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Tu1514 Can We Predict Quality of Bowel Preparation in Colonoscopy by Stool Frequency and Form Using Bristol Stool Scale?
Abstracts
Tu1513 Prospective Analysis of Associated Pain After ESD Using Submucosal Injection Solution With Lidocaine Jun Yong Bae, Chang Beom Ryu, Hyung Su Ahn, Seul Ki Min, Hee Yong Yoo, Jin Myung Byun, Moon Sung Lee Soon Chun Hyang University, Bucheon, Republic of Korea Background: The factors of pain after endoscopic submucosal dissection (ESD) are not well known. In previous a report, 41% of the patients suffered from pain over 1hr after ESD. To be better quality after ESD, management of pain is essential for patients. The effect of lidocaine mixture for degree of pain by visual analogue scale after ESD was evaluated. Materials and methods: Between September, 2009 and September 2010, total patients were 78 (male:female ⫽ 57: 21, mean age 58.53⫾11.56). ESD using two kinds of submucosal injection solution (lidocane group (n⫽16): 2% lidocane 5 cc ⫹ saline 14.7 cc ⫹ 0.1% epinephrine 0.1 cc vs saline group (n⫽62): saline 19.7 cc ⫹ 0.1% epinephrine 0.1 cc) was done. Pain assessment was performed by visual analogue scale (VAS, 0:no, 1⬃2: mild, 3⬃6: moderate, 7⬃10: severe) at baseline (am 8:00), 0 hour (usually pm 2:00), 3 hours (pm 5:00), 15hr (am 8:00 at the next day after ESD, 24 hours from baseline) after ESD and any time of patients requirement for pain killer. By VAS, pain control was performed by step by step. (0 to 2: observation, 3⬃6: tramadol hydrochloride IM, 7⬃10: meperidine IM). Associated factors including mean specimen size, procedure time, amount of injection solution, and tumor location, degree of pain, break through pain ( one or more point of pain score increase between each time interval), number of pain killer requirement, biological monitoring, and amount sedative drugs between both groups were analyzed statistically. Results: There were no differences of mean specimen size (saline vs lidocaine 43.24⫾14.69mm vs 42.62⫾12.64mm, p⫽0.951), mean procedure time (42.74⫾33.90min vs 27.40⫾17.27min, p⫽0.083), and mean amounts of submucosal injection (105.44⫾72.40ml vs 66.56⫾ 35.25 ml, p⫽0.094) between two groups. In lidocaine group, mean amounts of lidocaine were 248.43⫾64.20 mg. In lidocaine group, the decreased VAS was observed at 0 hour after ESD. (4.58⫾3.16, 2.18⫾2.90, p⫽0.005). The pain more than moderate (VAS ⱖ3) after 0 hour of ESD was decresed (p⫽0.004). The pain more than severe (VAS ⱖ7) and requirement of meperidine at the day of ESD was decreased(p⫽0.006, p⫽0.006). But, breakthrough pain was increased at 3 hours after ESD in lidocaine group (p⫽0.006). There were no abnormalities of blood pressure, pulse rate, O2 saturation, EKG, and the requirement of O2 supply in lidocaine group. The doses of sedatives were not different (p⫽0.331). Conclusions: Lidocaine mixture solution reduce average pain score and moderate to severe pain at 0 hr and need less dose of meperidine without any complication. However, breakthrough pain at 3 hr after ESD in lidocaine group tend to be increase.
Tu1514 Can We Predict Quality of Bowel Preparation in Colonoscopy by Stool Frequency and Form Using Bristol Stool Scale? Shashideep Singhal1, Manpreet Singh2, Harleen Bahga1, Mojdeh Momeni1, Mahesh Krishnaiah1, Sury Anand1 1 Gastorenterology, The Brooklyn Hospital Center, Brooklyn, NY; 2 Internal Medicine, The Brooklyn Hospital Center, Brooklyn, NY Introduction: Inadequate bowel preparation (IBP) during colonoscopy has both social and economic impact on our efforts to improve colorectal cancer screening using colonoscopy. It is important to determine predictors of IBP to target at risk subjects with necessary interventions. The study objective was to
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determine correlation between stool frequency and form using Bristol Stool Scale (BSS) with quality of bowel preparation using Boston Bowel Preparation Scale (BBPS). There are no previous studies using BSS to predict bowel preparation. Methods: Our single blind prospective study enrolled subjects reporting for screening colonoscopy. Study subjects were given a self administered questionnaire about demographics, stool frequency, stool form using BSS, compliance with instructions, co-morbidities and medications. All subjects received a gallon of polyethylene glycol (PEG) as bowel preparation regimen. After colonoscopy the endoscopists determined quality of bowel preparation using BBPS. Segmental scores were combined to calculate composite BBPS. Results: 150 subjects were enrolled in the study with the mean age of 59.9 ⫾ 13.3 yrs; 62% females and 38% males. Based on BMI; 20% were normal weight, 42.7% were overweight and 37.3% were obese. The main co-morbidities were hypertension 48.7%, diabetes 23.3 %, coronary artery disease 6.7% and 2.7% had stroke. Medications used were; opioids 8.7%, laxatives 8% and tricyclic antidepressants 2%. 91.3% of subjects were compliant with clear liquid diet on the day before procedure. Majority of subjects (71.3%) reported completing one gallon of PEG solution, while only 5.4% finished less than half gallon. Frequency of bowel movements on three consecutive days prior to starting colonoscopy instructions was reported as ⱖ 3 by 61.3%, 1-2 by 36.7% and none by 2%. Stool form/BSS Type was consistent with constipation (Type 1/2) in 20%, 70% had normal (Type 3/4) and remaining 10% had loose stools (Type 5 to 7). BBPS was 9 (excellent) in 36% and was ⱕ 6 (suboptimal) in 41.3%. Univariate followed by multivariate analysis was done to determine independent predictors of quality of bowel preparation. No association was found between BSS and BBPS. Compliance with finishing bowel preparation solution was associated with high composite BBPS (p⫽0.01). Also, subjects with lower frequency of bowel movements (⬍1/day) had low segmental BBPS (suboptimal preparation) in right colon (p⫽0.039). Conclusions: Compliance with completing PEG solution is an independent predictor of good quality of bowel preparation. Frequency of bowel movements can be helpful in predicting quality of preparation on right side of colon. Further studies are needed to establish if interventions to improve right sided bowel preparation such as split dosing of PEG or scheduling subjects earlier in the day are helpful in this subset.
Tu1515 Population-Based Measurement of Colonoscopy Quality in Ontario’s Colorectal Cancer Screening Program, ColonCancerCheck Jill M. Tinmouth1, Raymond Przybysz2, Nancy Lewis2, Linda Rabeneck2 1 Sunnybrook Health Sciences Centre, Toronto, ON, Canada; 2Cancer Care Ontario, Toronto, ON, Canada Introduction: Organized colorectal cancer (CRC) screening programs must ensure the delivery of high quality colonoscopy services to their participants. While specific colonoscopy quality indicators have been suggested by gastroenterology societies and organized screening programs, to date, there are few reports of colonoscopy quality at the program or population level. Ontario’s CRC screening program, ColonCancerCheck (CCC), was launched in 2007. Since 2008, data on quality has been prospectively collected using the Colonoscopy Interim Reporting Tool (CIRT) on all colonoscopies (regardless of indication) performed in CCC participating hospitals. In this study, we report on the quality of colonoscopy in fiscal years (FY) 2008 and 2009 in Ontario using CIRT. Methods: CIRT was linked to Ontario’s provincial health plan. Unique colonoscopies were defined as a record in CIRT and/or in the provincial health plan between April 1 2008 and March 30 2010. Of these, we then identified those that were done on adult patients (outpatients and inpatients) in CCC hospitals (n⫽74). We retained data on the characteristics (quality indicators, indication, inpatient/outpatient status, hospital and endoscopist) of these colonoscopies. Participating CCC endoscopists were defined as those with at least 5 colonoscopy records/year in CIRT. We measured endoscopist annual colonoscopy volume by counting unique colonoscopies /FY; we then computed the proportion of endoscopists who performed more than 200 colonoscopies in each FY. We calculated cecal intubation rate and the proportion of adequate bowel preparation for (1) all outpatient colonoscopies done in participating CCC hospitals and (2) CCC “program colonoscopies” (defined as FOBT⫹, aged 50-74 OR positive family history, over age 20). Results: Over the study period, there were 871,285 unique colonoscopies performed in Ontario. Of these, 501,921 were done on adult patients in participating CCC hospitals. In these hospitals, 477,507 outpatient colonoscopies were performed, of which 91,055 were program colonoscopies. During the study period, there were 792 participating CCC endoscopists. The median annual colonoscopy volume for these endoscopists was 469 (IQR: 237 to 756). 76% of endoscopists performed more than 200 colonoscopies/FY. The cecal intubation rate in outpatient and program colonoscopies in CCC was 95% and 97%, respectively. Similarly, the proportion of outpatient and program colonoscopies, respectively, with adequate bowel preparation was 96 and 97%. Conclusion: In the current study, we have demonstrated the feasibility of prospectively collecting colonoscopy quality data across a population-based CRC screening program. Results to date indicate that we are meeting program standards for cecal intubation and bowel preparation but fewer than expected endoscopists meet annual volume criteria.
Volume 73, No. 4S : 2011
GASTROINTESTINAL ENDOSCOPY
AB433
Tu1513 Prospective Analysis of Associated Pain After ESD Using Submucosal Injection Solution With Lidocaine Jun Yong Bae, Chang Beom Ryu, Hyung Su Ahn, Seul Ki Min, Hee Yong Yoo, Jin Myung Byun, Moon Sung Lee Soon Chun Hyang University, Bucheon, Republic of Korea Background: The factors of pain after endoscopic submucosal dissection (ESD) are not well known. In previous a report, 41% of the patients suffered from pain over 1hr after ESD. To be better quality after ESD, management of pain is essential for patients. The effect of lidocaine mixture for degree of pain by visual analogue scale after ESD was evaluated. Materials and methods: Between September, 2009 and September 2010, total patients were 78 (male:female ⫽ 57: 21, mean age 58.53⫾11.56). ESD using two kinds of submucosal injection solution (lidocane group (n⫽16): 2% lidocane 5 cc ⫹ saline 14.7 cc ⫹ 0.1% epinephrine 0.1 cc vs saline group (n⫽62): saline 19.7 cc ⫹ 0.1% epinephrine 0.1 cc) was done. Pain assessment was performed by visual analogue scale (VAS, 0:no, 1⬃2: mild, 3⬃6: moderate, 7⬃10: severe) at baseline (am 8:00), 0 hour (usually pm 2:00), 3 hours (pm 5:00), 15hr (am 8:00 at the next day after ESD, 24 hours from baseline) after ESD and any time of patients requirement for pain killer. By VAS, pain control was performed by step by step. (0 to 2: observation, 3⬃6: tramadol hydrochloride IM, 7⬃10: meperidine IM). Associated factors including mean specimen size, procedure time, amount of injection solution, and tumor location, degree of pain, break through pain ( one or more point of pain score increase between each time interval), number of pain killer requirement, biological monitoring, and amount sedative drugs between both groups were analyzed statistically. Results: There were no differences of mean specimen size (saline vs lidocaine 43.24⫾14.69mm vs 42.62⫾12.64mm, p⫽0.951), mean procedure time (42.74⫾33.90min vs 27.40⫾17.27min, p⫽0.083), and mean amounts of submucosal injection (105.44⫾72.40ml vs 66.56⫾ 35.25 ml, p⫽0.094) between two groups. In lidocaine group, mean amounts of lidocaine were 248.43⫾64.20 mg. In lidocaine group, the decreased VAS was observed at 0 hour after ESD. (4.58⫾3.16, 2.18⫾2.90, p⫽0.005). The pain more than moderate (VAS ⱖ3) after 0 hour of ESD was decresed (p⫽0.004). The pain more than severe (VAS ⱖ7) and requirement of meperidine at the day of ESD was decreased(p⫽0.006, p⫽0.006). But, breakthrough pain was increased at 3 hours after ESD in lidocaine group (p⫽0.006). There were no abnormalities of blood pressure, pulse rate, O2 saturation, EKG, and the requirement of O2 supply in lidocaine group. The doses of sedatives were not different (p⫽0.331). Conclusions: Lidocaine mixture solution reduce average pain score and moderate to severe pain at 0 hr and need less dose of meperidine without any complication. However, breakthrough pain at 3 hr after ESD in lidocaine group tend to be increase.
Tu1514 Can We Predict Quality of Bowel Preparation in Colonoscopy by Stool Frequency and Form Using Bristol Stool Scale? Shashideep Singhal1, Manpreet Singh2, Harleen Bahga1, Mojdeh Momeni1, Mahesh Krishnaiah1, Sury Anand1 1 Gastorenterology, The Brooklyn Hospital Center, Brooklyn, NY; 2 Internal Medicine, The Brooklyn Hospital Center, Brooklyn, NY Introduction: Inadequate bowel preparation (IBP) during colonoscopy has both social and economic impact on our efforts to improve colorectal cancer screening using colonoscopy. It is important to determine predictors of IBP to target at risk subjects with necessary interventions. The study objective was to
www.giejournal.org
determine correlation between stool frequency and form using Bristol Stool Scale (BSS) with quality of bowel preparation using Boston Bowel Preparation Scale (BBPS). There are no previous studies using BSS to predict bowel preparation. Methods: Our single blind prospective study enrolled subjects reporting for screening colonoscopy. Study subjects were given a self administered questionnaire about demographics, stool frequency, stool form using BSS, compliance with instructions, co-morbidities and medications. All subjects received a gallon of polyethylene glycol (PEG) as bowel preparation regimen. After colonoscopy the endoscopists determined quality of bowel preparation using BBPS. Segmental scores were combined to calculate composite BBPS. Results: 150 subjects were enrolled in the study with the mean age of 59.9 ⫾ 13.3 yrs; 62% females and 38% males. Based on BMI; 20% were normal weight, 42.7% were overweight and 37.3% were obese. The main co-morbidities were hypertension 48.7%, diabetes 23.3 %, coronary artery disease 6.7% and 2.7% had stroke. Medications used were; opioids 8.7%, laxatives 8% and tricyclic antidepressants 2%. 91.3% of subjects were compliant with clear liquid diet on the day before procedure. Majority of subjects (71.3%) reported completing one gallon of PEG solution, while only 5.4% finished less than half gallon. Frequency of bowel movements on three consecutive days prior to starting colonoscopy instructions was reported as ⱖ 3 by 61.3%, 1-2 by 36.7% and none by 2%. Stool form/BSS Type was consistent with constipation (Type 1/2) in 20%, 70% had normal (Type 3/4) and remaining 10% had loose stools (Type 5 to 7). BBPS was 9 (excellent) in 36% and was ⱕ 6 (suboptimal) in 41.3%. Univariate followed by multivariate analysis was done to determine independent predictors of quality of bowel preparation. No association was found between BSS and BBPS. Compliance with finishing bowel preparation solution was associated with high composite BBPS (p⫽0.01). Also, subjects with lower frequency of bowel movements (⬍1/day) had low segmental BBPS (suboptimal preparation) in right colon (p⫽0.039). Conclusions: Compliance with completing PEG solution is an independent predictor of good quality of bowel preparation. Frequency of bowel movements can be helpful in predicting quality of preparation on right side of colon. Further studies are needed to establish if interventions to improve right sided bowel preparation such as split dosing of PEG or scheduling subjects earlier in the day are helpful in this subset.
Tu1515 Population-Based Measurement of Colonoscopy Quality in Ontario’s Colorectal Cancer Screening Program, ColonCancerCheck Jill M. Tinmouth1, Raymond Przybysz2, Nancy Lewis2, Linda Rabeneck2 1 Sunnybrook Health Sciences Centre, Toronto, ON, Canada; 2Cancer Care Ontario, Toronto, ON, Canada Introduction: Organized colorectal cancer (CRC) screening programs must ensure the delivery of high quality colonoscopy services to their participants. While specific colonoscopy quality indicators have been suggested by gastroenterology societies and organized screening programs, to date, there are few reports of colonoscopy quality at the program or population level. Ontario’s CRC screening program, ColonCancerCheck (CCC), was launched in 2007. Since 2008, data on quality has been prospectively collected using the Colonoscopy Interim Reporting Tool (CIRT) on all colonoscopies (regardless of indication) performed in CCC participating hospitals. In this study, we report on the quality of colonoscopy in fiscal years (FY) 2008 and 2009 in Ontario using CIRT. Methods: CIRT was linked to Ontario’s provincial health plan. Unique colonoscopies were defined as a record in CIRT and/or in the provincial health plan between April 1 2008 and March 30 2010. Of these, we then identified those that were done on adult patients (outpatients and inpatients) in CCC hospitals (n⫽74). We retained data on the characteristics (quality indicators, indication, inpatient/outpatient status, hospital and endoscopist) of these colonoscopies. Participating CCC endoscopists were defined as those with at least 5 colonoscopy records/year in CIRT. We measured endoscopist annual colonoscopy volume by counting unique colonoscopies /FY; we then computed the proportion of endoscopists who performed more than 200 colonoscopies in each FY. We calculated cecal intubation rate and the proportion of adequate bowel preparation for (1) all outpatient colonoscopies done in participating CCC hospitals and (2) CCC “program colonoscopies” (defined as FOBT⫹, aged 50-74 OR positive family history, over age 20). Results: Over the study period, there were 871,285 unique colonoscopies performed in Ontario. Of these, 501,921 were done on adult patients in participating CCC hospitals. In these hospitals, 477,507 outpatient colonoscopies were performed, of which 91,055 were program colonoscopies. During the study period, there were 792 participating CCC endoscopists. The median annual colonoscopy volume for these endoscopists was 469 (IQR: 237 to 756). 76% of endoscopists performed more than 200 colonoscopies/FY. The cecal intubation rate in outpatient and program colonoscopies in CCC was 95% and 97%, respectively. Similarly, the proportion of outpatient and program colonoscopies, respectively, with adequate bowel preparation was 96 and 97%. Conclusion: In the current study, we have demonstrated the feasibility of prospectively collecting colonoscopy quality data across a population-based CRC screening program. Results to date indicate that we are meeting program standards for cecal intubation and bowel preparation but fewer than expected endoscopists meet annual volume criteria.
Volume 73, No. 4S : 2011
GASTROINTESTINAL ENDOSCOPY
AB433