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Colonoscopy Skill Score: Results of Expert Skill Testing
Abstracts
W1296 Diagnostic Utility of the ZAP Classification for Non-Erosive Reflux Disease (NERD), Using Distal Esophageal Biopsy Beom Jin Kim, Poong-Lyul Rhee, Jung Won Yun, Eaum-Seok Lee, Hyuk Lee, Jun Haeng Lee, Young-Ho Kim, Jae J. Kim, Jong Chul Rhee, Ji Hoon Kim Background/aim: It has been reported that the Z-line appearance (the ZAP grade) was correlated with the prevalence of intestinal metaplasia. This study was performed to investigate whether there is any correlation between the ZAP grade and the histology. Methods: We studied 80 consecutive young male patients with typical symptoms of GERD (heartburn and acid regurgitation).The symptom characteristics were collected by interviewing with a structured questionnaire. Upper GI endoscopy was performed to determine the ZAP grade and LA classification. Biopsies were taken at 2 cm above the Z-line and upper body of the stomach. Microscopic esophagitis was identified by more than one of the following findings; necrosis/erosion, neutrophil/eosinophil intraepithelial infiltration, basal cell hyperplasia, elongation of papillae, dilation of intercellular spaces. Idenfication of H.pylori and intestinal metaplasia of stomach were also evaluated. Results: Correlation was significant between the ZAP score and the LA classification (Spearman correlation factor: 0.463)There were significant differences in the ZAP grade between the non-erosive reflux disease (NERD) group and the erosive reflux disease (ERD) group (p ! 0.05).There were no significant differences in the severity, duration and frequency of symptom according to the ZAP score. Microscopic esophagitis were found in 13 of 48 patients (27.0%) with NERD (ZAP negative) and in 9 of 32 patients (28.1%) with ERD (ZAP positive) but no statistical significance was observed between the ZAP score and the histology.There were significant differences in the H.pylori infection according to the ZAP score (p ! 0.05). Intestinal metaplasia of gastric mucosa was found in only 1 patient with ERD. Conclusion: The ZAP classification could be applied to diagnosis of GERD, especially NERD. Biopsy taken at distal esophagus can be a limited but useful diagnostic tool, particularly in young patients with NERD.
and factor analysis indicated that time to cecum, drug dosages, and pain scores were independent components that when taken together, reflect the skill of the endoscopist. Conclusion: Our results demonstrate that expert colonoscopy skill can be quantified easily, reproducibly and reliably using readily obtained variables. This study forms the basis of the use of this tool to assess trainee skill that will further establish the reliability and construct validity of the colonoscopy skill score.
W1298 Use of Powder PEG-3350 As a Sole Bowel Preparation Manish Arora, Patrick I. Okolo III Objective: To assess the efficacy of low volume powder PEG-3350 as sole bowel preparation for colonoscopy. Methods: This is case series of 245 patients who underwent colonoscopy at a hospital endoscopy center in last 2 years. All the study group patients comprising of mix of inpatients and outpatients received powder PEG-3350 (Miralax, Braintree Laboratory Inc.) in the amount of 204 grams dissolved in 16-32 oz of water and to be taken in 3 divided doses 1 hour apart with 8 oz of water in between the doses. A previously utilized Colon Prep Scoring (CPS) was applied for assessing the qulaity of colon preparation in the study group. The results obtained from 245 subjects were collated and compared to the historical control of sodium phosphate (Fleet Phospho-soda). Results:The mean CPS score was calculated to be 3.43 with a standard deviation of 1.12. 192 subjects had the excellent colon cleansing and were graded as 4 on CPS, where as 5 subjects had incomplete colonoscopies secondary to failure of bowel preparation (CPS Z 0). Among the rest, 22 and 26 subjects were assigned as poor (CPS Z 1) and fair (CPS Z 2) bowel preparations. No serious side effects were noticed in the study population and patients were satisfied using this low volume bowel preparation. Conclusion:The low volume powder PEG-3350 formula used in our case series has shown impressive colon cleansing and can be used as a sole bowel preparation. Though, we recognize many limitations of our case series, the paucity of reports in the literature prompts consideration of this data as indicator that the powder PEG3350 formula can be utilized for colonoscopy preparation in adult population.
W1297 Colonoscopy Skill Score: Results of Expert Skill Testing Jessica D. Korman, Lawrence J. Brandt, Gustavo A. Marino, Louis Y. Korman Background: Several skill indicators are used informally as part of colonoscopy training assessment; however, these indicators have not been systematically quantified. Surveys of endoscopists, nurses, and trainees suggested that colonoscopy skill could be assessed by measuring time to cecum, narcotic and anxiolytic dose, and pain during colonoscopy. Objective: The goal of the present study is to test those variables as reflecting the skill of the expert colonoscopist and to establish a survey tool for quantifying skill to be used for training purposes. Methods: Nine expert endoscopists working at hospital outpatient and ambulatory endoscopy centers each performed up to 10 consecutive screening colonoscopies. A total of 70 colonoscopies were performed. For each colonoscopy, the following variables were recorded: time to cecum, anxiolytic and narcotic drug dosage, and pain assessment as determined by the colonoscopist, nurse and patient. The measurements were normalized by assigning point values and then combined into a single ‘‘colonoscopy skill score.’’ Results: The mean age of the patient was 62.5 years 8.4 (range Z 49-80 years). Forty seven percent were female and 53% were male. The mean colonoscopy skill score was 8.4 3.0 (range Z 4-21). The skill score followed a normal distribution. The Cronbach’s a, a measure of survey reliability, was 0.76 demonstrating internal consistency. The mean time to the cecum was 8.7 4.6 minutes (range Z 3-24 minutes). The mean dose of meperidine was 46.9 15.5 mg (range Z 20-100 mg). The mean dose of midazolam was 3.0 1.3 mg (range Z 2-9 mg). The mean dose of fentanyl was 118.0 23.8 mcg (range Z 100-150 mcg). Pain was measured on a scale of 0-3 (0 Z none, 1 Z mild, 2 Z moderate, 3 Z severe). The mean pain rating as assessed by the colonoscopists was 0.5 0.7 (range Z 0-3), by the nurse was 0.6 0.7 (range Z 0-2), and by the patient was 0.4 0.7 (range Z 0-3). Correlation
www.giejournal.org
Volume 65, No. 5 : 2007 GASTROINTESTINAL ENDOSCOPY AB327
W1296 Diagnostic Utility of the ZAP Classification for Non-Erosive Reflux Disease (NERD), Using Distal Esophageal Biopsy Beom Jin Kim, Poong-Lyul Rhee, Jung Won Yun, Eaum-Seok Lee, Hyuk Lee, Jun Haeng Lee, Young-Ho Kim, Jae J. Kim, Jong Chul Rhee, Ji Hoon Kim Background/aim: It has been reported that the Z-line appearance (the ZAP grade) was correlated with the prevalence of intestinal metaplasia. This study was performed to investigate whether there is any correlation between the ZAP grade and the histology. Methods: We studied 80 consecutive young male patients with typical symptoms of GERD (heartburn and acid regurgitation).The symptom characteristics were collected by interviewing with a structured questionnaire. Upper GI endoscopy was performed to determine the ZAP grade and LA classification. Biopsies were taken at 2 cm above the Z-line and upper body of the stomach. Microscopic esophagitis was identified by more than one of the following findings; necrosis/erosion, neutrophil/eosinophil intraepithelial infiltration, basal cell hyperplasia, elongation of papillae, dilation of intercellular spaces. Idenfication of H.pylori and intestinal metaplasia of stomach were also evaluated. Results: Correlation was significant between the ZAP score and the LA classification (Spearman correlation factor: 0.463)There were significant differences in the ZAP grade between the non-erosive reflux disease (NERD) group and the erosive reflux disease (ERD) group (p ! 0.05).There were no significant differences in the severity, duration and frequency of symptom according to the ZAP score. Microscopic esophagitis were found in 13 of 48 patients (27.0%) with NERD (ZAP negative) and in 9 of 32 patients (28.1%) with ERD (ZAP positive) but no statistical significance was observed between the ZAP score and the histology.There were significant differences in the H.pylori infection according to the ZAP score (p ! 0.05). Intestinal metaplasia of gastric mucosa was found in only 1 patient with ERD. Conclusion: The ZAP classification could be applied to diagnosis of GERD, especially NERD. Biopsy taken at distal esophagus can be a limited but useful diagnostic tool, particularly in young patients with NERD.
and factor analysis indicated that time to cecum, drug dosages, and pain scores were independent components that when taken together, reflect the skill of the endoscopist. Conclusion: Our results demonstrate that expert colonoscopy skill can be quantified easily, reproducibly and reliably using readily obtained variables. This study forms the basis of the use of this tool to assess trainee skill that will further establish the reliability and construct validity of the colonoscopy skill score.
W1298 Use of Powder PEG-3350 As a Sole Bowel Preparation Manish Arora, Patrick I. Okolo III Objective: To assess the efficacy of low volume powder PEG-3350 as sole bowel preparation for colonoscopy. Methods: This is case series of 245 patients who underwent colonoscopy at a hospital endoscopy center in last 2 years. All the study group patients comprising of mix of inpatients and outpatients received powder PEG-3350 (Miralax, Braintree Laboratory Inc.) in the amount of 204 grams dissolved in 16-32 oz of water and to be taken in 3 divided doses 1 hour apart with 8 oz of water in between the doses. A previously utilized Colon Prep Scoring (CPS) was applied for assessing the qulaity of colon preparation in the study group. The results obtained from 245 subjects were collated and compared to the historical control of sodium phosphate (Fleet Phospho-soda). Results:The mean CPS score was calculated to be 3.43 with a standard deviation of 1.12. 192 subjects had the excellent colon cleansing and were graded as 4 on CPS, where as 5 subjects had incomplete colonoscopies secondary to failure of bowel preparation (CPS Z 0). Among the rest, 22 and 26 subjects were assigned as poor (CPS Z 1) and fair (CPS Z 2) bowel preparations. No serious side effects were noticed in the study population and patients were satisfied using this low volume bowel preparation. Conclusion:The low volume powder PEG-3350 formula used in our case series has shown impressive colon cleansing and can be used as a sole bowel preparation. Though, we recognize many limitations of our case series, the paucity of reports in the literature prompts consideration of this data as indicator that the powder PEG3350 formula can be utilized for colonoscopy preparation in adult population.
W1297 Colonoscopy Skill Score: Results of Expert Skill Testing Jessica D. Korman, Lawrence J. Brandt, Gustavo A. Marino, Louis Y. Korman Background: Several skill indicators are used informally as part of colonoscopy training assessment; however, these indicators have not been systematically quantified. Surveys of endoscopists, nurses, and trainees suggested that colonoscopy skill could be assessed by measuring time to cecum, narcotic and anxiolytic dose, and pain during colonoscopy. Objective: The goal of the present study is to test those variables as reflecting the skill of the expert colonoscopist and to establish a survey tool for quantifying skill to be used for training purposes. Methods: Nine expert endoscopists working at hospital outpatient and ambulatory endoscopy centers each performed up to 10 consecutive screening colonoscopies. A total of 70 colonoscopies were performed. For each colonoscopy, the following variables were recorded: time to cecum, anxiolytic and narcotic drug dosage, and pain assessment as determined by the colonoscopist, nurse and patient. The measurements were normalized by assigning point values and then combined into a single ‘‘colonoscopy skill score.’’ Results: The mean age of the patient was 62.5 years 8.4 (range Z 49-80 years). Forty seven percent were female and 53% were male. The mean colonoscopy skill score was 8.4 3.0 (range Z 4-21). The skill score followed a normal distribution. The Cronbach’s a, a measure of survey reliability, was 0.76 demonstrating internal consistency. The mean time to the cecum was 8.7 4.6 minutes (range Z 3-24 minutes). The mean dose of meperidine was 46.9 15.5 mg (range Z 20-100 mg). The mean dose of midazolam was 3.0 1.3 mg (range Z 2-9 mg). The mean dose of fentanyl was 118.0 23.8 mcg (range Z 100-150 mcg). Pain was measured on a scale of 0-3 (0 Z none, 1 Z mild, 2 Z moderate, 3 Z severe). The mean pain rating as assessed by the colonoscopists was 0.5 0.7 (range Z 0-3), by the nurse was 0.6 0.7 (range Z 0-2), and by the patient was 0.4 0.7 (range Z 0-3). Correlation
www.giejournal.org
Volume 65, No. 5 : 2007 GASTROINTESTINAL ENDOSCOPY AB327