Endoscopy Suite Research Articles

Outcomes of Anesthesia-Supported versus Endoscopist-Driven Sedation Modalities: A retrospective cohort study.

Anesthesia involvement has become commonplace in many procedural settings. The goal of this study is to compare sedation modalities utilized by endoscopists and anesthesiologists in the endoscopy suite, particularly with respect to recovery time and adverse events. We conducted a retrospective cohort study including adults (≥18) undergoing outpatient EGD and/or colonoscopy at Mayo Clinic in Jacksonville, Florida between October 1, 2018 through December 31, 2022. Cases were clasified as utilizing Propofol only, Propofol±Adjuvants (including Dexmedetomidine, Ketamine, Fentanyl, Midazolam), General Anesthesia with Endotracheal Tube, or Midazolam/Fentanyl only. The primary outcome was length of stay in the post-anesthesia care unit (PACU LOS), and secondary outcomes included incidence of postoperative nausea and vomiting (PONV), hypoxemia (SpO2<risk 90), bradycardia (HR< 60), and escalation of care (hospital admission). 56,361 cases were included in the analysis. Among patients who received Midazolam/Fentanyl sedation, mean PACU LOS was 52.01, 49.68, and 53.24 minutes for EGD, COL, and Combined procedures, respectively. This was significantly higher than 44.65, 41.41, 41.92 for General Anesthesia, 32.35, 35.75, 33.42 for Propofol + Adjuvants, and 31.63, 32.61, 33.29 for Propofol (p<0.0001). Of the patient receiving Midazolam/Fentanyl, 8.39% experienced bradycardia, 6.12% experienced hypoxia, 0.24% experienced PONV, and 0.05% were hospitalized. These were substantially lower than the rates for other sedation groups, and odds ratios were significantly lower than 1.00 (p<0.05) in 30 out of 36 comparisons across procedural, sedative, and outcome categories. Sedation achieved with Midazolam/Fentanyl correlated with a lower rate of adverse events but significantly longer PACU LOS compared to Propofol, Propofol + Adjuvants, or General Anesthesia.

Prevalence of Helicobacter Pylori Among Patients with Chronic Gastritis in Nigeria

&amp;lt;i&amp;gt;Introduction&amp;lt;/i&amp;gt;: The stomach wall is made up of smooth muscles which are arranged in three layers: outer longitudinal, inner circular and innermost oblique layers. The mucosa is made up of simple columnar epithelium and is made up of several cell types which include: mucous cells which secrete alkaline mucous that protects the epithelium against acid and shear stress. Gastritis can involve the whole of the stomach, or a specific part of the stomach such as the fundus, body or the antrum and the distribution of gastritis may be related to an aetiologic factor. &amp;lt;i&amp;gt;H. pylori&amp;lt;/i&amp;gt; causes passive inflammation inside the gastric epithelium and alters signal transduction pathways that serve as a platform for the pathogenesis, but it also develops antimicrobial resistance via genetic changes and biofilm development. The bacterium floats in the direction of the epithelial membrane when it enters the stomach, taking advantage of areas of the stomach wall that are injured. &amp;lt;i&amp;gt;Method&amp;lt;/i&amp;gt;: The study was conducted in Kano, Nigeria from April 2021 to October 2021 and it is a Hospital-based Cross-sectional Descriptive study. Patients with dyspepsia referred for oesophagogastroduodenoscopy (OGD) at the endoscopy suite of the hospital constitute the study population, 197 patients that met the inclusion criteria were recruited and underwent OGD. Each patient were biopsied in accordance with the updated Sydney protocol. Data were collected and the report of both endoscopy and histological assessment for the presence of gastritis and &amp;lt;i&amp;gt;H. pylori&amp;lt;/i&amp;gt; were documented and analyzed using the SPSS 20. &amp;lt;i&amp;gt;Result&amp;lt;/i&amp;gt;: H. pylori was detected in 137 patients out of the 197 gastric biopsies sample of gastritis, the prevalence was 69.5%. Also, There was a statistically significant relationship between &amp;lt;i&amp;gt;H. pylori&amp;lt;/i&amp;gt; and those aged 31-40years (p = 0.025), however, the relationship was not significant for the other age groups and no significant relationship was found between sex (p = 0.512). The most common site affected by histologic gastritis in this study was the antrum (99.4%) and the high predominance of antral involvement is probably due to the high rate of &amp;lt;i&amp;gt;H. pylori&amp;lt;/i&amp;gt; infection in the study subjects which is known to be associated with antral affectation. &amp;lt;i&amp;gt;Conclusion&amp;lt;/i&amp;gt;: The most predominant pattern of histologic gastritis was chronic &amp;lt;i&amp;gt;H. pylori&amp;lt;/i&amp;gt; gastritis located in the antrum. The prevalence of &amp;lt;i&amp;gt;H. pylori&amp;lt;/i&amp;gt; infection was 69.5%, and it had significant association with both endoscopic and histologic gastritis. Therefore, prevention and eradication program for the &amp;lt;i&amp;gt;H. pylori&amp;lt;/i&amp;gt; infection are necessary in our environment.

New Instant Digital Pathology for EUS/EBUS Samples: The Last Advance in Bedside Diagnostics for Lung Carcinoma.

Background: Ex vivo fluorescence laser scanning microscopes (FCMs) allow digital tissue imaging directly from fresh, unfixed specimens without the need for conventional histological slide preparation. To date, no data have been reported on the use of FCMs in the endoscopy suite for immediate evaluation of endoscopic ultrasound (EUS)/endobronchial ultrasound (EBUS) fine needle aspiration/biopsy (FNA-B) specimens of lung lesions and/or mediastinal lymph nodes. Objectives: The aim of this study was to evaluate the performance of the FCM Vivascope 2500 (Vivascope, Munich, Germany) in providing real-time adequacy assessment and diagnostic information on the digital images of fresh unprocessed EUS/EBUS FNA-B specimens and to compare it with the corresponding final histological sections of formalin-fixed and paraffin-embedded cell blocks. Methods and Results: Thirty-two patients (50% male; 71 ± 8 years old) were enrolled between May 2023 and June 2024. In 28/32 (87.5%) patients, samples were defined as adequate at Vivascope evaluation, and in 20/28 (71.4%) patients, samples were classified as malignant. At final cytohistological evaluation, 87.5% of specimens were defined as adequate and 20/28 (71.4%) were diagnosed as malignant. There was perfect agreement between the Vivascope assessment of adequacy and the final cytohistological assessment on the same specimen (k Cohen 1). From a diagnostic point of view, perfect agreement was found between the two techniques in the identification of malignant neoplasms (k Cohen 1). Conclusions: The use of FCM could provide rapid information on both the adequacy and malignancy of the sample obtained during EBUS tissue acquisition (EBUS-TA), with minimal or no preparation and without destroying or losing the tissue. This technique allows for obtaining representative material in EBUS/EUS for lung cancer staging and is expected to change the turnaround time from biopsy sampling to diagnostic characterization of the tumor, ultimately improving patient management both at diagnosis and at restaging in follow up.

Use of Snare Tip Endoscopic Submucosal Dissection in the Endoluminal Management of Complex Colon Lesions.

Endoscopic submucosal dissection for advanced colon lesions is typically performed with specialized and costly endoscopic knives, potentially limiting accessibility and increasing procedural cost. Alternatively, the tip of an endoscopic snare, which is inexpensive and universally available, has demonstrated safe and efficient use in gastric lesions but lacks sufficient data for use in colon lesions. This study aimed to assess patient outcomes after endoscopic submucosal dissection of advanced colon lesions using the endoscopic snare tip. A retrospective review of a prospectively maintained database at a single tertiary care center was conducted. This study was conducted at a single tertiary care center. Adult patients with colon lesions that were not amenable to snare polypectomy were evaluated for endoscopic submucosal dissection. Snare tip resection was performed in select patients with lesions that were lifted adequately after submucosal injection. Patients who underwent hybrid resections with endoscopic mucosal dissection were excluded. En bloc resection rates, operative time, perioperative complications, and short-term outcomes, such as length of stay and lesion recurrence on follow-up colonoscopy, were evaluated. A total of 121 patients underwent snare tip endoscopic submucosal dissection, with a mean lesion size of 28.8 ± 9.84 mm. Most procedures were performed in the endoscopy suite (81.8%). The en bloc resection rate was 81.8%, with an average procedure time of 37.1 ± 29.8 minutes. There were 2 perforations (1.70%), one of which was managed operatively. Recurrence occurred in 6 patients (7.89%) at the time of follow-up colonoscopy. This study was retrospective, conducted by 2 skilled endoscopists with experience in endoscopic resection, and had short-term follow-up. Snare tip endoscopic submucosal dissection for advanced colon lesions demonstrates satisfactory short-term outcomes, suggesting its potential as a safe and accessible alternative to specialized knives, thereby possibly enhancing the adoption of endoscopic resection and improving patient accessibility. See Video Abstract . ANTECEDENTES:La disección submucosa endoscópica para lesiones avanzadas del colon generalmente se realiza con bisturíes endoscópicos especializados y costosos, lo que potencialmente limita la accesibilidad y aumenta el costo del procedimiento. Alternativamente, la punta de asa endoscópica, que es económica y está disponible universalmente, ha demostrado su uso seguro y eficiente en lesiones gástricas, pero carece de datos suficientes para su uso en lesiones de colon.OBJETIVO:Evaluar los resultados de los pacientes después de la disección submucosa endoscópica de lesiones avanzadas del colon utilizando la punta del asa endoscópica.DISEÑO:Revisión retrospectiva de una base de datos mantenida prospectivamente en un único centro de atención terciaria.AJUSTE:Estudio realizado en un único centro de atención terciaria.PACIENTES:Pacientes adultos con lesiones de colon no susceptibles a polipectomía con asa, fueron evaluados para disección submucosa endoscópica. La resección con punta del asa se realizó en pacientes seleccionados con lesiones que se levantaron adecuadamente después de la inyección submucosa. Se excluyeron pacientes sometidos a resecciones híbridas con disección endoscópica de la mucosa.PRINCIPALES MEDIDAS DE RESULTADO:Se evaluaron las tasas de resección en bloque, tiempo operatorio, complicaciones perioperatorias y resultados a corto plazo, como la duración de la estancia hospitalaria y la recurrencia de la lesión en la colonoscopia de seguimiento.RESULTADOS:Un total de 121 pacientes se sometieron a disección submucosa endoscópica con punta de asa, con un tamaño medio de lesión de 28,8 ± 9,84 mm. La mayoría de los procedimientos se realizaron en la sala de endoscopia (81,8%). La tasa de resección en bloque fue del 81,8% con un tiempo medio de procedimiento de 37,1 ± 29,8 min. Hubo dos perforaciones (1,70%), una de las cuales fue manejada quirúrgicamente. La recurrencia se observó en 6 pacientes (7,89%) durante la colonoscopia de seguimiento.LIMITACIONES:Estudio retrospectivo, realizado por dos endoscopistas expertos con experiencia en resección endoscópica y el seguimiento de corto plazo.CONCLUSIONES:La disección submucosa endoscópica con punta de asa para lesiones avanzadas del colon demuestra resultados satisfactorios a corto plazo, lo que sugiere su potencial como una alternativa segura y accesible a los bisturíes especializados, lo que posiblemente mejore la adopción de la resección endoscópica y la accesibilidad del paciente. (Traducción - Dr. Fidel Ruiz Healy ).

Near-Infrared On-Site Evaluation (NOSE) Examination of EBUS/EUSb Samples-A New Method for Sample Adequacy Evaluation.

Fine-needle aspiration biopsy is crucial for modern diagnostics of endoscopic procedures and thus an efficient and reliable method for increasing biopsy yields is urgently needed. In our study, we address the limited availability and high price of the rapid onsite evaluation (ROSE) technique by introducing the technique of near-infrared on-site evaluation (NOSE) consisting of spectral measurement of near-infrared radiation (NIR) transmitted through the evaluated material. For this purpose, we designed a special optical probe consisting of two fibres, of which one is a source fibre and the second is a detector fibre. The distal ends of both fibres are brought together into one bundle which is, with the help of a special extension, applied to a cuvette with an analysed sample at a defined distance from the cuvette bottom and fixed in place. A portion of the NIR radiation received by the detector fibre after it propagates through the sample then depends on the optical and therefore morphological characteristics of the sample. Based on the measured spectral curve, we can calculate the attenuation coefficient curve and subsequently the parameter of the sample richness and the parameter characterising the autofluorescence peak as well. We found that the value of our introduced parameters is in significant relation to sample richness as well as to sample malignity. NOSE evaluation of EBUS/EUSb (endobronchial/oesophageal ultrasound bronchoscopy) specimens can be considered an easy new technique aiming to improve sampling diagnostic accuracy and to diminish costs related to the presence of a cytopathologist and related instrumentation in the endoscopy suite.

Feeding Tube Clinic Effect on Nutrition.

Optimizing nutrition is essential for recovery after major surgery or severe illness. Feeding tubes (FT) can be placed in patients limited by oral enteral nutrition. Given the myriad of locations in which these procedures are performed (radiology, intensive care unit, and endoscopy suite), routine follow-up is challenging. The purpose of this study was to evaluate the impact of an FT clinic on nutrition. We hypothesized that enrollment in the FT clinic would result in improved nutritional outcomes. Retrospective review of Veteran Affairs Medical Center patients with FTs placed from January 2010 to January 2020. Demographics and body mass index (BMI) were recorded. Serum albumin recorded within 1 month of tube placement was compared to within 1 month of tube removal, death, or at the end of the study period. FT clinic participation required at least 2 visits. Indications for FT placement and duration were recorded. Patients were excluded when both BMI and albumin values were incomplete, and if FTs were placed for decompression. Ninety-three patients underwent FT placement during the study period; 5 (5%) were excluded. The average age was 64.8±9.7 years, with the majority being male, 85 patients (97%). Eighteen (20%) patients were seen in the FT clinic (FTC) and 70 (80%) were managed outside of FTC (nFTC). There were no differences in age, gender, or indication for FT. Mean albumin increased 0.42±0.85g/dL in the FTC group versus -0.07±0.72g/dL in the nFTC group ( P =0.037). The FTC group BMI increased, 0.38kg/m 2 vs. -1.48kg/m 2 in nFTC patients, P =0.041. The FTC patients maintained their tubes longer (36.5 vs. 7.0mo, P =0.0014). Patients managed in a dedicated FT clinic experienced an improvement in their serum albumin values and increases in their BMI. In addition, they also maintained their FTs longer. To optimize nutrition and reduce weight loss, patients who require FTs should be enrolled in a dedicated FT clinic.

Setting Up an Ambulatory GI Endoscopy Suite in the USA-Anesthesia and Sedation Challenges.

Gastrointestinal endoscopy units, both freestanding and associated with ambulatory surgical centers, are on the increase, and the trend is likely to continue. The concept is relatively new, and there are insufficient guidelines and a general dearth of information for prospective planners and physicians. Debate continues in areas such as the selection of patients, appropriateness of procedures, and access to tertiary care. Leaders often scramble to address both critical and non-critical issues, often after the center has opened to the public. They often encounter issues which were not anticipated. In this review, we have provided comprehensive and concise information on the various aspects of starting and running an endoscopy unit. Some of the areas considered are referral and recruitment systems, determination of the need and site selection, layout and regulations, aspects related to drugs, equipment, medical emergencies, and emergency room transfers, discharge criteria, post-discharge follow-up, and finally, we have addressed issues related to avoiding and managing cancelations. It is assumed that a majority of the procedures are performed with predominantly propofol-induced deep sedation.

A novel technique for conducting flexible bronchoscopy cryobiopsy under conscious sedation: An observational study.

Transbronchial lung cryobiopsy (TBCB) is a reliable method for obtaining histopathological findings in interstitial lung diseases. TBCB is traditionally performed during rigid bronchoscopy, positioning an endobronchial balloon blocker to facilitate bleeding management. Therefore, it can be challenging to implement in Centers without access to anesthesiologic support or dedicated beds for endoscopic procedures. We present a series of 11 patients who underwent 12 TBCBs using a flexible bronchoscope and a 5 Fr endobronchial blocker passing through an uncuffed endotracheal tube, under moderate sedation and spontaneous breathing. All procedures were carried out in an endoscopy suite, using fluoroscopy guidance but without requiring anesthesiologic assistance. TBCB was feasible in all cases, and it demonstrated similar or improved diagnostic yield (90.1%) and safety compared to rigid bronchoscopy. In 1 case, it was successfully repeated due to an inconclusive histological definition at the first attempt. The size of the samples was consistent with the literature, as it was the incidence of pneumothorax (16.6%). Four cases of moderate bleeding and 4 cases of severe bleeding were managed without further complications. To our knowledge, this is the first description of a technique allowing to perform TBCB through an artificial airway without need for either rigid bronchoscopy or general anesthesia. We believe this technique could make TBCB faster, cost-effective, and feasible even in resource-limited settings without compromising on safety. However, further studies are needed to validate these findings.

Boosting efficiency in the endoscopy suite: integrating team workflows improves productivity and minimizes cost

Inefficiencies in the endoscopy suite cause frustration for physicians, hospital administrators, staff, and patients. Turnover time (TOT), the time between one case ending and another beginning, is subjectively disproportionate between various team members. We aimed to define perceptions of TOT and target steps within the process to improve efficiency. This was a prospective cohort study at a tertiary center outpatient endoscopy unit. Phase I aimed to identify the TOT process components based on time stamps in the electronic medical record (N= 686). We defined gastroenterologist perceived TOT (pTOT), anesthesia pTOT, and standard TOT (sTOT). TOT length was calculated for each subgroup. Patient transport was identified as an intervenable target. In Phase II, the task of patient transport moved from the anesthesiology team to endoscopy nurses. Mean TOT and proportion of cases with sTOT<15 minutes' preintervention (n= 2192) and postintervention (n= 292) were compared. Seven key TOT components were identified that explain variations in pTOT. Average anesthesia pTOT was 15 minutes, whereas average gastroenterologist pTOT was 34 minutes (25.9% vs 57.2% of case length; P= .0007). In Phase II, mean sTOT improved from 18.51 to 14.25 minutes (P< .0001), and proportion of sTOT within 15 minutes improved from 41.79% to 58.90% (P< .0001). This intervention saved 45 minutes per room per day, allowing for a revenue potential of more than $300,000 per year per procedure room. This study defines variations in TOT and shows that finding imbalances and sharing the workload significantly cuts costs and improves the overall efficiency of the different subgroups in the turnover process.

Central Lung Cancer Location Along with Bronchoscopic Correlation- A Retrospective Cross-Sectional Study

Background: Lung cancer is currently the leading cause of death from neoplastic diseases worldwide. During the preceding decades, it was the most commonly occurring malignant disease, both in terms of impact and mortality. Fiberoptic bronchoscopy is the most important diagnostic tool for lung cancer. Early tissue diagnosis and proper staging remains the key to the management of the lung cancer patient. Endobronchial forceps biopsy has high diagnostic yield from the visible lesions. The aim of the study was to evaluate diagnostic yield of endobronchial biopsy. Methods: A Cross Sectional Retrospective study of all patients with provisional diagnosis of lung cancer based on computed tomography (CT) scan of chest undergoing fiberoptic bronchoscopy was done at Department of Respiratory Medicine, Ibn Sina Diagnostic &amp; Consultation Center, Chattogram, Bangladesh from July 2022 to June 2023. All fiberoptic bronchoscopy was done in endoscopy suite under local anesthesia. Patients were explained about the procedure thoroughly. Endobronchial biopsy was the main procedure performed. Results: A total of 120 patients underwent bronchoscopy for suspected lung cancer. The mean age of the patients was 58 years with range of 18 to 75 years. Among them 93 (77.5%) were male and 27 (22.5%) were female. Majority of the patients, 108 (90%) were smoker with a mean pack year of 42. The lesion was present more in right side (N=65) than the left side (N=55). Majority of the lesion was present in lobar bronchus followed by main bronchus. Bronchoscopy was normal in 10 patients (8.3%). 12 patients had lesion in multiple locations. The diagnostic yield of endobronchial biopsy was 75%. The diagnostic yield for central tumor was 81.6% which was statistically significant (p&lt;0.001) compared to peripheral tumor and extrinsic compression. Conclusion: Endobronchial biopsy provides good diagnostic yield especially in central tumors. Fiberoptic bronchoscopy is a safe procedure.

A novel mouth guard in endoscopy suite for limited oral access.

A novel mouth guard in endoscopy suite for limited oral access.

Waste Segregation Practice in Operating Theatres and Endoscopy Suites Survey in Australasian Hospitals: A Perspective from Anaesthesia and Gastrointestinal Endoscopy Nurses

Waste Segregation Practice in Operating Theatres and Endoscopy Suites Survey in Australasian Hospitals: A Perspective from Anaesthesia and Gastrointestinal Endoscopy Nurses

Increasing Antibiotic-Resistant Infections With Inpatient Endoscopic Retrograde Cholangioscopies (ERCP) Is Associated With Higher Mortality in the United States: A Cross-sectional Cohort Study.

This study aims to investigate associated mortality with inpatient endoscopic retrograde cholangiopancreatography (ERCP) with and without resistant infections. The co-primary objective compares frequencies of inpatient ERCP with resistant infections to overall hospitalizations with resistant infections. The risks of inpatient antibiotic-resistant organisms are known, but the associated mortality for inpatient ERCP is unknown. We aim to use a national database of hospitalizations and procedures to understand trends and mortality for patients with antibiotic-resistant infections during inpatient ERCP. The largest publicly available all-payer inpatient database in the United States (National Inpatient Sample) was used to identify hospitalizations associated with ERCPs and antibiotic-resistant infections for MRSA, VRE, ESBL, and MDRO. National estimates were generated, frequencies were compared across years, and multivariate regression for mortality was performed. From 2017 to 2020, national weighted estimates of 835,540 inpatient ERCPs were generated, and 11,440 ERCPs had coincident resistant infections. Overall resistant infection, MRSA, VRE, and MDRO identified at the same hospitalization of inpatient ERCPs were associated with higher mortality (OR CI(95%): Overall: 2.2(1.77-2.88), MRSA: 1.90 (1.34-2.69), VRE: 3.53 (2.16-5.76), and MDRO: 2.52 (1.39-4.55)). While overall hospitalizations with resistant infections have been decreasing annually, there has been a yearly increase in admissions requiring ERCPs with simultaneous resistant infections ( P =0.001-0.013), as well as infections with VRE, ESBL, and MDRO ( P =0.001-0.016). Required Research Practices for Studies Using the NIS scoring was 0, or the most optimal. Inpatient ERCPs have increasing coincident resistant infections and are associated with higher mortality. These rising infections during ERCP highlight the importance of endoscopy suite protocols and endoscopic infection control devices.

A136 EXPLORING ENDOSCOPIST PERCEPTIONS OF ARTIFICIAL INTELLIGENCE-AIDED COLONOSCOPY: A QUALITATIVE ANALYSIS

Abstract Background Artificial intelligence (AI) is gaining recognition as a promising adjunct in healthcare including gastrointestinal endoscopy. Randomized controlled trials have demonstrated improved polyp detection with computer-aided detection (CADe) systems in colonoscopy. Despite the foreseeable translation of CADe systems into the endoscopy suite, no study to date has explored how introducing this novel technology influences endoscopist perceptions and cognitive processes. Aims To explore how AI assistance impacts endoscopists’ perceptions of and cognitive processes during colonoscopy. Methods Faculty in gastroenterology and general surgery at the University Health Network (Toronto, Canada) were interviewed in April 2023 to explore their baseline perceptions of AI before the planned installation of the Medtronic GI GeniusTM Intelligent Endoscopy Module, an AI polyp detection tool, at Toronto Western Hospital in May 2023. After performing a minimum of 10 colonoscopies using GI GeniusTM, participants were re-interviewed to discuss their perceptions of AI-assisted colonoscopy and how it influenced their cognition during the procedure. Analysis was informed by constructivist grounded theory, whereby interview data were transcribed and coded iteratively using constant comparison to generate themes. Results In this interim constant comparative analysis, 9 participants (6 gastroenterologists and 3 general surgeons) were interviewed to generate 16 interview transcripts (9 pre-exposure and 7 post-exposure; 1 interview pending, 1 participant on leave). Participants held the view that: (1) AI will inevitably become the standard of care in colonoscopy, where clinicians and AI function symbiotically and in partnership; (2) CADe systems may facilitate standardization of practice and reduce inter-endoscopist variability by improving detection of specific types of lesions (e.g., sessile serrated polyps); (3) CADe assistance provides a “second set of eyes” that interacts with, but does not replace, endoscopists’ cognitive processes; and (4) trainees should gain familiarity with AI systems, despite mixed opinions regarding AI’s specific role in training. Conclusions We found that study participants conceptualize AI as an essential component of colonoscopy practice and training, with endoscopist thought processes and CADe systems appearing to function symbiotically. Elucidating the specific ways in which AI and endoscopist cognition interact will facilitate the future refinement of these tools. Funding Agencies None

P926 Improved standards of colonoscopy for Inflammatory Bowel Disease through implementation of key performance measures - A quality improvement initiative

Abstract Background Improving the quality of colonoscopy in inflammatory bowel disease is expected to improve clinical outcomes for patients. The European Society of Gastrointestinal Endoscopy (ESGE) recently published key performance measures for IBD colonoscopy assessment. This study aimed to assess the impact of implementing key performance measures and assess for sustainable improvement through a multimodal education intervention. Methods A baseline retrospective analysis was performed in patients with established IBD between June and August of 2022 at a tertiary hospital. The key performance measures included 1) pre-procedure metrics including indication, consent, and safety checklist (target of 100%) and 2) bowel preparation score, photo-documentation, disease activity scores, adequate biopsies, use of high-definition endoscopy and chromoendoscopy. There were six proceduralists involved and data was collected from electronic medical records including endoscopy and histopathology results. The ESGE performance measures were used to set minimum standards and we have adopted overall standards for our unit based on the ECCO and SCENIC consensus guidelines. Over 12 months, proceduralists and endoscopy nursing staff were engaged with educational interventions including didactic teaching for one hour and diagrammatic reminders in the endoscopy suites of the ESGE key performance measures. A post-implementation analysis was conducted at 1 year from baseline, from August to November of 2023. Results Baseline standards showed suboptimal performance in the use of disease activity scores and chromoendoscopy. Educational interventions were implemented and after 12 months, a repeat analysis of 50 consecutive patients showed significant improvement in all performance measures (see Table 1). Conclusion Quality metrics are important and underrecognised components in colonoscopy for IBD patients and form an integral part of improving patient care. Our study demonstrated that the implementation of the ESGE key performance measures is effective in improving the quality of colonoscopy assessment in IBD patients, identifying areas requiring further development and increasing the dysplasia detection rate. Acknowledging quality attrition over time, we recognise that regular teaching and education are required in addressing the challenge of sustainable long-term improvement.

Prevalence, patterns, and risk factors for endoscopy-related musculoskeletal injuries among endoscopists in Nigeria

Abstract Introduction: Musculoskeletal issues are quite common among endoscopists especially considering the complexity of GI endoscopy with prolonged examination time. In particular, the combination of repetitive movements, long procedure time, high volume and setup of the endoscopy suite provide the basis for these health issues. Considering the increasing number of new endoscopic interventional and diagnostic procedures, ergonomics in gastrointestinal endoscopy has not been addressed to the same extent. There has been no study on musculoskeletal injuries among practicing endoscopists in Nigeria. This study was designed to study the prevalence, patterns and risk factors for endoscopy-related musculoskeletal injuries among endoscopists in Nigeria. Methods: This was a nationwide cross-sectional questionnaire-based study in which practicing endoscopists in Nigeria were administered an online Google form. The questions on the questionnaire were adapted from the Nordic Musculoskeletal Questionnaire (NMQ). The questionnaire also included social demographic variables. There were 66 respondents which included gastroenterology physicians and surgeons. Data was analyzed with IBM-SPSS version 25. Inferential statistics was done using chi-square with p-value set at 0.05. Results: The Prevalence of endoscopy-related musculoskeletal injuries among endoscopists in Nigeria is very high. The commonest sites affected were the wrist/hands, lower back, neck and shoulders. These injuries prevented about one-third of the endoscopists from carrying out their normal activities while the injuries were severe enough to necessitate therapy in more than two-thirds of the respondents. The only statistically significant risk factor for endoscopy-related musculoskeletal injury was female sex. Conclusion: Most of the endoscopists in Nigeria have not had any form of training on ergonomics. While most of the endoscopists adopted the correct posture while performing endoscopies, a significant number did not practice ergonomic timeout nor use the finger grip technique. Thus there was a knowledge gap as well as a practice gap. A proper ergonomic education is a key step in preventing endoscopy-related musculoskeletal injury.

FIFTEEN YEARS’ EXPERIENCE IN PEDIATRIC ENDOSCOPIC PROCEDURES AT THE ENDOSCOPIC SUITE OF A TERTIARY CARE HOSPITAL

G.I. endoscopy is a highly efficient diagnostic and therapeutic tool now increasingly used in the pediatric population. Our country needs pediatric endoscopic data due to a lack of pediatric gastroenterologists and dedicated pediatric facilities; only a few facilities available in private setups are out of reach of the general population. Hence, this pediatric endoscopic audit was performed to analyze the indications, findings, and complications of all endoscopy procedures in a pediatric population referred to the endoscopy suite of a public sector tertiary care hospital. Data from all pediatric patients who underwent endoscopy from January 2006 to December 2020 was retrospectively reviewed for endoscopy indications, findings, and complications. Three thousand eight hundred seventy pediatric patients (age 0 -18 years) were analyzed. The mean age of the study population was 12.75 years, and the male-to-female ratio was 1.04:1. One thousand seven hundred seventy-nine patients underwent EGD, 1639 had colonoscopy, and 452 had ERCP. The most common indication for EGD was found to be epigastric pain (29.7%), the most common finding was gastritis (21.4%), and the complication rate for all upper G.I. endoscopic procedures was found to be 0.5%. The most common indication for colonoscopy was per rectal bleeding (69%), the most common finding was polyp (29.7%), and the complication rate was 0.9%. The most common indication for ERCP was found to be jaundice secondary to biliary obstruction (57.5%), the most common finding was bile duct stone (30%), and the complication rate was 5.6%. The overall incidence of adverse events was low and was found to be 0.7% in all of the 3870 procedures.

Electrocardiographic deep learning for predicting post-procedural mortality: a model development and validation study

Preoperative risk assessments used in clinical practice are insufficient in their ability to identify risk for postoperative mortality. Deep-learning analysis of electrocardiography can identify hidden risk markers that can help to prognosticate postoperative mortality. We aimed to develop a prognostic model that accurately predicts postoperative mortality in patients undergoing medical procedures and who had received preoperative electrocardiographic diagnostic testing. In a derivation cohort of preoperative patients with available electrocardiograms (ECGs) from Cedars-Sinai Medical Center (Los Angeles, CA, USA) between Jan 1, 2015 and Dec 31, 2019, a deep-learning algorithm was developed to leverage waveform signals to discriminate postoperative mortality. We randomly split patients (8:1:1) into subsets for training, internal validation, and final algorithm test analyses. Model performance was assessed using area under the receiver operating characteristic curve (AUC) values in the hold-out test dataset and in two external hospital cohorts and compared with the established Revised Cardiac Risk Index (RCRI) score. The primary outcome was post-procedural mortality across three health-care systems. 45 969 patients had a complete ECG waveform image available for at least one 12-lead ECG performed within the 30 days before the procedure date (59 975 inpatient procedures and 112 794 ECGs): 36 839 patients in the training dataset, 4549 in the internal validation dataset, and 4581 in the internal test dataset. In the held-out internal test cohort, the algorithm discriminates mortality with an AUC value of 0·83 (95% CI 0·79-0·87), surpassing the discrimination of the RCRI score with an AUC of 0·67 (0·61-0·72). The algorithm similarly discriminated risk for mortality in two independent US health-care systems, with AUCs of 0·79 (0·75-0·83) and 0·75 (0·74-0·76), respectively. Patients determined to be high risk by the deep-learning model had an unadjusted odds ratio (OR) of 8·83 (5·57-13·20) for postoperative mortality compared with an unadjusted OR of 2·08 (0·77-3·50) for postoperative mortality for RCRI scores of more than 2. The deep-learning algorithm performed similarly for patients undergoing cardiac surgery (AUC 0·85 [0·77-0·92]), non-cardiac surgery (AUC 0·83 [0·79-0·88]), and catheterisation or endoscopy suite procedures (AUC 0·76 [0·72-0·81]). A deep-learning algorithm interpreting preoperative ECGs can improve discrimination of postoperative mortality. The deep-learning algorithm worked equally well for risk stratification of cardiac surgeries, non-cardiac surgeries, and catheterisation laboratory procedures, and was validated in three independent health-care systems. This algorithm can provide additional information to clinicians making the decision to perform medical procedures and stratify the risk of future complications. National Heart, Lung, and Blood Institute.

Estimating the environmental impact of endoscopic activity at a tertiary center: a pilot study.

The growing number of endoscopic procedures, frequently requiring single-use disposable instruments, is responsible for the production of a large amount of waste. To this date, the reality of waste production at large European Gastroenterology centers is unknown. This study aimed to estimate the amount of waste due to endoscopic practice at a tertiary center in Portugal. We performed a prospective study to calculate the mass (in kg) of residues generated during a period of 5 working days of endoscopic practice. We included residues produced at endoscopy suites, pre and postprocedure areas and during endoscope reprocessing. Residues were categorized as non-dangerous (groups I/II), of biologic risk (group III) and specific hazardous hospital residues (group IV). The production of residues separated for recycling/valorization (paper/card and plastic) was also quantified. The volume of water used for reprocessing an endoscope was also assessed. During the analyzed period, 241 endoscopic procedures were performed. A total of 443.2 kg of waste (22.6 kg from groups I/II, 266.9 kg from group III and 3.9 kg from group IV) were produced, most from group III (75%). For each endoscopic procedure, 1.8 kg of waste was generated. Of the total waste mass, 17.8% was separated for recycling/valorization. A volume of 55L of water was required for reprocessing one endoscope. Each endoscopic procedure generated a significant amount of waste and water consumption during reprocessing. These real-life analyses are a pivotal step before implementing effective measures to improve resource utilization and more sustainable practices.

How Did COVID-19 Affect Mental Health and Access to Care in Persons With Inflammatory Bowel Disease.

The coronavirus disease pandemic globally affected public health and the world economy, leading to an increase in mental health symptoms, thought to be due in part to periods of quarantining, restrictions, and other interventions used to curb ongoing transmission of the virus. It is well established that persons with inflammatory bowel disease (IBD) have significantly higher rates of depression and anxiety than the general population and that mental health symptoms can exacerbate disease severity. For persons with IBD, psychological distress was correlated with challenges in accessing medical care. In the early stages of the pandemic, endoscopy suites were closed, leading to fewer colonoscopies, although this rebounded the following year. This likely led to fewer diagnoses of IBD initially as people avoided the health care system, and also a reduction in IBD-related dysplasia being detected during colonoscopy. Many hospitals and health care clinics adjusted by delivering telemedicine for ambulatory care. Persons with IBD had increased stress about accessing both their health care provider and gastroenterologist during the pandemic, although many had increased satisfaction with the level of care they received virtually. Telemedicine is now being used in most clinics in conjunction with in-person care, to help deliver care, and can be cost-effective. Additional research is needed to assess whether heightened levels of mental health symptoms have led to worsening disease activity, and further, if a delay in health care access including colonoscopies and surgeries, or the perceived decreased access to health care professionals for some will have detrimentally affected the disease course for persons with IBD.