The Impact of Face Shields on the Quality of Colonoscopy During the COVID-19 Pandemic

Background: The coronavirus disease 2019 (COVID-19) has become a global pandemic. Healthcare workers are at a higher risk for exposure to COVID-19 infection than the general population. During the COVID-19 pandemic, endoscopists are recommended to wear personal protective equipment (PPE), including face shields, to prevent COVID-19 transmission. However, to the best of our knowledge, there are no reports on the impact of face shields on the quality of colonoscopy. This study aimed to determine whether the use of PPE, including face shields, affects the quality of colonoscopy during the COVID-19 pandemic.Methods: We retrospectively reviewed the medical records of patients who underwent screening or surveillance colonoscopy performed at Dong-A University Hospital between June 2020 and March 2021 during the COVID-19 pandemic. Endoscopists wore isolation gowns, disposable gloves, and KF94 masks from June 2020 to October 2020. From November 2020, endoscopists additionally wore face shields. Therefore, we compared the colonoscopy quality indicators during the 5 months without the use of face shields and the 5 months with the use of face shields. We calculated the overall adenoma detection rates (ADRs) of the group using face shields and the group not using face shields. Further, the polyp detection rate (PDR), sessile serrated lesion detection rate (SSLDR), advanced neoplasia detection rate (ANDR), polyp per colonoscopy, and adenoma per colonoscopy were calculated for each group.Results: In total, 1,359 patients were included in the study; the face shield and non-face shield groups comprised 679 and 680 patients, respectively. We found no statistically significant differences in the PDR (49.04 vs. 52.50%, p=0.202), ADR (38.59 vs. 38.97%, p=0.884) SSPDR (1.91 vs. 1.32%, p=0.388), and ANDR (3.98 vs. 3.97%, p=0.991) between the groups. In both the experienced endoscopist group and trainee endoscopist group, there was no difference in the colonoscopy quality indicators between the groups of patients examined by endoscopists with and without face shields.Conclusions: The quality indicators of colonoscopy were not affected by face shields during the COVID-19 pandemic.

Is it time we split bowel preparation for all colonoscopies? Outcomes from a national survey of bowel preparation practice in the UK

IntroductionAdequate bowel preparation is a prerequisite for effective colonoscopy. Split bowel preparation results in optimal cleansing. This study assessed the bowel preparation regimes advised by endoscopy units across the UK, and correlated the differences with outcomes.MethodsTrusts in the UK were surveyed, with data requested between January 2018 and January 2019, including: the type and timing of preparation, pre-endoscopy diet, adequacy rates and polyp detection. Trusts were grouped according to the timing of bowel preparation. χ2 test was used to assess for differences in bowel preparation adequacy.ResultsMoviprep was the first line bowel preparation in 79% of trusts. Only 7% of trusts advised splitting bowel preparation for all procedures, however, 91% used split bowel preparation for afternoon procedures. Trusts that split preparation for all procedures had an inadequacy rate of 6.7%, compared with 8.5% (p<0.001) for those that split preparation for PM procedures alone and 9.5% (p<0.001) for those that provided day before preparation for all procedures. Morning procedures with day-before preparation had a higher rate of inadequate cleansing than afternoon procedures that received split preparation (7.7% vs 6.5 %, p<0.001). The polyp detection rate for procedures with adequate preparation was 37.1%, compared with 26.4% for those that were inadequate.ConclusionMost trusts in the UK do not provide instructions optimising the timing of bowel preparation prior to colonoscopy. This correlated with an increased rate of inadequate cleansing. Splitting bowel preparation is likely to reduce the impacts of poor cleansing: missed lesions, repeat colonoscopies and significant costs.

SP2.2.16Hospital compound level endoscopy training quality performance: scoping the spectrum

Aims This study aimed to assess the quality of endoscopy training in a single UK Statutory Educational Body (SEB), related to individual hospitals,compared with the Joint Advisory Group on Gastrointestinal Endoscopy Training (JETS) certification standards. Methods Training procedures numbering 28,928 recorded by 211 consecutive cross-specialty trainee endoscopists registered with JETS in18 hospitals during 2019were analysed. Data included trainer and trainee numbers, training list frequency, procedures, Direct Observation of Procedural Skills (DOPS) completion and Key Performance Indicators (KPI). Results Annual median training procedures per hospital were 1395 (interquartile range (IQR) 465-2365). Median (IQR) trainers and trainees per unit were 11 (6-18) and 12 (7-16) respectively (ratio 0.8 (0.7-1.3)). Annual training list frequency per trainee was 13 (10-17), 35.0% short of JAG standard (n = 20, p = 0.001, effect size -0.56), and median points per adjusted training list were 11 (5-18). Median DOPS completion per trainee and trainer were 3 (1-6) and 4 (1-7) respectively; completing 0.2 DOPS (0.1-0.4) per list and amounting to 6 (2-12) per 200 procedures: less than half of the JAG standard (p &lt; 0.001, -0.61). Median KPI for OGD: J Manoeuvre 94% (90-96), D2 intubation was 93% (91-96); and for Colonoscopy: Caecal intubation 82% (72-90), and Polyp Detection Rate 25% (18-34). Compound hospital training quality score varied 3-fold, the highest performing hospital scoring 26; compared to the poorest performing scoring 9: median 17 (14-20). Conclusion Important variation in endoscopy unit performance were apparent with compound hospital training quality varying almost 3-fold. Trainees, Training Programme Directors alike, should be aware of such data when planning educational programmes to focus, optimise the quality of endoscopic training.

SP1.1.11Is polyp detection rate a suitable surrogate measure for adenoma detection rate in colonoscopy?

Aims The Joint Advisory Group on GI Endoscopy (JAG) has set key quality indicators for colonoscopy, which includes an adenoma detection rate of a minimum of 15%. Given the difficulty in reporting adenoma detection rate, JAG have stated that polyp detection rate is accepted as a surrogate measure. Our aim was to assess whether polyp detection rate can be used as a substitute marker for adenoma detection, by examining the histology of samples taken as polyps to determine what proportion are truly adenomas. Methods The pathology department provided a registry of all histological samples taken from the colon or rectum during a one-year period April 2017 to April 2018. These samples were cross-referenced with the endoscopy report to assess which were identified as “polyps” by the performing endoscopist. The pathology report was then reviewed to determine what the histological conclusion was for each “polyp”. Results A total of 1601 colorectal histology samples were reviewed, taken by 32 different endoscopists. 451 of these were identified as polyps by the performing endoscopist. On histological review 153 (33.9%) were not adenomas of the colon or rectum. Common alternative histological diagnoses were hyperplastic polyp, inflammatory polyp and normal tissue. Rarer alternative histological diagnoses were melanosis coli, submucosal leiomyoma and endometriosis of the rectum. Conclusions Polyp detection rate which is used as a surrogate marker for adenoma detection rate is an inaccurate measure of colonoscopy quality.

Polyethylene Glycol Plus Linaclotide is an Effective Bowel Preparation Regimen for Patients with Bristol Stool Scale 1-2: a Randomized Controlled Trial

Background: To evaluate the effect of using linaclotide as an adjunctive agent with 3L polyethylene glycol (PEG) for bowel preparation among patients with Bristol stool form (BSFS) 1-2. Methods: Patients with BSFS 1-2 randomly received either 3L PEG (group A) or linaclotide plus 3L PEG (group B), patients with BSFS 3-7 received 3L PEG (group C) for bowel preparation. The primary outcome was the rate of adequate bowel preparation. The secondary endpoints were the polyp detection rate (PDR), acceptability and tolerability. Results: A total of 315 patients who underwent colonoscopy were enrolled. In per-protocol analysis, patient in group B attained significantly satisfactory bowel preparation rate than group A (77.9% vs 61.8%, PAB=0.049). The PDR in group B was significantly higher than group A (32.7% vs 15.7%, PAB=0.004), especially in rectosigmoid (25.0% vs 8.8%, PAB=0.002). Conclusion: 3L PEG plus 290ug Linaclotide can significantly improve the quality of bowel preparation and the colorectal polyps detection rate in patients with BSFS 1-2. The bowel preparation regimens is an effective and well-tolerated bowel preparation regimen.Trial registration: The study was registered at Chinese ClinicalTrials.gov (ChiCTR2100050437, 27/8/2021)

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

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.

Comparison of Indocyanine Green Angiography and Optical Coherence Tomography Angiography for Polypoidal Choroidal Vasculopathy

Purpose: To assess the diagnostic value of optical coherence tomography angiography (OCTA), and the factors affecting the diagnosis of polypoidal choroidal vasculopathy (PCV) by OCTA and indocyanine green angiography (ICGA). Methods: The numbers and area of polyps, and the presence and area of a branched vascular network (BVN) as revealed by ICGA and OCTA, were retrospectively analyzed in 43 patients with active PCV. The patients were divided into two groups according to whether the number of polyps matched between the two methods: group 1, equal number of polyps revealed by ICGA and OCTA; group 2, different number of polyps revealed by ICGA and OCTA. Results: In 43 PCV patients, the total number of polyps was 1.47 ± 0.83 in ICGA and 1.07 ± 0.91 in OCTA (<i>p</i> < 0.001), and the polyp area was 0.27 ± 0.42 mm² in ICGA and 0.17 ± 0.15 mm² in OCTA (<i>p</i> = 0.023). BVN was found in 33 eyes (76.7%) by ICGA and 29 eyes (67.4%) by OCTA (<i>p</i> < 0.001). The BVN area was 3.61 ± 2.59 mm² in ICGA and 2.74 ± 2.76 mm² in OCTA (<i>p</i> = 0.002). Central retinal thickness and central choroidal thickness were significantly greater in group 2 than group 1 (<i>p</i> < 0.001, respectively). Subretinal fluid (SRF) (<i>p</i> = 0.009) and subretinal hemorrhage (SRH) (<i>p</i> = 0.005) were significantly more prevalent in group 2 than group 1. Polyp height (<i>p</i> = 0.022) and diameter (<i>p</i> = 0.042) were significantly greater in group 2 than group 1. Conclusions: OCTA is a supplementary diagnostic technique for detecting PCV. The presence of SRF and SHR, and large polyp height and diameter, were associated with the polyp detection rate of OCTA for PCV.