Anthony Schore

High-Definition Colonoscopy Detects Colorectal Polyps at a Higher Rate Than Standard White-Light Colonoscopy

BACKGROUND & AIMS Adenoma detection rates might be improved through use of high-definition colonoscopy, which can detect subtle mucosal changes. We investigated whether the use of high-definition white-light (HDWL) colonoscopy resulted in a higher rate of adenoma detection than standard-definition white-light (SDWL) colonoscopy in a clinical practice setting. METHODS This retrospective study included 2430 patients who underwent colonoscopies from September 2006 to December 2007; 1226 received SDWL colonoscopy and 1204 received HDWL colonoscopy. We analyzed data from consecutive screening, surveillance, and diagnostic colonoscopies, comparing adenoma and overall polyp detection between procedures. Potentially confounding variables were controlled using multivariable logistic regression analysis. RESULTS The adenoma detection rate was higher among patients who underwent HDWL compared with SDWL colonoscopies (28.8% vs 24.3%; P = .012), as was the polyp detection rate (42.2% vs 37.8%; P = .026). These findings remained after adjustments for potentially confounding variables (P = .018 and .022, respectively). CONCLUSIONS In a general clinical practice setting, HDWL colonoscopy resulted in a higher adenoma detection rate compared with SDWL colonoscopy. The use of SDWL colonoscopy could reduce the number of missed adenomas and the subsequent risk for colorectal cancer.

Endoscopic mucosal ablation for the treatment of gastric antral vascular ectasia with the HALO90 system: a pilot study

BACKGROUND Gastric antral vascular ectasia (GAVE) often results in GI bleeding and chronic anemia. Treatment options are limited and include medical, endoscopic, and surgical therapies. OBJECTIVE To assess the utility of endoscopic mucosal ablative therapy by using the HALO(90) system for patients with GAVE and recurrent bleeding. DESIGN Prospective open-label case series. SETTING Tertiary referral center. PATIENTS Six consecutive patients with GAVE, bleeding, and blood transfusion dependence. MAIN OUTCOME MEASUREMENTS Comparison of preablation and postablation Hb levels and transfusion requirements. To assess the number of ablation sessions needed to stabilize the Hb level and eliminate the need for blood transfusion. RESULTS Six patients, (4 men, mean age 58 years, range 47-65 years) underwent endoscopic mucosal ablation of antral lesions (mean procedure time 29 minutes; mean treatments 1.7, range 1-3). The mean Hb level improved from 8.6 to 10.2 g/dl (mean 2 months after the last ablation). Five of 6 patients are no longer dependent on blood transfusions to maintain a stable Hb level. LIMITATIONS This is a pilot study, with a small number of patients at a single center, with limited patient follow-up. CONCLUSIONS This study suggests that endoscopic mucosal ablation by using the HALO(90) system is a promising treatment option for chronic bleeding related to GAVE.

Trainee participation is associated with increased small adenoma detection

BACKGROUND Previous studies examining the effect of fellow participation on adenoma detection rate in colonoscopy have yielded conflicting results, and factors such as adenoma size and location have not been rigorously evaluated. OBJECTIVE To examine whether fellow participation during screening, surveillance, or diagnostic colonoscopy affects overall, size-specific, or location-specific adenoma or polyp detection rate. METHODS This was a retrospective study of 2430 colonoscopies performed in our ambulatory surgical center between September 2006 and December 2007, comparing adenoma and polyp detection rates of colonoscopies performed by fellows with supervising staff endoscopists (n = 318) with colonoscopies performed by staff endoscopists without fellow participation (n = 2112). Study participants included patients who underwent screening, surveillance, or diagnostic colonoscopies in our GI suite. Logistic regression analysis was used to evaluate the association of fellow participation with adenoma and polyp detection. RESULTS There was evidence of a higher rate of small (<5 mm) adenoma detection in colonoscopies with a fellow present (25% vs 17%, P = .001). This remained significant after multiple-testing adjustment (P ≤ .003 considered significant). Findings were similar, although not significant for small polyps (36% vs 29%, P = .007). There was a trend toward increased adenoma detection in colonoscopies with a fellow present compared with those without (30% vs 26%, P = .11). Multivariable adjustment for potentially confounding variables did not alter these associations. LIMITATIONS The study had a retrospective design, and information regarding bowel preparation was not available for 37% of patients. CONCLUSION Fellow involvement was associated with increased detection rates of small adenomas, providing evidence that the presence of a fellow during colonoscopy plays a role in enhancing the effectiveness of the examination.

M1050 Are Four Eyes Better Than Two? the Effect of Trainee Participation in Colonoscopy On Adenomas Detection Rates

was recorded again with the number of polyps detected. Results: A total of 58 patients in each group were included. The number of patients with decrease in spasm score of 0, 1, and 2 between insertion and withdrawal were 6 (11.1%), 46 (85.2%), and 2 (3.7%) in the Hyosine group, and 2 (3.7%), 30 (55.6%), and 22 (40.7%) in the Placebo group, respectively (p<0.001). Overall, no significant differences were observed in the number of polyps detected per patient. However, in subgroup analysis of patients with spasm score≥ 3 during insertion, more polyps per patient were likely to be detected in the Hyoscine group than the Placebo group (1.21±2.23 vs. 0.41±0.91; p=0.060). Conslusions: Our study suggests that hyoscine might increase the detection rate of polyps in patients with moderate to marked degree of colonic spasm during colonoscope insertion. Further large scale studies are needed to validate our observations. Table 1. Spasm score

M1049 ABIM Recertification Status and Colonoscopy Adenoma Detection Rates: A Retrospective Study of 2011 Patients Undergoing Colonoscopy

was recorded again with the number of polyps detected. Results: A total of 58 patients in each group were included. The number of patients with decrease in spasm score of 0, 1, and 2 between insertion and withdrawal were 6 (11.1%), 46 (85.2%), and 2 (3.7%) in the Hyosine group, and 2 (3.7%), 30 (55.6%), and 22 (40.7%) in the Placebo group, respectively (p<0.001). Overall, no significant differences were observed in the number of polyps detected per patient. However, in subgroup analysis of patients with spasm score≥ 3 during insertion, more polyps per patient were likely to be detected in the Hyoscine group than the Placebo group (1.21±2.23 vs. 0.41±0.91; p=0.060). Conslusions: Our study suggests that hyoscine might increase the detection rate of polyps in patients with moderate to marked degree of colonic spasm during colonoscope insertion. Further large scale studies are needed to validate our observations. Table 1. Spasm score