High-quality Colonoscopy Research Articles

Long-Term Follow-Up of Colonoscopy Quality Monitoring.

High-quality colonoscopy is paramount for colorectal cancer prevention. Since 2009, endoscopists at our institution have received quarterly report cards summarizing individual colonoscopy quality indicators. We have previously shown that implementing this intervention was associated with short-term improvement in adenoma detection rate (ADR). However, the long-term effect of continued monitoring on colonoscopy quality is unclear. We conducted a retrospective study of prospectively administered quarterly colonoscopy quality report cards at the Roudebush Veteran's Affairs Medical Center between April 1, 2012, and August 31, 2019. The anonymized reports included individual endoscopists' ADRs, cecal intubation rates, and withdrawal times. Analyses were performed to determine slopes over time for each quality metric by physician and assess for differences based on whether ADRs were calculated quarterly or yearly. Data from the report cards of 17 endoscopists who had performed 24,361 colonoscopies were included. The mean quarterly ADR (±SD) was 51.7% (±11.7%) and mean yearly ADR was 47.2% (±13.8%). There was a small increase in overall ADR based on quarterly and yearly measurements (slope + 0.6%, P = 0.02; and slope +2.7%, P < 0.001, respectively), but no significant change in individual ADRs, cecal intubation rates, or withdrawal times. Analysis of SD of ADRs showed no significant difference between yearly and quarterly measurements ( P = 0.064). Individual endoscopists' ADR SD differences between yearly and quarterly measurements ranged from -4.7% to +6.8%. Long-term colonoscopy quality monitoring paralleled stable improvements in overall ADR. For endoscopists with baseline high ADR, frequent monitoring and reporting of colonoscopy quality metrics may not be necessary.

Can a high-quality screening colonoscopy decrease the need for subsequent surveillance colonoscopies?

Can a high-quality screening colonoscopy decrease the need for subsequent surveillance colonoscopies?

Endoscopist volume and the quality of colonoscopy of the Korean National Cancer Screening Program.

6627 Background: The Korean government established the National Cancer Screening Program (KNCSP). The KNCSP has provided annual faecal immunochemical test (FIT) for adults aged 50 years or older, and colonoscopy or a double-contrast barium enema test to those with positive results from the FIT. High-quality screening colonoscopy is mandatory to achieve maximum possible CRC prevention. The case volume has been shown to correlate with outcomes in surgical specialties. In contrast, relevant data on colonoscopy is limited. This study aimed to assess the quality indicators of organized CRC screening according to annual colonoscopy volume using KNCSP data. Methods: We used the KNCSP data from 2018 to 2020, which accounted for 378,354 colonoscopy examinations. We used cancer registration data of an extended health insurance program using ICD-11 codes (C18-20). A total of 12,109 CRC patients were registered within 1 year of the date of colonoscopy. We calculated the annual number of colonoscopy examinations by an individual endoscopist. We excluded endoscopists who had a very low or high number of examinations with the highest 1% or lowest 1% as outliers. The final number of endoscopists was 16,552 and colonoscopy examinations were 331,231 during 2018–2020. The annual colonoscopy volume by individual endoscopists was divided into four groups (2–12, 13–24, 25–36, and 37 or more examinations). Multiple linear regression analysis was performed to confirm the association between test accuracy indicators and colonoscopy frequency using a generalized linear model (GLM). We calculated the estimates of the rates for each indicator by adjusting the year. Results: The positive and false positive rates, sensitivity, specificity, and positive predictive value were 4.09%, 1.07%, 83.53%, 98.93%, and 74.68%, respectively. The cancer detection and interval cancer rates were 30.53‰ and 6.29‰, respectively. Quality indicators were related to the annual colonoscopy volume of the endoscopist. Endoscopists with a higher annual colonoscopy volume were more likely to have higher sensitivity, specificity, and positive predictive value than those with a lower annual colonoscopy volume. Endoscopists with higher annual colonoscopy volumes were more likely to have lower positive rates, cancer detection rates, false positive rates, and interval cancers rate than those with lower annual colonoscopy volumes. Conclusions: This study found that the annual volume of colonoscopy examinations was associated with better colonoscopy quality in an organized CRC screening program. A high colonoscopy load could be a sign of substantial experience and lead to better outcomes, as has been shown for surgery. The relationship between quality indicators and case volume is logical and plausible; therefore, more research is required to determine the number of cases that need to be performed in a year to adequately maintain high colonoscopy quality.

High quality colonoscopy: using textbook process as a composite quality measure.

BACKGROUND : High quality colonoscopy is fundamental to good patient outcomes. "Textbook outcome" has proven to be a feasible multidimensional measure for quality assurance between surgical centers. In this study, we sought to establish the "textbook process" (TP) as a new composite measure for the optimal colonoscopy process and assessed how frequently TP was attained in clinical practice and the variation in TP between endoscopists. METHODS : To reach consensus on the definition of TP, international expert endoscopists completed a modified Delphi consensus process. The achievement of TP was then applied to clinical practice. Prospectively collected data in two endoscopy services were retrospectively evaluated. Data on colonoscopies performed for symptoms or surveillance between 1 January 2018 and 1 August 2021 were analyzed. RESULTS : The Delphi consensus process was completed by 20 of 27 invited experts (74.1 %). TP was defined as a colonoscopy fulfilling the following items: explicit colonoscopy indication; successful cecal intubation; adequate bowel preparation; adequate withdrawal time; acceptable patient comfort score; provision of post-polypectomy surveillance recommendations in line with guidelines; and the absence of the use of reversal agents, early adverse events, readmission, and mortality. In the two endoscopy services studied, TP was achieved in 5962/8227 colonoscopies (72.5 %). Of 48 endoscopists performing colonoscopy, attainment of TP varied significantly, ranging per endoscopist from 41.0 % to 89.1 %. CONCLUSION : This study proposes a new composite measure for colonoscopy, namely "textbook process." TP gives a comprehensive summary of performance and demonstrates significant variation between endoscopists, illustrating the potential benefit of TP as a measure in future quality assessment programs.

Factors affecting the quality of bowel preparation for colonoscopy in hard-to-prepare patients: Evidence from the literature

Adequate bowel cleansing is critical for a high-quality colonoscopy because it affects diagnostic accuracy and adenoma detection. Nevertheless, almost a quarter of procedures are still carried out with suboptimal preparation, resulting in longer procedure times, higher risk of complications, and higher likelihood of missing lesions. Current guidelines recommend high-volume or low-volume polyethylene glycol (PEG)/non-PEG-based split-dose regimens. In patients who have had insufficient bowel cleansing, the colonoscopy should be repeated the same day or the next day with additional bowel cleansing as a salvage option. A strategy that includes a prolonged low-fiber diet, a split preparation regimen, and a colonoscopy within 5 h of the end of preparation may increase cleansing success rates in the elderly. Furthermore, even though no specific product is specifically recommended in the other cases for difficult-to-prepare patients, clinical evidence suggests that 1-L PEG plus ascorbic acid preparation are associated with higher cleansing success in hospitalized and inflammatory bowel disease patients. Patients with severe renal insufficiency (creatinine clearance < 30 mL/min) should be prepared with isotonic high volume PEG solutions. Few data on cirrhotic patients are currently available, and no trials have been conducted in this population. An accurate characterization of procedural and patient variables may lead to a more personalized approach to bowel preparation, especially in patients undergoing resection of left colon lesions, where intestinal preparation has a poor outcome. The purpose of this review was to summarize the evidence on the risk factors influencing the quality of bowel cleansing in difficult-to-prepare patients, as well as strategies to improve colonoscopy preparation in these patients.

Development and deployment of Computer-aided Real-Time feedback for improving quality of colonoscopy in a Multi-Center clinical trial

Background and ObjectiveThe quality of colonoscopy has been a subject of interest in the gastroenterology community for over two decades. High-quality colonoscopy leads to high polyp detection rates, reducing mortality associated with colorectal cancer. Methods: This paper describes the development and deployment of Endoscopic Multimedia Information System (EMIS), computer-aided software that provides real-time feedback on colonoscopy quality such as the endoscopist’s techniques in inspecting the colon. On the contrary, most other software in this field aims to recognize polyps. The deployed version of EMIS includes new analysis components using Convolutional Neural Networks and new types of visual feedback. EMIS gives feedback only when an important change in the quality of the examination occurs. We present first-hand technical and operational challenges faced during our three-center trial and current solutions. Results: This work provides valuable information for others attempting to implement real-time feedback in routine colonoscopy screening.

Epidemiology and early screening strategies for colorectal cancer in China.

China ranks the first worldwide in the number of new colorectal cancer (CRC) cases and CRC-related deaths. The increasing incidence of early-onset CRC in recent years highlights the challenges related to CRC screening and prevention. High-quality colonoscopy is the universally used gold standard for CRC screening. Risk assessment combined with a two-step screening strategy based on colonoscopy and non-invasive examinations was proven to be highly effective. However, systematic use of well-established risk factors associated with CRC, beyond age, could better identify those who might harbor advanced colorectal neoplasia, improve the diagnostic yield of current screening modalities, and optimize the selection of individuals who might benefit most from preventive strategies. "Personalization" and "Standardization" are the future development directions of CRC screening, from the initiation of screening in those at high risk for CRC to follow-up after treatment, which are the key to ensure the screening efficiency.

The effect of the endoscopic device Endocuff™/Endocuff vision™ on quality standards in colonoscopy: A systematic review and meta-analysis of randomized trials.

The adenoma detection rate (ADR) is an important quality measure, with a high ADR reflecting high-quality colonoscopy. This systematic review and meta-analysis aimed to assess the effects of Endocuff™/Endocuff Vision™-assisted colonoscopy (EAC) versus standard colonoscopy (SC) on ADR and other clinical, patient and resource-use outcomes. MEDLINE, EMBASE, Web of Science, Scopus and the Cochrane Central Register of Controlled Trials were searched for full papers reporting randomized studies comparing EAC with SC. The primary outcome was ADR. Secondary outcomes comprised key polyp/adenoma detection, procedure-related, patient-related and health economic measures. Random effects meta-analyses provided pooled estimates of outcomes [risk ratio (RR) or mean difference (MD), with 95% confidence intervals (CI)]. Twelve parallel-group randomized controlled trials (RCTs) and three crossover RCTs with data on 9140 patients were included. EAC significantly increased the ADR (RR 1.18, 95% CI 1.09-1.29), mean adenomas per procedure (MAP) (MD 0.19, 95% CI 0.06-0.33), polyp detection rate (PDR) (RR 1.20, 95% CI 1.10-1.30) and mean polyps per procedure (MPP) (MD 0.39, 95% CI 0.14-0.63) versus SC. EAC significantly increased segmental PDR versus SC in the sigmoid (RR 2.02, 95% CI 1.64-2.49), transverse (RR 1.63, 95% CI 1.09-2.42), ascending (RR 1.74, 95% CI 1.26-2.41) and caecal segments (RR 1.91, 95% CI 1.29-2.82). Procedure-related variables did not differ between arms. There were insufficient data for meta-analysis of health economic or patient-centred outcomes. EAC increased ADR, MAP, PDR and MPP versus SC without detrimental effects on procedure measures. Cost-effectiveness and patient experience data are lacking and would be valuable to inform practice recommendations.

Correlation between adenoma detection rate and other quality indicators, and its variability depending on factors such as sedation or indication for colonoscopy.

Colorectal cancer (CRC) is an important worldwide public health burden and colonoscopy is the main diagnostic and most importantly, preventive method. For this reason, many countries have implemented national or regional CRC screening programs. High-quality colonoscopy is a prerequisite to effectively detect premalignant lesions, like adenomas. The quality of colonoscopy is assessed using several quality indicators, the main one being adenoma detection rate (ADR). In Romania, despite CRC having the highest incidence of all cancers, there is no national screening program and quality in colonoscopy is not routinely assessed. We therefore wanted to evaluate the actual level of quality in colonoscopy in a region of Romania. Our study was conducted in two private endoscopy clinics over a period of 7months. 1,440 consecutive colonoscopies performed by five physicians were included in the study. We found that the quality level is above the minimum one recommended by international societies and that the ADR calculation method does not significantly influence its value. Furthermore, ADR correlated well with other quality indicators such as polyp detection rate (PDR) and adenoma per colonoscopy (APC). An interesting finding was that ADR was higher among colonoscopies performed without sedation. Thus, our data encourage endoscopists to adopt a sedation-free colonoscopy in their practice without an impact on the quality of the procedure.

Polyp detection rate and cumulative incidence of post-colonoscopy colorectal cancer in Germany.

Studies have shown that the quality of colonoscopy influences the incidence of post-colonoscopy colorectal cancer (PCCRC). However, data from Germany on this association are lacking. We aimed to assess cumulative incidence of PCCRC in persons undergoing colonoscopy in Germany according to the physician's polyp detection rate (PDR). Using the German Pharmacoepidemiological Research Database (GePaRD) with claims data of ~20% of the German population, we included persons with a baseline colonoscopy between 2008 and 2017 and categorized them according to the procedure at baseline (snare polypectomy, forceps polypectomy, no polypectomy). In each subgroup, we distinguished between persons examined by physicians with a PDR in the lowest quartile vs higher quartiles and described cumulative CRC incidence during follow-up. Overall, 822 715 persons examined by 1752 physicians were included. One quarter of the physicians had a PDR ≤21.8% (lowest quartile). In all subgroups, the 5-year cumulative CRC incidence was statistically significantly higher in persons examined by physicians with a PDR ≤21.8% vs >21.8%: It was 69% higher in persons with snare polypectomy (0.88% vs 0.52%), 87% higher in persons with forceps polypectomy (0.58% vs 0.31%), and 48% higher in persons without polypectomy at baseline (0.31% vs 0.21%). In conclusion, we found a substantially increased PCCRC risk in persons examined by physicians with a low PDR in Germany, irrespective of the baseline findings. Our study highlights the importance of a high-quality colonoscopy to maximize the preventive effect of colonoscopy on CRC incidence.

Colonoscopy quality of GP endoscopists in three rural hospitals in Queensland, Australia.

Rural general practitioners (GPs) are responsible for delivering primary and secondary care to rural populations in Australia. There is limited literature investigating the performance of GP endoscopists. Theaim of this study was to investigate the colonoscopy performance of three GP endoscopists in rural Queensland against current Australian quality indicator (QI) standards. A cross sectional study investigated eligible colonoscopies between January 2018 and February 2021by three GP endoscopists in three rural hospitals inQueensland, Australia. A total of 1674 colonoscopies were investigated. The GP endoscopists demonstrated high QI performance, above the recommended benchmarks. Caecal intubation rate, adenoma detection rate, sessile serrated adenoma/polyp detection rate and clinically significant serrated polyp detection rate were 97.9%, 49.5%, 16% and 14.1% respectively. The major colonoscopy-related complications rate was 0.06%. Rural GP endoscopists potentially can deliver safe, high-quality colonoscopy services for rural communities and can have an integral part in facilitating colorectal cancer prevention and treatment in rural communities.

Rates of repeated colonoscopies to clean the colon from low-risk and high-risk adenomas: results from the EPoS trials

ObjectiveHigh-quality colonoscopy (adequate bowel preparation, whole-colon visualisation and removal of all neoplastic polyps) is a prerequisite to start polyp surveillance, and is ideally achieved in one colonoscopy. In a large...

Impact of withdrawal time on adenoma detection rate: results from a prospective multicenter trial

Performing a high-quality colonoscopy is critical for optimizing the adenoma detection rate (ADR). Colonoscopy withdrawal time (a surrogate measure) of≥6 minutes is recommended; however, a threshold of a high-quality withdrawal and its impact on ADR are not known. We examined withdrawal time (excluding polyp resection and bowel cleaning time) of subjects undergoing screening and/or surveillance colonoscopy in a prospective, multicenter, randomized controlled trial. We examined the relationship of withdrawal time in 1-minute increments on ADR and reported odds ratio (OR) with 95% confidence intervals. Linear regression analysis was performed to assess the maximal inspection time threshold that impacts the ADR. A total of 1142 subjects (age, 62.3 ± 8.9 years; 80.5% men) underwent screening (45.9%) or surveillance (53.6%) colonoscopy. The screening group had a median withdrawal time of 9.0 minutes (interquartile range [IQR], 3.3) with an ADR of 49.6%, whereas the surveillance group had a median withdrawal time of 9.3 minutes (IQR, 4.3) with an ADR of 63.9%. ADR correspondingly increased for a withdrawal time of 6 minutes to 13 minutes, beyond which ADR did not increase (50.4% vs 76.6%, P< .01). For every 1-minute increase in withdrawal time, there was 6% higher odds of detecting an additional subject with an adenoma (OR, 1.06; 95% confidence interval, 1.02-1.10; P= .004). Results from this multicenter, randomized controlled trial underscore the importance of a high-quality examination and efforts required to achieve this with an incremental yield in ADR based on withdrawal time. (Clinical trial registration number: NCT03952611.).

Endoscopist Characteristics and Polyp Detection in Colonoscopy: Cross-Sectional Analyses of Screening of Swedish Colons

Endoscopist Characteristics and Polyp Detection in Colonoscopy: Cross-Sectional Analyses of Screening of Swedish Colons

S288 Long-Term Follow-Up of Colonoscopy Quality Monitoring

Introduction: High-quality colonoscopy is paramount to effective prevention of colorectal cancer. A variety of interventions have been proposed to monitor and improve colonoscopy quality at operator and institutional levels. Since 2009, endoscopists at our university-affiliated, Veterans Affairs Medical Center (VAMC) have received a quarterly report card summarizing individual colonoscopy quality indicators. This intervention was associated with short-term improvement in adenoma detection rate (ADR). However, long-term effects of this monitoring on colonoscopy quality metrics, and appropriate monitoring frequency, are unclear. Methods: We conducted a retrospective study of prospectively administered quarterly colonoscopy quality report cards at a VAMC from April 1, 2012 to August 31, 2019. Anonymized reports included individual endoscopists’ ADR, cecal intubation rates, and withdrawal time. We included endoscopists who had contributed at least 50 colonoscopies per year, and at least 4 consecutive quarters during the study time frame. Linear regression models were used to determine and test slopes over time for each quality metric by physician, and to determine if slopes differed for data above vs below the median for each metric. Analyses were performed for quarterly and yearly data to assess whether there are significant differences based on monitoring frequency. Results: Data from the report cards of 17 endoscopists who had performed 24,361 colonoscopies were included. The mean quarterly ADR (±SD) was 51.7% (±11.7%), while the mean yearly ADR was 47.2% (±13.8%). Over the study time frame, there was a small increase in overall ADR based on both quarterly and yearly measurements (slope + 0.6%, p=0.02; and slope +2.7%, p < 0.001, respectively). However, most endoscopists had no significant change in their ADRs (Table). Overall cecal intubation rates and withdrawal times did not change significantly. Analysis of standard deviation of ADRs (to represent outcome variability over time within a physician) showed no significant difference between yearly and quarterly measurements (p=0.064). Individual endoscopists’ ADR standard deviation differences between yearly and quarterly measurement ranged from -4.7% to +6.8%. Conclusion: Long-term colonoscopy quality monitoring was paralleled with modest improvement in overall ADR, likely due to temporal trends. For endoscopists with baseline high ADR, intensive monitoring and reporting of colonoscopy quality metrics is not necessary and could be performed annually. Table 1. - Mean ADR and slopes of ADR for yearly and quarterly measurement Quarterly Yearly Physician Mean (± SD) Slope SE p-value Mean (± SD) Slope SE p-value All 51.7% (+ 11.7%) 0.6% 0.2% 0.021 47.2% (+ 13.8%) 2.7% 0.4% < .001 Physician A 48.5% (+ 7.8%) 1.1% 2.6% 0.689 49.3% (+ 5.7%) -3.0% 2.3% 0.314 Physician B 39.4% (+ 5.4%) 0.2% 0.5% 0.628 36.8% (+ 9.4%) 1.6% 1.4% 0.306 Physician C 66.3% (+ 6.0%) 1.6% 0.7% 0.022 64.1% (+ 7.6%) 2.3% 1.2% 0.113 Physician D 53.4% (+ 9.2%) 1.2% 0.8% 0.155 47.9% (+ 13.3%) 3.5% 1.7% 0.084 Physician E 33.8% (+ 11.5%) 4.7% 10.8% 0.692 21.0% (+ 15.0%) 13.6% 6.3% 0.275 Physician F 46.4% (+ 6.3%) 0.6% 2.0% 0.761 48.2% (+ 4.8%) 1.8% 2.3% 0.531 Physician G 48.0% (+ 11.5%) 0.1% 1.1% 0.948 39.6% (+ 9.1%) 1.9% 1.3% 0.201 Physician H 60.3% (+ 8.6%) 1.2% 0.8% 0.118 54.0% (+ 13.3%) 3.6% 1.6% 0.070 Physician I 55.1% (+ 6.2%) -1.3% 0.9% 0.167 53.2% (+ 9.1%) 1.4% 2.3% 0.589 Physician J 51.8% (+ 7.5%) 0.4% 1.5% 0.802 48.9% (+ 12.2%) 3.6% 3.9% 0.431 Physician K 38.5% (+ 11.0%) -1.4% 1.3% 0.290 35.5% (+ 12.2%) 1.6% 2.4% 0.533 Physician L 50.1% (+ 8.1%) 14.2% 3.4% 0.052 35.9% (+ 14.9%) -21.0% Physician M 48.2% (+ 11.3%) 11.8% 3.8% 0.026 38.6% (+ 15.3%) 7.1% 13.6% 0.692 Physician N 60.0% (+ 7.5%) 2.0% 2.9% 0.506 59.7% (+ 2.8%) 0.8% 2.7% 0.819 Physician O 52.9% (+ 6.4%) 1.3% 1.2% 0.277 52.1% (+ 5.2%) 1.9% 1.6% 0.302 Physician P 59.1% (+ 10.4%) 6.0% 2.5% 0.043 59.2% (+ 8.6%) 5.6% 2.6% 0.160 Physician Q 55.2% (+ 10.7%) 0.4% 1.1% 0.747 48.5% (+ 13.6%) 3.0% 1.9% 0.169

S637 Evaluation of Online Educational Materials on Hospital Websites for Bowel Preparation

Introduction: High-quality screening colonoscopy is dependent on adequate colonoscopy preparation (prep). Despite many new formulations including low-volume laxative preps and split-prep schedules, inadequate colon preps are not uncommon. One important factor in improving the quality of colon prep is ensuring that patients understand the prep instructions. Apart from verbal communication, many hospitals post colonoscopy prep instructions on their website. In this study, we evaluated the readability, understandability, and actionability of online colonoscopy prep instructions. Methods: The top 75 hospitals in gastroenterology as ranked by 2021-22 US News and World Report were selected. These hospitals were entered into the Google search engine using the hospital’s name followed by “bowel preparation.” Each hospitals’ bowel preparation information was evaluated independently by four reviewers using a total of 21 website criteria including readability, understandability, and actionability. Readability of each website was evaluated by assessing the approximate reading grade level of the materials using the Flesch Kincaid Grade Level Calculator with a preferred reading grade level below 6. Understandability and actionability were measured with the Patient Education Materials Assessment Tool (PEMAT) with recommended scores above 70% for both. Materials were excluded from review if no standardized document was listed on the hospital website or if duplicate materials were listed among two websites. Results: After exclusion, a total of 51 out of 75 web pages were evaluated. Average reading grade level of the materials assessed was 9.1 ± 2.3. Overall understandability score was 78.1% ± 9.7%, and overall actionability score was 74.7% ± 30.1%. Of the websites assessed, 6% of hospitals included images to support text and 20% included videos in addition to text. 18% of the hospitals linked resources in different languages. 59% of materials did not include side effect warnings, and only one website listed an allergic reaction statement. Conclusion: The readability, understandability, and actionability of the written materials for bowel preparation among hospital websites are quite variable and do not meet the recommended standards. In addition, materials often lack key information. The educational content provided by physicians can be improved by further identifying what constitutes effective communication and using online tools to assess and improve readability and display.

S2155 Utilizing the Pure-Vu EVS for Inpatient Colonoscopy for Patients With an LVAD: A Case Report

Introduction: Colonoscopy is considered the standard for colon cancer screening. A key factor in ensuring high quality colonoscopy is adequate colon cleansing. In hospitalized patients, bowel preparation is often challenging and inadequate cleansing is often due to patient’s inability to tolerate the preparation, slow bowel transit in the setting of immobilization and acute illnesses, and the use of motility-altering medications. Poor bowel preparation limits visualization of the colonic mucosa and can lead to incomplete colonoscopies, missed pathology, adverse events, prolonged hospital stays and increased costs. New technologies have been developed to improve bowel preparations intra-procedurally. The Pure-Vu EVS system, which is an over-the-scope irrigation and cleansing device. This case report describes a novel use of the Pure-Vu EVS system to improve inpatient colonoscopy prep. Case Description/Methods: A 58-year-old female with past medical history significant for chronic systolic heart failure, ischemic cardiomyopathy status post Left Ventricular Assist Device (LVAD) one year prior. End stage heart failure patients requiring LVAD placement routinely undergo screening colonoscopy as part of their pre-transplant evaluation, as the presence of colon cancer or advanced neoplasia could preclude heart transplantation. As part of orthotopic heart transplant evaluation she was admitted to the hospital for IV heparin bridging for screening colonoscopy. After admission, the patient was started on standard bowel prep consisting of 4L of Golytely and Dulcolax suppository. Despite completion of prep, she continued to pass sediments and prep was deemed inadequate. The patients LVAD anticoagulation had been held for the procedure and the decision was made to proceed with colonoscopy utilizing the Pure-Vu EVS device. During the procedure the clinical team utilized the Pure-Vu EVS device and performed the procedure with cardiovascular anesthesia. The Pure-Vu EVS system effectively irrigated and suctioned areas of inadequate bowel prep with sediment larger than 3.8 mm, allowing for improved visualization of the colonic mucosa. Discussion: Pure-Vu EVS allowed for us to perform a screening colonoscopy as part of orthotopic heart transplant evaluation in a patient with LVAD admitted a hospital inpatient service for heparin bridge. This case report describes one of the first cases of the utilization of this unique technology in a patient requiring inpatient screening colonoscopy with advanced heart failure.

S2154 Utilizing the Mobile Pure-Vu System for Bedside Inpatient Colonoscopy: A Novel Technique

Introduction: Colonoscopy is considered the standard for evaluating patients with suspected colonic disease. A key factor in ensuring high quality colonoscopy is adequate colon cleansing. Unfortunately, in hospitalized patients, bowel preparation is often challenging and bowel cleansing is often due to patient’s inability to tolerate the preparation, slow bowel transit in the setting of immobilization and acute illnesses, and due to the use of motility-altering medications. Poor bowel preparation limits visualization of the colonic mucosa and this can lead to incomplete colonoscopies, missed pathology, adverse events, prolonged hospital stays and increased costs. Due to this recurrent problem, new technologies have been developed to improve bowel preparations intra-procedurally. One of those is the Pure-Vu EVS system, which is an over-the-scope irrigation and cleansing device. This case report describes the first use of the Pure-Vu EVS system for mobile bedside colonoscopy in an intensive care setting. Case Description/Methods: A 63-year-old Black male with a past medical history of cerebral vascular disease, hypertension, diabetes and chronic kidney disease presented from his rehabilitation facility with reported melena. The patient was found to be hypotensive and determined to be in hemorrhagic shock. The patient was admitted to the intensive care unit, initiated on pressors and administered colloids. The patient then underwent urgent bedside esophagogastroduodenoscopy which revealed no source of bleeding. A CAT scan was obtained which demonstrated no targeted source of bleeding for interventional radiology. The patient was then administered 2 liters of Polyethylene Glycol 3350 and underwent same day bedside colonoscopy. A Motus GI Pure-Vu EVS system was loaded onto a colonoscope and the colon was cleansed from a Boston bowel prep score of 4 to 8. An actively bleeding angioectasia was identified in the cecum and hemostasis was achieved with a hemoclip. The patients shock resolved and the bleeding ceased (Figure). Discussion: The newest version of Pure-Vu EVS is more compact and readily transportable. It’s design makes it ideal for utilization in mobile colonoscopy cases. This case illustrates the potential benefits of utilizing the Pure-Vu EVS system in mobile endoscopy cart and the potential to improve outcomes such as Boston Bowel prep score, rates of diagnosis, adenoma detection rates and ability to achieve hemostasis. Trials are currently underway examining this potential.Figure 1.: Angioectasia identified after bowel cleansing with Pure-Vu EVS.

S625 Adenoma Detection Rate Using LCI vs White Light Colonoscopy Both With and Without the Use of Artificial Intelligence: A Prospective Study in a Non-Academic Center in Latin America

Introduction: The adenoma detection rate (ADR) is a strong predictor of cancer prevention. The use of artificial intelligence could increase the detection of colorectal polyps. The Computer-Aided Polyp Detection systems (CADe) have shown high accuracy in polyp detection when retrospectively applied to endoscopy videos or images, but their live performance is still under scrutiny. There are other ways in which technology has helped in performance and efficiency, Linked Color Imaging (LCI) is a modern image-enhancing technology, its use along with artificial intelligence could be another tool in the detection of precancerous lesions. Methods: A prospective observational study was conducted on 637 subjects undergoing screening colonoscopies, follow up colonoscopies, or work-up from a fecal occult blood test, from January 2021 through June 10th, 2022, in a nonacademic center in the Dominican Republic. Colonoscopies performed during 2021 did not use the CADe technology, while patients in 2022 were exposed to the CADe technology, in addition, each patient was alternatively assigned to either LCI or white light colonoscopy. Two endoscopists performed the procedures during these two years. The primary outcome evaluated was the ADR using LCI vs. white light colonoscopy both with and without the use of artificial intelligence. Secondary outcomes were polyp detection rate (PDR) and average withdrawal time. Results: The ADR in patients not exposed to CADe (2021) was 56.6%, while patients exposed to CADe (2022) presented an ADR of 54.5%. PDR in 2021 was 72.3%, and in 2022 the result was 70.6%. The average withdrawal time in 2021 was 13 minutes and 14 minutes in 2022. When it comes to the use of LCI and white light without the use of AI (2021), the ADR with LCI was 52%, while the use of white light colonoscopy resulted in an ADR of 50.9%. The ADR in patients exposed to LCI with AI (2022) was 61.1%, while patients exposed to white light with AI presented an ADR of 61%. Conclusion: The polyp and adenoma detection rates calculated were higher than the average considered for a high-quality colonoscopy both with and without the use of artificial intelligence. When it comes to the use of other technologies like LCI, ADR was higher with LCI when compared to white light colonoscopy, while the NNT was 90. When comparing the use of both technologies, there was still no significant difference. Further studies are still needed to assess these new technologies and their effect on colonoscopy and polyp detection.

Top tips on organizing effective bowel preparation in the endoscopy unit

One of the most important aspects of a high-quality colonoscopy is the bowel preparation, eg, quality of bowel preparation, patient adherence, simple instructions, and reminders. In this issue of Gastrointestinal Endoscopy, Dr Aasma Shaukat provides easy-to-follow tips and instructions on how to organize an effective bowel preparation in the endoscopy unit. She highlights the importance of simple instructions, multiple methods and languages for providing the information, training of personnel who provide the instructions, and periodic review or audit of the methods used.