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Keating E, Leyden J, O'Connor DB, Lahiff C. Unlocking quality in endoscopic mucosal resection. World J Gastrointest Endosc 2023; 15:338-353. [PMID: 37274555 PMCID: PMC10236981 DOI: 10.4253/wjge.v15.i5.338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/24/2023] [Accepted: 04/12/2023] [Indexed: 05/16/2023] Open
Abstract
A review of the development of the key performance metrics of endoscopic mucosal resection (EMR), learning from the experience of the establishment of widespread colonoscopy quality measurements. Potential future performance markers for both colonoscopy and EMR are also evaluated to ensure continued high quality performance is maintained with a focus service framework and predictors of patient outcome.
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Affiliation(s)
- Eoin Keating
- Department of Gastroenterology, Mater Misericordiae University Hospital, Dublin 7, Ireland
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Jan Leyden
- Department of Gastroenterology, Mater Misericordiae University Hospital, Dublin 7, Ireland
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Donal B O'Connor
- Department of Surgery, Tallaght University Hospital, Dublin 24, Ireland
- School of Medicine, Trinity College Dublin, Dublin 2, Ireland
| | - Conor Lahiff
- Department of Gastroenterology, Mater Misericordiae University Hospital, Dublin 7, Ireland
- School of Medicine, University College Dublin, Dublin 4, Ireland
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Sundaram S, Giri S, Jearth V, Vizhi N K, Yelsangikar A, Bhat N. Image-enhanced endoscopy and endoscopic resection practices in the colon among endoscopists in India. Endosc Int Open 2022; 10:E1181-E1187. [PMID: 36118641 PMCID: PMC9473856 DOI: 10.1055/a-1914-6197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 12/27/2021] [Indexed: 12/04/2022] Open
Abstract
Background and study aims Clinical practice patterns for image-enhanced endoscopy (IEE) and colonic endoscopic resection practices vary among endoscopists. We conducted a survey to understand the differences in IEE and colonoscopic resection practices among endoscopists from India. Methods An online cross-sectional survey comprising 40 questions regarding quality control of colonoscopy, IEE, and colonic endoscopic resection practices was circulated through the registry of the Indian Society of Gastroenterology and Association of Colon and Rectal Surgeons of India. Participation was voluntary and response to all questions was compulsory. Results There were 205 respondents to the survey (93.2 % gastroenterologists, 90.2 % male, 54.6 % aged 30 to 40 years, 36.1 % working in academic institution, 36.1 % working in corporate hospitals). Of the endoscopists, 50.7 % had no training in IEE and 10.7 % performed endoscopy on systems without any IEE modalities. Endoscopists with more experience were more likely to use IEE modalities in practice routinely ( P = 0.007). Twenty percent never used IEE to classify polyps. Sixty percent of respondents did not use dye-chromoendoscopy. Less experienced endoscopists used viscous solutions as submucosal injectate ( P = 0.036) more often. Of the respondents, 44 % never tattooed the site of endoscopic resection. Ablation of edges post-endoscopic mucosal resection was not done by 25.5 % respondents. Most respondents used electronic chromoendoscopy (36.1 %) or random four-quadrant sampling (35.6 %) for surveillance in inflammatory bowel disease. Surveillance post-endoscopic resection was done arbitrarily by 24 % respondents at 6 months to 1 year. Conclusions There are several lacunae in the practice of IEE and colonic endoscopic resection among endoscopists, with need for programs for privileging, credentialing and proctoring these endoscopic skills.
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Affiliation(s)
- Sridhar Sundaram
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Mumbai
| | - Suprabhat Giri
- Department of Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai
| | - Vaneet Jearth
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh
| | - Kayal Vizhi N
- Department of Gastroenterology and Hepatology, Aster CMI Hospital, Bangalore
| | - Amit Yelsangikar
- Department of Gastroenterology and Hepatology, Aster CMI Hospital, Bangalore
| | - Naresh Bhat
- Department of Gastroenterology and Hepatology, Aster CMI Hospital, Bangalore
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Han SK, Kim H, Kim JW, Kim HS, Kim SY, Park HJ. Usefulness of a Colonoscopy Cap with an External Grid for the Measurement of Small-Sized Colorectal Polyps: A Prospective Randomized Trial. J Clin Med 2021; 10:jcm10112365. [PMID: 34072225 PMCID: PMC8197876 DOI: 10.3390/jcm10112365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 05/23/2021] [Accepted: 05/26/2021] [Indexed: 11/16/2022] Open
Abstract
Accurate measurement of polyp size during colonoscopy is crucial. The usefulness of cap-assisted colonoscopy and external grid application on monitor (gCAP) was evaluated for polyp size measurement in this 3-year, single-center, single-blind, randomized trial. Using the endoscopic forceps width as reference, the discrepancy percent (DP), error rate (ER), and measurement time were compared between gCAP and visual estimation (VE) after randomization. ER was calculated within a 20% and 33% limit. From the 111 patients, 280 polyps were measured. The mean polyp sizes were 4.0 ± 1.7 mm and 4.2 ± 1.8 mm with gCAP and VE, respectively (p = 0.368). Compared with that by the forceps method, DP was significantly lower in the gCAP group than in the VE group. Moreover, ER was significantly lower in the gCAP group within its preset limit. The measurement time was 4 s longer in the gCAP group than in the VE group (8.2 ± 4.8 s vs. 4.2 ± 1.5 s; p < 0.001). However, the forceps method lasted 28 s longer than the others. On subgroup analysis by size, gCAP was more accurate for polyp size ≥ 5 mm. The gCAP method was more accurate for polyp size measurement than VE, especially for polyps ≥ 5 mm, and was more convenient than the forceps method.
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Affiliation(s)
- Seul-Ki Han
- Department of Internal Medicine, Wonju College of Medicine, Yonsei University, Wonju 24626, Korea; (S.-K.H.); (H.K.); (J.-w.K.); (H.-S.K.); (S.-Y.K.)
| | - Hyunil Kim
- Department of Internal Medicine, Wonju College of Medicine, Yonsei University, Wonju 24626, Korea; (S.-K.H.); (H.K.); (J.-w.K.); (H.-S.K.); (S.-Y.K.)
| | - Jin-woo Kim
- Department of Internal Medicine, Wonju College of Medicine, Yonsei University, Wonju 24626, Korea; (S.-K.H.); (H.K.); (J.-w.K.); (H.-S.K.); (S.-Y.K.)
| | - Hyun-Soo Kim
- Department of Internal Medicine, Wonju College of Medicine, Yonsei University, Wonju 24626, Korea; (S.-K.H.); (H.K.); (J.-w.K.); (H.-S.K.); (S.-Y.K.)
| | - Su-Young Kim
- Department of Internal Medicine, Wonju College of Medicine, Yonsei University, Wonju 24626, Korea; (S.-K.H.); (H.K.); (J.-w.K.); (H.-S.K.); (S.-Y.K.)
| | - Hong-Jun Park
- Department of Internal Medicine, Wonju College of Medicine, Yonsei University, Wonju 24626, Korea; (S.-K.H.); (H.K.); (J.-w.K.); (H.-S.K.); (S.-Y.K.)
- Center of Evidence Based Medicine, Institute of Convergence Science, Yonsei University, Wonju 24626, Korea
- Correspondence: ; Tel.: +82-33-741-0526; Fax: +82-33-741-0951
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Hollenbach M, Siersema PD. Editorial: Cuff- and cap-assisted colonoscopy: More questions than answers. United European Gastroenterol J 2021; 9:425-426. [PMID: 33979030 DOI: 10.1002/ueg2.12078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Affiliation(s)
- Marcus Hollenbach
- Division of Gastroenterology, Medical Department II, University of Leipzig Medical Center, Leipzig, Germany
| | - Peter D Siersema
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
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Yoshida N, Inoue K, Yasuda R, Hirose R, Dohi O, Naito Y, Murakami T, Inada Y, Ogiso K, Morinaga Y, Kishimoto M, Rani RA, Itoh Y. An Additional 30-s Observation of the Right-Sided Colon with Narrow Band Imaging Decreases Missed Polyps: A Pilot Study. Dig Dis Sci 2018; 63:3457-3464. [PMID: 30232637 DOI: 10.1007/s10620-018-5275-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 09/04/2018] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Previous narrow-band imaging (NBI) was dark and reported not to be useful for polyp detection. In this study, we analyzed the efficacy of an additional 30-s observation of the right-sided colon with the recent bright high-resolution NBI. METHODS We enrolled patients undergoing colonoscopy from February 2015 to May 2017 in two institutions. All procedures were performed with the latest system (EVIS LUCERA ELITE, Olympus). The cecum and ascending colon were first observed with white light imaging (WLI) in both the NBI and WLI group. Then, the colonoscope was re-inserted, and the cecum and ascending colon were observed for an additional 30 s. In this second observation, NBI was performed for the first 130 patients in the NBI group and WLI for the next 130 in the WLI group. The number of adenoma and sessile serrated polyps (ASPs) in the second observation were examined in both groups. According to our initial pilot study, the sample size was estimated at 126. RESULTS In the first observation, the number of ASPs was 72 in the NBI group and 72 in the WLI group (p = 1.0). In the second observation, the number of ASPs was 23 in the NBI group and 10 in the WLI group (p = 0.02). The polyp and adenoma detection rates in the second observation were 16.2% and 12.3% in the NBI group and 7.7% (p = 0.03) and 6.2% (p = 0.09) in the WLI group. CONCLUSIONS The additional 30-s observation with recent NBI decreased missed polyps in the right-sided colon.
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Affiliation(s)
- Naohisa Yoshida
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Ken Inoue
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Ritsu Yasuda
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Ryohei Hirose
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Osamu Dohi
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Yuji Naito
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Takaaki Murakami
- Department of Gastroenterology, JCHO Kyoto Kuramaguchi Medical Center, Kyoto, Japan
| | - Yutaka Inada
- Department of Gastroenterology, Fukuchiyama City Hospital, Kyoto, Japan
| | - Kiyoshi Ogiso
- Department of Gastroenterology, Osaka General Hospital of West Japan Railway Company, Osaka, Japan
| | - Yukiko Morinaga
- Department of Surgical Pathology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Mitsuo Kishimoto
- Department of Surgical Pathology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Rafiz Abdul Rani
- Gastroenterology Unit, Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia
| | - Yoshito Itoh
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
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Gkolfakis P, Tziatzios G, Spartalis E, Papanikolaou IS, Triantafyllou K. Colonoscopy attachments for the detection of precancerous lesions during colonoscopy: A review of the literature. World J Gastroenterol 2018; 24:4243-4253. [PMID: 30310257 PMCID: PMC6175757 DOI: 10.3748/wjg.v24.i37.4243] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 08/06/2018] [Accepted: 08/24/2018] [Indexed: 02/06/2023] Open
Abstract
Although colonoscopy has been proven effective in reducing the incidence of colorectal cancer through the detection and removal of precancerous lesions, it remains an imperfect examination, as it can fail in detecting up to almost one fourth of existing adenomas. Among reasons accounting for such failures, is the inability to meticulously visualize the colonic mucosa located either proximal to haustral folds or anatomic curves, including the hepatic and splenic flexures. In order to overcome these limitations, various colonoscope attachments aiming to improve mucosal visualization have been developed. All of them - transparent cap, Endocuff, Endocuff Vision and Endorings - are simply mounted onto the distal tip of the scope. In this review article, we introduce the rationale of their development, present their mode of action and discuss in detail the effect of their implementation in the detection of lesions during colonoscopy.
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Affiliation(s)
- Paraskevas Gkolfakis
- Hepato-gastroenterology Unit, Second Department of Internal Medicine -Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University of Athens, ‘‘Attikon” University General Hospital, Athens 12462, Greece
| | - Georgios Tziatzios
- Hepato-gastroenterology Unit, Second Department of Internal Medicine -Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University of Athens, ‘‘Attikon” University General Hospital, Athens 12462, Greece
| | - Eleftherios Spartalis
- Laboratory of Experimental Surgery and Surgical Research, National and Kapodistrian University of Athens, Athens 12462, Greece
| | - Ioannis S Papanikolaou
- Hepato-gastroenterology Unit, Second Department of Internal Medicine -Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University of Athens, ‘‘Attikon” University General Hospital, Athens 12462, Greece
| | - Konstantinos Triantafyllou
- Hepato-gastroenterology Unit, Second Department of Internal Medicine -Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University of Athens, ‘‘Attikon” University General Hospital, Athens 12462, Greece
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