Indication For Colonoscopy Research Articles

P073 Diagnostic Outcome of Patients With Non-Specific Colitis.

Colitis describes inflammation in the colon and is classified into defined diseases: Inflammatory bowel disease (IBD), Microscopic colitis, Ischemic colitis and Infectious colitis. The clinical significance of non-specific colitis is unclear as there are limited analysis which report the issue. Notteghem et al. (1993) showed that of 104 patients with non-specific colitis, 52.3% had another episode of symptoms within 3 years. Of these patients 54% were diagnosed with ulcerative colitis, 33% with Crohn's disease, and 13% remained unclassified, suggesting that non-specific colitis could be undiagnosed IBD. The objective of this analysis is to determine the clinical course of non-specific colitis through colonoscopy and histologic findings. Retrospective observational study with patients underwent colonoscopies during the period from 2009 to 2019, whose biopsies were reported as non-specific colitis. 24 patients (18 women and 6 men) with non-specific colitis undergoing follow-up by the Gastroenterology outpatient clinic were included. The most frequent indications for colonoscopy were abdominal pain (43.7%), blood in stools (26.8%), diarrhea (21.6%) and anemia (7.9%). The mean age was 56.5 years. During follow-up, patients had at least 2 colonoscopies and 4 biopsies per colonic segment. In the male population ascending colon cancer was later diagnosed in 16.7%, another 16.7% were diagnosed with nonspecific chronic ulcerative colitis, 33.3% with eosinophilic colitis, and the rest of the patients were diagnosed with non-specific colitis. From the female group, 5.6% had lymphocytic colitis, 5.6% eosinophilic colitis, 5.6% collagenous colitis, 5.6% Crohn's disease, 5.6% mixed irritable bowel syndrome, and the rest of the patients (72%) had biopsy report of non-specific colitis. All patients with a histopathological diagnosis of non-specific colitis underwent a second colonoscopy with biopsy, which resulted in a definitive diagnosis of Crohn's disease in 5.6% of women and Ulcerative Colitis in 16.7% of men. This study comes to show that there is an important subgroup of patients who are underdiagnosed. We suggest that patients with non-specific colitis reported on a histopathology report must continue their follow-up by a specialized ward.

Deep neural network for video colonoscopy of ulcerative colitis: a cross-sectional study

A combination of endoscopic and histological evaluation is important in the management of patients with ulcerative colitis. We aimed to adapt our previous deep neural network system (deep neural ulcerative colitis [DNUC]) to full video colonoscopy and evaluate its validity in the real-time detection of histological mucosal inflammation. In this multicentre, cross-sectional study, we prospectively enrolled consecutive patients (≥15 years) with ulcerative colitis who had an indication for colonoscopy at five hospitals in Japan. Patients in clinical remission were randomly assigned (1:2) to study 1 and study 2. Those with clinically active disease were assigned to study 2 only. Study 1 assessed the validity of real-time histological assessment using DNUC and study 2 validated the consistency of endoscopic scoring between DNUC and experts. The primary endpoint for study 1 was comparison of the results judged by DNUC (healing or active) with biopsy specimens evaluated by pathologists. In study 2, the primary endpoint was the ability of DNUC to determine the Ulcerative Colitis Endoscopic Index of Severity score compared with centrally evaluated scoring by inflammatory bowel disease endoscopy experts. From April 1, 2020, to March 31, 2021, 770 patients (180 in study 1 and 590 in study 2) were enrolled. Using real-time histological evaluation, DNUC was able to evaluate the presence or absence of histological inflammation in 729 (81%) of 900 biopsy specimens. For predicting histological remission, the DNUC had a sensitivity of 97·9% (95% CI 97·0-98·5) and a specificity of 94·6% (91·1-96·9). Moreover, its positive predictive value was 98·6% (97·7-99·2) and negative predictive value was 92·1% (88·7-94·3). The intraclass correlation coefficient between DNUC and experts for endoscopic scoring was 0·927 (95% CI 0·915-0·938). DNUC provided consistently accurate endoscopic scoring and showed potential for reducing the number of biopsies required. This system is an objective and consistent application for video colonoscopy that has potential for use in various medical situations. Tokyo Medical and Dental University and Sony.

Educating Outpatients for Bowel Preparation Before Colonoscopy Using Conventional Methods vs Virtual Reality Videos Plus Conventional Methods

Adequate bowel preparation is essential for diagnostic, screening, and surveillance colonoscopy. Virtual reality (VR) has the characteristics of immersion, interaction, and imagination and has been widely used in medicine for training and teaching, indicating that it could be used in the education of outpatients for bowel preparation before colonoscopy. To investigate whether using VR videos for patient education before colonoscopy could improve bowel preparation. A prospective, single-blinded, randomized clinical trial of 346 patients undergoing colonoscopy with local anesthesia in a tertiary care hospital was conducted between October 1, 2018, and November 1, 2020. Outpatients who had indications for colonoscopy and had not received one before were enrolled. Statistical analysis was performed from November 1 to December 31, 2020. All data were analyzed according to the intention-to-treat approach. Conventional bowel preparation education (oral instructions and written materials that had the same contents) or conventional education plus VR videos. The primary outcome was the quality of bowel preparation measured by the Boston Bowel Preparation Scale score (range, 0-9, where 0 indicates extremely unsatisfactory bowel preparation and 9 indicates complete bowel preparation). Secondary outcomes included polyp and adenoma detection rates, compliance with complete bowel cleansing, preprocedure anxiety, overall satisfaction, and willingness to undergo a follow-up colonoscopy. A total of 346 outpatients were enrolled in the trial, with 173 patients randomly assigned to each group (control group: 87 women [50.3%]; mean [SD] age, 50.5 [12.5] years; VR video group: 84 women [48.6%]; mean [SD] age, 52.6 [11.4] years). Baseline characteristics, including demographic information, medical history, lifestyle, and the characteristics of stool, were comparable between the VR video group and the control group. The mean (SD) Boston Bowel Preparation Scale score was significantly higher in the VR video group than in the control group (7.61 [1.65] vs 7.04 [1.70]; P = .002). The detection rate of polyps (72 of 172 [41.9%] vs 46 of 172 [26.7%]; P = .003) and the detection rate of adenomas (56 of 172 [32.6%] vs 38 of 172 [22.1%]; P = .03) were also higher in the VR video group. Patients who received VR education had better compliance (119 [68.8%] vs 87 [50.3%]; P < .001) and higher mean (SD) overall satisfaction (8.68 [1.70] vs 8.16 [2.15]; P = .01) with bowel preparation. Patients who received VR video education before colonoscopy had better bowel preparation, higher polyp and adenoma detection rates, and improved compliance and satisfaction. ClinicalTrials.gov Identifier: NCT03667911.

Comparison of Endoscopic Activity before and during the Covid Pandemic at a Tertiary Care Hospital in South Punjab

Introduction: Coronavirus disease 2019 (COVID-19) has resulted in dramatic changes to health-care delivery. Endoscopic activity has had frequent disruptions during this pandemic. The objective of the study was to see the influence of pandemic over the endoscopic activity. Methods: This retrospective analysis of endoscopic activity was undertaken at Nishtar Hospital Multan. Procedural analysis was done in the three months immediately after covid lockdown (1st April till 30th June 2020) and was compared to a similar period one year back. Results: Five hundred and fifty-four (68.5%) patients underwent endoscopic procedures during the three months of pre-COVID era, while this number reduced to half (n=255, 31.5%) patients during the covid pandemic. Even though the absolute number of Esophagogastroduodenoscopies (EGDs) reduced during the pandemic, patients were more likely to undergo EGDs during the COVID pandemic in contrast to the era before the pandemic (79% versus 66%, p = 0.002). The most common indication for EGD was upper gastrointestinal bleeding (UGIB). The percentage of EGDs done for UGIB rose from almost 60% to 80% during the covid pandemic (p &lt; 0.001). The most common findings were esophageal varices and portal gastropathy (non-significant difference during and before the pandemic). Percentage of ERCPs done for obstructive jaundice doubled during the COVID pandemic (33% versus 65%, p = 0.002).The most common indication for sigmoidoscopy or colonoscopy was lower gastrointestinal bleeding. However, no significant difference was found before and during the covid pandemic (41.7% and 45.8% respectively, p=0.72). Internal hemorrhoids were the most common endoscopic finding. Colon cancer diagnosis reduced from 10% to undetected during the pandemic period. Conclusion: COVID pandemic resulted in considerable reduction in all type of endoscopic procedures. Majority of procedures were done for emergency indications like gastrointestinal bleeding. Rates of cancer detection was significantly reduced. MeSH: Endoscopy, COVID-19, Gastroenterology

SP1.1.6Incidence of post colonoscopy colorectal cancer, are we compliant with national guidelines?

Abstract Aims To investigate the incidence of post colonoscopy colorectal cancer (PCCRC) at a district NHS trust and assess compliance with UK key performance indicators and quality assurance standards for colonoscopy guidelines endorsed by JAG and the ACPGBI Methods We conducted a retrospective review of our trust colorectal MDT database to identify patients diagnosed with colorectal cancer in the period between January 2016 till June 2019 who underwent a colonoscopy within 6-36 month prior to their diagnosis with colorectal cancer. Patient demographics, indication of colonoscopy, date of cancer diagnosis, procedure related factors such as quality of bowel preparation, presence of diverticular disease, prior history of inflammatory bowel disease, previously diagnosed polyps and also grade of endoscopist were extrapolated. Results 1323 patients were diagnosed with colorectal cancer during the study period, out of these there were 111 patients who underwent a colonoscopy within 6-36 month prior to their diagnostic colonoscopy. After exclusion of cases with anastomotic recurrence (n = 2) and cases with no PCCRC (n = 82), there were 27 patients with confirmed PCCRC in accordance with WEO classification (PCCRC 2.8%, acceptable target 5%) Upon review of the 27 cases with PCCRC, there was equal gender distribution while the majority were 71-80 years old. There was evidence of diverticular disease in 44% and previous colonic polyps in 48%. The quality of bowel preparation was recorded as good in 25 cases while grade of endoscopist was consultant (n = 24), associate specialist (n = 1), nurse endoscopist (n = 2) Conclusions The incidence of PCCRC in our trust falls within national guidelines.

Multivariable models for advanced colorectal neoplasms in screen-eligible individuals at low-to-moderate risk of colorectal cancer: towards improving colonoscopy prioritization

BackgroundAdvanced colorectal neoplasms (ACNs), including colorectal cancers (CRC) and high-risk adenomas (HRA), are detected in less than 20% of persons aged 50 years or older who undergo colonoscopy. We sought to derive personalized predictive models of risk of harbouring ACNs to improve colonoscopy wait times for high-risk patients and allocation of colonoscopy resources.MethodsWe characterized colonoscopy indications, neoplasia risk factors and colonoscopy findings through chart review for consecutive individuals aged 50 years or older who underwent outpatient colonoscopy at The Ottawa Hospital (Ottawa, Canada) between April 1, 2008 and March 31, 2012 for non-life threatening indications. We linked patients to population-level health administrative datasets to ascertain additional historical predictor variables and derive multivariable logistic regression models for risk of harboring ACNs at colonoscopy. We assessed model discriminatory capacity and calibration and the ability of the models to improve colonoscopy specificity while maintaining excellent sensitivity for ACN capture.ResultsWe modelled 17 candidate predictors in 11,724 individuals who met eligibility criteria. The final CRC model comprised 8 variables and had a c-statistic value of 0.957 and a goodness-of-fit p-value of 0.527. Application of the models to our cohort permitted 100% sensitivity for identifying persons with CRC and > 90% sensitivity for identifying persons with HRA, while improving colonoscopy specificity for ACNs by 23.8%.ConclusionsOur multivariable models show excellent discriminatory capacity for persons with ACNs and could significantly increase colonoscopy specificity without overly sacrificing sensitivity. If validated, these models could allow more efficient allocation of colonoscopy resources, potentially reducing wait times for those at higher risk while deferring unnecessary colonoscopies in low-risk individuals.

S230 More Colonoscopies, but at What Cost? Determinants of Healthcare Utilization for Patients Requiring Inpatient Colonoscopy

Introduction: Colonoscopy has become one of the most widely utilized diagnostic and therapeutic procedures in America, with approximately 19 million performed annually. As the number of inpatient colonoscopies is on the rise, there is poor understanding of the effects on healthcare utilization. The aim of this study was to determine individual and hospital-related factors which play a role in total length of stay (LOS) and overall cost of inpatient colonoscopy. Methods: Data from the nationwide inpatient sample from 2016 to 2017 were used, which included 108,245 cases. The tenth version of the International Classification of Disease coding system (ICD10) was used for patient selection. We included demographic characteristics with a primary focus on independent variables affecting LOS and overall cost for patients requiring inpatient colonoscopy. The panel data was analyzed using hospital fixed-effects regression models to account for unobserved, time-invariant hospital characteristics. Results: The majority of the hospitals conducting inpatient colonoscopies in our sample period were large, urban, not-for-profit teaching hospitals. The average age of patients was 65 years with a largely female (52%), White (66%), low median household income (31%) and Medicare insured (60%) predominance. Female patients were found to have a shorter LOS compared to males (β = -0.3618, P < 0.05) as well as lower total cost (β = -4339.00, P < 0.05). Total hospital charges decreased with increasing patient age (β = -202.38, P < 0.05). Patients of Black (β = 0.2540, P < 0.05) and Native American races (β = 1.0265, P < 0.05) had longer LOS compared to those who are White. Among the included indications for colonoscopy, patients with inflammatory bowel disease, radiologic evidence of colitis, hematochezia and melena, and irritable bowel syndrome had both shorter LOS and lower overall cost. Patients with documented history of cerebrovascular accident had longer LOS after inpatient colonoscopy. Finally, comorbid conditions associated with higher total charges included chronic anticoagulation use, type 2 diabetes mellitus, obesity, and hypertension. Conclusion: The burden to healthcare utilization for patients undergoing inpatient colonoscopy remains largely variable amongst multiple patient etiologies. With the expanding need for inpatient colonoscopies, further studies are needed to evaluate the timing of colonoscopy with regards to patient characteristics and its impact on length of stay and overall hospitalization cost.Table 1.: Demographic characteristics and inpatient outcomes in oncologic patients with and without CDI in 2015-2017 in the US

S288 Missed High-Risk Adenomas and Colorectal Cancers Due to COVID-19 Pandemic at an Urban U.S. Tertiary Care Center in 2020

Introduction: During the COVID-19 pandemic, outpatient colonoscopies throughout the US were postponed, creating a significant backlog of procedures. We estimated the number of missed high-risk adenomas and colorectal cancers in 2020 at an urban, tertiary-care, safety-net teaching hospital in Boston, Massachusetts. Methods: This observational study evaluated the number of high-risk adenomas (defined as ≥3 adenomas, adenoma ≥10 mm in size, adenoma with tubulovillous or villous histological features, or adenoma with high-grade dysplasia) and colorectal cancers diagnosed by outpatient colonoscopy from January 2020 to November 2020, and compared it with those diagnosed from January 2017 to December 2019. Patients with a personal history of colorectal cancer or a colonoscopy indication of inflammatory bowel disease, therapeutic procedure (other than removal of large polyp), or diarrhea were excluded (10% of all colonoscopies). A Poisson regression model using colonoscopy data from 2017 to 2019--adjusted for age, sex, race/ethnicity and indication--was used to predict expected high-risk adenomas and colorectal cancers per month in 2020. Predicted values were compared to actual values to estimate missed diagnoses. Results: A total of 6597, 7136, and 6816 colonoscopies were performed in 2017, 2018 and 2019, respectively. There were 40% fewer colonoscopies performed in January to November 2020 (n = 3704) compared to the same period in 2019. In January to November 2020, 505 high-risk adenomas (Figure 1a) and 21 colorectal cancers (Figure 1b) were diagnosed. We estimate that 284 (36%) high-risk adenomas and 9 (30%) colorectal cancers were missed during this period. The rate of colorectal cancer detection was 6 per 1000 cases performed in 2017 to 2019. Assuming similar patient characteristics and indications, 1349 additional colonoscopies will be needed to diagnose 9 missed colorectal cancers. Conclusion: This study provides one of the first real world estimates of missed high-risk adenomas and colorectal cancers due to the cancellation of outpatient colonoscopies during the COVID-19 pandemic. The results have implications on planning strategies to schedule elective colonoscopies to increase the yield of detection of these high-risk lesions.Figure 1.: A. Actual versus Predicted High-Risk Adenomas. B. Actual versus Predicted Colorectal Cancers. Solid line—actual values; dashed line—predicted values; shaded area—95% confidence interval of predicted values.

Continuous monitoring of colonoscopy performance in the Netherlands: first results of a nationwide registry.

To optimize colonoscopy quality, several performance measures have been developed. These are usually assessed without distinction between the indications for colonoscopy. This study aimed to assess the feasibility of linking two national registries (one for colonoscopy and one for adverse events of gastrointestinal endoscopies in the Netherlands), and to describe the results of colonoscopy quality per indication. This retrospective study was conducted with prospectively collected data of the Dutch Gastrointestinal Endoscopy Audit (DGEA) and the Dutch Registration of Complications in Endoscopy (DRCE). Data between 01-01-2016 and 01-01-2019 were analyzed. To calculate adverse event rates, data were linked at the level of endoscopy service. During the 3-year study period, 266 981 colonoscopies were recorded in DGEA. Of all indications, cecal intubation rate was highest in fecal immunochemical test (FIT)-positive screening colonoscopies (97.1 %), followed by surveillance (93.2 %), diagnostic (90.7 %), and therapeutic colonoscopies (83.1 %). The highest rate of adequate bowel preparation was observed in FIT-positive screening colonoscopies (97.1 %). A total of 1540 colonoscopy-related adverse events occurred (0.58 % of all colonoscopies). Bleeding and perforation and rates were highest for therapeutic (1.56 % and 0.51 %, respectively) and FIT-positive screening (0.72 % and 0.06 %, respectively) colonoscopies. The colonoscopy-related mortality was 0.006 %. This study describes the first results of the Dutch national colonoscopy registry, which was successfully linked to data from the national registry for adverse events of gastrointestinal endoscopies. In this large dataset, performance varied between indications. Our results emphasize the importance of defining benchmarks per indication in future guidelines.

Recommendations for follow-up interval after colonoscopy with inadequate bowel preparation in a national colonoscopy quality registry

Endoscopist recommendations regarding a repeat colonoscopy after inadequate bowel cleanliness have not been fully described. Our aim was to evaluate the timing of recommendations for repeat colonoscopy after inadequate bowel preparation using a large, national colonoscopy registry. We performed a cross-sectional analysis of all outpatient screening and surveillance colonoscopies among adults ages 50 to 75 reported in the GI Quality Improvement Consortium from 2011 to 2018. The primary outcome was a recommendation to repeat colonoscopy within 1 year. Secondary outcomes were recommendations based on indication of colonoscopy and colonoscopy findings and predictors of a recommendation to follow-up within 1 year. There were 260,314 colonoscopies with inadequate bowel preparation performed at 672 different sites by 4001 endoscopists. Of these, 31.9% contained a recommendation for follow-up within 1 year. This did not differ meaningfully by examination indication. The severity of colonoscopy findings influenced the recommendations for follow-up (within 1 year in 84.0% of cases with adenocarcinoma, 51.8% with any advanced lesion, and 23.2% with 1-2 small adenomas). Younger age, more severe pathology, location in the Northeast, and performance by an endoscopist with an adenoma detection rate≥25% were associated with recommendations for follow-up within 1 year. Only some colonoscopies with inadequate bowel preparation are recommended to be repeated within 1 year, which may have implications for potential missed lesions. Further understanding of reasons driving recommendations is an important next step to improving guideline-concordant colonoscopy practice.

The Bowel CLEANsing National Initiative: High-Volume Split-Dose Vs Low-Volume Split-Dose Polyethylene Glycol Preparations: A Randomized Controlled Trial

The aim of this study was to compare high-volume polyethylene glycol (PEG) with low-volume PEG with bisacodyl split-dosing regimens. Adult outpatients in 10 Canadian tertiary hospitals were randomized, stratified by morning or afternoon colonoscopy, to high-volume split-dose PEG (2 L+ 2 L) (High-SD) or low volume (1 L+ 1 L)+ bisacodyl (15 mg) PEG (Low-SD), with a second randomization to liquid or low-residue diets. The primary end point, using noninferiority hypothesis testing, was adequate bowel cleansing (Boston Bowel Preparation Scale total score of ≥6, with each of 3 colonic segments subscores ≥2). Secondary objectives were willingness to repeat the preparation, withdrawal time, cecal intubation, and polyp detection rates. Over 29 months, 2314 subjects were randomized to High-SD (N= 1157) or Low-SD (N= 1157) (mean age, 56.2 ± 13.4 y; 52.1% women). Colonoscopy indications were 38.2% diagnostic, 36.8% screening, and 25.0% surveillance, with no between-group imbalances in patient characteristics. Low-SD satisfied noninferiority criteria vs High-SD for adequate bowel cleanliness with only marginally inferior results (90.1% vs 88.1%; P= .02; difference, 2.0%; 95% CI [0.0%; 4.5%]). High-SD was associated with lower willingness to repeat (66.9% vs 91.9%; P < .01), was less well tolerated (7.3 ± 2.3 vs 8.1 ± 1.9; P < .01), causing more symptoms. No differences in procedural outcomes were noted except for more frequent cecal intubation rates after High-SD (97.4% vs 95.6%; P= .02). Among the High-SD group, adequate bowel preparation was greater after a clear liquid diet (93.6% vs 87.9%; P < .01), a finding not seen in the Low-SD group. Low-SD is noninferior to High-SD in providing adequate bowel preparation. Low-SD results in fewer symptoms, with greater willingness to repeat and tolerability. The overall impact of diet was modest.The study was approved by the research ethic boards from all sites and was registered at ClinicalTrials.gov (NCT02547571).

Paediatric Colonoscopy: Experience from Pediatric Gastroenterology and Nutrition Department, BSMMU

Background: Colonoscopy of the lower gastrointestinal tract has both diagnostic and therapeutic value.&#x0D; Objective: This cross-sectional study aimed to investigate the indications, findings and complications of children who underwent the colonoscopy.&#x0D; Materials &amp; Methods: We studied the children between 1 and 18 years of age who presented with various indications and underwent both diagnostic and therapeutic colonoscopy in the Department of PGN, BSMMU, Dhaka from January 2015 to February 2018.&#x0D; Results: Among the total 332 patients reviewed,61.7% (205) were male and 38.3% (127)with a male to female ratio of 1.61:1. The most common (69.8%) indication was lower gastrointestinal bleeding (LGIB) followed by diarrhea (15.9%) and altered bowel (14%) as well. No serious complications occurred during the procedures. A total of 211 patients (63.5%) received a diagnosis, including 137 (41.3%) patients with colorectal polyps, erythema 40(12%) and diffuse nonspecific colitis 34(10.2%).Ninety four percent polyps are located in recto-sigmoid region. Juvenile polyp was the most common pathological findings.&#x0D; Conclusion: LGIB is the commonest indication for pediatric colonoscopy. Pediatric colonoscopy is effective diagnostic as well as therapeutic option for lower GI pathology.&#x0D; BANGLADESH J CHILD HEALTH 2021; VOL 45 (1) : 25-28

Risk Factors for Inadequate Bowel Preparation During Colonoscopy in Nigerian Patients.

BackgroundThe past few decades have witnessed the introduction of various innovative technologies into colon study by colonoscopy. A well-prepared bowel is crucial to their effective utilization. An inadequate bowel preparation during colonoscopy is associated with increased technical difficulties, enhanced risks of perforation, longer examination durations, reduced adenoma detection rates, and additional costs related to repeated colonoscopies. There is a paucity of literature from Africa on the multiple patient factors that affect the quality of bowel preparation; hence, the need to identify patients at risk for inadequate bowel preparation to allow for more diligence in this special group.AimTo study the risk factors of inadequate bowel preparation for colonoscopy and identify the group of patients who need intensified preparation in a Nigerian population.MethodsA case-control study of consecutive patients undergoing colonoscopy in an open access/referral-based multi-disciplinary endoscopy facility in Port Harcourt metropolis, Nigeria from March 2014 to November 2020. Consecutive adult patients who underwent colonoscopy with inadequate bowel preparation irrespective of the indication were retrospectively identified. Each case of inadequate bowel preparation while using a particular bowel preparation agent was matched with the next colon study with adequate bowel preparation (control) for the same agent in a 1:1 ratio. The variables collated were age, gender, literacy level, colonoscopy indication, medical history, bowel preparation agent, timing of endoscopy, and outcome. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 25 (IBM Corp., Armonk, NY).ResultsThere were 143 cases of inadequate bowel preparation during colonoscopy included in the study with an equal number of control (cases of adequate bowel preparation). The age of patients ranged from 24 years to 92 years. Bleeding per rectum - 122(42.7%), and screening for colorectal cancer - 67(23.4%), were the leading indications for colonoscopy in study patients. Bivariate analysis of cases and controls revealed significant difference in educational status, comorbidity of hypertension, and constipation (p < 0.01, p = 0.082, p = 0.143, respectively). In the multivariate analysis of risk factors, the odds ratio (OR) for secondary level of education and below was 2.54 (95% confidence interval CI 1.50-4.30; p = 0.001); hypertension - OR 1.64 (95% CI 0.98-2.73; p = 0.058); constipation - OR 1.27 (95% CI 0.52-3.10; p = 0.598).ConclusionThe educational status of patients is a strong risk factor associated with inadequate bowel preparation for colonoscopy in this Nigerian population. There is a need for effective patient education especially for patients with a low literacy level.

Adecuación de la indicación de la colonoscopia según criterios de EPAGE II en un hospital universitario de Uruguay

Background: Prioritization of criteria have been developed to reduce the increased demand. The European Society for Gastrointestinal Endoscopy developed an online program (EPAGE II). The aim of this study is to evaluate the appropriateness of the colonoscopy indication according to the EPAGE II criteria and correlate it with the endoscopic findings. Materials and Methods: Retrospective and analytical study that included all colonoscopies performed in the period March 2018 - March 2019. Colonoscopies with insufficient preparation and missing data, were excluded. They were categorized into having appropriate, inappropriate and uncertain indication, according to EPAGE II criteria. Sociodemographic data, indication, degree of preparation, and the presence of relevant findings were recorded. Results: 648 studies were included, 64.7% were women, and 51.8% were ordered by gastroenterologists. In 62% the preparation was adequate. In 171 (26.4%) the indication was CCR screening. In 525 (81%) the indication was appropriate, in 79 (12,2%) was not appropriate and in 44 (6,8%) was uncertain. An appropriate indication was significantly associated with age older than 50 years (p≤0.001). An endoscopic relevant diagnosis was observed in 55.2%. There was a significant association between appropriate indication and a relevant endoscopic diagnosis (p &lt;0.01). The sensitivity, specificity, PPV and NPV of EPAGE II for an appropriate indication in relation to a relevant endoscopic finding were 84.92 %, 24.14%, 69.72% and 43.75% respectively. Conclusions: In this group of patients the EPAGE II showed high sensitivity and low specificity for the appropriateness of the indication in relation to the findings.

Fecal microbiota transplant as a potential treatment for Parkinson's disease – A case series

ObjectiveWe aimed to determine whether fecal microbiota transplant (FMT) is safe and possibly efficacious in treating constipation, motor, and non-motor symptoms in Parkinson's disease (PD) patients. MethodsPatients with PD, constipation and an indication for screening colonoscopy were treated with FMT. The study was conducted from December 2017 to November 2019, and clinical outcomes assessing motor, non-motor and constipation symptoms were compared at baseline (week 0) and at 2, 4, 8, 12, 16, 20, and 24 weeks after the FMT. ResultsSix patients (3 men, age range 47–73, median age 52) were treated with FMT. Four weeks following the FMT, motor, non-motor and constipation scores were improved in 5 of 6 patients. At week 24, compared to before the FMT, the changes in motor scores ranged from − 13–7 points, in non-motor scores from − 2 to − 45 points, and in constipation scores from − 12–1 point. One patient had a serious adverse event requiring admission for observation only, and no adverse events were observed in all other patients. ConclusionsIn this preliminary uncontrolled case series of 6 PD patients, a treatment with donor FMT infused via colonoscopy, was safe and resulted in improvement of PD motor and non-motor symptoms, including constipation, at 6 months. Further research is needed to assess longer-term maintenance of efficacy and safety, including in large scale randomized controlled trials. Trial registrationClinicalTrials.gov – NCT03876327

Colorectal Polyps: A Histopathological Study in Tertiary Care Center

Introduction: Gastrointestinal polyps are commonly encountered in the colorectal region. They can be non-neoplastic or neoplastic. Neoplastic polyps include adenomas which are clinically important because of their premalignant nature. The study was carried out to analyze the histomorphological spectrum of polyps; in our institution with special emphasis on adenomatous polyps.Material and methods: This is a retrospective study done from January 2015 to December 2019 in the Department of Pathology, Dhulikhel Hospital - Kathmandu University Hospital (DH - KUH). Relevant clinical data of the patients were obtained from the histopathological records of the patient from the pathology department and biopsies stained with Haematoxylin and Eosin were studied under the light microscope.Results: A total of 168 cases of polyp were studied from 125 patients. The most common indication for colonoscopy in patients with polyp was per rectal bleeding. The age of the patient ranged from 2 to 83 years. The rectum was the commonest location. 106(63.1%) of polyps were non-neoplastic and 6(36.9%) of polyps were neoplastic. Juvenile polyp(71;42.3%) was the commonest polyp. Tubular adenoma(55;32.7%) was the commonest neoplastic polyp. Themaximum number of neoplastic polyps were seen in the age group of 51-60years (11;29.7%). Male predominance was seen in neoplastic as well as a non-neoplastic polyp. High grade adenoma(4;6.7%) was more commonly seen in adenomatous polyp &gt;2cm(3;75%) followed by 1-2cm(1;25%) and none in &lt;1cm.Conclusions: This study gives a fair insight into the distribution of neoplastic and nonneoplastic polyp in the colorectal region. Adenomatous polyps are premalignant.

Artificial intelligence and colonoscopy experience: lessons from two randomised trials

Background and aimsArtificial intelligence has been shown to increase adenoma detection rate (ADR) as the main surrogate outcome parameter of colonoscopy quality. To which extent this effect may be related...

Prevalence of Adenomas on Surveillance Colonoscopies for Patients with a History of Colonic Polyps of Unknown Histology

Guidelines for surveillance colonoscopy depend on polyp histology. When patients present to a new healthcare system and report a personal history of "colon polyps," however, information on polyp histology is frequently unavailable. To assess adenoma prevalence in patients with a history of colonic polyps of unknown histology and to compare it to patients undergoing either screening colonoscopy or surveillance colonoscopy for known adenomatous polyps. This cohort study evaluated colonoscopies of patients ≥ 50years of age over a 14-year period at a single institution. The exposure of interest was colonoscopy indication, categorized into three groups: screening colonoscopy, surveillance colonoscopy for history of colonic polyp(s) of unknown histology, and surveillance colonoscopy for history of adenoma(s). The primary outcome was adenoma detection rate. Multivariable logistic regression was used to assess the association between colonoscopy indication and adenoma detection rate. Of 31,856 colonoscopies, the adenoma prevalence was 26.1% for patients undergoing screening colonoscopy, 32.9% for patients with a history of polyps of unknown histology, and 41.9% for patients with a history of known adenomatous polyps. Relative to screening colonoscopies, there were higher odds of adenoma detection in surveillance colonoscopies for polyps of unknown histology (aOR compared to screening 1.42, 95% CI 1.30-1.55) and even higher odds among surveillance colonoscopies for a history of adenoma (aOR compared to screening 1.89, 95% CI 1.75-2.05). The adenoma prevalence on surveillance colonoscopy for patients with polyps of unknown histology was higher than that of screening colonoscopies but lower than that of surveillance colonoscopies for patients with adenomatous polyps.

ILEOSCOPY: WHEN ILEAL EVALUATION IS NOT MANDATORY DURING COLONOSCOPY.

Ileitis is defined as ileal inflammation, with several etiologies, including inflammatory bowel disease (IBD), and can be evaluated during the colonoscopy exam, but its mandatory evaluation is discussed, because of few diagnosis and procedure time. This study aims to evaluate the correlation of colonoscopic ileitis with the clinical presentation, in order to identify the cases where ileal examination is mandatory. A retrospective, cross-sectional study was conducted between 2013 and 2017. The examination report, indications for colonoscopy, and medical records were evaluated in order to identify whether the colonoscopic findings were clinically significant. Patients over 18 years of age who had undergone ileoscopy were included, whereas patients below 18 years of age, those with previous intestinal resections, and repeated examinations of the same patient in the study period were excluded. The estimated association measure was the odds ratio with 95% confidence intervals. P-values <0.05 indicated statistical significance. A total of 3382 cases were included. Among these participants, 64.5% were females and the average age was 56.9±13.1 years (18-89 years). Ileal alterations were observed in 5.3% of the patients, with 2.69% being clinically significant between all patients, and 0.96% excluding those with IBD. There was a positive correlation between the ileitis findings and IBD control examinations and a negative correlation in screening and change in bowel habit indications. Among the indications with ileitis clinically significant, IBD control still had a positive correlation, 'diarrhea' and 'others' did not show a statistical significance, and all other indications presented a negative correlation for ileal assessment. Ileal evaluation in only mandatory in IBD control. When the main colonoscopy objective is detecting colonic neoplasms, ileoscopy is unnecessary.

ILEITIS - DO ENDOSCOPIST AND PATHOLOGIST SPEAK THE SAME LANGUAGE?

Ileitis is defined as an inflammation of the ileum, which is evaluated during colonoscopy. Biopsies should be performed on altered ileus, aiding to the diagnosis. Evaluate the correlation of anatomopathological findings on ileitis between pathologists and endoscopists. A retrospective, cross-sectional study, between 2013 and 2017. Examination report, indications for colonoscopy, and medical records were evaluated to identify whether the colonoscopic findings were clinically significant. Anatomopathological samples were reviewed by a pathologist expert in gastrointestinal tract. Patients over 18 years of age who had undergone ileoscopy were included, whereas patients below 18 years of age and those with previous intestinal resections were excluded. The correlation was assessed using the kappa coefficient index. A total of 5833 colonoscopies were conducted in the study period and 3880 cases were included. Ileal alterations were observed in 206 cases, with 2.94% being clinically significant. A hundred and sixty three biopsies were evaluated using the kappa index, resulting in agreement among pathologists of 0.067 and among pathologist and endoscopist of 0.141. It was observed that despite the low concordance between pathologists and endoscopists, there was no change in patient outcomes. This study confirms the importance of knowledge of the main anatomopathological changes related to ileitis by pathologists and endoscopists, making the best diagnosis and follow-up.