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Adamsen S, Goodman AJ. Photodocumentation in colonoscopy. Gastrointest Endosc 2023; 98:803-805. [PMID: 37863572 DOI: 10.1016/j.gie.2023.07.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 07/26/2023] [Indexed: 10/22/2023]
Affiliation(s)
- Sven Adamsen
- Digestive Disease Center, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Adam J Goodman
- Division of Gastroenterology and Hepatology, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA
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2
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He X, Chen Y, Zhou X, Lu C. Clinical Course and Prognosis of Isolated Terminal Ileal Ulcers. ARCHIVES OF IRANIAN MEDICINE 2023; 26:434-438. [PMID: 38301105 PMCID: PMC10685738 DOI: 10.34172/aim.2023.66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 07/17/2022] [Indexed: 02/03/2024]
Abstract
BACKGROUND Isolated terminal ileal ulcers (ITIUs) may be a clue to hidden intestinal diseases. However, there are no specific guidelines for ITIUs. METHODS We retrospectively screened subjects undergoing colonoscopy at The First Affiliated Hospital, Zhejiang University from March 2014 to July 2019, and included patients with ITIUs in the study. Some patients underwent further examination of the entire small intestine. Subsequently, patients with undetermined ITIUs received empiric therapy or observational follow-up. At least one year after baseline colonoscopy, telephone follow-up was performed to collect prognostic information. RESULTS A total of 120 (0.3%) patients undergoing colonoscopy in our center were found with ITIUs. Fourteen patients underwent further examination of the entire small intestine, six of whom were found with additional small bowel ulcers, but it did not significantly help the diagnosis. We obtained follow-up information from 41 undiagnosed patients. Over an average follow-up of 35.4 months, there was no significant difference in the prognosis of patients receiving empiric therapy or observational follow-up. The clinical and endoscopic outcomes improved or remain unchanged in most patients. In logistic regression analysis, gender, age, chief complaint, number of ulcers, and follow-up strategy had no significant impact on prognosis. CONCLUSION Patients with nonspecific ITIUs usually improve without any therapy, and observational follow-up may be a reasonable strategy.
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Affiliation(s)
- Xinjue He
- Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Yue Chen
- Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Xinxin Zhou
- Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Chao Lu
- Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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3
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Alkhatib AA, Kumar S. Clinical Yield of Ileal Intubation During Screening Colonoscopy. Cureus 2022; 14:e20870. [PMID: 35145777 PMCID: PMC8803374 DOI: 10.7759/cureus.20870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2022] [Indexed: 11/06/2022] Open
Abstract
Objectives Ileal intubation during screening colonoscopy can serve as supportive evidence of complete examination. However, most studies conducted in Western countries showed a limited value of ileal inspection in asymptomatic patients undergoing colonoscopy. Therefore, our aim is to determine the clinical yield of routine ileal examination during the performance of screening colonoscopy in a cohort of patients in the Middle East and identify factors associated with successful ileal intubation in this setting. Methods A retrospective review of a prospectively collected database of all screening colonoscopies was performed at a single endoscopy unit. The patients were divided into two groups; group A included patients in whom the extent of examination was the cecum and group B comprised of those who underwent ileal intubation as well. We summarized the endoscopic and pathological findings of the ileoscopic examinations and their clinical impact. Univariate and multivariate analyses were used to compare both groups and to identify factors predictive of ileal intubation in the setting of screening colonoscopy. Results Two thousand four hundred seventy-three unique completed screening colonoscopies were analyzed (group A=1465 patients, group B=1008 patients). Overall Ileal intubation rate was 40.8%. Of the patients in group B, 3.7% were noted to have findings on ileoscopy, which were deemed to be clinically significant in almost half (1.8% overall). Univariate analysis identified the following factors as being predictive of ileal intubation during screening colonoscopy: patients' age (51.7 vs. 53.5 years, p<0.001), short cecal insertion time, endoscopists' specialty (gastroenterology 42.3% vs. surgery 24.3%, p<0.001), type of colonoscope (pediatric 47.1% vs. adult 33.5% colonoscope, p<0.001), and quality of preparation in the right colon (poor vs. adequate/good : (25.6% vs. 42.5%, p<0.001). Mixed-effects logistic regression identified patients' age, endoscopist specialty, quality of right colon preparation, and cases with short insertion time as independent variables predicting ileal intubation during SC Conclusion The clinical yield of routine ileal intubation during screening colonoscopy is low. Ileal intubation during screening colonoscopy in our cohort was more likely in younger patients with adequate/good right colon preparation and when the exam is performed by a gastroenterologist, in cases with short insertion time. Prospective studies are needed to assess our research findings and to determine the clinical value of routinely intubating terminal ileum during screening colonoscopy in the population of the Middle East.
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Kim JH, Lee JY, Park YE, Lee JH, Park J, Kim TO, Moon W, Park SJ. Clinical Course of Terminal Ileal Ulcers Observed Incidentally During Colonoscopy. Dig Dis Sci 2021; 66:4423-4428. [PMID: 33723699 DOI: 10.1007/s10620-020-06781-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 12/10/2020] [Indexed: 12/09/2022]
Abstract
BACKGROUND Cecal intubation is essential during colonoscopy, and observation of the terminal ileum is performed in most clinical practices. However, data on terminal ileal (TI) ulcers observed incidentally during colonoscopy are rare. AIM We aimed to identify the characteristics and clinical course of TI ulcers observed incidentally during colonoscopy. METHODS Between January 2008 and December 2018, medical records from multi-centers reporting asymptomatic subjects who underwent biopsy on TI ulcers during colonoscopy were retrospectively reviewed. The characteristics of endoscopic findings and clinical course of TI ulcers were analyzed, and the factors affecting the clinical course of TI ulcers were evaluated. RESULTS The median follow-up durations from first to second colonoscopy and from second to third colonoscopy were 20 months (interquartile range, 12-36) and 24 months (interquartile range, 12-34), respectively. A total of 134 subjects were included in the analysis. The histopathologic findings of TI ulcers were mostly chronic or active ileitis/inflammation (92.7%). On the second colonoscopy, 59 (44.0%) patients had no ulcers, 38 (28.4%) showed a decrease in size or number, and 37 (27.6%) patients showed no change in ulcers. Among 62 subjects who underwent a third colonoscopy, 14 (10.4%) had decreased size or number, 10 (7.5%) had no ulcer change, and two (1.5%) had increased ulcer size or number. In multivariate logistic regression analysis, a star shape was the only factor affecting continuation without improvement of incidental TI ulcers. CONCLUSIONS Most TI ulcers observed incidentally showed no unusual findings on biopsy and improved on follow-up colonoscopy without treatment.
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Affiliation(s)
- Jae Hyun Kim
- Department of Internal Medicine, Kosin University College of Medicine, Gamcheonro 262, Seo-gu, Busan, 49267, Korea
| | - Jong Yoon Lee
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Yong Eun Park
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jong Hoon Lee
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Jongha Park
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Tae Oh Kim
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Won Moon
- Department of Internal Medicine, Kosin University College of Medicine, Gamcheonro 262, Seo-gu, Busan, 49267, Korea
| | - Seun Ja Park
- Department of Internal Medicine, Kosin University College of Medicine, Gamcheonro 262, Seo-gu, Busan, 49267, Korea.
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Akturk R, Serinsoz S. WHEN AND FOR WHICH PATIENTS SHOULD WE PERFORM ILEAL INTUBATION AND ILEAL BIOPSY DURING COLONOSCOPY. SANAMED 2021. [DOI: 10.24125/sanamed.v16i1.485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Innocenti T, Dragoni G, Roselli J, Macrì G, Mello T, Milani S, Galli A. Non-small-bowel lesions identification by capsule endoscopy: A single centre retrospective study. Clin Res Hepatol Gastroenterol 2021; 45:101409. [PMID: 32245690 DOI: 10.1016/j.clinre.2020.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 02/23/2020] [Accepted: 03/02/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Capsule endoscopy has been considered the first-line approach for the investigation of obscure gastro-intestinal bleeding since its approval in 2001. Our study aims to evaluate the diagnostic yield of capsule endoscopy in the investigation of this condition. We also analyse the incidence of non-small-bowel lesions missed after conventional endoscopy and later detected by capsule endoscopy in patients with suspected obscure bleeding. METHODS A total of 290 patients with negative conventional endoscopy referred to our centre to undergo a capsule endoscopy examination for the investigation of obscure gastro-intestinal bleeding. We considered as non-small-bowel lesions those outside the tract between the second duodenal portion and the ileocecal valve. We also looked for actively bleeding lesions at the time of the exam. RESULTS Intestinal preparation was good, adequate or poor in 74.1%, 8.4%, and 17.5% of the tests, respectively. Caecum was reached in 92.4%. Capsule retention occurred in 0.7%. Mean small bowel transit time was 5hours and 13minutes. Diagnostic yield was 73.8%. An actively bleeding lesion was noticed in 39.3% of positive tests. Capsule endoscopy revealed clinically significant non-small-bowel lesions missed at gastroscopy or colonoscopy in 30.3% of patients, 43.2% of which were bleeding. CONCLUSIONS Capsule endoscopy has high diagnostic yield and safety in the investigation of obscure gastro-intestinal bleedings. Given the high percentage of non-small-bowel lesions detected, it may be appropriate to consider an endoscopic second look before performing a capsule endoscopy study.
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Affiliation(s)
- Tommaso Innocenti
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Viale G. B. Morgagni 50, 50134 Florence, Italy.
| | - Gabriele Dragoni
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Viale G. B. Morgagni 50, 50134 Florence, Italy
| | - Jenny Roselli
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Viale G. B. Morgagni 50, 50134 Florence, Italy
| | - Giuseppe Macrì
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Viale G. B. Morgagni 50, 50134 Florence, Italy
| | - Tommaso Mello
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Viale G. B. Morgagni 50, 50134 Florence, Italy
| | - Stefano Milani
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Viale G. B. Morgagni 50, 50134 Florence, Italy
| | - Andrea Galli
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Viale G. B. Morgagni 50, 50134 Florence, Italy
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Wang W, Chen K, Xu Y, Zhou Y, Chen P. Routine ileal intubation in colonoscopy does not increase the polyp detection rate: a retrospective study. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2020; 58:955-959. [PMID: 33036049 DOI: 10.1055/a-1213-6701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Colonoscopy is effective in the prevention and screening of colorectal cancer. Whether terminal ileal (TI) intubation is required during conventional colonoscopy and whether it offers clinical benefits with respect to polyp detection rate (PDR) remain unclear. This retrospective study included patients who underwent colonoscopy at our hospital between July 1, 2018 and April 20, 2019. The positive findings and time for TI intubation were recorded. Univariate and multivariate analyses were performed to identify factors associated with PDR. There were 1675 patients with cecal intubation colonoscopy, including 994 (59 %) with TI intubation and 8 (1 %) with intestinal disease. The mean time for TI intubation was 40 seconds (3-338), and the mean time from cecal intubation to arrival at the deep part of TI mucosa was 24 seconds (2-118). The overall PDR was 27 %. On multivariable analysis, age > 50 years [95 % confidence interval (CI) 2.837-4.590], male sex (95 %CI, 0.406-0.649), presence of symptoms (abdominal symptoms vs. asymptomatic, 95 % CI, 1.146-2.468; stool changes vs. asymptomatic, 95 % CI, 1.070-1.834), and non-TI intubation (95 % CI, 1.040-1.648) were independent predictors of higher PDR. Trend analysis indicated decreasing trend of PDR among non-TI intubation group, 0-5 cm TI intubation group, and > 5 cm TI intubation group (30 % vs. 27 % vs. 24 %, respectively; p < 0.05). TI intubation is necessary to identify small bowel disease among a designated population, but it was not suggested to be routinely performed as part of colonoscopy, owing to limited positive intestinal findings, extra time requirement, and possible PDR worsening.
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Affiliation(s)
- Weiyi Wang
- Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China., Shanghai, China.,Department of Gastroenterology, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China., Shanghai, China.,Department of Endoscopy, Shanghai Tong Ren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ke Chen
- Department of Endoscopy, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, PR China, Shanghai, China
| | - Ying Xu
- Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China., Shanghai, China.,Department of Gastroenterology, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China., Shanghai, China
| | - Yufen Zhou
- Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China., Shanghai, China.,Department of Gastroenterology, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China., Shanghai, China
| | - Ping Chen
- Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China., Shanghai, China.,Department of Gastroenterology, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China., Shanghai, China
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8
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Leiman DA, Jawitz NG, Lin L, Wood RK, Gellad ZF. Terminal ileum intubation is not associated with colonoscopy quality measures. J Gastroenterol Hepatol 2020; 35:1503-1508. [PMID: 32003060 DOI: 10.1111/jgh.14997] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 01/08/2020] [Accepted: 01/27/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND AIM Intubation of the terminal ileum (TI) demonstrates a complete colonoscopy, but its clinical value during screening exams is unknown. We aimed to determine whether TI intubation during screening colonoscopy is associated with colonoscopy quality measures or identifies subclinical pathology. METHODS We performed a retrospective cohort study examining average-risk screening colonoscopies performed at an academic health system between July 2016 and October 2017. Data were extracted from an internal colonoscopy quality registry and the electronic health record. Appropriate statistical tests were used for group comparisons, to correlate TI intubation rate (TIIR) with measures of colonoscopy quality and to examine factors associated with the likelihood of TI intubation. RESULTS There were 7799 colonoscopies performed with adequate prep quality by 28 gastroenterologists. Most patients were female (56.4%) with a median age of 58. The median TIIR was 37.0%, with significant variability among physicians (2-93%). The detection rates for all polyps, adenomas, and sessile serrated polyps were 62.1%, 45.5%, and 7.2%, respectively, and none correlated with TIIR. Intubation of the TI was associated with significantly longer withdrawal times. In a random 10% sample of cases with TI intubation, no clinically significant pathology was found. CONCLUSIONS There is wide variability in TIIR among endoscopists. Except to provide photodocumentation of exam extent when other images may be difficult to obtain, the lack of correlation between TI intubation and meaningful clinical outcomes together with the associated time costs suggest routine TI intubation during screening colonoscopy may not be warranted.
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Affiliation(s)
- David A Leiman
- Division of Gastroenterology, Duke University, Durham, North Carolina, USA.,Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Nicole G Jawitz
- Division of Gastroenterology, Duke University, Durham, North Carolina, USA
| | - Li Lin
- Department of Population Health Sciences, Duke University, Durham, North Carolina, USA
| | - Richard K Wood
- Division of Gastroenterology, Duke University, Durham, North Carolina, USA
| | - Ziad F Gellad
- Division of Gastroenterology, Duke University, Durham, North Carolina, USA.,Duke Clinical Research Institute, Durham, North Carolina, USA.,Division of Gastroenterology, Durham VA Health Care System, Durham, North Carolina, USA
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9
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Zimmermann-Fraedrich K, Sehner S, Rex DK, Kaltenbach T, Soetikno R, Wallace M, Leung WK, Guo C, Gralnek IM, Brand EC, Groth S, Schachschal G, Ikematsu H, Siersema PD, Rösch T. Right-Sided Location Not Associated With Missed Colorectal Adenomas in an Individual-Level Reanalysis of Tandem Colonoscopy Studies. Gastroenterology 2019; 157:660-671.e2. [PMID: 31103625 DOI: 10.1053/j.gastro.2019.05.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 05/07/2019] [Accepted: 05/10/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND & AIMS Interval cancers occur more frequently in the right colon. One reason could be that right-sided adenomas are frequently missed in colonoscopy examinations. We reanalyzed data from tandem colonoscopies to assess adenoma miss rates in relation to location and other factors. METHODS We pooled data from 8 randomized tandem trials comprising 2218 patients who had diagnostic or screening colonoscopies (adenomas detected in 49.8% of patients). We performed a mixed-effects logistic regression with patients as cluster effects with different independent parameters. Factors analyzed included location (left vs right, splenic flexure as cutoff), adenoma size, form, and histologic features. Analyses were controlled for potential confounding factors such as patient sex and age, colonoscopy indication, and bowel cleanliness. RESULTS Right-side location was not an independent risk factor for missed adenomas (odds ratio [OR] compared with the left side, 0.94; 95% CI, 0.75-1.17). However, compared with adenomas ≤5 mm, the OR for missing adenomas of 6-9 mm was 0.62 (95% CI, 0.44-0.87), and the OR for missing adenomas of ≥10 mm was 0.51 (95% CI, 0.33-0.77). Compared with pedunculated adenomas, sessile (OR, 1.82; 95% CI, 1.16-2.85) and flat adenomas (OR, 2.47; 95% CI, 1.49-4.10) were more likely to be missed. Histologic features were not significant risk factors for missed adenomas (OR for adenomas with high-grade intraepithelial neoplasia, 0.68; 95% CI, 0.34-1.37 and OR for sessile serrated adenomas, 0.87; 95% CI, 0.47-1.64 compared with low-grade adenomas). Men had a higher number of adenomas per colonoscopy (1.27; 95% CI, 1.21-1.33) than women (0.86; 95% CI, 0.80-0.93). Men were less likely to have missed adenomas than women (OR for missed adenomas in men, 0.73; 95% CI, 0.57-0.94). CONCLUSIONS In an analysis of data from 8 randomized trials, we found that right-side location of an adenoma does not increase its odds for being missed during colonoscopy but that adenoma size and histologic features do increase risk. Further studies are needed to determine why adenomas are more frequently missed during colonoscopies in women than men.
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Affiliation(s)
| | - Susanne Sehner
- Department of Medical Biometry and Epidemiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Douglas K Rex
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Tonya Kaltenbach
- Veterans Administration San Francisco and University of California San Francisco, San Francisco, California
| | - Roy Soetikno
- Veterans Administration San Francisco and University of California San Francisco, San Francisco, California
| | - Michael Wallace
- Division of and Hepatology, Mayo Clinic Jacksonville, Jacksonville, Florida
| | - Wai K Leung
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | - Chuanguo Guo
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | - Ian M Gralnek
- Institute of Gastroenterology and Hepatology, Emek Medical Center, Afula, Israel
| | - Eelco C Brand
- Department of Gastroenterology and Hepatology, University Medical Center, Utrecht, The Netherlands
| | - Stefan Groth
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Guido Schachschal
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Hiroaki Ikematsu
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Peter D Siersema
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Thomas Rösch
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
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10
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Tang SJ, Wu R. Ilececum: A Comprehensive Review. Can J Gastroenterol Hepatol 2019; 2019:1451835. [PMID: 30854348 PMCID: PMC6378086 DOI: 10.1155/2019/1451835] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 11/18/2018] [Accepted: 12/09/2018] [Indexed: 02/07/2023] Open
Abstract
For gastrointestinal endoscopists, the ileocecum is the finishing line during colonoscopy and it is identified by three endoscopic landmarks: terminal ileum, ileocecal valve, and the appendiceal orifice. Although ileal intubation is recommended during routine screening colonoscopy, it is not required in most cases of screening colonoscopy. Ileal intubation is indicated in certain circumstances such as suspected inflammatory bowel disease and GI bleeding. There is much pathology that can be observed within the ileocecum. Careful and systematic examination should be stressed during GI endoscopic training and practice. In this review, the authors demonstrate its anatomy, endoscopic findings, and pathologies.
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Affiliation(s)
- Shou-jiang Tang
- Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, USA
| | - Ruonan Wu
- Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, USA
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11
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Diagnostic Yield of Upper and Lower Gastrointestinal Endoscopies in Children in a Tertiary Centre. J Pediatr Gastroenterol Nutr 2017; 64:903-906. [PMID: 28333770 DOI: 10.1097/mpg.0000000000001582] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Endoscopy is integral to the diagnosis and management of many gastrointestinal problems in children. Recently the number of endoscopic procedures performed has increased considerably worldwide raising questions about their appropriateness and cost-efficacy. OBJECTIVES The aim of the study was to determine the diagnostic yield (the likelihood that a procedure or test will provide information required to establish a diagnosis) of endoscopy in a paediatric population in a large tertiary referral centre and to determine the terminal ileum intubation (TII) rate of paediatric ileocolonosocopy (IC) in an active training environment and compare with previously calculated rates. METHODS Random selection of cases from a theatre electronic database from a 30-month period covering April 2012 to October 2014. The data were collected for initial presenting symptoms; age at diagnosis; indications for endoscopy; endoscopic findings; histopathological findings; and any change in management postendoscopic procedure. The diagnostic yield of the endoscopies and the TII rate of IC were calculated. Change in and contribution to management was assessed. RESULTS Median age 9.58 (0.5-16.5) years and M:F ratio 1:1.42. The positive diagnostic yield was 18.9% for oesophago-gastro-duodenoscopy alone, 32.6% for IC alone, and 39.2% when both occurred. In 45% management was actively changed due to endoscopy/histopathology findings and a significant management contribution occurred in all patients. TII was achieved in 98% of cases, which compares favourably to a TII rate of 89% at the same centre during the period 2009 to 2011. CONCLUSIONS Diagnostic yield was 32.6% for IC and 39.2% when oesophago-gastro-duodenoscopy also occurred. A TII rate of 98% should be achievable in children. A change in management occurred in 45% and as a significant negative finding may be as important as a positive diagnosis for exclusion of suspected disorders, with consequent reassurance and change in management. Contribution to management was therefore identified in all cases.
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12
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Sakata S, Stevenson ARL, Naidu S, Hewett DG. Techniques for Terminal Ileal Intubation at Colonoscopy When Standard Maneuvers Fail. Am J Gastroenterol 2017; 112:11-12. [PMID: 27801887 DOI: 10.1038/ajg.2016.497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Shinichiro Sakata
- School of Medicine, The University of Queensland, Brisbane, Australia.,Department of Colon and Rectal Surgery, Royal Brisbane & Women's Hospital, Brisbane, Australia.,Department of Surgery, The Queen Elizabeth II Jubilee Hospital, Brisbane, Australia
| | - Andrew R L Stevenson
- School of Medicine, The University of Queensland, Brisbane, Australia.,Department of Colon and Rectal Surgery, Royal Brisbane & Women's Hospital, Brisbane, Australia
| | - Sanjeev Naidu
- School of Medicine, The University of Queensland, Brisbane, Australia.,Department of Surgery, The Queen Elizabeth II Jubilee Hospital, Brisbane, Australia
| | - David G Hewett
- School of Medicine, The University of Queensland, Brisbane, Australia.,Department of Surgery, The Queen Elizabeth II Jubilee Hospital, Brisbane, Australia
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13
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Rees CJ, Bevan R, Zimmermann-Fraedrich K, Rutter MD, Rex D, Dekker E, Ponchon T, Bretthauer M, Regula J, Saunders B, Hassan C, Bourke MJ, Rösch T. Expert opinions and scientific evidence for colonoscopy key performance indicators. Gut 2016; 65:2045-2060. [PMID: 27802153 PMCID: PMC5136701 DOI: 10.1136/gutjnl-2016-312043] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 09/08/2016] [Accepted: 09/11/2016] [Indexed: 12/12/2022]
Abstract
Colonoscopy is a widely performed procedure with procedural volumes increasing annually throughout the world. Many procedures are now performed as part of colorectal cancer screening programmes. Colonoscopy should be of high quality and measures of this quality should be evidence based. New UK key performance indicators and quality assurance standards have been developed by a working group with consensus agreement on each standard reached. This paper reviews the scientific basis for each of the quality measures published in the UK standards.
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Affiliation(s)
- Colin J Rees
- Department of Gastroenterology, South Tyneside District Hospital, South Shields, UK
| | - Roisin Bevan
- Department of Gastroenterology, North Tees University Hospital, Stockton-on-Tees, UK
| | | | - Matthew D Rutter
- Department of Gastroenterology, North Tees University Hospital, Stockton-on-Tees, UK
| | - Douglas Rex
- Department of Gastroenterology, Indiana University, Indianapolis, USA
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Thierry Ponchon
- Department of Gastroenterology and Hepatology, Edouard Herriot Hospital, Lyon University, Lyon, France
| | - Michael Bretthauer
- Department of Health Management and Health Economics and KG Jebsen Center for Colorectal Cancer Research, University of Oslo, Oslo, Norway
| | - Jaroslaw Regula
- Department of Gastroenterology, Medical Center for Postgraduate Education and the Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - Brian Saunders
- Department of Gastroenterology, St Mark's Hospital and Academic Institute, Harrow, UK
| | - Cesare Hassan
- Digestive Endoscopy Unit, Catholic University, Rome, Italy
| | - Michael J Bourke
- Department of Gastroenterology, Westmead Hospital, Sydney, Australia
| | - Thomas Rösch
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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14
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Affiliation(s)
- Colin Rees
- South Tyneside NHS Foundation Trust, Gastroenterology Department, South Shields, United Kingdom,Corresponding author Colin Rees South Tyneside NHS TrustGastroenterology DepartmentHarton LaneSouth Shields NE34 0PLUnited Kingdom
| | - Laura Neilson
- South Tyneside NHS Foundation Trust, Gastroenterology Department, South Shields, United Kingdom
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15
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Robertson DJ, Kaminski MF, Bretthauer M. Effectiveness, training and quality assurance of colonoscopy screening for colorectal cancer. Gut 2015; 64:982-90. [PMID: 25804631 DOI: 10.1136/gutjnl-2014-308076] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Accepted: 02/07/2015] [Indexed: 12/14/2022]
Abstract
Screening for colorectal cancer has been proven to be effective in reducing colorectal cancer incidence and mortality. While the precise benefit of screening exclusively by colonoscopy is not yet known, unarguably, the exam is central to the success of any screening programme. The test affords the opportunity to detect and resect neoplasia across the entire large bowel and is the definitive examination when other screening tests are positive. However, colonoscopy is invasive and often requires sedation as well as extensive bowel preparation, all of which puts the patient at risk. Furthermore, the test can technically be demanding and, unarguably, there is variation in how it is performed. This variation in performance has now been definitively linked to important outcome measures. For example, interval cancers are more common in low adenoma detectors as compared with high adenoma detectors. This review outlines the most current thinking regarding the effectiveness of colonoscopy as a screening tool. It also outlines key concepts to optimise its performance through robust quality assurance programmes and high-quality training.
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Affiliation(s)
- Douglas J Robertson
- VA Medical Center, White River Junction, Vermont, USA Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Michal F Kaminski
- Department of Gastroenterology and Hepatology, Medical Center for Postgraduate Education, Warsaw, Poland Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Michael Bretthauer
- Institute of Health and Society, University of Oslo, Oslo, Norway Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
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16
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Neilson LJ, Bevan R, Panter S, Thomas-Gibson S, Rees CJ. Terminal ileal intubation and biopsy in routine colonoscopy practice. Expert Rev Gastroenterol Hepatol 2015; 9:567-74. [PMID: 25582839 DOI: 10.1586/17474124.2015.1001744] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This special report focuses on the current literature regarding the utility of terminal ileal (TI) intubation and biopsy. The authors reviewed the literature regarding the clinical benefit of TI intubation at the time of colonoscopy and also the evidence for TI intubation as a colonoscopy quality indicator. TI intubation is useful to identify ileal diseases such as Crohn's disease and additionally as a means of confirming colonoscopy completion when classical caecal landmarks are not confidently seen. Previous studies have demonstrated that TI intubation has variable yield but may be more useful in patients presenting with diarrhea. Reported rates of TI intubation at colonoscopy vary. The authors demonstrate that terminal ileoscopy is feasible in clinical practice and sometimes yields additional clinical information. Additionally it may be used as an indicator of colonoscopy completion. It may be particularly helpful when investigating patients with diarrhea, abnormalities seen on other imaging modalities and patients with suspected Crohn's disease. TIs reported as normal at endoscopy have a low yield when biopsied; however, biopsies from abnormal-looking TIs demonstrate a higher yield and have greater diagnostic value.
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17
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Ahammed SM, Das K, Sarkar R, Dasgupta J, Bandopadhyay S, Dhali GK. Patient-posture and Ileal-intubation during colonoscopy (PIC): a randomized controlled open-label trial. Endosc Int Open 2014; 2:E105-10. [PMID: 26135254 PMCID: PMC4423309 DOI: 10.1055/s-0034-1365541] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Accepted: 01/31/2014] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND AND AIMS Patient's posture change is commonly employed by a colonoscopist to achieve complete examination. We studied whether patient's posture (left-lateral decubitus vs supine) influenced the success rate of ileal intubation. PATIENTS AND METHODS In this prospective open-label randomized study performed in the Endoscopy Suite of a tertiary-care center, all adult outpatients referred for colonoscopy, in whom cecal intubation was achieved and who satisfied predefined inclusion criteria, were randomized to undergo ileal intubation in either of the above two postures. Colonoscopy (EC-201 WL, Fujinon) was performed after overnight poly-ethylene-glycol preparation, under conscious sedation and continuous pulse-oxymetry monitoring. After confirming cecal intubation, patients were randomized for ileal intubation. Success was defined by visualization of ileal mucosa or villi (confirmed by digital photography) and was attempted until limited by pain and/or time of ≥ 6 min. RESULTS Of 320 eligible patients, 217 patients (150 males) were randomized, 106 to left-lateral decubitus and 111 to supine posture. At baseline, the two groups were evenly matched. Successful ileal intubation was achieved in 145 (66.8 %) patients overall, significantly higher in the supine posture (74.8 % versus 58.5 %; P = 0.014). On multivariate analysis, supine posture (P = 0.02), average/good right-colon preparation (P < 0.01), non-thin-lipped ileocecal (IC) valve (P < 0.001) and younger age (P = 0.02) were independent predictors of success. Positive ileal findings were recorded in 13 (9 %) patients. CONCLUSION Ileoscopy is more successful in supine than in left-lateral decubitus posture. Age, bowel preparation and type of IC valve also determine success.
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Affiliation(s)
- Sk Mahiuddin Ahammed
- Division of Gastroenterology, School of Digestive and Liver Diseases, IPGME and R, Kolkata, West Bengal, India
| | - Kshaunish Das
- Division of Gastroenterology, School of Digestive and Liver Diseases, IPGME and R, Kolkata, West Bengal, India
| | - R. Sarkar
- Division of Gastroenterology, School of Digestive and Liver Diseases, IPGME and R, Kolkata, West Bengal, India
| | - J. Dasgupta
- Division of Gastroenterology, School of Digestive and Liver Diseases, IPGME and R, Kolkata, West Bengal, India
| | - S. Bandopadhyay
- Division of Gastroenterology, School of Digestive and Liver Diseases, IPGME and R, Kolkata, West Bengal, India
| | - G. K. Dhali
- Division of Gastroenterology, School of Digestive and Liver Diseases, IPGME and R, Kolkata, West Bengal, India
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Abstract
PURPOSE Despite colonoscopic surveillance, Lynch syndrome patients develop colorectal cancer (CRC). Identification of modifiable factors has the potential to improve outcome of surveillance. The aims of this study were to determine (1) characteristics of patients with CRC, (2) endoscopic and histological features of these cancers, and (3) quality of the previous colonoscopy. METHODS Approximately 2,200 medical reports from proven and obligate mutation carriers identified at the Dutch Lynch Syndrome Registry and two large hospitals were retrospectively analyzed for the presence of an interval cancer defined as CRC diagnosed within 24 months of previous colonoscopy. RESULTS Thirty-one interval cancers were detected in 29 patients (median age of 52 [range 35-73]), after a median time of 17 months. All were MLH1 or MSH2 mutation carriers, and 39 % had a previous CRC. In patients without previous surgery for CRC, 84 % was proximally located. Of all interval cancers, 77 % were at local stage (T1-3N0Mx). In three patients (9 %) with an incomplete previous colonoscopy, CRC was located in the unexamined colon. In six of the nine patients with an adenoma during previous colonoscopy, the cancer was detected in the same colonic segment as the previously removed adenoma. CONCLUSIONS Interval cancers were detected in MLH1 and MSH2 mutation carriers, especially in those with a history of previous CRC and between 40 and 60 years. Interval cancer could be related to incompleteness of previous endoscopy and possibly residual adenomatous tissue. Further reduction of the interval cancer risk may be achieved by optimizing endoscopy quality and individualization of surveillance guidelines.
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Bourikas LA, Tsiamoulos ZP, Haycock A, Thomas-Gibson S, Saunders BP. How we can measure quality in colonoscopy? World J Gastrointest Endosc 2013; 5:468-475. [PMID: 24147190 PMCID: PMC3797899 DOI: 10.4253/wjge.v5.i10.468] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 07/10/2013] [Accepted: 08/17/2013] [Indexed: 02/05/2023] Open
Abstract
Measuring quality is a current need of medical services either to assess their cost-effectiveness or to identify discrepancies requiring refinement. With the advent of bowel cancer screening and increasing patient awareness of bowel symptoms, there has been an unprecedented increase in demand for colonoscopy. Consequently, there is an expanding open-discussion on missed rates of cancer or precancerous polyps during diagnostic/screening colonoscopy and on the rate of adverse events related to therapeutic colonoscopy. Delivering a quality colonoscopy service is therefore a healthcare priority. Colonoscopy is a multi-step process and therefore assessment of all aspects of the procedure must be addressed. Quality in colonoscopy refers to a combination of many patient-centered technical and non-technical skills and knowledge aiming to patient’s safety and satisfaction through a continuous effort for improvement. The benefits of this endless process are hiding behind small details which can eventually make the difference in colonoscopy. Identifying specific quality metrics help to define and shape an optimal service and forms a secure basis of improvement. Τhis paper does not aim to give technical details on how to perform colonoscopy but to summarize what to measure and when, in accordance with the current identified quality indicators and standards for colonoscopy.
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