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Kadle N, Westerveld DR, Banerjee D, Jacobs C, Gesiotto F, Moon N, Forde JJ, Conti M, Hatamleh D, Taylor R, Brar T, Riverso M, Jawaid S, Perbtani YB, Zhang Y, Draganov PV, Beyth R, Yang D. Discrepancy between self-reported and actual colonoscopy polypectomy practices for the removal of small polyps. Gastrointest Endosc 2020; 91:655-662.e2. [PMID: 31669181 DOI: 10.1016/j.gie.2019.10.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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] [Received: 08/07/2019] [Accepted: 10/13/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Cold snare polypectomy (CSP) is associated with higher rates of complete resection compared with cold biopsy forceps (CBF) for the removal of small polyps (4-9 mm). This study aimed to evaluate self-reported polypectomy preferences and actual practice patterns among endoscopists at an academic center and to identify factors associated with the use of CSP for small polyps. METHODS In phase A, endoscopists completed a survey evaluating preferences for polypectomy techniques. In phase B, we performed a retrospective analysis of all consecutive colonoscopies with polypectomy (January 2016 to September 2018). Uni- and multivariate analysis were performed to identify factors associated with CSP for small polyps. RESULTS Nineteen of 26 (73%) endoscopists completed the survey (phase A); 3 (15.8%) were interventional endoscopists. Most respondents indicated that they use CSP (89.5%) for small polyps and identified no reasons for choosing CBF over CSP (73.7%). In phase B, we identified 1118 colonoscopies with 2625 polypectomies for polyps ≤9 mm. Most diminutive polyps (≤3 mm) were removed with CBF (819 of 912; 90%). CBF (46.2%) was also preferentially used for removal of small polyps (n = 1713), followed by hot snare polypectomy (27.2%), and CSP (26.6%). On multivariate analysis, interventional endoscopists were associated with a higher likelihood of using CSP for small polyps (odds ratio, 1.38; 95% confidence interval, 1.07-1.79; P = .01). CONCLUSIONS Significant discrepancy exists between self-reported preferences and actual polypectomy practices. CBF is still preferentially used over CSP for the removal of polyps sized 4-9 mm; further strategies are needed to monitor and implement adequate polypectomy techniques.
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Affiliation(s)
- Nikhil Kadle
- Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida, USA
| | - Donevan R Westerveld
- Department of Internal Medicine, University of Florida, Gainesville, Florida, USA
| | - Debdeep Banerjee
- Department of Internal Medicine, University of Florida, Gainesville, Florida, USA
| | - Chelsea Jacobs
- Department of Internal Medicine, University of Florida, Gainesville, Florida, USA
| | - Francesca Gesiotto
- Department of Internal Medicine, University of Florida, Gainesville, Florida, USA
| | - Nabeel Moon
- Department of Internal Medicine, University of Florida, Gainesville, Florida, USA
| | - Justin J Forde
- Department of Internal Medicine, University of Florida, Gainesville, Florida, USA
| | - Mathew Conti
- Department of Internal Medicine, University of Florida, Gainesville, Florida, USA
| | - Diana Hatamleh
- Department of Internal Medicine, University of Florida, Gainesville, Florida, USA
| | - Robert Taylor
- Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida, USA
| | - Tony Brar
- Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida, USA
| | - Michael Riverso
- Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida, USA
| | - Salmaan Jawaid
- Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida, USA
| | - Yaseen B Perbtani
- Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida, USA
| | - Yang Zhang
- Department of Internal Medicine, University of Florida, Gainesville, Florida, USA
| | - Peter V Draganov
- Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida, USA
| | - Rebecca Beyth
- Department of Internal Medicine, University of Florida, Gainesville, Florida, USA
| | - Dennis Yang
- Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida, USA
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Abstract
In a preoperative anesthesia setting with integrated neuropsychology for individuals >64 years of age, we completed a pilot study examining the association between neurocognitive disorders with frequency of missed colonoscopies and quality of bowel preparation (prep). Gastroenterologists completed the Boston Bowel Preparation Scale (BBPS) for each patient. Of 47 older adults seen in our service, 68% met criteria for neurocognitive disorders. All individuals failing to attend the colonoscopy procedure had met criteria for major neurocognitive disorder. Poor bowel prep was also identified in 100% of individuals with major neurocognitive disorder and 28% of individuals with mild neurocognitive disorder. Our pilot data suggest that, in high-risk individuals, the presence of neurocognitive disorders is risk factors for missed appointments and inadequate bowel prep. These pilot data provide reference statistics for future intervention protocols.
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Affiliation(s)
- Franchesca Arias
- Pain Research and Intervention Center of Excellence, Gainesville, FL
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL
| | - Michael Riverso
- Division of Gastroenterology, Hepatology, & Nutrition, Gainesville, FL
| | - Shellie-Anne Levy
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL
| | - Rebecca Armstrong
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL
| | - David S. Estores
- Division of Gastroenterology, Hepatology, & Nutrition, Gainesville, FL
| | - Patrick Tighe
- Department of Anesthesiology, University of Florida, Gainesville, FL
| | - Catherine C. Price
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL
- Department of Anesthesiology, University of Florida, Gainesville, FL
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Flint A, Chaudhry NA, Riverso M, Pham A, Moser PP, Mramba LK, Zimmermann EM, Grajo JR. Effective communication of cross-sectional imaging findings in Crohn's disease: comparing conventional EMR reporting to a published scoring system. Abdom Radiol (NY) 2018; 43:1798-1806. [PMID: 29075825 DOI: 10.1007/s00261-017-1368-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE The purpose of the article is to compare information regarding small bowel lesions in Crohn's disease (CD) patients communicated by a published scoring system and radiology reports from electronic medical record (EMR) of cross-sectional abdominal imaging. METHODS Two gastrointestinal radiologists (reference readers) blinded to EMR reports scored cross-sectional imaging exams using a published scoring system. Investigators compared EMR and radiologist scores based on the mentioned findings and severity documentation of each variable. Statistical analysis involved means and difference in proportions and logistic regression modeling. RESULTS Seventy-three CD patients, with average age 40.6 years (± SD 14.4), having 80 small bowel lesions on imaging were included. EMR reports reliably mentioned within the consensus score included thickness (79%, p = 0.000), enhancement (70%, p = 0.000), active inflammation (86%, p = 0.000), perienteric fluid (82%, p = 0.000), and presence of stricture (62%, p = 0.002). Minimal lumen diameter (19%, p = 0.000), comb sign (19%, p = 0.000), lesion length (57%, p = 0.06), and fistula (50%, p = 1.0) were reported less often. There was a strong association between the EMR and scoring scale in noting severity of active inflammation (88%, p = 0.000), perienteric fluid (76%, p = 0.000), and internal fistula (71%, p = 0.000). The proportion matching severity values of comb sign and minimal lumen were 24% and 21%, respectively (p = 0.000). Severity matches for stricture were less likely among the non-GI radiologists (odds ratio = 0.33, SE = 0.168, p = 0.029). The odds of reporting stricture and fistula severity were 3.6 and 5.7, respectively, on MRE. CONCLUSIONS Findings and severity of inflammation were communicated consistently. Stricture severity including minimal luminal diameter, was less reliably reported, though its prognostic significance impacts management.
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Affiliation(s)
- Andrew Flint
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Naueen A Chaudhry
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Michael Riverso
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Angela Pham
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Patricia P Moser
- Division of Abdominal Imaging, Department of Radiology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Lazarus K Mramba
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Ellen M Zimmermann
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Joseph R Grajo
- Division of Abdominal Imaging, Department of Radiology, University of Florida College of Medicine, Gainesville, FL, USA.
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Westerveld D, Khullar V, Mramba L, Ayoub F, Brar T, Agarwal M, Forde J, Chakraborty J, Riverso M, Perbtani YB, Gupte A, Forsmark CE, Draganov P, Yang D. Adherence to quality indicators and surveillance guidelines in the management of Barrett's esophagus: a retrospective analysis. Endosc Int Open 2018; 6:E300-E307. [PMID: 29507870 PMCID: PMC5832463 DOI: 10.1055/s-0044-101351] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 12/18/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Adherence to quality indicators and surveillance guidelines in the management of Barrett's esophagus (BE) promotes high-quality, cost-effective care. The aims of this study were (1) to evaluate adherence to standardized classification (Prague Criteria) and systematic (four-quadrant) biopsy protocol, (2) to identify predictors of practice patterns, and (3) to assess adherence to surveillance guidelines for non-dysplastic BE (NDBE). METHODS This was a single-center retrospective study of esophagogastroduodenoscopy (EGD) performed for BE (June 2008 to December 2015). Patient demographics, procedure characteristics, and histology results were obtained from the procedure report-generating database and chart review. Adherence to Prague Criteria and systematic biopsies was based on operative report documentation. Multiple logistic regression analysis was performed to identify predictors of practice patterns. Guideline adherent surveillance EGD was defined as those performed within 6 months of the recommended 3- to 5-year interval. RESULTS In total, 397 patients (66.5 % male; mean age 60.1 ± 12.5 years) had an index EGD during the study period. Adherence to Prague Criteria and systematic biopsies was 27.4 % and 24.1 %, respectively. Endoscopists who performed therapeutic interventions for BE were more likely to use the Prague Criteria (OR: 3.16; 95 %CI: 1.47 - 6.82; P < 0.01) than those who did not. Longer time in practice was positively associated with adherence to Prague Criteria (OR 1.07; 95 %CI: 1.02 - 1.12; P < 0.01) but with a lower likelihood of performing systematic biopsies (OR 0.91; 95 %CI: 0.85 - 0.97; P < 0.01). More than half (55.6 %) of patients with NDBE underwent surveillance EGD sooner (range 1 - 29 months) than the recommended interval. CONCLUSION Adherence to quality indicators and surveillance guidelines in BE is low. Operator characteristics, including experience with endoscopic therapy for BE and time in practice predicted practice pattern. Future efforts are needed to reduce variability in practice and promote high-value care.
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Affiliation(s)
- Donevan Westerveld
- Department of Internal Medicine, University of Florida, Gainesville, FL, USA
| | - Vikas Khullar
- Division of Gastroenterology and Hepatology, University of Florida, Gainesville, FL, USA
| | - Lazarus Mramba
- Statistics, Department of Internal Medicine, University of Florida, Gainesville, FL, USA
| | - Fares Ayoub
- Department of Internal Medicine, University of Florida, Gainesville, FL, USA
| | - Tony Brar
- Department of Internal Medicine, University of Florida, Gainesville, FL, USA
| | - Mitali Agarwal
- Department of Internal Medicine, University of Florida, Gainesville, FL, USA
| | - Justin Forde
- Department of Internal Medicine, University of Florida, Gainesville, FL, USA
| | - Joydeep Chakraborty
- Department of Internal Medicine, University of Florida, Gainesville, FL, USA
| | - Michael Riverso
- Division of Gastroenterology and Hepatology, University of Florida, Gainesville, FL, USA
| | - Yaseen B. Perbtani
- Division of Gastroenterology and Hepatology, University of Florida, Gainesville, FL, USA
| | - Anand Gupte
- Division of Gastroenterology and Hepatology, University of Florida, Gainesville, FL, USA
| | - Chris E. Forsmark
- Division of Gastroenterology and Hepatology, University of Florida, Gainesville, FL, USA
| | - Peter Draganov
- Division of Gastroenterology and Hepatology, University of Florida, Gainesville, FL, USA
| | - Dennis Yang
- Division of Gastroenterology and Hepatology, University of Florida, Gainesville, FL, USA
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Riverso M, Chang M, Soldevila-Pico C, Lai J, Liu X. Histologic Characterization of Kratom Use-Associated Liver Injury. Gastroenterology Res 2018; 11:79-82. [PMID: 29511414 PMCID: PMC5827910 DOI: 10.14740/gr990e] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 02/02/2018] [Indexed: 12/15/2022] Open
Abstract
Kratom is an herbal product derived from the leaves of Southeast Asian Mitragyna speciosa trees. It has traditionally been used by indigenous people to relieve fatigue and manage pain, diarrhea, or opioid withdrawal. The use of kratom has become more commonplace in the United States for similar purposes. Only rare reports of kratom liver toxicity exist in the literature but without histologic characterization. Herein, we report one case of kratom use-associated liver toxicity in a 38-year-old patient. The patient complained of dark colored urine and light colored stools after using kratom. He had unremarkable physical examination. Laboratory testing at presentation revealed elevated alanine aminotransferase (389 U/L), aspartate aminotransferase (220 U/L), total bilirubin (5.1 mg/dL), and alkaline phosphatase (304 U/L). There was no serology evidence of viral hepatitis A, B, and C. The acetaminophen level at presentation was below detectable limits. Ultrasound examination of the right upper quadrant revealed normal echogenicity and contour of the liver without bile ductal dilatation or disease of the gallbladder. The patient underwent liver biopsy 4 days after the initial presentation which revealed a pattern of acute cholestatic liver injury including zone 3 hepatocellular and canalicular cholestasis, focal hepatocyte dropout, mild portal inflammation, and bile duct injury. Kratom was stopped, the patient improved clinically and biochemically and was discharged 8 days after the initial presentation. To our best knowledge, this is the first case report detailing the histology of kratom use-associated liver injury.
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Affiliation(s)
- Michael Riverso
- Department of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, FL, USA
| | - Michael Chang
- Department of Pathology, Immunology, and Laboratory Medicine, Gainesville, FL, USA
| | - Consuelo Soldevila-Pico
- Department of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, FL, USA
| | - Jinping Lai
- Department of Pathology, Immunology, and Laboratory Medicine, Gainesville, FL, USA
| | - Xiuli Liu
- Department of Pathology, Immunology, and Laboratory Medicine, Gainesville, FL, USA
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Riverso M, Perbtani YB, Shuster JJD, Chakraborty J, Brar TS, Agarwal M, Zhang H, Gupte A, Chauhan SS, Forsmark CE, Draganov PV, Yang D. Carbon dioxide insufflation is associated with increased serrated polyp detection rate when compared to room air insufflation during screening colonoscopy. Endosc Int Open 2017; 5:E905-E912. [PMID: 28924598 PMCID: PMC5597937 DOI: 10.1055/s-0043-116382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Accepted: 06/16/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND STUDY AIMS Sessile serrated adenomas (SSA) and traditional serrated adenomas (TSA) have been increasingly recognized as precursors of colorectal cancer. The aim of this study was to compare the effect of carbon dioxide insufflation (CO 2 I) vs. room air insufflation (AI) on serrated polyp detection rate (SPDR) and to identify factors associated with SPDR. PATIENTS AND METHODS Single-center retrospective cohort study of 2083 screening colonoscopies performed with AI (November 2011 through January 2013) or CO 2 I (February 2013 to June 2015). Data on demographics, procedure characteristics and histology results were obtained from a prospectively maintained endoscopy database and chart review. SPDR was defined as proportion of colonoscopies in which ≥ 1 SSA, TSA or hyperplastic polyp (HP) ≥ 10 mm in the right colon was detected. Multi-variate analysis (MVA) was performed to identify predictors of SPDR. RESULTS A total of 131 histologically confirmed serrated polyps (129 SSA, 2 TSA and 0 HP ≥ 10 mm) were detected. SPDR was higher with CO 2 I vs. AI (4.8 % vs. 1.4 %; P < 0.0001). On MVA, CO 2 I was associated with higher SPDR when compared to AI (OR: 9.52; 95 % CI: 3.05 - 30.3). Both higher body mass index (OR 1.05; 95 % CI:1.02 - 1.09) and longer colonoscope withdrawal time (OR 1.11; 95 % CI: 1.07 - 1.16) were also associated with higher SPDR. CONCLUSION CO 2 I is associated with higher SPDR when compared to AI during screening colonoscopy. While the mechanism remains unknown, we speculate that the favorable gas characteristics of CO 2 compared to room air results in improved polyp detection by optimizing bowel insufflation. These findings suggest an additional reason to prefer the use of CO 2 I over AI during colonoscopy.
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Affiliation(s)
- Michael Riverso
- Division of Gastroenterology, University of Florida, Gainesville, Florida, United States
| | - Yaseen B. Perbtani
- Division of Gastroenterology, University of Florida, Gainesville, Florida, United States
| | - Jonathan J. D. Shuster
- Department of Health Outcomes and Policy, University of Florida, Gainesville, Florida, United States
| | - Joydeep Chakraborty
- Department of Medicine, University of Florida, Gainesville, Florida, United States
| | - Tony S. Brar
- Department of Medicine, University of Florida, Gainesville, Florida, United States
| | - Mitali Agarwal
- Department of Medicine, University of Florida, Gainesville, Florida, United States
| | - Han Zhang
- Department of Medicine, University of Florida, Gainesville, Florida, United States
| | - Anand Gupte
- Division of Gastroenterology, University of Florida, Gainesville, Florida, United States
| | - Shailendra S. Chauhan
- Division of Gastroenterology, University of Florida, Gainesville, Florida, United States
| | | | - Peter V. Draganov
- Division of Gastroenterology, University of Florida, Gainesville, Florida, United States
| | - Dennis Yang
- Division of Gastroenterology, University of Florida, Gainesville, Florida, United States,Corresponding author Dennis Yang, MD Division of GastroenterologyUniversity of Florida1329 SW 16th Street, Suite 5251Gainesville, FL 32608+1-352-627-9002
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Yang D, Perbtani YB, An Q, Agarwal M, Riverso M, Chakraborty J, Brar TS, Westerveld D, Zhang H, Chauhan SS, Forsmark CE, Draganov PV. Survey study on the practice patterns in the endoscopic management of malignant distal biliary obstruction. Endosc Int Open 2017; 5:E754-E762. [PMID: 28791325 PMCID: PMC5546911 DOI: 10.1055/s-0043-111592] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 03/23/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND STUDY AIM Endoscopic biliary drainage for malignant distal biliary obstruction (MDBO) is a common practice. Controversy persists with regard to its role in resectable MDBO, the optimal technical method and type of stent. The aim of this study was to evaluate practice patterns in the treatment of MDBO among endoscopists with varying levels of experience and practice backgrounds. METHODS Electronic survey distributed to members of the American Society for Gastrointestinal Endoscopy (ASGE). The main outcome measures included practice setting (academic vs. community), volume of endoscopic retrograde cholangiopancreatographies (ERCPs), reasons for endoscopic drainage in MDBO, and technical approach. RESULTS A total of 335 subjects (54 % community-based endoscopists) completed the survey. Most academic physicians (69 %) reported performing ≥ 150 ERCPs annually compared to 18.8 % of community physicians ( P < 0.001). In aggregate, 13.1 % of respondents performed ERCP in resectable MDBO because of surgeon preference or as the standard of care at their institution. The use of metal vs. plastic stents in MDBO varied based on practice setting. Routine sphincterotomy for MDBO was more common among community (78 %) vs academic endoscopists (61.1 %) ( P < 0.001). Over half (58 %) of the subjects avoided covering the cystic duct take-off during stenting MDBO if there was a gallbladder in situ. CONCLUSION There is significant variability in practice patterns for the treatment of MDBO. In spite of the recent ASGE guideline recommendations, some patients with resectable MDBO still undergo preoperative ERCP. Current clinical practices are not clearly supported by available data and underscore the need to increase adherence to gastrointestinal societal recommendations and an evidence-based approach to standardized patient care.
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Affiliation(s)
- Dennis Yang
- Division of Gastroenterology and Hepatology, University of Florida, Gainesville, FL, USA,Corresponding author Dennis Yang, MD Division of GastroenterologyUniversity of Florida1329 SW 16th StreetSuite 5251GainesvilleFL 32608USA+1-352-627-9002
| | - Yaseen B. Perbtani
- Division of Gastroenterology and Hepatology, University of Florida, Gainesville, FL, USA
| | - Qi An
- Department of Health Outcomes and Policy, University of Florida, Gainesville, FL, USA
| | - Mitali Agarwal
- Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Michael Riverso
- Division of Gastroenterology and Hepatology, University of Florida, Gainesville, FL, USA
| | | | - Tony S. Brar
- Department of Medicine, University of Florida, Gainesville, FL, USA
| | | | - Han Zhang
- Department of Medicine, University of Florida, Gainesville, FL, USA
| | | | | | - Peter V. Draganov
- Division of Gastroenterology and Hepatology, University of Florida, Gainesville, FL, USA
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Perbtani YB, Riverso M, Shuster JJ, Chakraborty J, Brar TS, Agarwal M, Zhang H, Gupte A, Chauhan SS, Forsmark CE, Draganov PV, Yang D. Does carbon dioxide insufflation impact adenoma detection rate? A single-center retrospective analysis. Endosc Int Open 2016; 4:E1275-E1279. [PMID: 27995188 PMCID: PMC5161121 DOI: 10.1055/s-0042-118177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 09/12/2016] [Indexed: 12/21/2022] Open
Abstract
Background and study aims: Carbon dioxide (CO2) has been associated with reduced post-procedural pain and improved patient satisfaction when compared to air insufflation (AI). The effect of CO2 insufflation (CO2I) on the adenoma detection rate (ADR) remains unclear. The aims of this study are to compare ADR in patients undergoing screening colonoscopy with AI vs. CO2I and identify predictors of ADR. Patients and methods: Single-center retrospective cohort study of 2,107 patients undergoing screening colonoscopy at the University of Florida Hospital between November 2011 and June 2015. Patient demographics, procedural parameters, and histology results were retrospectively obtained from a prospectively maintained colonoscopy database. Univariate and multivariate analysis were performed to identify predictors of ADR. Results: A total of 2107 colonoscopies (644 with AI and 1463 with CO2I) were analyzed. Overall ADR was 27.8 %. There was no significant difference in ADR between AI (27.6 %) vs. CO2I (27.8 %) (P = 0.93). Method of insufflation (AI vs. CO2I) was not significantly associated with ADR (OR 0.9; 95 % CI:0.7 - 1.2). Older age (OR: 1.02; 95 % CI: 1.001 - 1.03 per year increase), male gender (OR 1.48; 95 % CI: 1.17 - 1.87), and longer scope withdraw time (OR 1.13; 95 % CI: 1.1 - 1.16 per minute) were associated with a higher ADR. Fellow involvement was negatively associated with ADR (OR 0.60; 95 % CI: 0.47 - 0.77). Conclusion: ADR was similar between patients who underwent screening colonoscopy with AI vs. CO2I. While CO2I has been associated with improved patient comfort and post-procedural recovery time, there is no definitive evidence to suggest that this method of luminal distention enhances ADR.
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Affiliation(s)
- Yaseen B. Perbtani
- Department of Medicine, University of
Florida, Gainesville, Florida, United States
| | - Michael Riverso
- Department of Medicine, University of
Florida, Gainesville, Florida, United States
| | - Jonathan J. Shuster
- Department of Health Outcomes and Policy
University of Florida, Gainesville, Florida, United States
| | - Joydeep Chakraborty
- Department of Medicine, University of
Florida, Gainesville, Florida, United States
| | - Tony S. Brar
- Department of Medicine, University of
Florida, Gainesville, Florida, United States
| | - Mitali Agarwal
- Department of Medicine, University of
Florida, Gainesville, Florida, United States
| | - Han Zhang
- Department of Medicine, University of
Florida, Gainesville, Florida, United States
| | - Anand Gupte
- Division of Gastroenterology, University of
Florida, Gainesville, Florida, United States
| | - Shailendra S. Chauhan
- Division of Gastroenterology, University of
Florida, Gainesville, Florida, United States
| | | | - Peter V. Draganov
- Division of Gastroenterology, University of
Florida, Gainesville, Florida, United States
| | - Dennis Yang
- Division of Gastroenterology, University of
Florida, Gainesville, Florida, United States,Corresponding author Dennis Yang,
MD Division of Gastroenterology, University of
Florida1329 SW 16th Street, Suite
5251Gainesville, FL 32608United
States+1-352-273-9474+1-352-627-9002
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Rovida E, Barbetti V, Morandi A, Riverso M, Bessi S, Giannini A, Di Leo A, Dello Sbarba P. 90P Identification in Breast Cancer Cells of A Novel Mechanism of Csf-1R Signaling Which Involves its Nuclear Translocation and Binding to the Promoter of Genes Relevant to Cancer Progression. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(19)65734-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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