- Email: [email protected]
Unsedated endoscopy: a reality or still a dream
S290
Abstracts
difference in EPAGE ordinal score between both groups of physicians for UGE indications. Conclusions: General practitioners request UGE at the same frequency for inappropriate indications compared to gastroenterologists. 882 CLINICAL EVALUATION OF FECAL INCONTINENCE BY QUESTIONNAIRE COMPARED TO ENDOANAL ULTRASOUND–DEMONSTRATED DEFECTS Keri L. Hill, M.D. and Douglas Faigel, M.D.*. Department of Gastroenterology, Oregon Health Sciences University, Portland, Oregon. Purpose: Fecal incontinence is a debilitating condition with a negative impact on quality of life. Many patients have demonstrable anatomical defects in the anal sphincters which may be surgically correctible. Questionnaires have been used to assess the presence and degree of fecal incontinence, but the literature is mixed regarding whether the symptoms and medical history elicited from a questionnaire are predictive of sphincter defects. The purpose of this study was to determine whether fecal incontinence questionnaires are predictive of sphincter defects documented by endoanal ultrasound. Methods: 80 patients (age 32 to 84 years, mean 55) referred from various clinics at the Portland VA and Oregon Health Sciences University Hospitals underwent endoanal ultrasound (EUS). The integrity of the internal anal sphincter (IAS) and external anal sphincter (EAS) were assessed separately as intact or disrupted. A digital rectal exam (DRE) was also performed and the resting tone and voluntary squeeze were assessed. Participants were administered a validated questionnaire and responses were compared to the corresponding EUS and DRE result and analyzed for correlation using the chi–square and t–tests. Results: A history of rectal surgery or sphincter tear during childbirth significantly correlated (p⬍0.05, both IAS and EAS disruption) with EUS– demonstrated sphincter defects. Use of a vacuum extractor during vaginal delivery was more frequent in IAS disruption (p⬍0.05), while standard forceps assisted delivery had no correlation with anatomic defects. Decreased or absent voluntary rectal squeeze and a palpable sphincter defect on digital rectal examination significantly correlated with EAS defects (p⬍0.05), but not with IAS defects (p ⫽ 0.08 and 0.3). The clinical impression of sphincter disruption on DRE correlated significantly with both IAS and EAS defects (p⬍0.05). No clinically elicited symptoms commonly associated with fecal incontinence correlated significantly with EUS– documented sphincter disruption. Conclusions: Comprehensive fecal incontinence questionnaires, even when validated and reproducible, are not predictive of anatomic sphincter defects as documented objectively by EUS evaluation. Past medical history can be helpful, but is limited to prior rectal surgery or known sphincter tear, both of which have good specificity but poor sensitivity. DRE had good correlation with EUS– documented EAS defects but mixed positive predictive values. 883 MELANOSIS COLI AS A MARKER OF COLONIC NEOPLASIA Vivaik Tyagi, M.D., Gergec Abouzeidan, M.D., Fredrick Oni, M.D. and Vlado Simko, M.D.*. Medicine, Brooklyn Campus, VA NY Harbor Health Care System, Brooklyn, NY. Purpose: Melanosis coli may spare colonic polyps from pigmentation. Can it be considered as a potential tool for bioendoscopy? Methods: An 83 year old male patient with chronic constipation of many years, partly related to Parkinson’s disease,with poor response to multiple laxatives, underwent screening colonoscopy. There were three polyps (3–7 mm) starkly contrasting in whitish appearance with the very darkly pigmented mucosa of the surrounding ascending colon. Histology revealed two tubular and one villotubular adenomas with remarkable absence of the pigment in the polyps.
AJG – Vol. 97, No. 9, Suppl., 2002
Results: Despite the clinical terminology, the pigment is lipofuscin and not melanin. Stimulant laxatives of the anthraquinone type are very popular and available as non–precription remedies (incl. Senna, Ex–Lax and herbal teas). Anthranoids induce transient waves of apoptosis by releasing cytokines and altering the tight inter– epithelial junctions. This leads to the development of lipofuscin granules that are taken up by macrophages in the lamina propria. Macrophages then migrate to the regional lymph nodes. Anthranoids cause pigmentation only in the colon where colonic microorganisms transform the prodrug into an absorbable stimulant. Highest intensity of pigmentation occurs in the proximal colon. When the laxative is discontinued, the pigmentation gradually disappears. Conclusions: Our report confirms previous observation on hypopigmentation of neoplastic tissue in patients with melanosis coli. The goals of future research should be to determine why preneoplastic tissue is not affected by anthranoids. Ultimately, an anthranoid molecule should be identified which would be safe to use as a biomarker for endoscopic screening of colonic polyps.
884 DETECTION OF SMALL COLORECTAL ADENOMAS BY ROUTINE CHROMOENDOSCOPY WITH INDIGOCARMINE Jun Haeng Lee, M.D., Jung Uk Kim, M.D., Yong Kyun Cho, M.D., Chung Il Sohn, M.D., Woo Kyu Jeon, M.D. and Byung Ik Kim, M.D.*. Deparment of Medicine, Kangbuk Samsung Hospital, Seoul, Korea. Purpose: Non–polypoid adenomas, which can be important precursors of colorectal cancers, are difficult to find during routine colonoscopy. The aim of this study was to evaluate the usefulness of routine chromoendoscopy in Korea, where the incidence of colorectal cancer is low compared to the western countries. Methods: Colonoscopy with chromoendoscopy was performed in 50 consecutive patients (32 men, 18 women; mean age 52.4 years). After a careful examination of the whole colon, a defined segment of the sigmoid colon and rectum (0 –30 cm from the anal verge) was stained with 20 ml of 0.4% indigocarmine solution using a spraying catheter. Non–polypoid lesions were classified as flat or depressed types. Biopsies were taken from all lesions detected before or after staining with indigocarmine. Results: Indications for colonoscopy included routine check– up (15 patients), bowel habit change (13 patients), abdominal pain (6 patients), bleeding (4 patients) and others (12 patients). Before staining, 33 lesions were found in 18 patients (36%). Histology showed tubular adenoma in 22 lesions, hyperplastic or inflammatory changes in 8 lesions, adenocarcinoma in 2 lesions, and villous adenoma in 1 lesion. After indigocarmine staining for normal–looking distal 30 cm colorectal mucosa, 131 lesions were found in 31 patients (62%). Histologically, 114 lesions (from 23 patients) were hyperplastic or inflammatory in nature, and 17 lesions (from 10 patients) were tubular adenomas. Adenomas seen only after spraying indigocarmine were 2.6 ⫹/– 0.7 mm in diameter and classified as flat adenomas except for one small (1.5 mm) depressed adenoma. No adenoma with high– grade dysplasia or cancer was found after staining. Presence of macroscopic lesions before staining could not predict the existence of adenoma after staining. Conclusions: In a large proportion of Korean patients, flat or depressed adenomas could be found after spraying indigocarime for normal–looking colorectal mucosa. The clinical significance of these small adenomas, which could be found only after chromoscopy, needs to be further investigated.
885 UNSEDATED ENDOSCOPY: A REALITY OR STILL A DREAM Anand Madan, M.D. and Anil Minocha, M.D., FACG*. Division of Gastroenterology, Southern Illinois University School of Medicine, Springfield, IL and Division of Digestive Diseases, University of Mississippi Medical Center, Jackson, MS.
AJG – September, Suppl., 2002
Purpose: Several studies from major medical centers have reported that upto 90% of patients undergoing endoscopy are willing to undergo such procedures without sedation. According to our experience, these numbers are irrelevant in community setting and most patients actually ask for general anesthesia for endoscopy. We evaluated the willingness of patients in a community to undergo unsedated endoscopy and also assessed any characteristics which may predict such willingness. We also investigated if physicians and GI and non GI nurses would themselves be willing to undergo unsedated endoscopy. Methods: Adult patients who were referred for outpatient colonoscopy and/or EGD were invited to participate in the study. They filled out questionnaires asking for their demographic information and their willingness to undergo endoscopy without sedation. Pre–procedure anxiety level was assessed using Beck Anxiety Inventory. Similar information was obtained from physicians as well as GI and non–GI nursing staff. Results: Total of 295 subjects participated in the study. These included 127 patients, 51 physicians, 61 GI nurses and 56 non GI nursing staff from 6 different hospitals in central Illinois. Only 16.6% of patients and 15% of healthcare professionals were willing to undergo unsedated endoscopy. Physicians were least likely to agree to unsedated endoscopy (2.2%) as compared to patients (16.6%). Overall, there was no significant difference in willingness to forego sedation for EGD vs colonoscopy. Sub– data analysis revealed that 39% of GI nurses agreed to unsedated EGD as opposed to only 19% for colonoscopy. Among non–GI nurses, only 7% agreed to unsedated EGD while none wanted unsedated colonoscopy. Among patients, there was no significant corelation between educational level or anxiety scores and willingness for unsedated endoscopy. Fifteen percent of high school graduates were willing to undergo unsedated endoscopy compared to 18% with college or higher education. Patients with minimal or mild anxiety were just as unlikely to agree to an unsedated endoscopy as the subjects with moderate to severe anxiety (23% vs 19%). Conclusions: Unlike reports from major medical centers, most patients as well as medical professionals in community hospitals are unwilling to undergo unsedated endoscopy.
886 WRITTEN REPORTS IMPROVE PATIENT RECALL OF ENDOSCOPY RESULTS AND RECOMMENDATIONS Jason Poston, Ryan Day and David T. Rubin, M.D.*. Section of Gastroenterology, University of Chicago, Chicago, IL. Purpose: Growing demand for endoscopy associated with colorectal cancer screening has resulted in increased use of open access endoscopy (OAE), in which patients are referred without prior consultation by a gastroenterologist. Previous work has shown that OAE patients are less likely to recall the results or even the type of procedure they have had. We sought to determine whether providing patients with a written copy of their endoscopy report at the conclusion of their procedure enhanced recall of the findings and recommendations. Methods: 80 consecutive outpatients presenting to three endoscopists were randomized to receive the results of their endoscopy via standard verbal report (VR) or by VR followed by receipt of a computer generated endoscopy report (VR⫹WR) from the Olympus ImageManager威 report generator. The endoscopist communicated the VR after a standard post–procedure recovery period, and routinely discussed all findings and recommendations as mentioned in the WR. The endoscopist was blinded as to whether the patient subsequently received the WR. Recall of the endoscopic procedure was assessed using a piloted 11– question survey instrument to be filled– out three days post–procedure. Results were calculated using Fisher exact and Wilcoxon rank–sum tests. Results: 78 of 80 (98%) of patients agreed to participate. 62 (79%) were OAE patients. Of these, response rate was 75% for VR and 73% for VR⫹WR patients. VR⫹WR patients overall had a greater composite score than VR patients (8.8/10 vs. 7.3/10, p⬍0.01). VR⫹WR patients were also significantly more likely to recall the indications for their procedure (100% vs. 85%, p⬍0.05), recommendations for therapy or follow– up (68% vs.
Abstracts
S291
36%, p⬍0.01), whether a biopsy was performed (95% vs. 71%, p⬍0.05), and name of the endoscopist (95% vs.67%, p⬍0.05). When non–OAE patients were included in the analysis, similar statistically significant results were found regarding composite score (p⬍0.01), recommendations (p⬍0.01), and name of the endoscopist (p⬍0.05). Conclusions: A computer– generated endoscopy report significantly improves patient recall of endoscopic procedure information compared to a verbal report alone. Despite this, patients were unable to recall 32% of recommendations. Future work should assess whether patient– directed reports enhance patient satisfaction and follow– up.
887 PATIENT PREFERENCES REGARDING COLONOSCOPIC LAVAGE PREPARATIONS Kirin Kanji, M.D., Sanjay Garuda, M.D. and Michael D. Brown, M.D., FACG*. Section of Digestive Diseases, Rush Presbyterian St. Luke’s Medical Center, Chicago, IL. Purpose: For many patients the most unpleasant part of colonoscopy is the lavage preparation. Over 80% of the preparations for colonoscopy in the U.S. involve the use of a 4L polyethylene glycol (PEG) lavage. Complete consumption of all 4L is achievable by less than 70% of patients and is associated with significant side effects including nausea and dyspepsia. Newer preparations using sodium phosphate (NaP) in liquid or tablet form may be more tolerable and therefore preferred by patients. However, patients are rarely allowed to choose from preparations. We questioned patients on their preferences for preparations after having completed a single screening colonoscopy with either PEG lavage or NaP tablets. Methods: 117 patients undergoing screening colonoscopy for the first time were provided a questionnaire after the procedure describing details of three preparations; PEG lavage, NaP liquid and NaP tablets. 44 patients had received a PEG lavage and 73 had taken a 28 tablet NaP preparation. The patients were asked which preparation they would prefer given similar efficacy during their next colonoscopy. They were also asked if they would prefer to choose their preparation and whether the opportunity to choose a preparation might influence their choice of gastroenterologist. Results: Of the 44 patients who had taken the 4L PEG preparation only 5 (12%) would choose this prep again. 29 (66%) and 10 (22%) would choose NaP tablets and liquid respectively. Of the 73 who had taken NaP tablets, 67 (92%) would take the tablets again whereas 0 (0%) chose the PEG solution. 6 (8%) patients in this group choose the NaP liquid preparation. When patients are given a choice between PEG preparation and NaP tablets, there was a statistically significant difference in favor of the NaP tablets (chi– square ⫽ 81.990, p⬍ 0.0001). Of 113 patients answering the follow up questions, 106 (94%) would prefer to have a choice of preparation and 69 (61%) felt that providing different options for preparations might influence their choice of gastroenterologist. Conclusions: Patients prefer lower volume NaP preparations when allowed to choose a preparation for colonoscopy regardless of their previous preparation. Having a role in this decision is desirable and may influence a patient’s choice of gastroenterologist. 888 IS NORMAL TIBC A GOOD PREDICTOR OF NEGATIVE COLONOSCOPY? Rajeev Jayadevan, M.D., Pallavi Aggarwal, M.D., Edward Norkus, Ph.D., Hilary Hertan, M.D. and Capecomorin Pitchumoni, M.D.*. Gastroenterology, Our Lady of Mercy Medical Center, Bronx, NY. Purpose: To identify predictors of normal colonoscopy in anemic patients who undergo endoscopic investigation. Methods: In an ongoing prospective study of anemia, data on the first 60 consecutive patients were analyzed. Patients had anemia as defined by hemoglobin of ⬍13 g for men and ⬍12 g for women, with at least one of the following parameters: MCV ⬍80 fl, serum iron ⬍ 50 ug/dl, TIBC ⬎250 mg/dl, ferritin ⬍30 ng/ml, absence of overt blood loss or other well
Abstracts
difference in EPAGE ordinal score between both groups of physicians for UGE indications. Conclusions: General practitioners request UGE at the same frequency for inappropriate indications compared to gastroenterologists. 882 CLINICAL EVALUATION OF FECAL INCONTINENCE BY QUESTIONNAIRE COMPARED TO ENDOANAL ULTRASOUND–DEMONSTRATED DEFECTS Keri L. Hill, M.D. and Douglas Faigel, M.D.*. Department of Gastroenterology, Oregon Health Sciences University, Portland, Oregon. Purpose: Fecal incontinence is a debilitating condition with a negative impact on quality of life. Many patients have demonstrable anatomical defects in the anal sphincters which may be surgically correctible. Questionnaires have been used to assess the presence and degree of fecal incontinence, but the literature is mixed regarding whether the symptoms and medical history elicited from a questionnaire are predictive of sphincter defects. The purpose of this study was to determine whether fecal incontinence questionnaires are predictive of sphincter defects documented by endoanal ultrasound. Methods: 80 patients (age 32 to 84 years, mean 55) referred from various clinics at the Portland VA and Oregon Health Sciences University Hospitals underwent endoanal ultrasound (EUS). The integrity of the internal anal sphincter (IAS) and external anal sphincter (EAS) were assessed separately as intact or disrupted. A digital rectal exam (DRE) was also performed and the resting tone and voluntary squeeze were assessed. Participants were administered a validated questionnaire and responses were compared to the corresponding EUS and DRE result and analyzed for correlation using the chi–square and t–tests. Results: A history of rectal surgery or sphincter tear during childbirth significantly correlated (p⬍0.05, both IAS and EAS disruption) with EUS– demonstrated sphincter defects. Use of a vacuum extractor during vaginal delivery was more frequent in IAS disruption (p⬍0.05), while standard forceps assisted delivery had no correlation with anatomic defects. Decreased or absent voluntary rectal squeeze and a palpable sphincter defect on digital rectal examination significantly correlated with EAS defects (p⬍0.05), but not with IAS defects (p ⫽ 0.08 and 0.3). The clinical impression of sphincter disruption on DRE correlated significantly with both IAS and EAS defects (p⬍0.05). No clinically elicited symptoms commonly associated with fecal incontinence correlated significantly with EUS– documented sphincter disruption. Conclusions: Comprehensive fecal incontinence questionnaires, even when validated and reproducible, are not predictive of anatomic sphincter defects as documented objectively by EUS evaluation. Past medical history can be helpful, but is limited to prior rectal surgery or known sphincter tear, both of which have good specificity but poor sensitivity. DRE had good correlation with EUS– documented EAS defects but mixed positive predictive values. 883 MELANOSIS COLI AS A MARKER OF COLONIC NEOPLASIA Vivaik Tyagi, M.D., Gergec Abouzeidan, M.D., Fredrick Oni, M.D. and Vlado Simko, M.D.*. Medicine, Brooklyn Campus, VA NY Harbor Health Care System, Brooklyn, NY. Purpose: Melanosis coli may spare colonic polyps from pigmentation. Can it be considered as a potential tool for bioendoscopy? Methods: An 83 year old male patient with chronic constipation of many years, partly related to Parkinson’s disease,with poor response to multiple laxatives, underwent screening colonoscopy. There were three polyps (3–7 mm) starkly contrasting in whitish appearance with the very darkly pigmented mucosa of the surrounding ascending colon. Histology revealed two tubular and one villotubular adenomas with remarkable absence of the pigment in the polyps.
AJG – Vol. 97, No. 9, Suppl., 2002
Results: Despite the clinical terminology, the pigment is lipofuscin and not melanin. Stimulant laxatives of the anthraquinone type are very popular and available as non–precription remedies (incl. Senna, Ex–Lax and herbal teas). Anthranoids induce transient waves of apoptosis by releasing cytokines and altering the tight inter– epithelial junctions. This leads to the development of lipofuscin granules that are taken up by macrophages in the lamina propria. Macrophages then migrate to the regional lymph nodes. Anthranoids cause pigmentation only in the colon where colonic microorganisms transform the prodrug into an absorbable stimulant. Highest intensity of pigmentation occurs in the proximal colon. When the laxative is discontinued, the pigmentation gradually disappears. Conclusions: Our report confirms previous observation on hypopigmentation of neoplastic tissue in patients with melanosis coli. The goals of future research should be to determine why preneoplastic tissue is not affected by anthranoids. Ultimately, an anthranoid molecule should be identified which would be safe to use as a biomarker for endoscopic screening of colonic polyps.
884 DETECTION OF SMALL COLORECTAL ADENOMAS BY ROUTINE CHROMOENDOSCOPY WITH INDIGOCARMINE Jun Haeng Lee, M.D., Jung Uk Kim, M.D., Yong Kyun Cho, M.D., Chung Il Sohn, M.D., Woo Kyu Jeon, M.D. and Byung Ik Kim, M.D.*. Deparment of Medicine, Kangbuk Samsung Hospital, Seoul, Korea. Purpose: Non–polypoid adenomas, which can be important precursors of colorectal cancers, are difficult to find during routine colonoscopy. The aim of this study was to evaluate the usefulness of routine chromoendoscopy in Korea, where the incidence of colorectal cancer is low compared to the western countries. Methods: Colonoscopy with chromoendoscopy was performed in 50 consecutive patients (32 men, 18 women; mean age 52.4 years). After a careful examination of the whole colon, a defined segment of the sigmoid colon and rectum (0 –30 cm from the anal verge) was stained with 20 ml of 0.4% indigocarmine solution using a spraying catheter. Non–polypoid lesions were classified as flat or depressed types. Biopsies were taken from all lesions detected before or after staining with indigocarmine. Results: Indications for colonoscopy included routine check– up (15 patients), bowel habit change (13 patients), abdominal pain (6 patients), bleeding (4 patients) and others (12 patients). Before staining, 33 lesions were found in 18 patients (36%). Histology showed tubular adenoma in 22 lesions, hyperplastic or inflammatory changes in 8 lesions, adenocarcinoma in 2 lesions, and villous adenoma in 1 lesion. After indigocarmine staining for normal–looking distal 30 cm colorectal mucosa, 131 lesions were found in 31 patients (62%). Histologically, 114 lesions (from 23 patients) were hyperplastic or inflammatory in nature, and 17 lesions (from 10 patients) were tubular adenomas. Adenomas seen only after spraying indigocarmine were 2.6 ⫹/– 0.7 mm in diameter and classified as flat adenomas except for one small (1.5 mm) depressed adenoma. No adenoma with high– grade dysplasia or cancer was found after staining. Presence of macroscopic lesions before staining could not predict the existence of adenoma after staining. Conclusions: In a large proportion of Korean patients, flat or depressed adenomas could be found after spraying indigocarime for normal–looking colorectal mucosa. The clinical significance of these small adenomas, which could be found only after chromoscopy, needs to be further investigated.
885 UNSEDATED ENDOSCOPY: A REALITY OR STILL A DREAM Anand Madan, M.D. and Anil Minocha, M.D., FACG*. Division of Gastroenterology, Southern Illinois University School of Medicine, Springfield, IL and Division of Digestive Diseases, University of Mississippi Medical Center, Jackson, MS.
AJG – September, Suppl., 2002
Purpose: Several studies from major medical centers have reported that upto 90% of patients undergoing endoscopy are willing to undergo such procedures without sedation. According to our experience, these numbers are irrelevant in community setting and most patients actually ask for general anesthesia for endoscopy. We evaluated the willingness of patients in a community to undergo unsedated endoscopy and also assessed any characteristics which may predict such willingness. We also investigated if physicians and GI and non GI nurses would themselves be willing to undergo unsedated endoscopy. Methods: Adult patients who were referred for outpatient colonoscopy and/or EGD were invited to participate in the study. They filled out questionnaires asking for their demographic information and their willingness to undergo endoscopy without sedation. Pre–procedure anxiety level was assessed using Beck Anxiety Inventory. Similar information was obtained from physicians as well as GI and non–GI nursing staff. Results: Total of 295 subjects participated in the study. These included 127 patients, 51 physicians, 61 GI nurses and 56 non GI nursing staff from 6 different hospitals in central Illinois. Only 16.6% of patients and 15% of healthcare professionals were willing to undergo unsedated endoscopy. Physicians were least likely to agree to unsedated endoscopy (2.2%) as compared to patients (16.6%). Overall, there was no significant difference in willingness to forego sedation for EGD vs colonoscopy. Sub– data analysis revealed that 39% of GI nurses agreed to unsedated EGD as opposed to only 19% for colonoscopy. Among non–GI nurses, only 7% agreed to unsedated EGD while none wanted unsedated colonoscopy. Among patients, there was no significant corelation between educational level or anxiety scores and willingness for unsedated endoscopy. Fifteen percent of high school graduates were willing to undergo unsedated endoscopy compared to 18% with college or higher education. Patients with minimal or mild anxiety were just as unlikely to agree to an unsedated endoscopy as the subjects with moderate to severe anxiety (23% vs 19%). Conclusions: Unlike reports from major medical centers, most patients as well as medical professionals in community hospitals are unwilling to undergo unsedated endoscopy.
886 WRITTEN REPORTS IMPROVE PATIENT RECALL OF ENDOSCOPY RESULTS AND RECOMMENDATIONS Jason Poston, Ryan Day and David T. Rubin, M.D.*. Section of Gastroenterology, University of Chicago, Chicago, IL. Purpose: Growing demand for endoscopy associated with colorectal cancer screening has resulted in increased use of open access endoscopy (OAE), in which patients are referred without prior consultation by a gastroenterologist. Previous work has shown that OAE patients are less likely to recall the results or even the type of procedure they have had. We sought to determine whether providing patients with a written copy of their endoscopy report at the conclusion of their procedure enhanced recall of the findings and recommendations. Methods: 80 consecutive outpatients presenting to three endoscopists were randomized to receive the results of their endoscopy via standard verbal report (VR) or by VR followed by receipt of a computer generated endoscopy report (VR⫹WR) from the Olympus ImageManager威 report generator. The endoscopist communicated the VR after a standard post–procedure recovery period, and routinely discussed all findings and recommendations as mentioned in the WR. The endoscopist was blinded as to whether the patient subsequently received the WR. Recall of the endoscopic procedure was assessed using a piloted 11– question survey instrument to be filled– out three days post–procedure. Results were calculated using Fisher exact and Wilcoxon rank–sum tests. Results: 78 of 80 (98%) of patients agreed to participate. 62 (79%) were OAE patients. Of these, response rate was 75% for VR and 73% for VR⫹WR patients. VR⫹WR patients overall had a greater composite score than VR patients (8.8/10 vs. 7.3/10, p⬍0.01). VR⫹WR patients were also significantly more likely to recall the indications for their procedure (100% vs. 85%, p⬍0.05), recommendations for therapy or follow– up (68% vs.
Abstracts
S291
36%, p⬍0.01), whether a biopsy was performed (95% vs. 71%, p⬍0.05), and name of the endoscopist (95% vs.67%, p⬍0.05). When non–OAE patients were included in the analysis, similar statistically significant results were found regarding composite score (p⬍0.01), recommendations (p⬍0.01), and name of the endoscopist (p⬍0.05). Conclusions: A computer– generated endoscopy report significantly improves patient recall of endoscopic procedure information compared to a verbal report alone. Despite this, patients were unable to recall 32% of recommendations. Future work should assess whether patient– directed reports enhance patient satisfaction and follow– up.
887 PATIENT PREFERENCES REGARDING COLONOSCOPIC LAVAGE PREPARATIONS Kirin Kanji, M.D., Sanjay Garuda, M.D. and Michael D. Brown, M.D., FACG*. Section of Digestive Diseases, Rush Presbyterian St. Luke’s Medical Center, Chicago, IL. Purpose: For many patients the most unpleasant part of colonoscopy is the lavage preparation. Over 80% of the preparations for colonoscopy in the U.S. involve the use of a 4L polyethylene glycol (PEG) lavage. Complete consumption of all 4L is achievable by less than 70% of patients and is associated with significant side effects including nausea and dyspepsia. Newer preparations using sodium phosphate (NaP) in liquid or tablet form may be more tolerable and therefore preferred by patients. However, patients are rarely allowed to choose from preparations. We questioned patients on their preferences for preparations after having completed a single screening colonoscopy with either PEG lavage or NaP tablets. Methods: 117 patients undergoing screening colonoscopy for the first time were provided a questionnaire after the procedure describing details of three preparations; PEG lavage, NaP liquid and NaP tablets. 44 patients had received a PEG lavage and 73 had taken a 28 tablet NaP preparation. The patients were asked which preparation they would prefer given similar efficacy during their next colonoscopy. They were also asked if they would prefer to choose their preparation and whether the opportunity to choose a preparation might influence their choice of gastroenterologist. Results: Of the 44 patients who had taken the 4L PEG preparation only 5 (12%) would choose this prep again. 29 (66%) and 10 (22%) would choose NaP tablets and liquid respectively. Of the 73 who had taken NaP tablets, 67 (92%) would take the tablets again whereas 0 (0%) chose the PEG solution. 6 (8%) patients in this group choose the NaP liquid preparation. When patients are given a choice between PEG preparation and NaP tablets, there was a statistically significant difference in favor of the NaP tablets (chi– square ⫽ 81.990, p⬍ 0.0001). Of 113 patients answering the follow up questions, 106 (94%) would prefer to have a choice of preparation and 69 (61%) felt that providing different options for preparations might influence their choice of gastroenterologist. Conclusions: Patients prefer lower volume NaP preparations when allowed to choose a preparation for colonoscopy regardless of their previous preparation. Having a role in this decision is desirable and may influence a patient’s choice of gastroenterologist. 888 IS NORMAL TIBC A GOOD PREDICTOR OF NEGATIVE COLONOSCOPY? Rajeev Jayadevan, M.D., Pallavi Aggarwal, M.D., Edward Norkus, Ph.D., Hilary Hertan, M.D. and Capecomorin Pitchumoni, M.D.*. Gastroenterology, Our Lady of Mercy Medical Center, Bronx, NY. Purpose: To identify predictors of normal colonoscopy in anemic patients who undergo endoscopic investigation. Methods: In an ongoing prospective study of anemia, data on the first 60 consecutive patients were analyzed. Patients had anemia as defined by hemoglobin of ⬍13 g for men and ⬍12 g for women, with at least one of the following parameters: MCV ⬍80 fl, serum iron ⬍ 50 ug/dl, TIBC ⬎250 mg/dl, ferritin ⬍30 ng/ml, absence of overt blood loss or other well