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Bilal M, Feld LD, Hernandez LV, Feld AD, Anderson JC, Bloomfeld RS. Professionalism in the Management of Endoscopic Adverse Events: Consensus Document From the American College of Gastroenterology Professionalism Committee. Am J Gastroenterol 2023; 118:1725-1730. [PMID: 37589497 DOI: 10.14309/ajg.0000000000002474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 08/11/2023] [Indexed: 08/18/2023]
Affiliation(s)
- Mohammad Bilal
- Division of Gastroenterology & Hepatology, Minneapolis VA Medical Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - Lauren D Feld
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Lyndon V Hernandez
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- GI Associates, Racine, Kenosha, and Milwaukee, Wisconsin, USA
| | - Andrew D Feld
- Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
- Division of Gastroenterology, Kaiser Permanente, Seattle, Washington, USA
| | - Joseph C Anderson
- Division of Gastroenterology and Hepatology, Department of Veterans Affairs Medical Center, The Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
- University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Richard S Bloomfeld
- Section of Gastroenterology, Wake Forest University School of Medicine, Winston Salem, North Carolina, USA
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Manem N, Donovan K, Miller D, Yodice M, Wang K, Balogun K, Kabbach G, Feustel P, Tadros M. Open-access colonoscopy quality indicators and patient perception using split-dose bowel preparation. JGH Open 2021; 5:563-567. [PMID: 34013055 PMCID: PMC8114982 DOI: 10.1002/jgh3.12532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 02/08/2021] [Accepted: 03/11/2021] [Indexed: 11/12/2022]
Abstract
Background and Aim Open-access (OA) colonoscopies are defined as those scheduled without a gastrointestinal (GI) office visit. Past research has not focused on split preparation use and patient perception within OA. We aim to identify differences in bowel preparation (BP) adequacy, adenoma detection rate (ADR), self-reported compliance, and patient perception between OA and GI providers using split prep. Methods This was a cross-sectional study using split BP for colonoscopies. Patients completed a survey, and demographics, BP adequacy, and ADR were recorded. BP compliance was self-reported. Patients were asked three questions qualifying the BP instructions. Data were analyzed using chi square and Mann-Whitney tests by SPSS. Results BP adequacy was reported for 56 of 60 patients. Twenty-one participants (38%) were scheduled on OA, and 35 participants (62%) were scheduled after a GI office visit. Adequate BP was more frequent in 86% (18/21) of OA patients compared to 60% (21/35) in the GI group (P = 0.043). OA patients reported better review and explanation of the BP instructions compared to GI patients. There was no statistical difference between the demographics of the OA and GI groups or self-reported compliance and patient understanding of instructions. Conclusion OA scheduled colonoscopies were associated with more adequate BP. This could be explained by patients' self-motivation or an explanation of the importance of completing BP. This study supports the use of OA procedures as a standard of care.
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Affiliation(s)
| | | | | | | | - Katie Wang
- Division of Nephrology Stanford University School of Medicine Palo Alto California USA
| | - Khadijat Balogun
- Department of Gastroenterology Eastern Connecticut Healthcare Network Manchester Connecticut USA
| | - Ghassan Kabbach
- Department of Internal Medicine Albany Medical Center Albany New York USA
| | - Paul Feustel
- Department of Neuroscience and Experimental Therapeutics Albany Medical Center Hospital Albany New York USA
| | - Micheal Tadros
- Department of Gastroenterology Albany Medical Center Hospital Albany New York USA
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Rogers BD, Shy C, Rampgopal R, Hengehold T, Almuhaidb A, Weaver M, Quader F, Roediger R, Walker T, Gyawali CP, Sayuk GS. Patient Engagement with Interactive Text Message System Improves Successful Colonoscopy Rates in an Outpatient Endoscopy Center. Dig Dis 2020; 39:399-406. [PMID: 32961537 DOI: 10.1159/000511767] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 09/21/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Text message-based interventions reduce colonoscopy no-show rates and improve bowel preparation scores. In this non-randomized study, we assessed whether an interactive text messaging system could improve colonoscopy outcomes. METHODS Colonoscopy pre-procedural instructions were programmed into a dedicated software platform created for this study. In the intervention arm, text messages were sent to veterans during a 4-week study period. Validated pre-procedural satisfaction questionnaires were completed by patients during standard protocol and intervention periods. Demographics and colonoscopy outcomes data were compared between the standard protocol and intervention arms, including procedure completion rate on scheduled date, Boston bowel preparation score (BPPS), adenoma detection rate, and satisfaction. RESULTS Of 241 patients, 128 were in the standard protocol arm and 113 in the intervention arm. Higher proportions of patients receiving text messages underwent colonoscopy on their scheduled date (69.9%) compared to the ones in the standard protocol (50.8%, p = 0.015). Patients with ≥3 interactions with the system had 80.6% likelihood of completing colonoscopy on the scheduled date compared to 56.9% with <3 interactions and 50.8% with standard protocol (p < 0.001). Frequency of interaction with the system was similar between older (>65 years) and younger patients (p = 1.0). Among older patients, colonoscopy was completed successfully in 84.2% when alert-based human interactions occurred compared to 65.6% in those without and 47.9% with standard protocol (p = 0.018). More than 90% indicated they would recommend the system to patients undergoing future colonoscopy. CONCLUSION An interactive text messaging system improves successful colonoscopy rates in a VA setting, with greatest impact in older patients.
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Affiliation(s)
- Benjamin D Rogers
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Corey Shy
- Department of Internal Medicine, Washington University School of Medicine, St Louis, Missouri, USA
| | - Rajeev Rampgopal
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Tricia Hengehold
- Department of Internal Medicine, Washington University School of Medicine, St Louis, Missouri, USA
| | - Aymen Almuhaidb
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Michael Weaver
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Farhan Quader
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Rebecca Roediger
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Ted Walker
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA
| | - C Prakash Gyawali
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Gregory S Sayuk
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA.,Division of Gastroenterology, John Cochran Veteran's Administration Medical Center, St Louis, Missouri, USA
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Kapila N, Singh H, Kandragunta K, Castro FJ. Open Access Colonoscopy for Colorectal Cancer Prevention: An Evaluation of Appropriateness and Quality. Dig Dis Sci 2019; 64:2798-2805. [PMID: 30955174 DOI: 10.1007/s10620-019-05612-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 04/02/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Open access colonoscopy (OAC) has gained widespread acceptance and has the potential to increase colorectal cancer (CRC) screening. However, there is little data evaluating its appropriateness for CRC prevention. AIMS The aim of this study is to evaluate the appropriateness of OAC in CRC screening and polyp surveillance by comparing to procedures ordered by gastroenterologists (NOAC). As secondary outcomes, we compared the quality of bowel preparation and adenoma detection rate (ADR) between OAC and NOAC. METHODS It is retrospective single-center study. Inclusion criteria included patients > 50 years of age undergoing a colonoscopy for CRC screening and surveillance. Appropriateness was defined as those colonoscopies performed within 12 months of the recommended 2012 consensus guidelines. Secondary outcomes included the quality of bowel preparation and ADR. RESULTS 5211 colonoscopies met inclusion criteria, and 64.9% were OAC. Screening OAC was appropriately 91.6% and NOAC 92.9% of the time (p = 0.179). Surveillance NOAC were inappropriate in 26.4% of cases, and surveillance OAC was 32.6% (p = 0.008). Multivariate analysis demonstrated that OAC did not influence ADR (OR for NOAC 0.97; 95% CI 0.86-1.1; p = 0.644) or an adequate bowel preparation (OR for NOAC 1.11; 95% CI 0.91-1.36; p = 0.306). CONCLUSION OAC performed similarly to NOAC for screening indications, quality of bowel preparation, and ADR. However, more surveillance procedures were inappropriate in the OAC group although both groups had a high number of inappropriate indications. Although OAC can be efficiently performed for screening indications, measures to decrease inappropriate surveillance colonoscopies are needed.
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Affiliation(s)
- Nikhil Kapila
- Department of Gastroenterology, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL, USA.
| | - Harjinder Singh
- Department of Gastroenterology, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL, USA
| | - Kiranmayee Kandragunta
- Department of Gastroenterology, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL, USA
| | - Fernando J Castro
- Department of Gastroenterology, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL, USA
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Fudman DI, Papamichael K, Roemi L, Rao V, Falchuk KR, Leffler DA, Feuerstein JD. Effect of Consent and Educational Adjuncts to Consent on Patient Perceptions About Colonoscopy. J Clin Gastroenterol 2019; 53:e316-21. [PMID: 30001290 DOI: 10.1097/MCG.0000000000001093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND AIMS Informed consent is a vital preprocedural step for endoscopy but there are substantial variations in its delivery. We therefore sought to assess a multifaceted intervention to improve the consent process. METHODS Gastroenterologists at a tertiary center were educated on the recommended components of informed consent. Following this, 3 cohorts of patients undergoing colonoscopy were surveyed before and after consent. In one cohort, the effect of optimized verbal consent alone was assessed. In the second and third groups, the effects of the addition of either a handout or a video describing colonoscopy and its risks were evaluated. The primary outcomes were the changes between preconsent and postconsent survey responses regarding confidence in understanding the procedure's purpose, likelihood of adverse events, and levels of anxiety. RESULTS In total, 240 patients were included with 79 to 81 patients per group. There were no significant differences among the groups' survey responses. Compared with patients receiving verbal consent alone, fewer patients in the handout and video groups increased their perceived risk of adverse events following consent, but this difference did not reach significance (P=0.08). Examining all groups together, anxiety levels changed significantly after consent (P=0.003), with 31% of patients reducing their anxiety level, 8% increasing it, and 62% having no change. CONCLUSIONS The consent process appears to decrease patient anxiety about colonoscopy. When used in conjunction with a high-quality verbal consent, written or video educational adjuncts provided on the day of colonoscopy likely have no effect on patient perceptions.
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Fudman DI, Roemi L, Leffler DA, Feuerstein JD. Letter to the Editor: High Rate of Incomplete Consent for Colonoscopy: Identifying an Area for Improvement in Gastrointestinal Endoscopy. Am J Med Qual 2019; 35:283-284. [PMID: 31423820 DOI: 10.1177/1062860619868296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Awuku YA, Awuku NA, Lovi JI, Nartey YA, Abbew TE. Wooden toothpick partially embedded in the gastric antrum: a case report of an unusual finding in open access gastrointestinal endoscopy. Ghana Med J 2019; 52:112-114. [PMID: 30662084 DOI: 10.4314/gmj.v52i2.8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Ingested toothpick is an unusual occurrence in clinical practice. This is a medical emergency and all effort should be made to localize the toothpick and appropriate intervention instituted. We report a case of accidentally ingested toothpick with successful endoscopic removal in a case of a 24year old male who presented for open access endoscopy with complaint of abdominal pain. During endoscopy a foreign body (sharp object) was seen partially embedded at the gastric antrum which was later identified as a wooden toothpick. Endoscopic removal was done using a Caesar grasping forceps (CGF-1-240). No complication was reported during and after the procedure. Ingested toothpick should be managed as an emergency in all cases and should be considered an important differential diagnosis in clients with complaint of abdominal pain especially in open access endoscopy. Funding None.
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Affiliation(s)
- Yaw A Awuku
- Department of Medicine and Therapeutics, University of Cape Coast, Cape Coast. Ghana.,Department of Medicine and Therapeutics, Cape Coast Teaching Hospital, P.O Box 1363, Cape Coast, Ghana
| | - Nana A Awuku
- Department of Haematology, Cape Coast Teaching Hospital, P.O Box 1363, Cape Coast, Ghana
| | - Janice I Lovi
- Department of Medicine and Therapeutics, Cape Coast Teaching Hospital, P.O Box 1363, Cape Coast, Ghana
| | - Yvonne A Nartey
- Department of Medicine and Therapeutics, Cape Coast Teaching Hospital, P.O Box 1363, Cape Coast, Ghana
| | - Tabitha E Abbew
- Department of Medicine and Therapeutics, Cape Coast Teaching Hospital, P.O Box 1363, Cape Coast, Ghana
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Restall G, Walker JR, Waldman C, Zawaly K, Michaud V, Moffat D, Singh H. Perspectives of primary care providers and endoscopists about current practices, facilitators and barriers for preparation and follow-up of colonoscopy procedures: a qualitative study. BMC Health Serv Res 2018; 18:782. [PMID: 30333033 PMCID: PMC6191911 DOI: 10.1186/s12913-018-3567-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 09/26/2018] [Indexed: 01/28/2023] Open
Abstract
Background Colonoscopy has become a common medical procedure due to increased use of colonoscopy for evaluation of symptoms, colorectal cancer screening and surveillance of people with higher risks of developing colorectal cancer. Timely access to colonoscopy is essential for diagnosis of colorectal cancer, as well as diagnosis and management of inflammatory bowel disease and gastrointestinal symptoms such as diarrhea. The purpose of this study was to obtain the perspectives of primary care providers and endoscopists about current practices, barriers and facilitators to following recommended practice for preparation and follow-up after colonoscopy. We also aimed to obtain recommendations for approaches to improve the process. Methods Six focus groups (two with gastroenterologists, two with surgeons who perform colonoscopies and two with primary care providers) were held between October 2015 and January 2016. Analysis was performed using inductive qualitative approaches. Results Variations and challenges in communication for continuity of care and understanding the distribution of responsibility were identified, as were perceived benefits and challenges of a central intake system for colonoscopies. Recommendations were made to improve processes including strengthening communication and information sharing. A comprehensive quality improvement plan would facilitate implementation of recommendations. Conclusions Findings emphasize the need for improved patient-focused information resources for each step of the colonoscopy process and improved communication among practitioners. The findings apply to other services requiring collaboration among patients, primary care providers, and medical specialists. Electronic supplementary material The online version of this article (10.1186/s12913-018-3567-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gayle Restall
- Department of Occupational Therapy, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, R106 - 771 McDermot Avenue, Winnipeg, MB, R3E 0T6, Canada.
| | - John R Walker
- Department of Clinical Health Psychology, Rady Faculty of Health Sciences University of Manitoba, Winnipeg, MB, Canada
| | - Celeste Waldman
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Kathleen Zawaly
- Interdisciplinary Studies, Faculty of Graduate Studies, University of Manitoba, Winnipeg, MB, Canada
| | - Valerie Michaud
- Department of Internal Medicine, College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Dana Moffat
- Department of Internal Medicine, College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Harminder Singh
- Department of Internal Medicine, College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
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Silvester JA, Kalkat H, Graff LA, Walker JR, Singh H, Duerksen DR. Information seeking and anxiety among colonoscopy-naïve adults: Direct-to-colonoscopy vs traditional consult-first pathways. World J Gastrointest Endosc 2016; 8:701-708. [PMID: 27909550 PMCID: PMC5114459 DOI: 10.4253/wjge.v8.i19.701] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 05/28/2016] [Accepted: 07/22/2016] [Indexed: 02/05/2023] Open
Abstract
AIM To investigate the effects of direct to colonoscopy pathways on information seeking behaviors and anxiety among colonoscopy-naïve patients.
METHODS Colonoscopy-naïve patients at two tertiary care hospitals completed a survey immediately prior to their scheduled outpatient procedure and before receiving sedation. Survey items included clinical pathway (direct or consult), procedure indication (cancer screening or symptom investigation), telephone and written contact from the physician endoscopist office, information sources, and pre-procedure anxiety. Participants reported pre-procedure anxiety using a 10 point scale anchored by “very relaxed” (1) and “very nervous” (10). At least three months following the procedure, patient medical records were reviewed to determine sedative dose, procedure indications and any adverse events. The primary comparison was between the direct and consult pathways. Given the very different implications, a secondary analysis considering the patient-reported indication for the procedure (symptoms or screening). Effects of pathway (direct vs consult) were compared both within and between the screening and symptom subgroups.
RESULTS Of 409 patients who completed the survey, 34% followed a direct pathway. Indications for colonoscopy were similar in each group. The majority of the participants were women (58%), married (61%), and internet users (81%). The most important information source was family physicians (Direct) and specialist physicians (Consult). Use of other information sources, including the internet (20% vs 18%) and Direct family and friends (64% vs 53%), was similar in the Direct and Consult groups, respectively. Only 31% of the 81% who were internet users accessed internet health information. Most sought fundamental information such as what a colonoscopy is or why it is done. Pre-procedure anxiety did not differ between care pathways. Those undergoing colonoscopy for symptoms reported greater anxiety [mean 5.3, 95%CI: 5.0-5.7 (10 point Likert scale)] than those for screening colonoscopy (4.3, 95%CI: 3.9-4.7).
CONCLUSION Procedure indication (cancer screening or symptom investigation) was more closely associated with information seeking behaviors and pre-procedure anxiety than care pathway.
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Chandrasekhara V, Eloubeidi MA, Bruining DH, Chathadi K, Faulx AL, Fonkalsrud L, Khashab MA, Lightdale JR, Muthusamy VR, Pasha S, Saltzman JR, Shaukat A, Wang A, Cash B, DeWitt JM. Open-access endoscopy. Gastrointest Endosc 2016; 81:1326-9. [PMID: 25865387 DOI: 10.1016/j.gie.2015.03.1917] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 03/12/2015] [Indexed: 12/13/2022]
Abstract
OAE is commonly used. The majority of patients referred for OAE are considered appropriate for endoscopy according to ASGE guidelines. Most patients undergoing OAE procedures are knowledgeable about the study and are satisfied with the experience. Several potential problems have been identified, including inappropriate referrals, communication errors, and inadequately prepared or informed patients. OAE can be safely used if preprocedure assessment, informed consent, information transfer, patient safety, and satisfaction are addressed in all cases.
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Vaessen HHB, Knape JTA. Considerable Variability of Procedural Sedation and Analgesia Practices for Gastrointestinal Endoscopic Procedures in Europe. Clin Endosc 2016; 49:47-55. [PMID: 26855924 PMCID: PMC4743717 DOI: 10.5946/ce.2016.49.1.47] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 07/24/2015] [Accepted: 08/16/2015] [Indexed: 12/19/2022] Open
Abstract
Background/Aims: The use of moderate to deep sedation for gastrointestinal endoscopic procedures has increased in Europe considerably. Because this level of sedation is a risky medical procedure, a number of international guidelines have been developed. This survey aims to review if, and if so which, quality aspects have been included in new sedation practices when compared to traditional uncontrolled sedation practices.
Methods: A questionnaire was sent to the National Associations of Nurse Anesthetists in Europe and the National Delegates of the European Section and Board of Anaesthesiology from January 2012 to August 2012.
Results: Huge variation in practices for moderate to deep sedation were identified between and within European countries in terms of safety, type of practitioners, responsibilities, monitoring, informed consent, patient satisfaction, complication registration, and training requirements. Seventy-five percent of respondents were not familiar with international sedation guidelines. Safe sedation practices (mainly propofol-based moderate to deep sedation) are rapidly gaining popularity.
Conclusions: The risky medical procedure of moderate to deep sedation has become common practice for gastrointestinal endoscopy. Safe sedation practices requiring adequate selection of patients, adequate monitoring, training of sedation practitioners, and adequate after-care, are gaining attention in a field that is in transition from uncontrolled sedation care to controlled sedation care.
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Affiliation(s)
- Hermanus H B Vaessen
- Division of Anaesthesiology, Intensive Care and Emergency Medicine, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Johannes T A Knape
- Division of Anaesthesiology, Intensive Care and Emergency Medicine, University Medical Centre Utrecht, Utrecht, Netherlands
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Hol L, Sutradhar R, Gu S, Baxter NN, Rabeneck L, Tinmouth JM, Paszat LF. Repeat colonoscopy after a colonoscopy with a negative result in Ontario: a population-based cohort study. CMAJ Open 2015; 3:E244-50. [PMID: 26389103 PMCID: PMC4565168 DOI: 10.9778/cmajo.20140063] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Data suggest the overuse of repeat colonoscopies, especially in patients at low risk for colorectal cancer. Our objective was to evaluate the time to repeat colonoscopies in low-risk patients aged 50-79 years old and the associated patient- and endoscopist-related factors. METHODS All patients aged 50-79 years of age who underwent a complete outpatient colonoscopy with a negative result between 2000 and 2007 were identified from the Ontario Health Insurance Plan database. A colonoscopy performed within 5.5 years of follow-up after the index colonoscopy was considered an early repeat colonoscopy. Patient, endoscopist and endoscopy setting characteristics were recorded and their association with an early repeat colonoscopy was determined using an extended Cox proportional hazards regression model. RESULTS The cohort consisted of 546 467 patients: 55.4% of the patients were female with a mean age of 61.1 years (95% confidence interval [CI] 61.1-61.2). The cumulative percentage of early repeat colonoscopy after 5.5 years was 33.7%. The rate decreased significantly between 2000 and 2007 (hazard ratio [HR] 0.35, 95% CI 0.34-0.36). General surgeons were associated with a higher risk of early repeat colonoscopy than gastroenterologists (HR 1.27, 95% CI 1.25-1.28). Endoscopists practising in a nonhospital setting were more likely to perform an early repeat colonoscopy (HR 1.26, 95% CI 1.22-1.30) than endoscopists at a hospital. INTERPRETATION This study showed that there was overuse of early repeat colonoscopy in more than 30% of patients who were at low risk for colorectal cancer. The risk decreased significantly between 2000 and 2007 but was still greater than 20% in 2007. Our findings can be used to develop targeted educational interventions among subgroups of endoscopists with a higher rate of early repeat colonoscopy.
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Affiliation(s)
- Lieke Hol
- Institute for Clinical Evaluative Sciences, Toronto, Ont. ; Department of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Rinku Sutradhar
- Institute for Clinical Evaluative Sciences, Toronto, Ont. ; Dalla Lana School of Public Health, University of Toronto, Toronto, Ont
| | - Sumei Gu
- Institute for Clinical Evaluative Sciences, Toronto, Ont. ; Dalla Lana School of Public Health, University of Toronto, Toronto, Ont
| | - Nancy N Baxter
- Institute for Clinical Evaluative Sciences, Toronto, Ont. ; Department of Surgery and Li Ka Shing Research Institute, St. Michael's Hospital, Toronto, Ont
| | - Linda Rabeneck
- Institute for Clinical Evaluative Sciences, Toronto, Ont. ; Prevention and Cancer Control, Cancer Care Ontario, Toronto, Ont
| | - Jill M Tinmouth
- Institute for Clinical Evaluative Sciences, Toronto, Ont. ; Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Lawrence F Paszat
- Institute for Clinical Evaluative Sciences, Toronto, Ont. ; Sunnybrook Health Sciences Centre, Toronto, Ont
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Hadlock S, Rabeneck L, Paszat LF, Sutradhar R, Wilton AS, Tinmouth J. Open-access colonoscopy on Ontario: associated factors and quality. Can J Gastroenterol 2013; 27:341-6. [PMID: 23781517 DOI: 10.1155/2013/295412] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Open-access (OA) colonoscopy may increase efficiency and decrease wait times; however, because the patient is seen for the first time at the endoscopy appointment, previous processes, such as information about the procedure, preparation and appropriate triage, may be suboptimal. OBJECTIVE To identify factors associated with OA colonoscopy and to determine the relationship between OA colonoscopy and an important quality measure, incomplete colonoscopy. METHODS A population-based analysis of all adult outpatients undergoing a first-time colonoscopy between 1997 and 2007 in Ontario was performed. Colonoscopy was considered to be OA if there were no visits in the preceding five years with the physician performing the colonoscopy. Using logistic regression, patient, physician and institution factors associated with OA colonoscopy were identified. Using propensity score matching, the relationship between OA colonoscopy and incomplete colonoscopy in 2006 was examined. RESULTS A total of 1,079,259 colonoscopies were performed. Of these, 14% were OA in 1997 compared with 26% in 2007. Patients 50 to 69 years of age, those from higher-income neighbourhoods and those with less comorbidity were more likely to undergo OA colonoscopy. The odds of receiving OA colonoscopy were six times greater in a nonhospital clinic compared with a community hospital. Colonoscopy was more likely to be complete if the procedure was OA (OR 1.3 [95% CI 1.2 to 1.4]; P<0.0001). CONCLUSIONS Rates of OA colonoscopy have increased substantially since 1997. Institution type was most strongly associated with OA colonoscopy. Colonoscopy completeness, a recognized quality indicator, does not appear to be compromised by OA colonoscopy.
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Abstract
Informed consent is necessary in good clinical practice. It is based on the patient´s ability to understand the information about the proposed procedure, the potential consequences and complications, and alternative options. The information is written in understandable language and is fortified by verbal discussion between physician and patient. The aim is to explain the problem, answer all questions and to ensure that the patient understands the problems and is able to make a decision. The theory is clear but what happens in daily practice?
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Affiliation(s)
- Marcela Kopacova
- Marcela Kopacova, Jan Bures, 2nd Department of Medicine, Faculty of Medicine at Hradec Králové, University Teaching Hospital, Sokolská 581, 500 05 Hradec Králové, Czech Republic
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Ellingson D, Miick R, Chang F, Hillard R, Choudhary A, Ashraf I, Bechtold M, Diaz-Arias A. Diagnostic Yield of Microscopic Colitis in Open Access Endoscopy Center. Gastroenterology Res 2011; 4:139-142. [PMID: 27942330 PMCID: PMC5139724 DOI: 10.4021/gr339e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2011] [Indexed: 11/18/2022] Open
Abstract
Background The diagnostic yield in open access endoscopy has been evaluated which generally support the effectiveness and efficiency of open access endoscopy. With a few exceptions, diagnostic yield studies have not been performed in open access endoscopy for more specific conditions. Therefore, we conducted a study to determine the efficiency of open access endoscopy in the detection of microscopic colitis as compared to traditional referral via a gastroenterologist. Methods A retrospective search of the pathology database at the University of Missouri for specimens from a local open access endoscopy center was conducted via SNOMED code using the terms: “microscopic”, “lymphocytic”, “collagenous”, “spirochetosis”, “focal active colitis”, “melanosis coli” and “histopathologic” in the diagnosis line for the time period between January 1, 2004 and May 25, 2006. Specimens and colonoscopy reports were reviewed by a single pathologist. Results Of 266 consecutive patients with chronic diarrhea and normal colonoscopies, the number of patients with microscopic disease are as follows: Lymphocytic colitis (n = 12, 4.5%), collagenous colitis (n = 17, 6.4%), focal active colitis (n = 15, 5.6%), and spirochetosis (n = 2, 0.4%). Conclusions The diagnostic yield of microscopic colitis in this study of an open access endoscopy center does not differ significantly from that seen in major medical centers. In terms of diagnostic yield, open access endoscopy appears to be as effective in diagnosing microscopic colitis.
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Affiliation(s)
- Derek Ellingson
- Department of Pathology and Anatomical Sciences, University of Missouri-Columbia, One Hospital Drive, Columbia, MO 65212, USA
| | - Ronald Miick
- Department of Pathology and Anatomical Sciences, University of Missouri-Columbia, One Hospital Drive, Columbia, MO 65212, USA
| | - Faye Chang
- Department of Pathology and Anatomical Sciences, University of Missouri-Columbia, One Hospital Drive, Columbia, MO 65212, USA
| | - Robert Hillard
- Department of Pathology and Anatomical Sciences, University of Missouri-Columbia, One Hospital Drive, Columbia, MO 65212, USA
| | - Abhishek Choudhary
- Department of Internal Medicine-Gastroenterology, University of Missouri-Columbia, Five Hospital Drive, Columbia, MO 65212, USA
| | - Imran Ashraf
- Department of Internal Medicine-Gastroenterology, University of Missouri-Columbia, Five Hospital Drive, Columbia, MO 65212, USA
| | - Matthew Bechtold
- Department of Internal Medicine-Gastroenterology, University of Missouri-Columbia, Five Hospital Drive, Columbia, MO 65212, USA
| | - Alberto Diaz-Arias
- Department of Pathology and Anatomical Sciences, University of Missouri-Columbia, One Hospital Drive, Columbia, MO 65212, USA
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Nathanson JW, Zisman TL, Julian C, McCaffrey S, Rubin DT. Identification of patients at increased risk for colorectal cancer in an open access endoscopy center. J Clin Gastroenterol 2008; 42:1025-31. [PMID: 18719509 DOI: 10.1097/MCG.0b013e3181468613] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
GOALS To determine whether patients referred for open access endoscopy (OAE) are being appropriately identified as "increased risk" or "average risk" for colorectal cancer (CRC) by referring physicians. BACKGROUND OAE allows nongastroenterologists to schedule elective endoscopies without prior consultation with a gastroenterologist. It is unknown how accurately referring physicians identify CRC risk of such patients. METHODS We retrospectively reviewed the records of outpatients referred to a single OAE center for screening or surveillance colonoscopy from July 1, 2001 to November 8, 2002. Before colonoscopy, a 3-question tool was used to stratify each patient as average risk or increased risk for CRC. CRC risk assessment was compared with the referring physician's indication for colonoscopy. Chi-square testing was used to compare the incidence of neoplastic polyps between average risk and increased risk patients. RESULTS Two hundred eighty-eight patients met inclusion criteria. Referring physicians accurately identified 61% of 126 increased risk patients, including 13 of 19 patients (68%) with a personal history of CRC, 29 of 61 patients (48%) with a family history of CRC, 47 of 61 patients (77%) with a personal history of colonic polyps, and 0 of 8 patients (0%) who met clinical criteria for hereditary nonpolyposis colorectal cancer. Adenomatous polyps were found in 24% of average risk patients compared with 41% of increased risk patients (P<0.01). CONCLUSIONS In an OAE system, referring physicians often fail to correctly identify patients at increased risk for CRC. Our 3-question tool for risk assessment helps to better identify patients at increased risk of CRC and can be used by gastroenterologists to stratify patients referred for OAE.
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Coombes JM, Steiner JF, Bekelman DB, Prochazka AV, Denberg TD. Clinical outcomes associated with attempts to educate patients about lower endoscopy: a narrative review. J Community Health 2008; 33:149-57. [PMID: 18165928 DOI: 10.1007/s10900-007-9081-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Patient knowledge about lower endoscopy might have beneficial effects on satisfaction outcomes, pre-procedure anxiety, and adherence, although this is poorly understood. Methods Searching the national and international literature, we reviewed 20 years of observational studies and randomized trials that examine possible relationships between educating patients about lower endoscopy and clinical outcomes. Twenty-three publications were included but their heterogeneity precluded meta-analyses. Standard and modified informed consent procedures and enhanced educational interventions were associated most often with levels of patient knowledge, satisfaction, anxiety, and adherence. Regardless of the approach, a large proportion of patients have poor comprehension of lower endoscopy's risks, benefits, and alternatives; patient satisfaction with information and procedures manifests ceiling effects; only a subset of patients have clinically significant pre-procedure anxiety; and providing written information and reminders may improve procedure adherence. Future work should focus on strategies for improving patient knowledge in the setting of initial screening colonoscopy within open access systems. Patient knowledge of lower endoscopy is often inadequate even though greater knowledge might be associated with better clinical outcomes for certain patient subgroups. Professional societies have an important role to play in endorsing educational strategies and in clarifying and assessing the adequacy of patient knowledge.
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Affiliation(s)
- John M Coombes
- Five Irongate Center, Gastroenterology Associates of Northern New York, P.C., Glens Falls, NY 12801, USA
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Abstract
BACKGROUND AND AIM Although direct access colonoscopy is a common practice, some consider the level of informed consent as inadequate, and therefore a medico-legal concern. The aim of this study was to assess the adequacy of informed consent from a patient perspective in a direct access colonoscopy service. METHODS All patients having outpatient colonoscopy from May 2003 to February 2004 at a direct access colonoscopy service were considered for inclusion into the study. Information was obtained from patients by structured questionnaire administered either at the time of discharge from the day ward or mailed to their homes. RESULTS Information was obtained from 346 direct access colonoscopy patients (172 male, 159 female; 226 >or= 50 years, 103 < 50 years), 80% of whom were referred by their family doctor. Colonoscopy was done for investigation of symptoms in 220 patients, and for screening and surveillance in 115 patients, with an indication not specified in 11 patients. The majority of patients were either very satisfied (70.5%) or satisfied (25.1%) with the consent process, with no demographic characteristics found to predict dissatisfaction. Thirty-seven patients expressed a preference to have seen a gastroenterologist prior to colonoscopy, and four of these patients reported the consent process to be unsatisfactory. Seventy (20.2%) patients reported that the most useful information about colonoscopy was received after they had completed bowel preparation. CONCLUSION No demographic characteristics were found to predict the small fraction of patients dissatisfied with the informed consent process. Further medico-legal risk reduction may be facilitated by enhancing the provision of information prior to bowel preparation.
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Affiliation(s)
- Dev S Segarajasingam
- Department of Gastroenterology and Hepatology, Royal Perth Hospital, Perth, Western Australia, Australia.
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Zuckerman MJ, Shen B, Harrison ME, Baron TH, Adler DG, Davila RE, Gan SI, Lichtenstein DR, Qureshi WA, Rajan E, Fanelli RD, Van Guilder T. Informed consent for GI endoscopy. Gastrointest Endosc 2007; 66:213-8. [PMID: 17643691 DOI: 10.1016/j.gie.2007.02.029] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Rubin DT, Ulitsky A, Poston J, Day R, Huo D. What is the most effective way to communicate results after endoscopy? Gastrointest Endosc 2007; 66:108-12. [PMID: 17591482 DOI: 10.1016/j.gie.2006.12.056] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2006] [Accepted: 12/26/2006] [Indexed: 02/08/2023]
Abstract
BACKGROUND The growing demand for endoscopy associated with colorectal cancer screening has resulted in busier endoscopy units and an increase in the practice of open-access endoscopy, in which patients are referred for procedures without prior consultation by the gastroenterologist, all of which may result in less-informed patients. OBJECTIVE We sought to determine whether providing patients with a written copy of their standard endoscopy report at the conclusion of their procedure enhanced recall of the findings and recommendations. DESIGN Eighty consecutive outpatients who presented to 3 endoscopists were randomized to receive the results of their upper or lower endoscopy via standard verbal report (VR) or by standard VR followed by receipt of a computer-generated endoscopy report (VR+WR) from the Olympus ImageManager report generator. The endoscopist communicated the VR after a standard postprocedure recovery period of 30 to 60 minutes 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 by using a piloted 11-question survey instrument to be filled out 3 days after the procedure. Results were calculated by using the Fisher exact and Wilcoxon rank sum tests. PATIENTS Referral for endoscopy from University of Chicago physicians. RESULTS Seventy-eight of 80 patients (98%) approached about the study agreed to participate. The response rate was 77%. Patients in the VR+WR group overall had a greater composite score than patients in the VR group (8.9/10 vs 7.7/10, P<.01). Patients in the VR+WR group were also significantly more likely to recall the recommendations for therapy or follow-up (72% vs 42%, P<.01) and the name of the endoscopist (97% vs 74%, P<.05). LIMITATIONS Patients with an education beyond the 10th-grade level were not formally accessed in this study. Because of this, we could not evaluate whether differences in educational attainment affected patient understanding of endoscopy procedure details and findings. CONCLUSIONS A computer-generated endoscopy report (WR) significantly improved patient recall of endoscopic procedure information compared with a VR alone. Despite this, patients were unable to recall 28% of recommendations. Additional study to determine if such enhanced physician-patient communication improves patient satisfaction or follow-up, and whether more specific patient-directed results further improve recall needs to occur.
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Affiliation(s)
- David T Rubin
- Department of Medicine, University of Chicago, Chicago, Illinois 60637, USA
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Early DS. How to deliver the news. Gastrointest Endosc 2007; 66:113-5. [PMID: 17591483 DOI: 10.1016/j.gie.2007.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2007] [Accepted: 02/05/2007] [Indexed: 12/10/2022]
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Balaguer F, Llach J, Castells A, Bordas JM, Ppellisé M, Rodríguez-Moranta F, Mata A, Fernández-Esparrach G, Ginès A, Piqué JM. The European panel on the appropriateness of gastrointestinal endoscopy guidelines colonoscopy in an open-access endoscopy unit: a prospective study. Aliment Pharmacol Ther 2005; 21:609-13. [PMID: 15740545 DOI: 10.1111/j.1365-2036.2005.02359.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The demand for gastrointestinal endoscopy is increasing in most developed countries, resulting in an important rise in overall costs and waiting lists for endoscopic procedures. Therefore, adherence to appropriate indications for these procedures is essential for the rational use of finite resources in an open-access system. AIM To assess indications and appropriateness of colonoscopy according to the European Panel on the Appropriateness of Gastrointestinal Endoscopy (EPAGE) criteria. METHODS From May to June 2004, all consecutive patients referred to our Unit for open-access colonoscopy were considered for inclusion in this prospective study. Appropriateness of each colonoscopy was established according to the EPAGE criteria. In order to evaluate whether appropriateness of use correlated with the diagnostic yield of colonoscopy, relevant endoscopic findings were also recorded. RESULTS A total of 350 consecutive patients were included in the study. In 38 of them, the colonoscopy indication was not listed in the EPAGE guidelines and, consequently, they were not evaluated. In the remaining 312 patients, the indication for the procedure was considered inappropriate in 73 (23%) patients. Both referring doctor characteristics (specialty and health care setting) and patient data (age) correlated with appropriateness of endoscopy. The diagnostic yield was significantly higher for appropriate colonoscopies (42%) than in those judged inappropriate (21%) (P = 0.001). CONCLUSIONS A noteworthy proportion of patients referred for colonoscopy to an open-access endoscopy unit are considered inappropriate because of their indication, with significant differences among specialties. These results suggest that implementation of validated guidelines for its appropriate use could improve this situation and, considering the correlation between appropriateness and diagnostic yield, even contribute to improve the prognosis of patients with colorectal diseases.
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Affiliation(s)
- F Balaguer
- Department of Gastroenterology, Institut de Malalties Digestives, Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain
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Kartsonis AP. Scheduling and preparation for endoscopic procedures: a biased perspective from a private practice. Gastrointest Endosc Clin N Am 2004; 14:629-34, vii. [PMID: 15363767 DOI: 10.1016/j.giec.2004.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Our ability to function successfully as efficient physicians depends substantially on our employees who surround us in our practices. It is our office associates who initially come into contact with our patients, generally spend more time with them than we do, and clearly play the major role in the scheduling of, and preparation for, endoscopic examinations. In this article we discuss ways in which we can improve scheduling and preparation for endoscopic procedures.
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Eisen GM, Baron TH, Dominitz JA, Faigel DO, Goldstein JL, Johanson JF, Mallery JS, Raddawi HM, Vargo JJ, Waring JP, Fanelli RD, Wheeler-Harbaugh J. Open access endoscopy. Gastrointest Endosc 2002; 56:793-5. [PMID: 12447287 DOI: 10.1016/s0016-5107(02)70349-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Cappell MS, Friedel D. The role of sigmoidoscopy and colonoscopy in the diagnosis and management of lower gastrointestinal disorders: technique, indications, and contraindications. Med Clin North Am 2002; 86:1217-52. [PMID: 12510453 DOI: 10.1016/s0025-7125(02)00076-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Flexible sigmoidoscopy and colonoscopy have revolutionized the clinical management of colonic diseases. Colonoscopy has a broad range of indications, including evaluating lower GI symptoms such as lower GI bleeding, evaluating abnormal radiographic findings, and screening and surveillance for colon cancer. Colonoscopy is increasingly being used therapeutically. Patient evaluation, patient instructions, and colonic preparation before colonoscopy are essential for safe and efficient colonoscopy. Intravenous sedation reduces patient pain and anxiety during colonoscopy, but requires monitoring by pulse oximetry and automated measurements of vital signs. An experienced colonoscopist can complete colonoscopy in 90% or more of cases, using maneuvers to maintain the colonic lumen in view, straighten the colonoscope, and avoid looping during colonic intubation.
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Affiliation(s)
- Mitchell S Cappell
- Division of Gastroenterology, Department of Medicine, Woodhull Medical Center, Department of Medicine, State University of New York, Downstate Medical School, Brooklyn, NY, USA
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Abstract
Interventional endoscopy is a general label given to endoscopic procedures used to deal with a variety of gastrointestinal disorders. The interventional endoscopic procedures of interest in this review are those used specifically with gastric disorders. They include hemostasis, endoscopic ultrasound, endoscopic mucosal resection, stenting, percutaneous endoscopic gastrostomy tube placement and photodynamic laser therapy. Here, we review the latest data related to (a) a number of general issues having an impact on this diverse group of procedures (eg, such as proper patient selection criteria, consent in the era of open access endoscopy, protocol for anticoagulation, and sedation); (b) the methodology and outcomes of each of these unique procedures as they apply to the stomach; and (c) some of the latest technologic advances and developments that will potentially have an impact the future use of these procedures.
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Affiliation(s)
- W Wassef
- Division of Gastroenterology, University of Massachusetts Memorial Health Care, University of Massachusetts Medical Center, Worcester, Massachusetts 01655, USA.
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