscopy volume and PDR, SSPDR, or cecal intubation (Table 1). Conclusions Annual colonoscopy volumes do not predict ADR, PDR, SSPDR, or cecal intubation rate. Results of unconditional and conditional approaches for examining the predictive value of annual colonoscopy volume for quality related outcomes. Funding Agencies None

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