Roger Charles

Effect of a quality program with adverse events identification on airway management during overtube-assisted enteroscopy.

BACKGROUND AND STUDY AIMS Adverse events associated with overtube-assisted enteroscopy are similar to those with routine endoscopy. Our endoscopy quality program identified a number of respiratory adverse events resulting in emergency resuscitation efforts. The aim is to report all adverse events identified by quality monitoring and outcomes of adverse events associated with overtube-assisted enteroscopy. METHODS A retrospective study used data prospectively obtained from consecutive patients undergoing overtube-assisted enteroscopy between December 2008 and July 2012. Patient characteristics, medical history, procedure indication, and procedure outcomes, including diagnosis, endoscopic therapy, and complications, were obtained. RESULTS In 432 overtube-assisted enteroscopies, 15 adverse events (most frequently hypoxemia, 9 /15, 60 %) occurred in 14 patients (3.2 % of total cohort; 12 were outpatients) mostly during antegrade enteroscopy. Four patients required endotracheal intubation and 4 /12 outpatients required intensive care. The procedure was aborted in 13 /14 patients, and only 1 of 10 patients scheduled for repeat antegrade enteroscopy returned. There was no mortality. Based on the frequency of adverse events, and in consultation with anesthesia providers, from August 2012 all antegrade overtube-assisted enteroscopies at our institution were done with general anesthesia. From then till September 2013, 145 antegrade and 52 retrograde overtube-assisted enteroscopies have been done, with no adverse events. CONCLUSIONS Monitoring of endoscopy practice identified adverse events associated with overtube-assisted enteroscopy. The peer-review prompted a change in practice: all patients undergoing antegrade overtube-assisted enteroscopy at our institution now have endotracheal intubation which has dramatically decreased the rate of respiratory adverse events. The impact of endoscopic quality measurements on practices, procedures, and outcomes will be of further interest.

The role of endoscopy in inflammatory bowel disease

Inflammatory bowel disease (IBD) is a group of chronic immune‐mediated disorders of the gastrointestinal tract. It is often the result of the interaction of genetic and environmental factors. The role of endoscopy in disease surveillance is unprecedented. However, there is considerable debate in therapeutic goals in IBD patients, ranging from the resolution of clinical symptoms to mucosal healing. Furthermore, deep remission has recently been advocated for altering disease course in these patients. Additionally, neoplasia continues to be a significant cause of morbidity and mortality in IBD patients. This review discussed the role of several endoscopic techniques in assessing mucosal healing and neoplasia with emphasis on novel non‐invasive endoscopic techniques.

Initial experience with a variable width and extreme tip angulation colonoscope

Screening and surveillance colonoscopies can be affected by colon looping, angulations, diverticulosis, previous surgeries, body mass index, ability to sedate or type of sedation, bowel preparation, and female sex. Incomplete colonoscopies can be economically and emotionally costly and may result in decreased compliance with screening for colon neoplasia [1]. Instruments that improve the cecal intubation and adenoma detection rate, reduce the number of incomplete colonoscopies and improve patient satisfaction are desirable. Studies have shown that pediatric as well as variable stiffness colonoscopes achieve cecal intubation rates similar to standard colonoscopes, but possibly with less pain and with faster cecal intubation times [2, 3]. More recently, ultrathin colonoscopes have been reported to be better at negotiating acute luminal angulations, and patients may require less sedation than when standard colonoscopes are used. However, looping, difficulty removing larger polyps, and a higher ileal intubation failure rate have been reported [1, 4, 5]. We are, to the best of our knowledge, the first to report the ease of use and initial impressions with a newly available variable width colonoscope with extreme tip angulation capability.

Mo1077 Clinical Efficacy of Same Day CT Colonography Following Incomplete Colonoscopy

Background: Colonoscopy is the preferred screening method for colorectal cancer (CRC) but may be incomplete in 4% to 25% of cases. CT colonography (CTC) is an adjunct to evaluate the colon after an incomplete colonoscopy (IC). No study has focused on same day CTC after an IC. Our primary aim was to determine the yield of same day CTC after IC. Methods: Our institution has the capability to perform same day CTC in patients with an incomplete colonoscopy. This was a retrospective review of all CTC done immediately following IC from January 2008 to December 2012. 198 CTC met inclusion criteria. Descriptive statistics were used. Results: Of 198 patients with IC and CTC 50 patients had 61 intracolonic findings. 23/50 (46%) were screening procedures, 1/50 (2%) high risk screening, 17/50 (34%) had a diagnostic colonoscopy and 9/50 (18%) surveillance colonoscopy. 10/50 patients had 12 findings on CTC on areas that were not reached by incomplete colonoscopy. 6 of these 10 patients had a follow up intervention: 2 had retrograde double balloon enteroscopy and 4 had colonoscopies. 3 findings correlated with CTC (1 ascending colon adenocarcinoma and 2 polyps) and 3 did not ( normal colonoscopy/DBE). 40 patients had 49 colonic findings on CTC on areas reached but not described during IC. 19/49 (39%) findings were not described during the initial colonoscopy. Only 6 of these 40 pts had a repeat colonoscopy. 9 findings did not correlate with subsequent complete colonoscopy. Only 1 CTC finding correlated with repeat colonoscopy. There were 30 colonic findings on CTC in areas that were reached and described during the incomplete colonoscopy. Nineteen were sigmoid diverticular strictures with no additional findings in the rest of the colon, 10 were diverticulosis of the sigmoid and 1 ascending colon adenocarcinoma with no synchronous lesions. Conclusions: Same day CTC can be of added value in patients with incomplete colonoscopy. Potential benefits include no need to repeat bowel cleansing and no extra day lost from work. Our data showed that correlation of findings by CTC in areas not visualized by incomplete colonoscopy was poor as 50% of patients had CTC abnormalities which did not correlate with a repeat colonoscopy. When CTC described an abnormality in an area already reached but not described during IC correlation was also poor as only one patient had correlation between CTC and repeat colonoscopy. When CTC reported the same findings described during IC correlation was 100%. More data on the efficacy and cost-effectiveness of same day CTC compared to repeating a colonoscopy or maybe performing a retrograde overtube assisted enteroscopy is needed to determine which effort is worthwhile.