A62 POST COLONOSCOPY COLORECTAL CANCERS IN ALBERTA. A PROCESS FOR IDENTIFYING TRUE CASES
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Determining Post Colonoscopy Colorectal Cancer (PCCRC) rates is one of the most important measures of colonoscopy quality. Most commonly, PCCRCs are the result of technical factors surrounding the colonoscopy such as inadequate bowel preparation, incomplete examination, missed early lesions and failure to adhere to follow-up guidelines. As these factors are amenable to quality interventions, we set out to identify PCCRC cases from a population perspective with a view to calculating incidence rates. Our objective was to develop a framework for data gathering and analysis in order to identify PCCRC cases and rates in Alberta in order to obtain a clearer understanding of the underlying causes of PCCRC where potential quality interventions might be applied. This was a retrospective population based review of all cases of colorectal cancer (CRC) diagnosed in Alberta in 2013. Data from the Alberta Cancer Registry (ACR) was linked to the Discharge Abstract Database (DAD), the National Ambulatory Care Reporting System (NACRS) and Alberta Ambulatory Care Reporting System (AACRS) databases to determine the timing of antecedent colonoscopies. We defined a PCCRC as a case identified in the ACR with ICD-10 codes for colorectal cancer with an antecedent colonoscopy greater than 6 months but less than 3 years prior to the diagnosis of CRC. Individual chart reviews were carried out to exclude high-risk groups such as IBD or genetic syndromes and to determine lesion location. Before a PCCRC rate could be calculated, we identified that the initial data linking process provided a number of cases that required further in depth review to determine if they met inclusion and exclusion criteria. Subsequently, through an iterative process of chart review, we developed a decision analysis framework (see Figure1), that provided a rational basis for case exclusion as well as systematic categorization of PCCRC root causes. Our analysis also identified areas for future quality improvement initiatives: such as the failure to arrange follow-up after poor bowel preparation or advanced lesions. We also identified cases where access to timely care resulted in the development of a PCCRC. Attempts to identify cases of PCCRC through database linkage identifies cases that require in depth analysis to determine eligibility. We have developed an algorithm that provides a rational basis for case exclusion as well as systematic categorization of PCCRC root causes. NoneAbstract The reported rates of incomplete colonoscopy (IC) range from 4% to 25% for both screening and nonscreening colonoscopy. Colonic neoplasm can be found in up to 53% on successful repeat colonoscopy. Transparent cap‐assisted colonoscopy (TCAC) and water‐exchange colonoscopy (WEC) have been applied seperately for repeat colonoscopy in the setting of failed difficult colonoscopy, but combination of these two methods for previous incomplete difficult colonoscopy has not been reported. The aim of this study is to report the success rate, time‐to cecum duration, polyp detection rate, and any complications using the combined methods of TCAC and WEC for previous incomplete difficult colonoscopy. Eight cases of incomplete difficult colonoscopy were enrolled from November 2016 to October 2018. Water exchange method (air‐less colonoscopy) performed during insertion of Cap‐fitted colonoscope, and after reaching the cecum, CO 2 was insufflated for examination during withdrawal. The mean age of all eight female patients was 59 years (39‐72 year). One patient had failed colonoscopy twice previously, four had previous abdominal surgery. Six cases were performed by gastroenterologists, and two by colorectal surgeons previously. The cecal intubation rate was 100% on repeat colonoscopy with the combined TCAC and WEC methods without complications. The mean duration time to reach the ceum was 12.5 minutes (6.8‐23.3 minutes). Out of the eight patients, four had colon polyps, all confined to proximal colon. Two patients have advanced colon adenoma. Combining cap‐assisted colonoscopy (TCAC), and water exchange colonoscopy (WEC) are useful in previous incomplete colonoscopy cases.
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Cecal intubation is one of the goals of colonoscopy. We sought to describe the methodology used by a single experienced examiner to perform colonoscopy in a consecutive group of patients with challenging colons.Records of 42 consecutive patients with one or more prior unsuccessful attempts at colonoscopy by a gastroenterologist or surgeon and referred for a repeat attempt at colonoscopy were reviewed.Colonoscopy was complete to the cecum in 40 of the 42 patients (95%). An array of methods was employed, including propofol sedation (n = 2), pediatric colonoscope (n = 8), an external straightener (n = 9), external straightener with pediatric colonoscope (n = 2), upper endoscope (n = 8), guidewire exchange (n = 3), and enteroscope with a colon straightener (n = 1) or an enteroscope straightener (n = 1).A variety of methods and instruments were employed to achieve a high cecal intubation rate during colonoscopy in a group of patients with prior incomplete colonoscopies. Others may find one or more of these methods useful in patients with challenging colons.
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Implementation of colorectal cancer screening programme and provision of cancer service within certain timeframe has significantly increased the workload on endoscopy services. Direct access colonoscopy in primary care centers helps offload burden on conventional colonoscopy in secondary care, thereby reducing waiting times. The aim of this study was to assess the safety and efficacy of direct access colonoscopy service.Provision of colonoscopy service in our healthcare trust was analysed retrospectively during a two-year period. Safety and feasibility of direct access colonoscopy was analysed against conventional colonoscopy. The groups were compared for findings at colonoscopy, procedural outcomes, and complications.A total of 3468 colonoscopies were analysed. Of those, 1189(34.3%) were performed as direct access colonoscopy and 2279(65.7%) as conventional colonoscopy. No abnormality was detected in 408/1189(34.3%) and 825/2279(36.2%) patients in the direct access colonoscopy and conventional colonoscopy groups, respectively (p = 0.52). Colorectal cancer detection rate was similar between the groups; conventional colonoscopy vs direct access colonoscopy, 3.1% (68/2279) vs 3.2% (39/1189) (p = 0.85). However, there was significantly higher detection rate of polyps greater than 1 cm in conventional colonoscopy group compared to direct access colonoscopy group, 22.6%(518/2289) vs 12.6% (150/1189) (p = 0.02). Complication rates were comparable between the groups.Direct access colonoscopy in primary care centers is safe and feasible. Colorectal cancer detection remains comparable to that of conventional colonoscopy in secondary care despite relatively lower polyp detection rate.
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Objective To summarize the technique of one-man colonoscopy. Method The data of one-man colonoscopy and two-men colonoscopy on 360 patients were comparatively analyzed. Results The success rate of one-man colonoscopy was up to 96.9%, while two-men colonoscopy was 85.5%. The rate of reaching the end of ileum by one-man colonoscopy was 85%, and that of two-men colonoscopy was 56.0%. Eight minutes and eight seconds were spent for one-man colonoscopy to reach ileocecus on average, which was faster than two-men colonoscopy(11.5 minutes on average). The incidence of complication caused by two-men colonoscopy was 0%, whereas two-men colonoscopy was 0.88%. All results of one-man colonoscopy were superior to those of the control group. Conclusion One-man colonoscopy is not only time-saving and manpower-saving, but also safe and efficient.
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Objective To compare the clinical choosing principles of sedated colonoscopy with con-ventional colonoscopy. Methods Outpatients who were willing to accept colonoscopy with or without seda-tion were prospectively recruited,which were assigned to sedated colonoscopy group(n=362)and conven-tional colonoscopy group(n=323). All patients and endoscopists were asked to answer a self-administered questionnaire. The colonoscopy completion,operation time,procedure-related discomfort,and questionnaire results of the two groups were compared and statistically analyzed. Results The completion rate was 98. 9%in the sedated colonoscopy group(358/362)and 89. 8% in the conventional colonoscopy group(290/323) ( P=0. 337 ). The operation time of sedated and conventional group were( 5. 60 ± 3. 25 ) minutes and (7. 71 ± 5. 70)minutes respectively(P<0. 001). And the average cost was CNY 886. 54 per patient in se-dated group and CNY 386. 00 per patient in the conventional group. Patient satisfaction score of conventional group and sedated group were 4(3-4)and 3(2-3)points(P<0. 001),while endoscopist satisfaction score was 4(3-4)and 4(4-4)(P<0. 001). A total of 354 patients(97. 79%)in the sedated group and 225 pa-tients(69. 66%)in the conventional group showed willingness to repeat the identical colonoscopy( P <0. 001). Patients who were male(P=0. 035),having no past abdominal operations(P<0. 001),or no ab-dominal pain during colonoscopy( P =0. 015 )in the conventional group preferred to repeat conventional colonoscopy. Conclusion Although the examination time of conventional colonoscopy is longer than sedated colonoscopy,it could reduce anesthesia risk and the cost. Conventional colonoscopy remains an irreplaceable examination of colorectal diseases in developing countries. Physicians should not only focus on patients'com-fort during endoscopy,but also help patients make a decision based on their actual situation and endoscopic indications to make the best of medical resources.
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Colonoscopy ; Toleration ; Patient satisfaction ;
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Introduction: Sessile serrated adenomas (SSAs) are important premalignant lesions that are difficult to detect during colonoscopy due to poor definition, concealment by mucous caps, and flat appearance. High definition (HD) colonoscopy may uniquely aid in the detection of these inconspicuous lesions compared to standard definition (SD) colonoscopes. We performed a retrospective study to evaluate the benefit of HD colonoscopy on SSA detection rate (SSADR) in average-risk patients undergoing screening colonoscopy. Methods: Data from screening colonoscopies for patients aged 50-76 years within two years before and two years after the transition from SD colonoscopy to HD colonoscopy were compiled from our large, academic teaching center. Patients with symptoms of colorectal disease, positive occult blood test, history of colon polyps, cancer, polyposis syndrome, inflammatory bowel disease or family history of colon cancer or polyps were excluded. Patients whose endoscopists did not perform colonoscopies both before and after scope definition change were also excluded. Differences in individual endoscopist, average, and overall SSADRs with SD colonoscopy vs HD colonoscopy were also evaluated for significance. Results: A total of 3657 colonoscopies met eligibility criteria with 2012 colonoscopies from the SD colonoscopy period and 1645 colonoscopies from the HD colonoscopy period. Eleven endoscopists performed colonoscopies both before and after implementation of HD colonoscopy. Significant improvements of 2.30% in mean SSADR and 2.53% in overall SSADR were noted with HD colonoscopy (P = 0.00028 and P = 0.00849, respectively). On the individual level, three endoscopists saw significant benefit with HD colonoscopy (+5.74%, P = 0.0056; +4.50%, P = 0.0278; +4.84%, P = 0.03486). Conclusion: Our study suggests that high definition colonoscopy statistically significantly improves sessile serrated adenoma detection in the screening of average risk patients during screening colonoscopy. By improving the detection and removal of these lesions, adoption of high definition colonoscopy may reduce the significant premalignant burden of sessile serrated adenomas.Figure 1:: Endoscopist, overall, and average SSADRs during SD colonoscopy and HD colonoscopy. * denotes statistically significant difference (P <0.05)Table 1.: Endoscopist, overall, and average SSADRs with corresponding colonoscopy volumes during SD colonoscopy and HD colonoscopy.
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To estimate the accuracy of CT colonoscopy in patients with lower GI symptoms who have been referred to the department of radiology from the department of gastroenterology at Sree balaji medical college and hospital, Chennai. To compare the findings obtained from CT colonoscopy with conventional colonoscopy and provide better understanding about the use of CT colonoscopy in regular practice and determine the utility, advantages and limitations of virtual colonoscopy in detection and diagnosis of colonic pathologies. In our study CT colonoscopy 80 % sensitivity of detecting hemorrhoids which was lesser compared to that of conventional colonoscopy. CT colonoscopy detected that 38% of the patients had extra colonic findings of whichthe predominant finding was renal calculi. Patient acceptability was better in our study and there was no need for sedation and analgesics.
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As the significance of the quantitative fecal immunochemical test (FIT) in patients who previously underwent a colonoscopy is unknown, this study aimed at investigating the association between fecal hemoglobin concentration and the risk of colorectal cancer (CRC).We retrospectively analyzed FIT-positive patients who underwent a colonoscopy through our opportunistic annual screening program from April 2010 to March 2017 at the Kyoto Second Red Cross Hospital. We stratified them into no colonoscopy and past colonoscopy (>5 years or ≤5 years) groups based on whether they had a history of undergoing a colonoscopy and analyzed the correlation between fecal hemoglobin concentration and advanced neoplasia or invasive cancer detection in each group. We analyzed 1248 patients with positive FIT results. There were 748 (59.9%), 198 (15.9%), and 302 (24.2%) patients in the no colonoscopy, past colonoscopy (>5 years), and past colonoscopy (≤5 years) groups, respectively. In the no colonoscopy group, the advanced neoplasia detection rate significantly increased with the fecal hemoglobin concentration (P < 0.001). However, no significant trend was observed in the past colonoscopy (both >5 years and ≤5 years) group (P = 0.982). No invasive cancer was detected in the past colonoscopy (≤5 years) group.The risk of CRC might be low even if fecal hemoglobin concentration was high, especially in those who underwent colonoscopy within 5 years.
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Background/Aims: Colonoscopy is an important method to screen for colorectal neoplasm and it is known to be a relatively safe procedure. Yet various minor complications, such as abdominal pain or discomfort, may result from colonoscopy or from additional colonoscopic procedures. In this study, we estimated the incidence of minor complications, the related risk factors and the total time requirement for colonoscopy. Methods: We conducted a prospective analysis from 201 patients who visited Hanyang University Guri Hospital for colonoscopy during February to April, 2008. On the first day after colonoscopy, we asked the patients about the length of personal time devoted to the colonoscopy, such as the time taken for bowel preparation. We contacted all the patients by telephone 3 days after colonoscopy and we asked about any minor complications after colonoscopy, what was the most difficult part of the procedure and the time it took to get back to normal activity. Results: Minor complications occurred in 66 patients (32.8%), of which abdominal discomfort was the most common complaint (74.2%). The incidence of minor complications was increased significantly in proportion to the procedure time (p ＜0.0001). Bowel preparation was the most difficult part of the procedure for patients (88.0%). The mean duration of colonoscopy was 20 minutes, while the entire time allotted for colonoscopy from bowel preparation to arriving home was an average of 8.24 hours. The mean recovery time to normal activity was 19.02 hours. Conclusions: Minor complications are relatively common when undergoing colonoscopy, and the duration of the procedure is significantly related to the incidence of minor complications. The majority of patients have difficulty with bowel preparation, so further studies concerning the development of a comfortable and effective preparation method are needed.
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