Drew Schembre

The effect of periodic monitoring and feedback on screening colonoscopy withdrawal times, polyp detection rates, and patient satisfaction scores

BACKGROUND Previous studies showed a correlation between mean withdrawal times during screening colonoscopy and polyp/neoplasia detection rates. OBJECTIVES To assess the effect of a monitoring and feedback program on withdrawal times, polyp/neoplasia detection rates, and patient satisfaction. DESIGN Comparison of retrospective and prospective data. SETTING Teaching hospital. PATIENTS Asymptomatic adults undergoing screening colonoscopy. INTERVENTIONS Monitoring and feedback program. MAIN OUTCOME MEASUREMENTS Withdrawal times, polyp and neoplasia detection rates, and patient satisfaction scores. METHODS We retrospectively reviewed 850 screening colonoscopies, recording withdrawal times, polyp findings, and patient satisfaction scores. All procedures were performed by 10 experienced gastroenterologists who were then informed that periodic confidential monitoring and feedback of withdrawal times, polyp detection rates, and satisfaction scores would be started. We then prospectively collected data on another 541 screening colonoscopies. We compared pre- and postmonitoring outcome measures. RESULTS Overall, after monitoring had begun, there was an increase in mean withdrawal times (from 6.57 to 8.07 minutes; P < .0001), and polyp detection rates (from 33.1% to 38.1%; P = .04, significance removed by Bonferroni correction). Nine of the 10 endoscopists increased their withdrawal times significantly. There was a small, nonsignificant increase in the neoplasia detection rate (from 19.6% to 22.7%; P = .17), but no significant change in mean satisfaction scores. Across endoscopists, there was a moderate correlation (r = 0.63; P = .04, significance removed by Bonferroni correction) between withdrawal times and polyp detection rates, but not between withdrawal times and satisfaction scores. LIMITATIONS No randomization, possible response bias, confounding of intervention effects, and sample size limitations. CONCLUSIONS Monitoring and feedback are associated with increases in mean withdrawal times and polyp detection rates, but not patient satisfaction scores. Neoplasia detection rates showed a statistically nonsignificant trend toward an increase.

Recent Advances in the Use of Stents for Esophageal Disease

The use of self-expanding metal esophageal stents has evolved dramatically over the last 20 years. Stents themselves have morphed from simple open-mesh wire devices to a variety of partially and fully covered metal and plastic protheses designed to resist in-growth and migration. Indications include grown considerably from simply palliating malignant dysphagia to the treatment of benign conditions such as refractory strictures, perforations, and fistulas, bridging tumors through neoadjuvant therapy and even serving as support for mucosal healing after ablative therapies. This article describes the current experience with esophageal stenting for malignant and benign conditions and examines new innovations in stent design and applications.