The Impact of the Endoscopy Nurse on Colonoscopy Completion Rates

Abstract

The Impact of the Endoscopy Nurse on Colonoscopy Completion Rates Madhusudhan R. Sanaka, Nirav Shah, Kevin D. Mullen, Saeid Amini, Arthur J. McCullough Background: Colonoscopy is a technically demanding procedure, frequently requiring multiple maneuvers including change in patient’s position and application of appropriate external abdominal pressure by the nurse to assist in completion of procedure. Hence, the endoscopy nurse may have an important role in colonoscopy completion rates. Aims: To determine and compare the colonoscopy incompletion rates among individual endoscopy nurses in our unit. Methods: Retrospective chart review of all colonoscopies performed in our endoscopy unit from November 2003 to October 2004 at MetroHealth Medical Center, Cleveland, Ohio. Colonoscopies are performed by either gastroenterology trainees under attending supervision or by attending physicians. There are a total of 12 endoscopy nurses who assist in colonoscopies, of which 5 are registered nurses (RN) and 7 are licensed practical nurses (LPN). Patient demographics, indications for procedure and colonoscopic findings were reviewed. Patients who had incomplete colonoscopy due to poor bowel preparation and colonic pathology precluding completion were excluded. Results: A total of 1896 colonoscopies were included in the analysis, of which 62 were incomplete (3.3%). Mean number of colonoscopies assisted by each individual endoscopy nurse was 158 (range 86-392). Mean endoscopy work experience of the nurses was 4.5 years (range 0.5-15 years). Incompletion rate of colonoscopies was similar among the individual nurses and ranged from 1.0% to 5.8% (p O 0.05). Incompletion rate did not correlate with either nurse’s work experience or the level of education, LPN versus RN (p O 0.05). Conclusions: The endoscopy nurse assisting in colonoscopy does not impact colonoscopy completion rate. Also, there is no correlation between the nurse’s work experience or the level of education (LPN versus RN) on colonoscopy completion rates. W1150 Colonic Polyps and Malignant Potential – Does Size Matter? Uwe Seitz, Tiing Leong Ang, Frederick Dy, Theerapong Sookpaisal, Johannes Sadikin, Indra Marki, Frank Thonke, Stefan Seewald, Sabine Bohnacker, Andreas De Weerth, Nib Soehendra Background: When colonic polyps are encountered during colonoscopy, polypectomy is the standard of care. Malignant potential was correlated with larger adenoma size, villous histology, and more severe dysplasia. Adenomas have classically been categorized into three size groups: !1 cm, 1-2 cm, and O2 cm. Whether the malignant potential differs among polyps O2 cm is not well defined. Aim: To correlate the size of colonic polyps with severity of dysplasia, occurrence of malignancy and histological subtype. Methods: The clinical data of all patients who underwent colonoscopy and polypectomy during the period from October 1997 to October 2004 was reviewed retrospectively. Only patients with resected polyps and histology were included. Polypectomy was performed using a monofilament snare. For large sessile polyps, piecemeal resection was preferred. None of these patients had endoscopic suspicion of malignancy such as induration, ulceration and friability. The size of the polyps was correlated with the histological findings. Results: A total of 12164 colonoscopies were performed during the review period and 2681 patients (mean age 63 years, range 18 to 94; male 61%) were eligible, yielding a total of 6453 polyps. The size of the polyps ranged from !0.5 to 20 cm. The number of polyps larger than 2 cm was 409. Distribution of polyps based on dysplasia: high grade dysplasia (H) 3.6%, low grade dysplasia (L) 72.1% and carcinoma (C) 0.8%. Histological subtype: tubular adenoma (T) 73.8%, tubulovillous adenoma (TV) 25.4% and villous adenoma (V) 1.3%. Correlation of polyp size with severity of dysplasia: !0.5 cm: C 0.1%, H 0.7%; 0.5-1 cm: C 0.8%, H 3.6%; 1-2 cm: C 3.7%, H 8.6%; 2-3 cm: C 5.2%, H 15.7%; 3-4 cm: C 2.3%, H 34.5%; O4 cm: C 2.9%, H 46.4% (p ! 0.01). Correlation of polyp size with histological subtype: !0.5 cm: TV 13.2%, V 0.4%; 0.5-1 cm: TV 19.5%, V 0.7%; 1-2 cm: TV 38.3%, V 1.7%; 2-3 cm: TV 51.4%, V 4.9%; 3-4 cm: TV 67.9% V 9.5%; O4 cm: TV 68.7%, V 11.9% (p ! 0.01). Three polyps measured 10 cm (C 1; H 2) while 1 polyp measured 20 cm (H). Conclusion: A larger polyp size was significantly associated with increased severity of dysplasia and villous histology. Beyond 4 cm size, although the tendency for HGD continued to rise, the risk for invasive cancer appears to plateau off. Thus, in the context of large colonic polyps without obvious endoscopic features of malignancy, endoscopic resection should be attempted first if technically feasible and the expertise is available.