A113 ANNUAL COLONOSCOPY VOLUME IS NOT PREDICTIVE OF COLONOSCOPY QUALITY - FINDINGS FROM THE SOUTHWEST ONTARIO COLONOSCOPY COHORT

Background

Performing a minimum number of colonoscopies annually has been proposed by some jurisdictions as a requirement for maintaining privileges. However, this practice is supported by limited evidence.

Aims

The objective of this study was to determine if annual colonoscopy volume was associated with colonoscopy quality metrics.

Methods

A population-based study was performed using the Southwest Ontario Colonoscopy cohort, which consists of all adult patients who underwent colonoscopy between April 2017 and Oct 2018 at 21 academic and community hospitals within the health region. Data were collected through a mandatory quality assurance form completed after each procedure and pathology reports were manually reviewed. Physician annualized colonoscopy volumes were compared by correlation analysis to each quality-related outcome, by means of the area under the receiver operating characteristics curve (AUROC), and logistic regression. The prognostic value of colonoscopy volume was also adjusted for case-mix and potential confounders in separate regression analyses for each outcome. The primary outcome was ADR. Secondary outcomes were polyp detection rate (PDR), sessile serrated polyp detection rate (SSPDR), and cecal intubation.

Results

A total of 47,195 colonoscopies were performed by 75 physicians (37.5% by gastroenterologists, 60% by general surgeons, 2.5% others). There were no clear relationships between annual colonoscopy volumes and study outcomes. Colonoscopy volume was not associated with ADR (OR 1.03, 95% CI 0.96–1.10, p=0.48) and corresponded to an AUROC not significantly different from the null (AUROC 0.52, 95% CI 0.43–0.61, p=0.65). Multi-variable regression adjusting for case-mix also demonstrated no predictive value of annual colonoscopy volume for the primary outcome (OR 1.03, 95% CI 0.94–1.12, p=0.55). Similarly, analyses of secondary outcomes failed to find an association between colonoscopy volume and PDR, SSPDR, or cecal intubation (Table 1).

Conclusions

Annual colonoscopy volumes do not predict ADR, PDR, SSPDR, or cecal intubation rate.

Results of unconditional and conditional approaches for examining the predictive value of annual colonoscopy volume for quality related outcomes.

Funding Agencies

None

A117 PROPOFOL SEDATION DOES NOT IMPROVE MEASURES OF COLONOSCOPY QUALITY – FINDINGS FROM THE SOUTHWEST ONTARIO COLONOSCOPY COHORT

Background

The use of propofol during colonoscopy has gained increased popularity due to deeper anesthesia compared to conscious sedation. Prior studies examining the use of propofol sedation during colonoscopy have primarily focused on anesthesia outcomes. Whether propofol sedation is associated with improvements in colonoscopy outcomes is uncertain.

Aims

The primary outcome was adenoma detection rate (ADR). Secondary outcomes were the detection of any adenoma (conventional adenoma, sessile serrated polyp, and traditional serrated adenoma), sessile serrated polyp detection rate, polyp detection rate, cecal intubation rate, and perforation rate.

Methods

The Southwest Ontario Colonoscopy cohort consists of all patients who underwent colonoscopy between April 2017 and Oct 2018 at 21 hospitals serving a large geographic area in Southwest Ontario. Procedures performed in patients less than 18 years of age or by endoscopist who perform <50 colonoscopies/year were excluded. Data were collected through a mandatory quality assurance form that was completed by the endoscopist after each procedure. Pathology reports were manually reviewed.

Results

A total of 46,634 colonoscopies were performed by 75 physicians (37.5% by gastroenterologists, 60% by general surgeons, 2.5% others) of which 16,408 (35.2%) received propofol and 30,226 (64.8%) received conscious sedation (e.g. combination of a benzodiazepine and a narcotic). Patients who received propofol were likely to have a screening indication (49.2% vs 45.5%, p<0.0001), not have a trainee endoscopist present and be performed at a non-academic centre (32.2% vs 44.6%, p<0.0001). Compared to conscious sedation, use of propofol was associated with a lower ADR (24.6% vs. 27.0%, p<0.0001) and detection of any adenoma (27.7% vs. 29.8%, p<0.0001); no difference was observed in the detection ofsessile serrated polyps (5.0% vs. 4.7%, p=0.26), polyp detection rate (41.2% vs 41.2%, p=0.978), cecal intubation rate (97.1% vs. 96.8%, p=0.15) or perforation rate (0.04% vs. 0.06%,p=0.45). On multi-variable analysis, the use of propofol was not significantly associated with any improvement in ADR (RR=0.90, 95% CI 0.74–1.10, p=0.30), detection of any adenoma (RR=0.93, 95% CI 0.75–1.14, p=0.47), sessile serrated polyp detection rate (RR=1.20, 95%CI 0.90–1.60, p=0.22), polyp detection rate (RR=1.00, 95% CI 0.90–1.11, p=0.99), or cecal intubation rate (RR=1.00, 95%CI 0.80–1.26, p=0.99).

Conclusions

The use of propofol sedation does not improve colonoscopy quality metrics.

Funding Agencies

None

Guido Pontecorvo. 29 November 1907 – 25 September 1999

Guido Pontecorvo was elected a Fellow of The Royal Society in 1955 for his contributions to the genetics of Drosophila and the fungus Aspergillus nidulans . Pontecorvo was a leading British geneticist, prominent in the decade preceding the discovery of DNA, who enriched our understanding of genes and whose pioneering work on the parasexual cycle in fungi found application in human somatic cell genetics.

Known to friends as Ponte, he had a strong personality. Somewhat irascible but warm, with a wry sense of humor, he made many lifelong friends and acquired a large body of admirers.

Guido Pontecorvo, 29 November 1907 - 25 September 1999

Guido Pontecorvo was elected a Fellow of The Royal Society in 1955 for his contributions to the genetics of Drosophilia and the fungus Aspergillus nidulans. Pontecorvo was a leading British geneticist, prominent in the decade preceding the discovery of DNA, who enriched our understanding of genes and whose pioneering work on the parasexual cycle in fungi found application in human somatic cell genetics. Known to friends as Ponte, he had a strong personality. Somewhat irascible but warm, with a wry sense of humor, he made many lifelong friends and acquired a large body of admirers.

Genetic analysis of olfC demonstrates a role for the position-specific integrins in the olfactory system of Drosophila melanogaster

Genetic analysis of olfC provides evidence for a role for integrins in the development and/or function of the olfactory system of Drosophila. The olfC gene was identified on the basis of mutations that result in specific defects in behavioural responses to acetate esters, and has been mapped to the cytogenetic interval 7D1;D5-6 on the X chromosome. The myospheroid (mys) gene maps to this region and encodes a beta subunit of integrins. Integrins are alpha(beta) heterodimers which are present on the cell surface and have been implicated in a variety of signalling roles. Mutations in mys fail to complement the olfactory deficits of olfC mutants. These defects can be rescued by misexpression of the mys+ gene under control of a hsp70 promoter. Mutations that affect the alpha subunit of the position-specific integrin PS2 show a dominant interaction with olfC. These results suggest that olfC is allelic to mys and functions together with alphaPS2 integrins in the olfactory pathway in Drosophila.

Evidence of age-related changes in the antennal glomeruli of Drosophila melanogaster using monoclonal antibodies

As a tool to better understand the organization of the olfactory pathway three monoclonal antibodies have been isolated and characterized each having a unique staining pattern in the antenna and antennal lobe of Drosophila melanogaster. Monoclonal antibody F14-2D6 stains sensilla coeloconica and thick sensilla basiconica in the funiculus, Y1-3D10 stains only a few sensilla especially in and around the sacculus, while F15-12E8 stains all the sensilla. All three antibodies stain a subset of the glomeruli in the antennal lobe, of which 11 glomeruli are stained in common by all three antibodies. These antibodies could be used to study projection patterns of the sensilla into the antennal lobe. Glomerular staining was observed at different developmental times with the different antibodies. F15-12E8 stains all the glomeruli at eclosion, Y1-3D10 stains only a few glomeruli at eclosion but most glomeruli are stained by the first day after eclosion. F14-2D6 stains all glomeruli only after eclosion. F15-12E8 also stains the mushroom bodies. The antigen recognized by F14-2D6 in the glomeruli shows an increase with age of the flies, measured as increased intensity of staining. These observations suggest that age-related changes continue in the antennal lobe of the flies even after eclosion. These antibodies could therefore serve as unique markers for other studies on the development of the olfactory system.

Olfaction in invertebrates

Olfactory transduction in invertebrates seems to be similar to that in vertebrates. Three signalling systems involving activation of adenylate cyclase, phospholipase C and guanylate cyclase are present. A variety of second messengers, including cAMP, inositol 1,4,5-trisphosphate, diacylglycerol, nitric oxide and Ca2+, have been identified but their target sites and mode of action are not yet fully understood. The central projections of olfactory signals in invertebrates are relatively simple and perhaps more hard-wired than in vertebrates. Information about circuitry and functional mapping in the olfactory pathway is lacking. This is essential for understanding the sensory code and higher olfactory functions. Neurogenetic analysis has provided useful insights into olfaction and olfactory learning.

Closely linked lesions in a region of the X chromosome affect central and peripheral steps in gustatory processing in Drosophila

We have analyzed a set of closely linked mutations on the X chromosome of Drosophila that lead to defects in gustatory behavior. The mutations map to a small region of the X chromosome between 10E1-4. Two distinct complementation groups, gustB and gustD, map to the ends of this region. These groups show complex complementation patterns with the mutations gustC and GT-1, which also map to this region. We describe the behavioral and electrophysiological properties of the mutants. These mutations affect peripheral receptor properties as well as more central processing steps in the gustatory pathway.

Genetics of olfactory behavior in Drosophila melanogaster

We have used a behavioral genetic approach to identify six X-linked loci which specify olfaction in Drosophila melanogaster. Mutations in five of these genes lead to partial anosmias affecting responses either to aldehydes (olfA, olfB, olfE and olfF) or to acetate esters (olfC). Only one of the mutants obtained in our screening (olfD) resulted in a insensitivity to several different odorants. olfA, olfE and olfC map close together in a small region of the chromosome between 7C and 7D. The alleles at the olfC locus fall into two phenotypic classes according to their responses to different acetate esters. The two groups of olfC alleles interact in-trans.

A gene affecting the specificity of the chemosensory neurons of Drosophila

The sensilla on the proboscis and tarsi of Drosophila contain five neurons, four chemosensory and one mechanosensory. The sugar-sensitive neuron, designated S, carries independent acceptor sites for pyranose, furanose and trehalose. Two others, L1 and L2, respond to salts. The fourth neuron, W, is inhibited by salts and sugars, and is believed to mediate detection of water. We describe here a gene in which mutations alter the neurons in such a way that the S cell is excited by salts. As a result, the mutant flies are strongly attracted by NaCl at concentrations which are repellent to the wild type. To our knowledge, this is the first instance of a mutation which changes the specificity of the chemosensory neurons.

Projection patterns of different types of antennal sensilla in the antennal glomeruli of Drosophila melanogaster

Cobalt fills from small, defined regions of the antenna in D. melanogaster show that the three types of sensilla on the third segment, the flagellum, and a fourth sensillum located in the arista, project into the glomeruli of the antennal lobe. We have identified 19 glomeruli in each lobe, according to their location, shape, and size. At least ten of these represent major projection areas of flagellar or aristal sensilla. The large majority of glomeruli is innervated from both antennae, but a small group of five receive exclusively ipsilateral input. A particular sensory fiber appears to terminate only in one specific glomerulus, either in the ipsilateral or in both lobes. Fills from flagellar regions bearing a single type of sensillum, yield a specific pattern of glomeruli containing stained terminals. Aristal projections remain strictly ipsilateral, whereas those from the other sensilla consist of an ipsilateral and a bilateral component. When filling from different points in an area bearing one type of sensillum, similar projections are produced, suggesting that projection patterns observed reflect predominantly the type of sensillum rather than its location on the flagellum. Accordingly, individual glomeruli might represent functional units, each receiving antennal input in a characteristic combination.

A gustatory mutant of Drosophila defective in pyranose receptors

Mutations in an X-linked gene, gust-A, block the responses of Drosophila melanogaster to a group of pyranose sugars. It is shown that the behavioural effects of this mutation are correlated with a loss of electrical responses in taste receptors. The mutation affects the chemoacceptors for pyranose sugars leaving the furanose acceptors intact.

torpid a new sex-linked paralytic mutation in Drosophila melanogaster

A new temperature-sensitive paralytic locus on the X chromosome of Drosophila melanogaster called torpid is described. Mosaic analysis shows that the focus of defect in torp lies in the presumptive neural region of the blastoderm. Electrophysiological tests indicate that the excitability of the cervical axons is lowered at elevated temperatures.

Depression of alkaline phosphatase in Hfr of Escherichia coli during conjugation

In a mating mixture of Hfr and F- bacteria the gene for alkaline phosphatase undergoes a transient derepression at the time of transfer. It is shown that this escape from repression occurs in the donor cells and is probably connected with the synchronous duplication of the transferred genome.

Neurophysiological defects in temperature-sensitive paralytic mutants of Drosophila melanogaster

A new temperature-sensitive paralytic mutant of Drosophila, comatose, is compared behaviorally and physiologically with the previously known types, para and shi. All three have different properties with respect to kinetics of paralysis at high temperature and recovery from paralysis; com is hypersensitive to paralysis by cooling. Neurophysiological experimeents indicate different mechanisms for paralysis in each of the mutants.