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Tu1063 Colonoscopy for Abdominal Pain: Is It Worth Performing?
Abstracts
Conculsions: EGD-colonoscopy is the optimal sequence for same-day BDE. In this order, the procedures are better tolerated, the sedation doses are reduced, and the recovery time is shorter.
Tu1061 Adenoma Detection Rates Correlate With Sessile Serrated Polyp Detection Rates Jennifer Nayor*1, Sergey Goryachev2, Vivian S. Gainer2, John R. Saltzman1 1 Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Boston, MA; 2Partners HealthCare, Research Computing, Boston, MA Background and Aim: Adenoma detection rate (ADR) is a measure of colonoscopy quality that is correlated with interval colon cancer occurrence. Sessile serrated polyp detection rate (SDR) may provide additional information on colonoscopy quality. The aim of this study was to determine if there is a correlation between ADR and SDR. Methods: Natural language processing (NLP) was used to identify adenomas and SSPs in pathology reports of patients who underwent a screening colonoscopy between June 2010 and August 2015. ADR and SDR were then calculated based on these results. Twenty endoscopists from an academic tertiary care hospital, who each performed at least 50 screening colonoscopies during the study period, were included in the analysis. Results: 8,480 screening colonoscopies were linked to 4,005 pathology reports (47.2%). Endoscopists were all gastroenterologists and had been in practice for a mean of 11.4 years. Endoscopists performed an average of 375 screening colonoscopies during the study period. The mean total ADR was 24.7% (range 14.7-53.2%); mean male ADR was 32.9 (range 19.7-62.9%); and mean female ADR was 23.5% (range 9.1-51.0%). The mean SDR was 3.4% (range 1.0-9.6%). There was a good correlation between total ADR and SDR (rZ0.84). Conclusions: The SDR correlates well with the ADR. The ADR alone may be an adequate colonoscopy quality metric as it also predicts the SDR.
Tu1062 Patients With Previous History of Colonoscopy Are Less Likely to Achieve High Quality Preparation After Implementing Split Dose Bowel Preparation Pratyusha Parava1,2, Hussein Bitar1,2, Hassaan Zia1,2, Owais I. Bhatti1,2, Teresa Yanchak1,2, Muhammad H. Bashir1,2, William M. Tierney1,2, Mohammad F. Madhoun*1,2 1 Internal Medicine/Digestive Diseases, University of Oklahoma Health Sciences Center, Oklahoma City, OK; 2Veteran Affairs Medical Center, Oklahoma City, OK Background: Anecdotally, we noticed that patients who had colonoscopy in the past are less likely to follow newly implemented split dose bowel preparation (SDBP) instructions. Aim: We investigated whether the indication of colonoscopy is an independent factor for achieving high quality bowel preparation among patients asked to follow SDBP. Patients and Methods: We performed a retrospective study of data from 1478 (mean age 629.9; 94% male) patients who received outpatient colonoscopies in 2014 (year of implementation of the SDBP) at our Veterans Affairs Medical Center. We collected information related to demographics, body mass index, indications, and medical/surgical history (diabetes mellitus, stroke, cirrhosis, dementia, constipation, hypothyroidism and use of narcotics or antidepressants/ anxiolytics). Indications for colonoscopy were dichotomized into surveillance (previously had colonoscopy) vs. non-surveillance (positive occult blood test or screening). Quality of the bowel preparation was scored using the Boston Bowel Preparation Scale (BBPS) and categorized as either excellent vs. not excellent (BBPS7 vs. BBPS<7). A multivariate logistic regression analysis to identify factors independently associated with excellent bowel preparation was performed. Results: Bowel preparation quality was excellent in 59%. 535 (35%) were surveillance colonoscopies. More patients in the non-surveillance group achieved excellent bowel preparation compared to the surveillance group (64% vs. 53%, p<0.001). Independent factors for excellent bowel preparation were diabetes (OR, 0.8; 95% CI 0.6-0.99; pZ0.05), male sex (OR, 2; 95% CI, 1.32-3.2; pZ0.002), constipation (OR, 0.6; 95% CI, 0.4-0.8; PZ 0.02), cirrhosis (OR, 0.2; 95%CI, 0.1-0.6; PZ 0.002), and surveillance indication (OR, 0.9; 95%CI, 0.8-0.9; P<0.001). Conclusion: Patients with a prior colonoscopy might intentionally or unintentionally elect not to follow the split dose bowel preparation instructions. Educational interventions emphasizing the benefits of SDBP in this group of patients may help ensure compliance and avoid the habitual use of day prior preparations.
detection of colorectal cancer. Abdominal pain is a common presenting complaint in secondary care, and is generally accepted to be non-specific, with a low predictive value for significant pathology in the absence of other symptoms (altered bowel habit, bleeding). The ASGE in their guidelines for appropriate use of colonoscopy indicate that this procedure is not indicated in “Chronic, stable, irritable bowel syndrome or chronic abdominal pain”. In observed practice, however, abdominal pain seems to be a common reason for referral for colonoscopy. For an endoscopy unit to be successful and with pressures of waiting times growing it is important not to overburden this with inappropriate referrals. We hypothesize that colonoscopy performed solely for abdominal pain has a low diagnostic yield and should therefore be avoided. Aims & Methods: The aim of the study was to assess abdominal pain as an indication for colonoscopy. A single centre, retrospective analysis of patients undergoing colonoscopy for abdominal pain in a North London NHS Hospital Trust was performed. Patients were identified using the Unisoft Endoscopy reporting software across a 5 year period (March 2010-March2015). Data was scrutinized for procedure findings and result of histology obtained. If abnormal, the patient’s electronic record was scrutinized for documentation of additional symptoms prior to colonoscopy. Results: A total of 1021 patients underwent colonoscopy for abdominal pain. 38 were diagnostic of Inflammatory Bowel Disease. 7 were diagnostic of adenocarcinoma. All of these patients had at least one other indication (diarrhea, bleeding, weight loss or anaemia). Adenomatous polyp detection rate in this study was 6%, comparable to asymptomatic individuals. Conclusion: From this study we can conclude that a large number of colonoscopies are performed for patients with abdominal pain. When pathology is detected it is always with other symptoms. This study suggests that colonoscopy is not a useful investigation in patients presenting solely with abdominal pain, as the diagnostic yield is poor. Avoiding such a procedure in this group of patient would free up space within the endoscopy units and reduce waiting times. Colonoscopy as an investigation for abdominal pain as the sole indication should not be performed.
Tu1064 Colonoscopy Quality Criteria: A Study With Three Delphi Rounds. A Scoring Initiative From Latin America Luis A. Diaz*1, Arnoldo Riquelme2, Luis E. Caro3, Asadur Tchekmedyian4, Ivonne D. Orellana5, Roque Saenz6 1 Department of Internal Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile; 2Department of Gastroenterology, Pontificia Universidad Católica de Chile, Santiago, Chile; 3Managing director GEDYT, Universidad de Buenos Aires, Buenos Aires, Argentina; 4 Coordinator of the Communications Committee of SIED, President of the Uruguayan Society of Gastroenterology, Montevideo, Uruguay; 5 Servicio Axxis Gastro, Universidad Central de Ecuador, Quito, Ecuador; 6Department of Gastroenterology, Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile This is a collaborative work between 65 endoscopists from 9 countries (Argentina, Brazil, Chile, Ecuador, United States of America, Mexico, Peru, Uruguay and Venezuela). Introduction: The quality within colonoscopies is the degree in which the test increases the likelihood of good health outcomes. The quality may be affected before, during or after the procedure. If the endoscopist meets the criteria of quality and performance, he/she can continuously improve performance and safety. Objective: To develop a tool for assessing the performance of endoscopists and endoscopy units in terms of the quality of the examination, so that the results can discriminate between an excellent, regular and bad performance of the endoscopists. Materials and Methods: A MEDLINE search was done, and the results were used by a group of six experts to generate items. A modified Delphi methodology was used to achieve consensus (Likert scale 1-5). The rounds were applied electronically and all the data was used anonymously. Results: One hundred four items were proposed. Forty three out of sixty five endoscopists from 9 Latin American countries (response rate of 66.2%), assessed the degree of importance in the 1st and 2nd round. In the 3rd round (35 items), 23 endoscopists assessed the degree of agreement and critical importance. A final 8-item instrument was obtained to evaluate the quality in colonoscopies. The five most critical items were: colon cleansing (Boston), the cecal intubation rate, the colonoscopy withdrawal time, the presence of photo-documentation and the adenoma detection rate. Conclusion: Colonoscopy Quality Score (CoQS) is a useful questionnaire to evaluate the performance of the endoscopists. Additionally, the results could be adapted in the usual endoscopic report to adjust the frequency of monitoring.
Tu1063 Colonoscopy for Abdominal Pain: Is It Worth Performing? Endip Dhesi*, Kalpesh Besherdas Gastroenterology, Royal Free Hospital, Hertfordshire, United Kingdom Introduction: Colonoscopy is accepted as the gold standard imaging modality for colonic symptoms of altered bowel habit, anaemia, rectal bleeding and for the
www.giejournal.org
Volume 83, No. 5S : 2016 GASTROINTESTINAL ENDOSCOPY AB549
Conculsions: EGD-colonoscopy is the optimal sequence for same-day BDE. In this order, the procedures are better tolerated, the sedation doses are reduced, and the recovery time is shorter.
Tu1061 Adenoma Detection Rates Correlate With Sessile Serrated Polyp Detection Rates Jennifer Nayor*1, Sergey Goryachev2, Vivian S. Gainer2, John R. Saltzman1 1 Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Boston, MA; 2Partners HealthCare, Research Computing, Boston, MA Background and Aim: Adenoma detection rate (ADR) is a measure of colonoscopy quality that is correlated with interval colon cancer occurrence. Sessile serrated polyp detection rate (SDR) may provide additional information on colonoscopy quality. The aim of this study was to determine if there is a correlation between ADR and SDR. Methods: Natural language processing (NLP) was used to identify adenomas and SSPs in pathology reports of patients who underwent a screening colonoscopy between June 2010 and August 2015. ADR and SDR were then calculated based on these results. Twenty endoscopists from an academic tertiary care hospital, who each performed at least 50 screening colonoscopies during the study period, were included in the analysis. Results: 8,480 screening colonoscopies were linked to 4,005 pathology reports (47.2%). Endoscopists were all gastroenterologists and had been in practice for a mean of 11.4 years. Endoscopists performed an average of 375 screening colonoscopies during the study period. The mean total ADR was 24.7% (range 14.7-53.2%); mean male ADR was 32.9 (range 19.7-62.9%); and mean female ADR was 23.5% (range 9.1-51.0%). The mean SDR was 3.4% (range 1.0-9.6%). There was a good correlation between total ADR and SDR (rZ0.84). Conclusions: The SDR correlates well with the ADR. The ADR alone may be an adequate colonoscopy quality metric as it also predicts the SDR.
Tu1062 Patients With Previous History of Colonoscopy Are Less Likely to Achieve High Quality Preparation After Implementing Split Dose Bowel Preparation Pratyusha Parava1,2, Hussein Bitar1,2, Hassaan Zia1,2, Owais I. Bhatti1,2, Teresa Yanchak1,2, Muhammad H. Bashir1,2, William M. Tierney1,2, Mohammad F. Madhoun*1,2 1 Internal Medicine/Digestive Diseases, University of Oklahoma Health Sciences Center, Oklahoma City, OK; 2Veteran Affairs Medical Center, Oklahoma City, OK Background: Anecdotally, we noticed that patients who had colonoscopy in the past are less likely to follow newly implemented split dose bowel preparation (SDBP) instructions. Aim: We investigated whether the indication of colonoscopy is an independent factor for achieving high quality bowel preparation among patients asked to follow SDBP. Patients and Methods: We performed a retrospective study of data from 1478 (mean age 629.9; 94% male) patients who received outpatient colonoscopies in 2014 (year of implementation of the SDBP) at our Veterans Affairs Medical Center. We collected information related to demographics, body mass index, indications, and medical/surgical history (diabetes mellitus, stroke, cirrhosis, dementia, constipation, hypothyroidism and use of narcotics or antidepressants/ anxiolytics). Indications for colonoscopy were dichotomized into surveillance (previously had colonoscopy) vs. non-surveillance (positive occult blood test or screening). Quality of the bowel preparation was scored using the Boston Bowel Preparation Scale (BBPS) and categorized as either excellent vs. not excellent (BBPS7 vs. BBPS<7). A multivariate logistic regression analysis to identify factors independently associated with excellent bowel preparation was performed. Results: Bowel preparation quality was excellent in 59%. 535 (35%) were surveillance colonoscopies. More patients in the non-surveillance group achieved excellent bowel preparation compared to the surveillance group (64% vs. 53%, p<0.001). Independent factors for excellent bowel preparation were diabetes (OR, 0.8; 95% CI 0.6-0.99; pZ0.05), male sex (OR, 2; 95% CI, 1.32-3.2; pZ0.002), constipation (OR, 0.6; 95% CI, 0.4-0.8; PZ 0.02), cirrhosis (OR, 0.2; 95%CI, 0.1-0.6; PZ 0.002), and surveillance indication (OR, 0.9; 95%CI, 0.8-0.9; P<0.001). Conclusion: Patients with a prior colonoscopy might intentionally or unintentionally elect not to follow the split dose bowel preparation instructions. Educational interventions emphasizing the benefits of SDBP in this group of patients may help ensure compliance and avoid the habitual use of day prior preparations.
detection of colorectal cancer. Abdominal pain is a common presenting complaint in secondary care, and is generally accepted to be non-specific, with a low predictive value for significant pathology in the absence of other symptoms (altered bowel habit, bleeding). The ASGE in their guidelines for appropriate use of colonoscopy indicate that this procedure is not indicated in “Chronic, stable, irritable bowel syndrome or chronic abdominal pain”. In observed practice, however, abdominal pain seems to be a common reason for referral for colonoscopy. For an endoscopy unit to be successful and with pressures of waiting times growing it is important not to overburden this with inappropriate referrals. We hypothesize that colonoscopy performed solely for abdominal pain has a low diagnostic yield and should therefore be avoided. Aims & Methods: The aim of the study was to assess abdominal pain as an indication for colonoscopy. A single centre, retrospective analysis of patients undergoing colonoscopy for abdominal pain in a North London NHS Hospital Trust was performed. Patients were identified using the Unisoft Endoscopy reporting software across a 5 year period (March 2010-March2015). Data was scrutinized for procedure findings and result of histology obtained. If abnormal, the patient’s electronic record was scrutinized for documentation of additional symptoms prior to colonoscopy. Results: A total of 1021 patients underwent colonoscopy for abdominal pain. 38 were diagnostic of Inflammatory Bowel Disease. 7 were diagnostic of adenocarcinoma. All of these patients had at least one other indication (diarrhea, bleeding, weight loss or anaemia). Adenomatous polyp detection rate in this study was 6%, comparable to asymptomatic individuals. Conclusion: From this study we can conclude that a large number of colonoscopies are performed for patients with abdominal pain. When pathology is detected it is always with other symptoms. This study suggests that colonoscopy is not a useful investigation in patients presenting solely with abdominal pain, as the diagnostic yield is poor. Avoiding such a procedure in this group of patient would free up space within the endoscopy units and reduce waiting times. Colonoscopy as an investigation for abdominal pain as the sole indication should not be performed.
Tu1064 Colonoscopy Quality Criteria: A Study With Three Delphi Rounds. A Scoring Initiative From Latin America Luis A. Diaz*1, Arnoldo Riquelme2, Luis E. Caro3, Asadur Tchekmedyian4, Ivonne D. Orellana5, Roque Saenz6 1 Department of Internal Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile; 2Department of Gastroenterology, Pontificia Universidad Católica de Chile, Santiago, Chile; 3Managing director GEDYT, Universidad de Buenos Aires, Buenos Aires, Argentina; 4 Coordinator of the Communications Committee of SIED, President of the Uruguayan Society of Gastroenterology, Montevideo, Uruguay; 5 Servicio Axxis Gastro, Universidad Central de Ecuador, Quito, Ecuador; 6Department of Gastroenterology, Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile This is a collaborative work between 65 endoscopists from 9 countries (Argentina, Brazil, Chile, Ecuador, United States of America, Mexico, Peru, Uruguay and Venezuela). Introduction: The quality within colonoscopies is the degree in which the test increases the likelihood of good health outcomes. The quality may be affected before, during or after the procedure. If the endoscopist meets the criteria of quality and performance, he/she can continuously improve performance and safety. Objective: To develop a tool for assessing the performance of endoscopists and endoscopy units in terms of the quality of the examination, so that the results can discriminate between an excellent, regular and bad performance of the endoscopists. Materials and Methods: A MEDLINE search was done, and the results were used by a group of six experts to generate items. A modified Delphi methodology was used to achieve consensus (Likert scale 1-5). The rounds were applied electronically and all the data was used anonymously. Results: One hundred four items were proposed. Forty three out of sixty five endoscopists from 9 Latin American countries (response rate of 66.2%), assessed the degree of importance in the 1st and 2nd round. In the 3rd round (35 items), 23 endoscopists assessed the degree of agreement and critical importance. A final 8-item instrument was obtained to evaluate the quality in colonoscopies. The five most critical items were: colon cleansing (Boston), the cecal intubation rate, the colonoscopy withdrawal time, the presence of photo-documentation and the adenoma detection rate. Conclusion: Colonoscopy Quality Score (CoQS) is a useful questionnaire to evaluate the performance of the endoscopists. Additionally, the results could be adapted in the usual endoscopic report to adjust the frequency of monitoring.
Tu1063 Colonoscopy for Abdominal Pain: Is It Worth Performing? Endip Dhesi*, Kalpesh Besherdas Gastroenterology, Royal Free Hospital, Hertfordshire, United Kingdom Introduction: Colonoscopy is accepted as the gold standard imaging modality for colonic symptoms of altered bowel habit, anaemia, rectal bleeding and for the
www.giejournal.org
Volume 83, No. 5S : 2016 GASTROINTESTINAL ENDOSCOPY AB549