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Wang CL, Zhao ZY, Wu JY, Yan FH, Yuan J, Xing JJ, Wang H, Yu ED. Efficacy of cecal retroflexion observed on adenoma missing of ascending colon during colonoscopy: A prospective, randomized, pilot trial. Medicine (Baltimore) 2023; 102:e34806. [PMID: 37653767 PMCID: PMC10470795 DOI: 10.1097/md.0000000000034806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Although colonoscopic retroflexion has been proved effective in reducing missed adenomas, there is still a lack of comprehensive and in-depth research focused on the ascending colon. We aimed to conduct a randomized controlled trial and tandem colonoscopy to investigate whether cecal retroflexion observed during colonoscopy can reduce missed adenomas in the ascending colon. METHODS Men and women required to be between 45 and 80 years of age were screened for enrollment in the trial. Patients were randomly assigned according to a 1:1 ratio to either the trial group or control group. Patients in the trial group underwent 2 forward examination and a cecal retroflexion observed in the ascending colon, while patients in the control group underwent only 2 forward examinations in the ascending colon. The primary outcome was adenoma miss rate. The secondary outcomes contained adenoma detection rate, polyp miss rate, polyp detection rate, insertion time and withdrawal time. Differences between groups in the primary outcome and in the other categorical indicators were tested using chi-squared test and Fisher exact test. For the comparison of continuous outcomes, the Student t test was applied. RESULTS A total of 60 subjects were eligible for the study between April to June 2020, of which 55 were randomized and eligible for analysis (26 to the control group and 29 to the trial group). The characteristics of patients were no significant differences statistically between the trial group and the control group. Similarly, the characteristics of the colonoscopy procedures included cecal insertion distance, the length of cecum and ascending colon, insertion time, withdrawal time, quality of bowel preparation, numerical rating scale for pain, polyps detected, and adenomas detected, and there were no significant differences statistically between the 2 groups (P = .864, P = .754, P = .700, P = .974, P = .585, P = .835, P = .373, P = .489). The characteristics of the polyps were also no significant differences statistically between the 2 groups. CONCLUSION This pilot trial failed to show benefit of cecal retroflexion observed on adenoma missing of ascending colon during colonoscopy; however, further conclusions require a prospective study with a higher level of evidence. (NCT03355443).
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Affiliation(s)
- Cheng-Long Wang
- Department of Colorectal Surgery and GI Endoscopy Center, Naval Medical University First Affiliated Hospital (Changhai Hospital), Shanghai, China
- Department of Gastroenterology and GI Endoscopy Center, Xiamen University Affiliated Chenggong Hospital (Chinese PLA 73rd Army Corps Hospital), Xiamen, Fujian, China
| | - Zi-Ye Zhao
- Department of Colorectal Surgery and GI Endoscopy Center, Naval Medical University First Affiliated Hospital (Changhai Hospital), Shanghai, China
| | - Jia-Yi Wu
- Department of Civil Engineering and Architecture, Jinhua Open University, Jinhua, Zhejiang, China
| | - Fei-Hu Yan
- Department of Colorectal Surgery and GI Endoscopy Center, Naval Medical University First Affiliated Hospital (Changhai Hospital), Shanghai, China
| | - Jie Yuan
- Department of Colorectal Surgery and GI Endoscopy Center, Naval Medical University First Affiliated Hospital (Changhai Hospital), Shanghai, China
| | - Jun-Jie Xing
- Department of Colorectal Surgery and GI Endoscopy Center, Naval Medical University First Affiliated Hospital (Changhai Hospital), Shanghai, China
| | - Hao Wang
- Department of Colorectal Surgery and GI Endoscopy Center, Naval Medical University First Affiliated Hospital (Changhai Hospital), Shanghai, China
| | - En-Da Yu
- Department of Colorectal Surgery and GI Endoscopy Center, Naval Medical University First Affiliated Hospital (Changhai Hospital), Shanghai, China
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Albuquerque A, Etienney I. Identification and Reporting of Anal Pathology during Routine Colonoscopies. JOURNAL OF COLOPROCTOLOGY 2023; 43:152-158. [DOI: 10.1055/s-0043-1769921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
Abstract
AbstractThe gold-standard procedure for anal canal examination is anoscopy. Nonetheless, patients are referred for a colonoscopy for many reasons, and a routine exam might provide an opportunity to diagnose anal pathologies, such as hemorrhoids, anal fissures, anal polyps, condylomas, and anal squamous cell carcinoma. It is important to know the main features of these conditions and relevant information to report in order to help guide patient treatment and follow-up.
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Affiliation(s)
- Andreia Albuquerque
- Gastroenterology Department, Teaching Hospital of Fernando Pessoa University, Cosme, Portugal
- Precancerous lesions and early cancer management research group RISE@CI-IPO (Health Research Network), Portuguese Oncology Institute of Porto (IPO-Porto), Porto, Portugal
| | - Isabelle Etienney
- Department of Proctology, Deaconesses Croix Saint-Simon Hospital, Paris, France
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Keating E, Leyden J, O'Connor DB, Lahiff C. Unlocking quality in endoscopic mucosal resection. World J Gastrointest Endosc 2023; 15:338-353. [PMID: 37274555 PMCID: PMC10236981 DOI: 10.4253/wjge.v15.i5.338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/24/2023] [Accepted: 04/12/2023] [Indexed: 05/16/2023] Open
Abstract
A review of the development of the key performance metrics of endoscopic mucosal resection (EMR), learning from the experience of the establishment of widespread colonoscopy quality measurements. Potential future performance markers for both colonoscopy and EMR are also evaluated to ensure continued high quality performance is maintained with a focus service framework and predictors of patient outcome.
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Affiliation(s)
- Eoin Keating
- Department of Gastroenterology, Mater Misericordiae University Hospital, Dublin 7, Ireland
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Jan Leyden
- Department of Gastroenterology, Mater Misericordiae University Hospital, Dublin 7, Ireland
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Donal B O'Connor
- Department of Surgery, Tallaght University Hospital, Dublin 24, Ireland
- School of Medicine, Trinity College Dublin, Dublin 2, Ireland
| | - Conor Lahiff
- Department of Gastroenterology, Mater Misericordiae University Hospital, Dublin 7, Ireland
- School of Medicine, University College Dublin, Dublin 4, Ireland
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Detection of Anal Intraepithelial Neoplasia and Anal Squamous Cell Carcinoma on Colonoscopy. ACG Case Rep J 2022; 9:e00792. [PMID: 35756724 PMCID: PMC9225483 DOI: 10.14309/crj.0000000000000792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 02/23/2022] [Indexed: 11/17/2022] Open
Abstract
The purpose of this case series is to review the endoscopic detection of anal intraepithelial neoplasia and anal squamous cell carcinoma including the role of rectal retroflexion and narrow-band imaging. Four cases of anal intraepithelial neoplasia were incidentally discovered in women aged 55–71 years. Anal lesions identified included sessile polyps, nodular mucosa, and circumferential polyps. A fifth patient, who presented with abdominal pain, was found to have a 3 cm anal squamous cell carcinoma on diagnostic colonoscopy, despite a negative colonoscopy 21 months earlier. In the absence of contraindications, retroflexion should be performed on all patients. Suspicious anal mucosa warrants biopsy.
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5
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Ikematsu H, Murano T, Shinmura K. Detection of colorectal lesions during colonoscopy. DEN OPEN 2022; 2:e68. [PMID: 35310752 PMCID: PMC8828173 DOI: 10.1002/deo2.68] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 12/11/2022]
Abstract
Owing to its high mortality rate, the prevention of colorectal cancer is of particular importance. The resection of colorectal polyps is reported to drastically reduce colorectal cancer mortality, and examination by endoscopists who had a high adenoma detection rate was found to lower the risk of colorectal cancer, highlighting the importance of identifying lesions. Various devices, imaging techniques, and diagnostic tools aimed at reducing the rate of missed lesions have therefore been developed to improve detection. The distal attachments and devices for improving the endoscopic view angle are intended to help avoid missing blind spots such as folds and flexures in the colon, whereas the imaging techniques represented by image‐enhanced endoscopy contribute to improving lesion visibility. Recent advances in artificial intelligence‐supported detection systems are expected to supplement an endoscopist's eye through the instant diagnosis of the lesions displayed on the monitor. In this review, we provide an outline of each tool and assess its impact on the reduction in the incidence of missed colorectal polyps by summarizing previous clinical research and meta‐analyses. Although useful, the many devices, image‐enhanced endoscopy, and artificial intelligence tools exhibited various limitations. Integrating these tools can improve their shortcomings. Combining artificial intelligence‐based diagnoses with wide‐angle image‐enhanced endoscopy may be particularly useful. Thus, we hope that such tools will be available in the near future.
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Affiliation(s)
- Hiroaki Ikematsu
- Division of Science and Technology for Endoscopy Exploratory Oncology Research & Clinical Trial Center National Cancer Center Chiba Japan.,Department of Gastroenterology and Endoscopy National Cancer Center Hospital East Chiba Japan
| | - Tatsuro Murano
- Department of Gastroenterology and Endoscopy National Cancer Center Hospital East Chiba Japan
| | - Kensuke Shinmura
- Department of Gastroenterology and Endoscopy National Cancer Center Hospital East Chiba Japan
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6
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Kim YI, Joo JY, Yang HR. Inflammatory cloacogenic polyps in children: diagnostic yield of rectal retroflexion during colonoscopy. BMC Gastroenterol 2022; 22:42. [PMID: 35114936 PMCID: PMC8815161 DOI: 10.1186/s12876-022-02119-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/21/2022] [Indexed: 11/12/2022] Open
Abstract
Background and aims Inflammatory cloacogenic polyps (ICPs) are inflammatory lesions occurring around the anal transitional zone. These are rare in the pediatric population, and most reported cases are found in adults. Therefore, this study aimed to evaluate the usefulness of rectal retroflexion (RR) during colonoscopy in detecting ICPs in children.
Methods A total of 1837 colonoscopies were performed in 1278 children between September 2003 and August 2020 at the Seoul National University Bundang Hospital. The laboratory test results and colonoscopic and histopathological findings were retrospectively reviewed. ICP was detected using the RR and was diagnosed based on the histologic findings of the polyp. Results A total of 69 patients were diagnosed with juvenile polyps (n = 62) or ICP (n = 7), with the latter being detected through RR. All children with ICP were diagnosed from 2013 onwards when RR during colonoscopy came to be routinely performed in our medical center. The patients with ICP were older at diagnosis and more associated with a family history of colorectal polyps than JP. Stool occult blood and the polyps’ endoscopic characteristics, such as number, location, volume, and shape, significantly varied between the two groups. Additionally, there was a statistically significant difference in the polypectomy method. During the long-term follow-up, there was no recurrence of ICP. Conclusions Due to their location at the anorectal junction, ICPs may be overlooked during colonoscopy, leading to misdiagnosis. Therefore, a retroflexion view during colonoscopy may help detect ICPs in pediatric patients, especially those presenting with hematochezia.
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Affiliation(s)
- You Ie Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jung Yeon Joo
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hye Ran Yang
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea. .,Seoul National University College of Medicine, Seoul, Korea.
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Zelhart MD, Kann BR. Endoscopy. THE ASCRS TEXTBOOK OF COLON AND RECTAL SURGERY 2022:51-77. [DOI: 10.1007/978-3-030-66049-9_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Saito Y, Oka S, Kawamura T, Shimoda R, Sekiguchi M, Tamai N, Hotta K, Matsuda T, Misawa M, Tanaka S, Iriguchi Y, Nozaki R, Yamamoto H, Yoshida M, Fujimoto K, Inoue H. Colonoscopy screening and surveillance guidelines. Dig Endosc 2021; 33:486-519. [PMID: 33713493 DOI: 10.1111/den.13972] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/21/2021] [Accepted: 03/09/2021] [Indexed: 12/15/2022]
Abstract
The Colonoscopy Screening and Surveillance Guidelines were developed by the Japan Gastroenterological Endoscopy Society as basic guidelines based on the scientific methods. The importance of endoscopic screening and surveillance for both detection and post-treatment follow-up of colorectal cancer has been recognized as essential to reduce disease mortality. There is limited high-level evidence in this field; therefore, we had to focus on the consensus of experts. These clinical practice guidelines consist of 20 clinical questions and eight background knowledge topics that have been determined as the current guiding principles.
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Affiliation(s)
- Yutaka Saito
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Shiro Oka
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | | | - Ryo Shimoda
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | | | - Naoto Tamai
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Kinichi Hotta
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | | | - Masashi Misawa
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Shinji Tanaka
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | | | - Ryoichi Nozaki
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | | | | | | | - Haruhiro Inoue
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
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9
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Multidirectional Colonoscopy Quality Improvement Increases Adenoma Detection Rate: Results of the Seoul National University Hospital Healthcare System Gangnam Center Colonoscopy Quality Upgrade Project (Gangnam-CUP). Dig Dis Sci 2020; 65:1806-1815. [PMID: 31732905 DOI: 10.1007/s10620-019-05944-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 11/06/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND To prevent colorectal cancer, high-quality colonoscopy is advocated, undertaken by endoscopists with high adenoma detection rates (ADRs). Despite reports that various factors may impact ADRs, the significance of such factors is still unclear. AIMS The analysis was aimed at quality-oriented interventions for boosting ADRs. METHODS Study enrollees were adults subjected to screening colonoscopy between September 2013 and August 2016 at the Gangnam Center of Seoul National University Hospital Healthcare System. The investigation entailed six periods (P1-6) of 6 months each, during which serial multidirectional quality improvement efforts were instituted. In particular, we sought to further educate endoscopists, provide feedback on individual ADRs, and introduce a split-dose regimen, gauging results via the Boston Bowel Preparation Score. Changes in polyp detection rates (PDRs) and ADRs were then analyzed. RESULTS A total of 13,430 colonoscopies were undertaken by 15 experienced endoscopists. Overall, the ADR increased from 45.6% (P1) to 48.2% (P6, p < 0.001). The PDR, ADR, and advanced adenoma detection rate (AdvADR) showed the greatest increases between P3 and P4 [PDR 67.8% → 71.2% (p < 0.001); ADR 44.1% → 47.7% (p = 0.001); AdvADR 2.3% → 3.3% (p = 0.028)] in keeping with the introduction of a split-dose regimen. The sessile serrated adenoma detection rate (SSADR) increased substantially from 2.1% (P1) to 7.9% (P6, p < 0.001), with the largest gain between P1 and P2, just after education (p = 0.023). CONCLUSIONS Successful quality improvement in colonoscopy was achieved through comprehensive multidirectional efforts in education, feedback, and enhanced bowel preparation. Achieving high-level bowel preparation was paramount in ADR improvement. The SSADR was improved through education.
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10
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Gomes A, Minata MK, Jukemura J, de Moura EGH. Video anoscopy: results of routine anal examination during colonoscopies. Endosc Int Open 2019; 7:E1549-E1562. [PMID: 31723578 PMCID: PMC6847703 DOI: 10.1055/a-0998-3958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 07/22/2019] [Indexed: 12/17/2022] Open
Abstract
Background and study aims Anal examination and video anoscopy (VA) are rarely performed during colonoscopies. The aim of this study is to demonstrate that anal examination and VA provide important information in all routine colonoscopies. Patients and methods A cross-sectional study was conducted on 12,151 patients screened by VA which were performed during routine outpatient colonoscopy between 2006 and 2018. The aspects studied were: normal examination; hemorrhoidal disease; thrombosed hemorrhoids; anal fissure; perianal Crohn's Disease; perianal fistula; condyloma; polyps; neoplasms; stenosis; bleeding. Results Of the colonoscopies performed on 12,151 patients, 9,364 cases (77.06 %) presented some alterations. Internal I degree hemorrhoids (5911 - 48.65 %); internal hemorrhoids of II, III and IV degrees (2362 - 19.44 %); thrombosed hemorrhoids (120 - 0.99 %); bleeding (56 - 0.46 %); fissure (415 - 3.42 %); perianal fistula (42 - 0.35 %); perianal Crohn's Disease (34 - 0.28 %); condylomas (18 - 0.15 %); anal stenosis (30 - 0.25 %); other findings (310 - 2.55 %); polyps (62 - 0.51 %), one of which was adenomatous with high-grade dysplasia; four cases of anal canal neoplasia (0.03 %): two cases of squamous cell carcinoma and two cases of adenocarcinoma. Conclusion The association of routine video anoscopy during colonoscopy improved diagnosis of neoplastic anal lesions, allowed correct classification of the degree of hemorrhoidal disease, helped to confirm the bleeding site and detected other anal pathologies. The main findings were hemorrhoidal diseases, fissures and perianal fistulas. The study suggests that VA should be used in all colonoscopies.
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Affiliation(s)
- Alexandre Gomes
- Department of Gastroenterology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil,Corresponding author Alexandre Gomes, MD, MSc Department of GastroenterologyHospital das Clínicas da Faculdade de Medicina da Universidade de São PauloRua Dr. Luiz Garcia Duarte 12518047-599 Sorocaba – São PauloBrasil+55-15-32113601
| | - Maurício Kazuyoshi Minata
- Department of Gastroenterology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - José Jukemura
- Department of Gastroenterology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Maida M, Morreale G, Sinagra E, Ianiro G, Margherita V, Cirrone Cipolla A, Camilleri S. Quality measures improving endoscopic screening of colorectal cancer: a review of the literature. Expert Rev Anticancer Ther 2019; 19:223-235. [PMID: 30614284 DOI: 10.1080/14737140.2019.1565999] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 01/04/2019] [Indexed: 02/09/2023]
Abstract
Colorectal cancer (CRC) is a major health-care problem all over the world and CRC screening is effective in reducing mortality and increasing the 5-year survival. Colonoscopy has a central role in CRC screening. It can be performed as a primary test, as a recall policy after a positive result of another screening test, and for surveillance. Since effectiveness of endoscopic screening depends on adequate detection and removal of colonic polyps, consistent quality measures, which are useful in enhancing the diagnostic yield of examination, are essential. Areas covered: The aim of this review is to analyze current evidence from literature supporting quality measures able to refine endoscopic screening of colorectal cancer. Expert commentary: Quality measures namely a) time slot allotted to colonoscopy, b) assessment of indication, c) bowel preparation, d) Cecal intubation, e) withdrawal time, f) adenoma detection rate, g) proper management of lesions (polypectomy technique, polyps retrieval rate and tattooing of resection sites), and h) adequate follow-up intervals play a key role in identifying malignant and at-risk lesions and improving the outcome of screening. Adherence to these quality measures is critical to maximize the effectiveness of CRC screening, as well as, a proper technique of colonoscopy and a quality report of the procedure. Among all recommended measures, adenoma detection rate is the most important and must be kept above the recommended quality threshold by all physicians practicing in the setting of screening.
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Affiliation(s)
- Marcello Maida
- a Section of Gastroenterology , S.Elia - Raimondi Hospital , Caltanissetta , Italy
| | - Gaetano Morreale
- a Section of Gastroenterology , S.Elia - Raimondi Hospital , Caltanissetta , Italy
| | - Emanuele Sinagra
- b Gastroenterology and Endoscopy Unit , Fondazione Istituto San Raffaele Giglio , Cefalù , Italy
| | - Gianluca Ianiro
- c Internal Medicine, Gastroenterology & Liver Unit , Università Cattolica Sacro Cuore , Rome , Italy
| | - Vito Margherita
- d Section of Public Health Epidemiology and Preventive Medicine , S.Elia-Raimondi Hospital , Caltanissetta , Italy
| | - Alfonso Cirrone Cipolla
- d Section of Public Health Epidemiology and Preventive Medicine , S.Elia-Raimondi Hospital , Caltanissetta , Italy
| | - Salvatore Camilleri
- a Section of Gastroenterology , S.Elia - Raimondi Hospital , Caltanissetta , Italy
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Floer M, Meister T. Endoscopic Improvement of the Adenoma Detection Rate during Colonoscopy - Where Do We Stand in 2015? Digestion 2017; 93:202-13. [PMID: 26986225 DOI: 10.1159/000442464] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 11/14/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND The presence of colorectal adenomas is considered a major risk factor for colorectal cancer development. The implementation of screening colonoscopy programs in the Western world has led to a substantial reduction of colorectal cancer death. Many efforts have been made to reduce the adenoma miss rates by the application of new endoscopic devices and techniques for better adenoma visualization. SUMMARY This special review gives the readership an overview of current endoscopic innovations that can aid in the increase of the adenoma detection rate (ADR) during colonoscopy. These innovations include the use of devices like EndoCuff® and EndoRings® as well as new technical equipment like third-eye endoscope® and full-spectrum endoscopy (FUSE®). KEY MESSAGE Technical improvements and newly developed accessories are able to improve the ADR. However, additional costs and a willingness to invest into potentially expensive equipment might be necessary. Investigator-dependent skills remain the backbone in the ADR detection.
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Affiliation(s)
- Martin Floer
- Department of Gastroenterology, HELIOS Albert-Schweitzer-Hospital Northeim, Northeim, Germany
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Abstract
OPINION STATEMENT The adenoma detection rate (ADR), i.e., the proportion of average risk patients with at least one adenoma detected during screening colonoscopy, is inversely associated with the development of interval colorectal cancer. Increasing the ADR is therefore an important proxy for increase in quality and efficacy of (screening) colonoscopy. Several potentially modifiable factors, such as, procedural and technological factors, and quality improvement programs, and their effect on the ADR will be reviewed. Procedural factors, such as, bowel preparation, withdrawal time, and position changes of the patient are associated with the ADR. While the relation of others, such as inspection during insertion, use of antispasmodic agents, and second inspection in the proximal colon, with the ADR is not completely clear. Many new colonoscopy technologies have been evaluated over recent years and are still under evaluation, but no unequivocal positive effect on the ADR has been observed in randomized trials that have mostly been performed by experienced endoscopists with high baseline ADRs. Several quality improvement programs have been evaluated and seem to have a positive effect on endoscopists' ADR. Increase in ADR is important for the protective benefit of colonoscopy. There are now extensive methods to measure, benchmark, and improve ADR but increased awareness of these is critical. We have provided an overview of potential factors that can be used to increase personal ADRs in every day practice.
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Affiliation(s)
- Eelco C Brand
- Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.,Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Michael B Wallace
- Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
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Rees CJ, Thomas Gibson S, Rutter MD, Baragwanath P, Pullan R, Feeney M, Haslam N. UK key performance indicators and quality assurance standards for colonoscopy. Gut 2016; 65:1923-1929. [PMID: 27531829 PMCID: PMC5136732 DOI: 10.1136/gutjnl-2016-312044] [Citation(s) in RCA: 214] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 07/08/2016] [Accepted: 07/17/2016] [Indexed: 12/12/2022]
Abstract
Colonoscopy should be delivered by endoscopists performing high quality procedures. The British Society of Gastroenterology, the UK Joint Advisory Group on GI Endoscopy, and the Association of Coloproctology of Great Britain and Ireland have developed quality assurance measures and key performance indicators for the delivery of colonoscopy within the UK. This document sets minimal standards for delivery of procedures along with aspirational targets that all endoscopists should aim for.
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Affiliation(s)
- Colin J Rees
- Department of Gastroenterology, South Tyneside NHS Foundation Trust, South Shields, UK,Durham University School of Medicine, Pharmacy and Health,Northern Region Endoscopy Group
| | | | - Matt D Rutter
- Durham University School of Medicine, Pharmacy and Health,Northern Region Endoscopy Group,Department of Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, UK
| | - Phil Baragwanath
- University Hospital of Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Rupert Pullan
- South Devon Healthcare NHS Foundation Trust, Torquay, UK
| | - Mark Feeney
- South Devon Healthcare NHS Foundation Trust, Torquay, UK
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15
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Rees CJ, Bevan R, Zimmermann-Fraedrich K, Rutter MD, Rex D, Dekker E, Ponchon T, Bretthauer M, Regula J, Saunders B, Hassan C, Bourke MJ, Rösch T. Expert opinions and scientific evidence for colonoscopy key performance indicators. Gut 2016; 65:2045-2060. [PMID: 27802153 PMCID: PMC5136701 DOI: 10.1136/gutjnl-2016-312043] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 09/08/2016] [Accepted: 09/11/2016] [Indexed: 12/12/2022]
Abstract
Colonoscopy is a widely performed procedure with procedural volumes increasing annually throughout the world. Many procedures are now performed as part of colorectal cancer screening programmes. Colonoscopy should be of high quality and measures of this quality should be evidence based. New UK key performance indicators and quality assurance standards have been developed by a working group with consensus agreement on each standard reached. This paper reviews the scientific basis for each of the quality measures published in the UK standards.
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Affiliation(s)
- Colin J Rees
- Department of Gastroenterology, South Tyneside District Hospital, South Shields, UK
| | - Roisin Bevan
- Department of Gastroenterology, North Tees University Hospital, Stockton-on-Tees, UK
| | | | - Matthew D Rutter
- Department of Gastroenterology, North Tees University Hospital, Stockton-on-Tees, UK
| | - Douglas Rex
- Department of Gastroenterology, Indiana University, Indianapolis, USA
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Thierry Ponchon
- Department of Gastroenterology and Hepatology, Edouard Herriot Hospital, Lyon University, Lyon, France
| | - Michael Bretthauer
- Department of Health Management and Health Economics and KG Jebsen Center for Colorectal Cancer Research, University of Oslo, Oslo, Norway
| | - Jaroslaw Regula
- Department of Gastroenterology, Medical Center for Postgraduate Education and the Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - Brian Saunders
- Department of Gastroenterology, St Mark's Hospital and Academic Institute, Harrow, UK
| | - Cesare Hassan
- Digestive Endoscopy Unit, Catholic University, Rome, Italy
| | - Michael J Bourke
- Department of Gastroenterology, Westmead Hospital, Sydney, Australia
| | - Thomas Rösch
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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16
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Papanikolaou IS, Karatzas PS, Varytimiadis LT, Tsigaridas A, Galanopoulos M, Viazis N, Karamanolis DG. Effective colonoscopy training techniques: strategies to improve patient outcomes. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2016; 7:201-210. [PMID: 27099542 PMCID: PMC4822804 DOI: 10.2147/amep.s99617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Colonoscopy has substantially evolved during the last 20 years and many different training techniques have been developed in order to improve the performance of endoscopists. The most known are mechanical simulators, virtual reality simulators, computer-simulating endoscopy, magnetic endoscopic imaging, and composite and explanted animal organ simulators. Current literature generally indicates that the use of simulators improves performance of endoscopists and enhances safety of patients, especially during the initial phase of training. Moreover, newer endoscopes and imaging techniques such as high-definition colonoscopes, chromocolonoscopy with dyes spraying, and third-eye retroscope have been incorporated in everyday practice, offering better visualization of the colon and detection of polyps. Despite the abundance of these different technological features, training devices are not widely used and no official guideline or specified training algorithm or technique for lower gastrointestinal endoscopy has been evolved. In this review, we present the most important training methods currently available and evaluate these using existing literature. We also try to propose a training algorithm for novice endoscopists.
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Affiliation(s)
- Ioannis S Papanikolaou
- Hepato-gastroenterology Unit, 2nd Department of Internal Medicine, Attikon University General Hospital, University of Athens, Athens, Greece
| | | | | | | | | | - Nikos Viazis
- Gastroenterology Department, Evangelismos Hospital, Athens, Greece
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17
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Aranda-Hernández J, Hwang J, Kandel G. Seeing better - Evidence based recommendations on optimizing colonoscopy adenoma detection rate. World J Gastroenterol 2016; 22:1767-1778. [PMID: 26855536 PMCID: PMC4724608 DOI: 10.3748/wjg.v22.i5.1767] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 08/17/2015] [Accepted: 12/01/2015] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer is one of the three most frequent causes of cancer deaths in men and women in Europe and North America. Diagnosis and resection of adenomas has convincingly demonstrated its utility in diminishing colorectal cancer incidence. Therefore, colonoscopy is now the gold standard for colorectal cancer screening. But it is also known that colonoscopy effectiveness varies among endoscopists. Among different quality indicators, the most used is the adenoma detection rate (ADR) which is the percentage of average-risk patients for colorectal cancer who are found to have at least one adenoma or adenocarcinoma during a screening colonoscopy. There is compelling evidence supporting an inverse correlation between ADR and interval colorectal cancer (cancer found after a screening colonoscopy). Many factors such as quality of precolonoscopy preparation, additional observers, manoeuvres with the endoscope (second view, retroflexion, water inflation rather than air), time spent during withdrawal, changes in patient position, fold-flattener devices, new imaging or endoscopic modalities and use of intravenous or through the scope sprayed drugs, have been studied and developed with the aim of increasing the ADR. This reviews discusses these factors, and the current evidence, to “see better” in the colon and optimize ADR.
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Affiliation(s)
- Douglas K Rex
- Indiana University School of Medicine, Indianapolis, Indiana, USA
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Chandran S, Parker F, Vaughan R, Mitchell B, Fanning S, Brown G, Yu J, Efthymiou M. Right-sided adenoma detection with retroflexion versus forward-view colonoscopy. Gastrointest Endosc 2015; 81:608-13. [PMID: 25440687 DOI: 10.1016/j.gie.2014.08.039] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 08/29/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND Colonoscopy and polypectomy can prevent up to 80% of colon cancer; however, a significant adenoma miss rate still exists, particularly in the right side of the colon. OBJECTIVE To assess whether retroflexion in the right side of the colon significantly improves the adenoma detection rate (ADR) over forward-view assessment. DESIGN Multicenter prospective cohort study. SETTING Three tertiary care public and 2 private hospitals. PATIENTS A total of 1351 consecutive adult patients undergoing elective colonoscopy. INTERVENTION Withdrawal from the cecum was performed in the forward view initially and identified polyps removed. Once the hepatic flexure was reached, the cecum was reintubated and the right side of the colon was assessed in the retroflexed view to the hepatic flexure. MAIN OUTCOME MEASUREMENTS ADR in the retroflexed view when compared with forward-view examination of the right side of the colon. RESULTS Retroflexion was successful in 95.9% of patients, with looping the predominant (69.6%) reason for failure. Forward-view assessment of the right side of the colon identified 642 polyps, of which 531 were adenomas yielding a polyp and ADR of 28.57% and 24.64%, respectively. Retroflexion identified a further 84 polyps of which 75 were adenomas, improving the polyp and ADR to 30.57% and 26.4%, respectively. LIMITATIONS Observational study. CONCLUSION Right-sided retroflexion was successful in most of our cohort with a statistically significant but small increase in ADR. Right-sided retroflexion is safe when performed by experienced endoscopists with no adverse events observed in this cohort. ( CLINICAL TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry, ACTRN12613000424707.).
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Affiliation(s)
- Sujievvan Chandran
- Department of Gastroenterology, Austin Health, Melbourne, Victoria, Australia; Department of Medicine, Austin Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Frank Parker
- Department of Anaesthetics, Austin Health, Melbourne, Victoria, Australia
| | - Rhys Vaughan
- Department of Gastroenterology, Austin Health, Melbourne, Victoria, Australia; Department of Medicine, Austin Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Brent Mitchell
- Department of Gastroenterology, Launceston General Hospital, Tasmania, Australia; Calvary Health Care, St. Vincent's Campus, Tasmania, Australia
| | - Scott Fanning
- Department of Gastroenterology, Launceston General Hospital, Tasmania, Australia; Calvary Health Care, St. Vincent's Campus, Tasmania, Australia
| | - Gregor Brown
- Department of Gastroenterology, Alfred Health, Victoria, Australia; Epworth HealthCare, Richmond, Victoria, Australia
| | - Jenny Yu
- Department of Gastroenterology, Austin Health, Melbourne, Victoria, Australia
| | - Marios Efthymiou
- Department of Gastroenterology, Austin Health, Melbourne, Victoria, Australia
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Fujihara S, Kobara H, Mori H, Goda Y, Chiyo T, Matsunaga T, Nishiyama N, Ayaki M, Yachida T, Masaki T. Comparison of Retroflexed and Forward Views for Colorectal Endoscopic Submucosal Dissection. Int J Med Sci 2015; 12:450-7. [PMID: 26078705 PMCID: PMC4466509 DOI: 10.7150/ijms.11930] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 05/18/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The use of a retroflexed view exposes the entire tumor surface, which is obscured in the forward view, and contributes to complete tumor resection when combined with forward views. However, the efficacy and safety of using the retroflexed view for colorectal endoscopic submucosal dissection (ESD) are poorly understood. METHODS In this study, we assessed the efficacy and safety of the retroflexed view in colorectal ESD. From April 2009 to December 2013, 130 colorectal tumors were examined in 128 patients treated with ESD. A total of 119 patients with a mean tumor size of 27.2 mm were enrolled in the study, and these patients were assigned to undergo colorectal ESD with or without a retroflexed view. RESULTS The use of retroflexion was successful in 84.2% of patients. There were no perforations in the study and no complications related to the use of retroflexed views. The mean procedure time was 103.6 ± 55.8 min in the retroflexed group, as compared with 108.0 ± 66.5 min in the forward view group. The mean procedure time for resecting tumors >40 mm was significantly shorter in the retroflexed group relative to the forward group. Additionally, the mean dissection speed per unit area was significantly faster in the retroflexed group, as compared with the forward group. CONCLUSIONS Retroflexed views can be used to remove lesions >40 mm and shorten procedure times. Retroflexion may also contribute to an improved en bloc resection rate.
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Affiliation(s)
- Shintaro Fujihara
- Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Japan
| | - Hideki Kobara
- Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Japan
| | - Hirohito Mori
- Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Japan
| | - Yasuhiro Goda
- Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Japan
| | - Taiga Chiyo
- Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Japan
| | - Tae Matsunaga
- Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Japan
| | - Noriko Nishiyama
- Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Japan
| | - Maki Ayaki
- Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Japan
| | - Tatsuo Yachida
- Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Japan
| | - Tsutomu Masaki
- Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Japan
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Ruiz-Rebollo ML, Gómez De La Cuesta S, Pérez Fernández C, González Hernández JM. [Quality criteria in screening colonoscopies]. GASTROENTEROLOGIA Y HEPATOLOGIA 2014; 37:593-4. [PMID: 25108832 DOI: 10.1016/j.gastrohep.2014.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Accepted: 01/31/2014] [Indexed: 02/03/2023]
Affiliation(s)
| | - Sara Gómez De La Cuesta
- Servicio de Aparato Digestivo, Hospital Clínico Universitario, Valladolid, España; Servicio de Medicina Interna, Hospital Clínico Universitario, Valladolid, España
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Dik VK, Moons LMG, Siersema PD. Endoscopic innovations to increase the adenoma detection rate during colonoscopy. World J Gastroenterol 2014; 20:2200-2211. [PMID: 24605019 PMCID: PMC3942825 DOI: 10.3748/wjg.v20.i9.2200] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 12/06/2013] [Accepted: 01/20/2014] [Indexed: 02/06/2023] Open
Abstract
Up to a quarter of polyps and adenomas are missed during colonoscopy due to poor visualization behind folds and the inner curves of flexures, and the presence of flat lesions that are difficult to detect. These numbers may however be conservative because they mainly come from back-to-back studies performed with standard colonoscopes, which are unable to visualize the entire mucosal surface. In the past several years, new endoscopic techniques have been introduced to improve the detection of polyps and adenomas. The introduction of high definition colonoscopes and visual image enhancement technologies have been suggested to lead to better recognition of flat and small lesions, but the absolute increase in diagnostic yield seems limited. Cap assisted colonoscopy and water-exchange colonoscopy are methods to facilitate cecal intubation and increase patients comfort, but show only a marginal or no benefit on polyp and adenoma detection. Retroflexion is routinely used in the rectum for the inspection of the dentate line, but withdrawal in retroflexion in the colon is in general not recommended due to the risk of perforation. In contrast, colonoscopy with the Third-Eye Retroscope® may result in considerable lower miss rates compared to standard colonoscopy, but this technique is not practical in case of polypectomy and is more time consuming. The recently introduced Full Spectrum Endoscopy™ colonoscopes maintains the technical capabilities of standard colonoscopes and provides a much wider view of 330 degrees compared to the 170 degrees with standard colonoscopes. Remarkable lower adenoma miss rates with this new technique were recently demonstrated in the first randomized study. Nonetheless, more studies are required to determine the exact additional diagnostic yield in clinical practice. Optimizing the efficacy of colorectal cancer screening and surveillance requires high definition colonoscopes with improved virtual chromoendoscopy technology that visualize the whole colon mucosa while maintaining optimal washing, suction and therapeutic capabilities, and keeping the procedural time as low and patient discomfort as optimal as possible.
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Chandran S, Parker F, Vaughan R, Efthymiou M. The current practice standard for colonoscopy in Australia. Gastrointest Endosc 2014; 79:473-9. [PMID: 24332081 DOI: 10.1016/j.gie.2013.10.050] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 10/30/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Despite having one of the highest rates per capita for colonoscopy worldwide, colorectal cancer remains the second most commonly diagnosed malignancy in Australia. OBJECTIVE Our aim was to document colonoscopy/polypectomy practice nationwide and assess whether significant differences exist. DESIGN Observational study. SETTING Online survey conducted nationally in 2012. PARTICIPANTS Medical practitioners registered with the Gastroenterological Society of Australia practicing colonoscopy. MAIN OUTCOME MEASUREMENTS Rates of polypectomy techniques for varying polyp sizes, postpolypectomy bleeding prophylaxis techniques, and adenoma detection practices. To assess whether variations exist according to practice location, specialty, and experience and comparison of practice with a previous American cohort. RESULTS Of the 846 members contacted, 244 (28.8%) responded. The cohort consisted primarily of consultant gastroenterologists (182/244, 74.6%). The cold-snare technique was preferred (165/244, 67.6%) for polyps 3 mm in size; however, this decreased rapidly with increasing polyp size (5 mm [120/244, 49.2%] and 7-9 mm [18/244, 7.4%]). EMR was the preferred method of resection for polyps 7 to 9 mm in size (148/244, 60.7%). The withdrawal technique predominantly consisted of double-passing high-risk areas and rectal retroflexion (134/244, 54.9%). Significant differences across specialty, location, and experience included polypectomy method for diminutive polyps, the use of EMR, and retroflexion. LIMITATIONS Survey-based study and response rate. CONCLUSION Although variations in colonoscopy and polypectomy practice exist, the majority of our cohort performs cold-snare polypectomy for diminutive polyps and pass high-risk, poorly visualized areas twice on withdrawal. This is a significant shift in practice from that of the U.S. cohort studied 10 years earlier.
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Affiliation(s)
- Sujievvan Chandran
- Department of Gastroenterology, Austin Health, Heidelberg, Victoria, Australia
| | - Frank Parker
- Department of Anesthetics, Austin Health, Heidelberg, Victoria, Australia
| | - Rhys Vaughan
- Department of Gastroenterology, Austin Health, Heidelberg, Victoria, Australia
| | - Marios Efthymiou
- Department of Gastroenterology, Austin Health, Heidelberg, Victoria, Australia
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Endoscopy reporting standards. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2014; 27:286-92. [PMID: 23712304 DOI: 10.1155/2013/145894] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The Canadian Association of Gastroenterology (CAG) recently published consensus recommendations for safety and quality indicators in digestive endoscopy. The present article focuses specifically on the identification of key elements that should be found in all electronic endoscopy reports detailing recommendations adopted by the CAG consensus group. METHODS A committee of nine individuals steered the CAG Safety and Quality Indicators in Endoscopy Consensus Group, which had a total membership of 35 voting individuals with knowledge on the subject relating to endoscopic services. A comprehensive literature search was performed with regard to the key elements that should be found in an electronic endoscopy report. A task force reviewed all published, full-text, adult and human studies in French or English. RESULTS Components to be entered into the standardized report include identification of procedure, timing, procedural personnel, patient demographics and history, indication(s) for procedure, comorbidities, type of bowel preparation, consent for the procedure, pre-endoscopic administration of medications, type and dose of sedation used, extent and completeness of examination, quality of bowel preparation, relevant findings and pertinent negatives, adverse events and resulting interventions, patient comfort, diagnoses, endoscopic interventions performed, details of pathology specimens, details of follow-up arrangements, appended pathology report(s) and, when available, management recommendations. Summary information should be provided to the patient or family. CONCLUSION Continuous quality improvement should be the responsibility of every endoscopist and endoscopy facility to ensure improved patient care. Appropriate documentation of endoscopic procedures is a critical component of such activities.
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Kwon KA, Hahm KB. Rectal Retroflexion during Colonoscopy: A Bridge over Troubled Water. Clin Endosc 2014; 47:3-4. [PMID: 24570876 PMCID: PMC3928488 DOI: 10.5946/ce.2014.47.1.3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 12/27/2013] [Indexed: 02/03/2023] Open
Affiliation(s)
- Kwang An Kwon
- Department of Gastroenterology, Gachon University Gil Medical Center, Gachon University of Medicine and Science, Incheon, Korea
| | - Ki Baik Hahm
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
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26
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Téllez-Ávila F, Barahona-Garrido J, García-Osogobio S, López-Arce G, Camacho-Escobedo J, Saúl A, Herrera-Gómez S, Elizondo-Rivera J, Barreto-Zúñiga R. Diagnostic yield and therapeutic impact of rectal retroflexion: a prospective, single-blind study conducted in three centers. Clin Endosc 2014; 47:79-83. [PMID: 24570887 PMCID: PMC3928497 DOI: 10.5946/ce.2014.47.1.79] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 07/21/2013] [Accepted: 08/12/2013] [Indexed: 01/05/2023] Open
Abstract
Background/Aims No clear data have been established and validated regarding whether rectal retroflexion has an important and therapeutic impact. The aim of the present study was to evaluate the diagnostic yield and therapeutic impact of rectal retroflexion compared with straight view examination. Methods A prospective single-blind study was conducted. Consecutive patients evaluated between October 2011 and April 2012 were included. Results A total of 934 patients (542 women, 58%) were included. The mean age was 57.4±14.8 years. Retroflexion was successful in 917 patients (98.2%). Distinct lesions in the anorectal area were detected in 32 patients (3.4%), of which 10 (1%) were identified only on retroflex view and 22 (2.4%) on both straight and retroflex views. Of the 32 identified lesions, 16 (50%) were polyps, nine (28.1%) were angiodysplasias, six (18.8%) were ulcers, and one (3.1%) was a flat lesion. All 10 patients (1%) in whom lesions were detected only by rectal retroflexion showed a therapeutic impact. Conclusions Rectal retroflexion has minimal diagnostic yield and therapeutic impact. However, its low rate of major complications and the possibility of detecting lesions undetectable by straight viewing justify its use.
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Affiliation(s)
- Félix Téllez-Ávila
- Endoscopy Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Josué Barahona-Garrido
- Gastroenterology and Digestive Endoscopy Unit, Hospital Las Américas, Guatemala City, Guatemala
| | | | - Gustavo López-Arce
- Endoscopy Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Jesús Camacho-Escobedo
- Endoscopy Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Angela Saúl
- Endoscopy Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Salvador Herrera-Gómez
- Endoscopy Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Javier Elizondo-Rivera
- Endoscopy Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Rafael Barreto-Zúñiga
- Endoscopy Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Abstract
A retroview in the colon permits an 11-25% increase in the adenoma detection rate when compared with a standard straight forward view during colonoscopy. This can often be accomplished in the rectum or the proximal colon by using dial controls and shaft manipulation to turn the tip of a standard colonoscope 180°. A special slim caliber instrument, the "Third Eye Retroscope" (a backward viewing device) has been developed which is inserted through the working channel of a colonoscope. New colonoscopes are being developed that have the capability of side vision with accompanying light illumination which, with wide angle lenses, provide an almost complete retroview of the colon.
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Affiliation(s)
- Jerome D Waye
- Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, 1 Gustave Levy Place, New York, NY 10029, USA.
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Mohammed N, Subramanian V. Screening colonoscopy: should we focus more on technique and less on technology? F1000PRIME REPORTS 2013; 5:32. [PMID: 23967383 PMCID: PMC3734930 DOI: 10.12703/p5-32] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Several large studies have confirmed that high quality colonoscopic surveillance can improve outcomes with substantial reduction in colorectal cancer rates. In order to improve outcomes from screening colonoscopy and help detect adenomas, the emphasis has been mainly on improvements in technology like high-resolution scopes, computerized as well as dye-based chromoendoscopy and wide-angle endoscopes. In addition to the equipment and technological innovation in the equipment used, a number of other factors like experience of the endoscopist, optimal withdrawal techniques, position changes during colonoscopy and bowel preparation can all influence adenoma detection and thereby the quality of colonoscopic surveillance. In this review we will focus on recent studies investigating these aspects of colonoscopy and their impact on adenoma or polyp detection.
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Affiliation(s)
- Noor Mohammed
- Department of Gastroenterology, Leeds Teaching Hospital NHS TrustLeeds LS9 7TF
| | - Venkataraman Subramanian
- Department of Gastroenterology, Leeds Teaching Hospital NHS TrustLeeds LS9 7TF
- Leeds Institute of Molecular Medicine St James University Hospital, Leeds Teaching Hospital NHS TrustLeeds LS9 7TF
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Rex DK. Avoiding and defending malpractice suits for postcolonoscopy cancer: advice from an expert witness. Clin Gastroenterol Hepatol 2013; 11:768-73. [PMID: 23376796 DOI: 10.1016/j.cgh.2013.01.027] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 01/15/2013] [Indexed: 02/07/2023]
Affiliation(s)
- Douglas K Rex
- Division of Gastroenterology/Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA.
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30
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Rex DK, Vemulapalli KC. Retroflexion in colonoscopy: why? Where? When? How? What value? Gastroenterology 2013; 144:882-3. [PMID: 23499952 DOI: 10.1053/j.gastro.2013.01.077] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 01/29/2013] [Indexed: 12/14/2022]
Affiliation(s)
- Douglas K Rex
- Department of Medicine, Division of Gastroenterology, Indiana University Health, Indianapolis, IN 46202, USA.
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Abstract
Colonoscopy is the best imaging device currently available for the detection of lesions in the large bowel, but may be an imperfect tool against colon cancer. Because recent guidelines for colorectal cancer screening and surveillance depend on whether polyps are found on colonoscopy and on their size, the need to identify all the neoplasia in the colon has assumed greater importance. This article reviews and assesses the latest developments in colonoscopy including wide-angle optics, endoscope caps and hoods, retroflexion and the use of the third eye retroscope.
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Affiliation(s)
- Jerome D Waye
- Mount Sinai Hospital, World Endoscopy Organization (OMED), Mount Sinai Medical Center, 650 Park Avenue, New York, NY 10065, USA.
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33
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Waye JD. Improving lesion detection during colonoscopy. Gastroenterol Hepatol (N Y) 2010; 6:647-652. [PMID: 21103444 PMCID: PMC2978415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Colonoscopy has changed since it was first introduced 50 years ago, with glass fibers being replaced by video electronics, the addition of water jets, better illumination, and the use of filters to enhance visual identification of polyps. In spite of these improvements, polyps and tumors of the colon are still overlooked even by the most meticulous examiner. Because missed lesions can develop into cancer, better imaging methods are required. The Third Eye Retroscope is a device that, in conjunction with the video colonoscope, may be able to find virtually all lesions in the colon. This novel device is described here and presents a new way to look into the colon.
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Affiliation(s)
- Jerome D Waye
- Dr. Waye is Clinical Professor of Medicine at Mount Sinai Medical Center and Director of Endoscopic Education at Mount Sinai Hospital, both in New York, New York. Dr. Waye is also President of the World Endoscopy Organization
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34
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Lee YT. Improve anorectal examination by the cap-assisted colonoscopy method. Gastrointest Endosc 2010; 71:433. [PMID: 20152327 DOI: 10.1016/j.gie.2009.05.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Accepted: 05/26/2009] [Indexed: 12/10/2022]
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