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Su1519 Colonoscopy Prep Movie Increases Quality of Colon Prep, With Many Secondary Benefits
Abstracts
Previous Author/
Age/
Duration
Indication for
Cultured
Prophylaxis
History of Peritonitis
Reference
Sex
of CAPD
Colonoscopy
Polypectomy
Infection
Microorganism(s)
Given
Noted
Holley
69/F
__
Positive Hemoccult
+
24 hrs
E. coli
-
-
(1987) Sprenger
54/F
1 year
Positive Hemoccult
+
72 hrs
Enterococcus
+*
-
(1987) Ray (1990)
65/F
__
Rectal bleeding
+
24 hrs
Nonfragilis Bacteroides (4
+**
-
-
-
E. coli
-
+
E. coli K. oxytocea
-
-
-
-
Bac (1994)
51/F
4 years
Fecal blood loss
+
Time to
24 hrs
species) P. asaccharolyticus B. disens B. ureolyticus
Poortviet [1] (2010)
67/F
4 years
Rectal bleeding
+
48 hrs
Poortviet [2]
73/ M
\“years\”
Rectal bleeding
+
48 hrs
(2010) Lin (2012)
53/F
4 years
History of colonic
+
polyps and elevated CEA
24 hrs
Enterococcacea E. coli K. pneumoniae E. faecalis
*Intraperitoneal cephalothin; **Intravenous vancomycin and gentamycin
Su1518 Study to Validate a New Practical and Simplified Colonoscopy Bowel Preparation Scale Tanvi Khurana*, Justin B. Herman, Mitchell Conn, Howard Kroop, Jorge Prieto, Leo Katz, Louis Broad, Marianne T. Ritchie, Robert M. Coben, Constantine Daskalakis, Rebecca Matro, Paul Alves, Ramez Issa, David M. Kastenberg Thomas Jefferson University Hospital, Philadelphia, PA Background: Determining preparation adequacy for colonoscopy has important ramifications. A recent multi-society (AGA, ASGE, ACG) task force on bowel preparation recommended adequacy be assessed based on the ability to detect polyps O5mm and comply with surveillance and screening guidelines post-colonoscopy. Aim To validate a 2-category scale (Adequate/Inadequate) for colon cleansing defining Adequate as: 1) polyps R 5 mm can be detected anywhere in the colon, and 2) the interval to the next colonoscopy not be shortened due to the preparation quality. Secondarily, we validated a 3-category scale consisting of Excellent (Adequate with little suctioning/flushing), Good (Adequate with a lot of suctioning/flushing), and Inadequate. Methods: Eighty de-identified complete colonoscopies were videotaped. Eight readers participated, each GI board certified and completed O10,000 colonoscopies. Readers completed a pre-study session where the protocol, and Adequate (Good and Excellent) and Inadequate videos (not part of the final 80 study videos) were reviewed. Grading was based on optimal cleansing achieved on withdrawal. Readers read 40 cases total; each colonoscopy was read by 4 readers. Reader panels (comprised of a combination of 4 of the 8 participating readers assigned to each case) were randomized. Readers read assigned cases twice, 4 weeks apart. At each time point, assigned cases were read in a predetermined randomized order. We used percent agreement and the kappa statistic to quantify intra- and inter-reader agreement for the 2-category (Adequate/Inadequate) and 3-category (Excellent, Good, or Inadequate) classifications. Results: There were 320 readings total at each of the two time-points. For the 2-category scale, intra-reader agreement across the 8 readers ranged from 63% to 98% (median Z 81%) and kappa ranged from 0.25 to 0.88 (median Z 0.54). Grading varied significantly across the 8 readers (Adequate ranged from 50% to 98%, p Z 0.001). For the 2-category scale, overall interreader kappa was 0.35 for the 1st reading and 0.26 for the 2nd reading. Intra- and inter-reader reliability of the 3-category scale was generally lower than that of the 2-category (intra-reader kappa median Z 0.36; inter-reader kappa: 0.27 for first reading, 0.15 for second reading). Conclusions: A grading scale that discriminates Adequate from Inadequate colon cleansing based on the ability to detect polyps R 5 mm and the effect on the recommendation for screening or surveillance interval appropriate to the findings on colonoscopy has moderate intra-observer and fair inter-observer agreement. While significantly better than chance, agreement was substantially lower than the priori target of 0.70. For the 3-category scale, intra- and inter-agreement was fair to slight. Neither scale may be appropriate for clinical practice.
Su1519 Colonoscopy Prep Movie Increases Quality of Colon Prep, With Many Secondary Benefits Jesse Lachter*1,2, Eugene Pahk1, Eliza Shackelford1 1 Gastroenterology, Rambam Health Care Campus, Technion, Haifa, Israel; 2Meuhedet Health Care, Haifa, Israel
resources. Non-adherence of patients to written and oral prep instructions are potential causes of poor preps. A DDW2014 presentation by others found a prep movie somewhat useful, but nearly 40% of subjects handed a DVD for colonoscopy prep did not actually watch the DVD. Aim: To increase adherence to prep instructions, a movie was produced, and shown to subjects, supplementing oral and on-paper instructions. Methods: 40 consecutive patients were asked to watch a movie detailing the prep, administered immediately following physician visit, comprising the experimental group. Exclusion criteria: non-consenting patients. Another 80 consecutive patients’ colonoscopies served as the control group. A secretary or student administered the movie and then a feedback form. Procedures were all performed by a single endoscopist. The study was blinded, the endoscopist not receiving information as to which patients saw the movie. Data analysis included demographics, feedback from those watching the movie, and data on the quality of the prep, using the 9-point validated Boston Prep scale. The local IRB approved the study. An institutional medical statistician determined the sample size by power analysis, and helped with the statistical interpretations. A health literacy expert reviewed the movie for understandability. The movie showed the endoscopist and a nurse explaining the prep using ASGE guidelines. Results: The patients who saw the movie had significantly better preps on average: Boston prep scale scores were 7.8 vs. 6.4 (p!0.01). Viewers overwhelmingly described the movie as informative, easy to understand and helpful and that they would recommend seeing the movie to others. 92% of patient who had previously undergone colonoscopy wrote that instructions were more clear with the movie than without. Patients said that they’d like to see it again at home or on youtube. Discussion: Secondary benefits included 1- medicolegal: in the movie patients were carefully warned of side-effects of the prep, and of the risk of missing polyps. 2- Informed consent process was thus reinforced. 3- The time saved and 4- burnout prevented by having the endoscopist relieved of saying some of the prep instructions to patients was appreciable. 6- Five patients offered that they felt less anxiety/fear after watching the movie. Limitations: the various preps used suggest need for a variety of movies. Conclusion: The ASGE is urged, based on these preliminary highly beneficial results of using a prep movie, to facilitate/produce high-quality colonoscopy prep movies.
Su1520 The Effect of Fiber-Free Diet and Splitting the Dose of a Low Volume Polyethylene Glycol Electrolyte Solution on the Quality of Colonoscopy Preparation Assaad M. Soweid*, Khabib Dgayli Internal Medicine, American University of Beirut, Beirut, Lebanon Background: For colonoscopy preparation, splitting the dose of Polyethylene Glycol-Electrolyte Solution (PEG-ES) into two doses or liberalizing the diet from clear fluid (CFD) to fiber free (FFD) has been shown to enhance tolerability and improve colonoscopy preparation quality. MoviprepÒ is a new low-volume PEG-ES solution containing PEG 3350, ascorbic acid, and sodium sulphate. It allows for the reduction of the total amount of PEG-ES consumed from 4 to 2 liters. Aim: We aimed to compare the effect of the split dose of this preparation (with or without FFD) to that of a single dose (with or without FFD). Methods: This is a singlecenter, randomized, prospective, single-blinded study. A total of 219 consecutive patients undergoing colonoscopy were randomized to one of four groups: single dose PEG-ES with CFD [CF (NZ55)], single dose PEG-ES with FFD [FF (NZ55)], split dose PEG-ES with CFD [Split CF (NZ55)], and split dose with FFD [Split FF (NZ54)]. Demographics and tolerability data were collected by a survey interview prior to the colonoscopy. The quality of colonoscopy preparation was determined by the blinded endoscopist. Results: Tolerance to the preparation was similar with no statistically significant difference in terms of side effects, subjective difficulty, effect on daily activity, or amount of PEG-ES consumed among the four groups. The quality of the colonoscopy preparation was significantly better (p ! 0.05) when the diet was liberalized from CFD to FFD in a single dose setting (43.6% satisfactory preparations in CF vs. 80% in FF), when the dose of PEG-ES was split while maintaining a CFD (43.6% in CF vs. 90.9% in Split CF), or when both liberalizing the diet to FFD and splitting the dose were combined (43.6% in CF vs. 98.1% in Split FF). Moreover, splitting the dose of the PEG-ES while maintaining a FFD significantly improved the quality of colon cleanliness (80% in FF vs. 98.1% in Split FF, p! 0.05). Liberalizing the diet to FFD while maintaining a split dose of PEG-ES was associated with an improvement in the number of satisfactory bowel preparations but with no statistical significance (90.9% in Split CF vs. 98.1% in Split FF, p O 0.05) (fig 1). Finally, the total adenoma detection rate of the study was 39.27% without significant difference among the study groups. Conclusions: FFD given with a single dose of the low volume PEG-ES on the day before the procedure was more effective than CLD for colonoscopy preparation. Moreover, splitting the dose of the low volume PEG-ES was shown to be superior to using a single dose in terms of cleanliness of colonoscopy preparation regardless of the diet. Splitting the dose of the PEG-ES while liberalizing the diet to FFD was shown to be non-inferior to splitting the dose of PEG-ES with a CLD.
Introduction: Suboptimal bowel preparation (prep) often significantly reduces the quality of colonoscopies. Suboptimal preps have been associated with decreased adenoma detection and subsequent increased interval cancers. After suboptimal preps, guidelines recommend earlier repeat colonoscopies, leading to a waste of
www.giejournal.org
Volume 81, No. 5S : 2015 GASTROINTESTINAL ENDOSCOPY AB313
Previous Author/
Age/
Duration
Indication for
Cultured
Prophylaxis
History of Peritonitis
Reference
Sex
of CAPD
Colonoscopy
Polypectomy
Infection
Microorganism(s)
Given
Noted
Holley
69/F
__
Positive Hemoccult
+
24 hrs
E. coli
-
-
(1987) Sprenger
54/F
1 year
Positive Hemoccult
+
72 hrs
Enterococcus
+*
-
(1987) Ray (1990)
65/F
__
Rectal bleeding
+
24 hrs
Nonfragilis Bacteroides (4
+**
-
-
-
E. coli
-
+
E. coli K. oxytocea
-
-
-
-
Bac (1994)
51/F
4 years
Fecal blood loss
+
Time to
24 hrs
species) P. asaccharolyticus B. disens B. ureolyticus
Poortviet [1] (2010)
67/F
4 years
Rectal bleeding
+
48 hrs
Poortviet [2]
73/ M
\“years\”
Rectal bleeding
+
48 hrs
(2010) Lin (2012)
53/F
4 years
History of colonic
+
polyps and elevated CEA
24 hrs
Enterococcacea E. coli K. pneumoniae E. faecalis
*Intraperitoneal cephalothin; **Intravenous vancomycin and gentamycin
Su1518 Study to Validate a New Practical and Simplified Colonoscopy Bowel Preparation Scale Tanvi Khurana*, Justin B. Herman, Mitchell Conn, Howard Kroop, Jorge Prieto, Leo Katz, Louis Broad, Marianne T. Ritchie, Robert M. Coben, Constantine Daskalakis, Rebecca Matro, Paul Alves, Ramez Issa, David M. Kastenberg Thomas Jefferson University Hospital, Philadelphia, PA Background: Determining preparation adequacy for colonoscopy has important ramifications. A recent multi-society (AGA, ASGE, ACG) task force on bowel preparation recommended adequacy be assessed based on the ability to detect polyps O5mm and comply with surveillance and screening guidelines post-colonoscopy. Aim To validate a 2-category scale (Adequate/Inadequate) for colon cleansing defining Adequate as: 1) polyps R 5 mm can be detected anywhere in the colon, and 2) the interval to the next colonoscopy not be shortened due to the preparation quality. Secondarily, we validated a 3-category scale consisting of Excellent (Adequate with little suctioning/flushing), Good (Adequate with a lot of suctioning/flushing), and Inadequate. Methods: Eighty de-identified complete colonoscopies were videotaped. Eight readers participated, each GI board certified and completed O10,000 colonoscopies. Readers completed a pre-study session where the protocol, and Adequate (Good and Excellent) and Inadequate videos (not part of the final 80 study videos) were reviewed. Grading was based on optimal cleansing achieved on withdrawal. Readers read 40 cases total; each colonoscopy was read by 4 readers. Reader panels (comprised of a combination of 4 of the 8 participating readers assigned to each case) were randomized. Readers read assigned cases twice, 4 weeks apart. At each time point, assigned cases were read in a predetermined randomized order. We used percent agreement and the kappa statistic to quantify intra- and inter-reader agreement for the 2-category (Adequate/Inadequate) and 3-category (Excellent, Good, or Inadequate) classifications. Results: There were 320 readings total at each of the two time-points. For the 2-category scale, intra-reader agreement across the 8 readers ranged from 63% to 98% (median Z 81%) and kappa ranged from 0.25 to 0.88 (median Z 0.54). Grading varied significantly across the 8 readers (Adequate ranged from 50% to 98%, p Z 0.001). For the 2-category scale, overall interreader kappa was 0.35 for the 1st reading and 0.26 for the 2nd reading. Intra- and inter-reader reliability of the 3-category scale was generally lower than that of the 2-category (intra-reader kappa median Z 0.36; inter-reader kappa: 0.27 for first reading, 0.15 for second reading). Conclusions: A grading scale that discriminates Adequate from Inadequate colon cleansing based on the ability to detect polyps R 5 mm and the effect on the recommendation for screening or surveillance interval appropriate to the findings on colonoscopy has moderate intra-observer and fair inter-observer agreement. While significantly better than chance, agreement was substantially lower than the priori target of 0.70. For the 3-category scale, intra- and inter-agreement was fair to slight. Neither scale may be appropriate for clinical practice.
Su1519 Colonoscopy Prep Movie Increases Quality of Colon Prep, With Many Secondary Benefits Jesse Lachter*1,2, Eugene Pahk1, Eliza Shackelford1 1 Gastroenterology, Rambam Health Care Campus, Technion, Haifa, Israel; 2Meuhedet Health Care, Haifa, Israel
resources. Non-adherence of patients to written and oral prep instructions are potential causes of poor preps. A DDW2014 presentation by others found a prep movie somewhat useful, but nearly 40% of subjects handed a DVD for colonoscopy prep did not actually watch the DVD. Aim: To increase adherence to prep instructions, a movie was produced, and shown to subjects, supplementing oral and on-paper instructions. Methods: 40 consecutive patients were asked to watch a movie detailing the prep, administered immediately following physician visit, comprising the experimental group. Exclusion criteria: non-consenting patients. Another 80 consecutive patients’ colonoscopies served as the control group. A secretary or student administered the movie and then a feedback form. Procedures were all performed by a single endoscopist. The study was blinded, the endoscopist not receiving information as to which patients saw the movie. Data analysis included demographics, feedback from those watching the movie, and data on the quality of the prep, using the 9-point validated Boston Prep scale. The local IRB approved the study. An institutional medical statistician determined the sample size by power analysis, and helped with the statistical interpretations. A health literacy expert reviewed the movie for understandability. The movie showed the endoscopist and a nurse explaining the prep using ASGE guidelines. Results: The patients who saw the movie had significantly better preps on average: Boston prep scale scores were 7.8 vs. 6.4 (p!0.01). Viewers overwhelmingly described the movie as informative, easy to understand and helpful and that they would recommend seeing the movie to others. 92% of patient who had previously undergone colonoscopy wrote that instructions were more clear with the movie than without. Patients said that they’d like to see it again at home or on youtube. Discussion: Secondary benefits included 1- medicolegal: in the movie patients were carefully warned of side-effects of the prep, and of the risk of missing polyps. 2- Informed consent process was thus reinforced. 3- The time saved and 4- burnout prevented by having the endoscopist relieved of saying some of the prep instructions to patients was appreciable. 6- Five patients offered that they felt less anxiety/fear after watching the movie. Limitations: the various preps used suggest need for a variety of movies. Conclusion: The ASGE is urged, based on these preliminary highly beneficial results of using a prep movie, to facilitate/produce high-quality colonoscopy prep movies.
Su1520 The Effect of Fiber-Free Diet and Splitting the Dose of a Low Volume Polyethylene Glycol Electrolyte Solution on the Quality of Colonoscopy Preparation Assaad M. Soweid*, Khabib Dgayli Internal Medicine, American University of Beirut, Beirut, Lebanon Background: For colonoscopy preparation, splitting the dose of Polyethylene Glycol-Electrolyte Solution (PEG-ES) into two doses or liberalizing the diet from clear fluid (CFD) to fiber free (FFD) has been shown to enhance tolerability and improve colonoscopy preparation quality. MoviprepÒ is a new low-volume PEG-ES solution containing PEG 3350, ascorbic acid, and sodium sulphate. It allows for the reduction of the total amount of PEG-ES consumed from 4 to 2 liters. Aim: We aimed to compare the effect of the split dose of this preparation (with or without FFD) to that of a single dose (with or without FFD). Methods: This is a singlecenter, randomized, prospective, single-blinded study. A total of 219 consecutive patients undergoing colonoscopy were randomized to one of four groups: single dose PEG-ES with CFD [CF (NZ55)], single dose PEG-ES with FFD [FF (NZ55)], split dose PEG-ES with CFD [Split CF (NZ55)], and split dose with FFD [Split FF (NZ54)]. Demographics and tolerability data were collected by a survey interview prior to the colonoscopy. The quality of colonoscopy preparation was determined by the blinded endoscopist. Results: Tolerance to the preparation was similar with no statistically significant difference in terms of side effects, subjective difficulty, effect on daily activity, or amount of PEG-ES consumed among the four groups. The quality of the colonoscopy preparation was significantly better (p ! 0.05) when the diet was liberalized from CFD to FFD in a single dose setting (43.6% satisfactory preparations in CF vs. 80% in FF), when the dose of PEG-ES was split while maintaining a CFD (43.6% in CF vs. 90.9% in Split CF), or when both liberalizing the diet to FFD and splitting the dose were combined (43.6% in CF vs. 98.1% in Split FF). Moreover, splitting the dose of the PEG-ES while maintaining a FFD significantly improved the quality of colon cleanliness (80% in FF vs. 98.1% in Split FF, p! 0.05). Liberalizing the diet to FFD while maintaining a split dose of PEG-ES was associated with an improvement in the number of satisfactory bowel preparations but with no statistical significance (90.9% in Split CF vs. 98.1% in Split FF, p O 0.05) (fig 1). Finally, the total adenoma detection rate of the study was 39.27% without significant difference among the study groups. Conclusions: FFD given with a single dose of the low volume PEG-ES on the day before the procedure was more effective than CLD for colonoscopy preparation. Moreover, splitting the dose of the low volume PEG-ES was shown to be superior to using a single dose in terms of cleanliness of colonoscopy preparation regardless of the diet. Splitting the dose of the PEG-ES while liberalizing the diet to FFD was shown to be non-inferior to splitting the dose of PEG-ES with a CLD.
Introduction: Suboptimal bowel preparation (prep) often significantly reduces the quality of colonoscopies. Suboptimal preps have been associated with decreased adenoma detection and subsequent increased interval cancers. After suboptimal preps, guidelines recommend earlier repeat colonoscopies, leading to a waste of
www.giejournal.org
Volume 81, No. 5S : 2015 GASTROINTESTINAL ENDOSCOPY AB313