High-quality Colonoscopy Research Articles

Dedicated staff for patient education improves bowel preparation quality and reduces the cecal intubation time of colonoscopy: A single institution retrospective study.

Adequate bowel preparation is an essential part of a high-quality colonoscopy. Recent studies showed that the small-volume bowel cleansing agent Bowklean performs better in terms of tolerability and acceptability. However, its split-dose regimen is sometimes confusing to the patient. To promote Bowklean in Fu Jen Catholic University Hospital, dedicated staff for patient education on bowel preparation were provided by Universal Integrated Corporation (Taiwan), but not in every period because of the clinic room availability and manpower capacity. This provided us an opportunity to compare the quality of colonoscopy between those with and without the dedicated patient education. This study aimed to compare various quality indices between the two groups. We set bowel preparation quality as the primary endpoint, assessed by modified Aronchick scale, and other quality indices including procedure time and adenoma detection rate as the secondary endpoints. We performed a single institution retrospective study. All patients who received colonoscopy from an outpatient setting with Bowklean as the bowel cleansing agent from October 2020 to November 2020 were reviewed. Primary and secondary endpoints were then compared between the conventional group and the dedicated staff group, with StataSE 14 by Wilcoxon rank sum test or logistic regression. Four hundred ten patients were recruited, including 217 patients with dedicated patient education and 193 without. The proportion of bowel preparation quality “Excellent + Good + Fair” was significantly higher in dedicated staff group than conventional group (97.7% vs 93.3%, P = .03; logistic regression coefficient = 1.12). The cecal intubation time was significantly shorter in the dedicated staff group (3.68 ± 2.02 minutes vs 4.52 ± 3.25 minutes, P < .01). After excluding those with polypectomy or biopsy, the total procedure time tended to be shorter in the dedicated staff group (10.2 ± 3.35 minutes vs 9.40 ± 2.43 minutes, P = .06). There was no significant difference regarding adenoma detection rate between the two groups. Our study shows that patient education by dedicated staff can improve bowel preparation quality and has the potential to decrease procedure time. Further large-scale prospective trials are still needed to evaluate if it can also achieve a better adenoma detection rate.

The Effectiveness and Tolerability of a Very Low-Volume Bowel Preparation for Colonoscopy Compared to Low and High-Volume Polyethylene Glycol-Solutions in the Real-Life Setting.

Adequate bowel cleansing is essential for high-quality colonoscopy. Recently, a new very low-volume 1 litre (1L) polyethylene glycol (PEG) plus ascorbate solution (ASC) has been introduced. Our aims were to assess the effectiveness and tolerability of this product compared to low-volume 2L PEG-ASC and high-volume 4L PEG solutions, in a real-life setting. In six endoscopy units in Sweden, outpatients undergoing colonoscopy were either prescribed solutions according to local routines, or the very low-volume solution in split dose regimen. Bowel cleansing effectiveness and patient experience was assessed using the Boston Bowel preparation scale (BBPS) and a patient questionnaire. A total of 1098 patients (mean age 58 years, 52% women) were included. All subsegment and the total BBPS scores were significantly greater for 1L PEG-ASC in comparison to other solutions (p < 0.05 for 1L PEG-ASC and 4L PEG for transverse and left colon, otherwise p < 0.001). Nausea was more frequent with 1L PEG-ASC compared to 2L PEG-ASC (p < 0.001) and vomiting were more often reported compared to both other solutions (p < 0.01 and p < 0.05 for 2L PEG-ASC and 4L PEG, respectively). Smell, taste, and total experience was better for 1L PEG-ASC compared to 4L PEG (p < 0.001), and similar compared to the 2L PEG-ASC. In conclusion, 1L PEG-ASC leads to better bowel cleansing compared to 2L PEG-ASC or 4L PEG products, with similar or greater patient satisfaction.

High-Quality Colonoscopy: A Review of Quality Indicators and Best Practices

Colorectal cancer (CRC) continues to be the third leading cause of cancer-related deaths in the US. Colonoscopy remains the best preventative tool against the development of CRC. As a result, high-quality colonoscopy is becoming increasingly important. Specifically, recent guidelines have highlighted pre-procedural, peri-procedural, and post-procedural practices, which promise to improve patient outcomes and reduce the mortality and interval cancer rates in patients undergoing colonoscopies. Despite the guidelines and advances in modern endoscopy, the procedure remains provider-dependent, which results in differences in outcomes. As a result, incorporating high-quality colonoscopy approaches early in training is key to improving patient outcomes. Additionally, ensuring that high-quality colonoscopy is practiced widely by endoscopists can lead to the most cost-effective care.

Supplementary education can improve the rate of adequate bowel preparation in outpatients: A systematic review and meta-analysis based on randomized controlled trials

Colonoscopy is widely used for the screening, diagnosis and treatment of intestinal diseases. Adequate bowel preparation is a prerequisite for high-quality colonoscopy. However, the rate of adequate bowel preparation in outpatients is low. Several studies on supplementary education methods have been conducted to improve the rate of adequate bowel preparation in outpatients. However, the controversial results presented encourage us to perform this meta-analysis. According to the PRISMA statement (2020), the meta-analysis was registered on PROSPERO. We searched all studies up to August 28, 2021, in the three major electronic databases of PubMed, Web of Science and Cochrane Library. The primary outcome was adequate bowel preparation rate, and the secondary outcomes included bowel preparation quality score, polyp detection rate, adenoma detection rate, cecal intubation time, withdrawal time, nonattendance rate and willingness to repeat rate. If there was obvious heterogeneity, the funnel plot combined with Egger's test, meta-regression analysis, sensitivity analysis and subgroup analysis were used to detect the source of heterogeneity. RevMan 5.3 and Stata 17.0 software were used for statistical analysis. A total of 2061 records were retrieved, and 21 full texts were ultimately included in the analysis. Our meta-analysis shows that supplementary education can increase the rate of adequate bowel preparation for outpatients (79.9% vs 72.9%, RR = 1.14, 95% CI: 1.08-1.20, I2 = 87%, p<0.00001). Supplementary education shortened the withdrawal time (MD: -0.80, 95% CI: -1.54 to -0.05, p = 0.04) of outpatients, increased the Boston Bowel Preparation Scale (MD: 0.40, 95% CI: 0.36 to 0.44, p<0.00001), reduced the Ottawa Bowel Preparation Scale (MD: -1.26, 95% CI: -1.66 to -0.86, p<0.00001) and increased the willingness to repeat (91.9% vs 81.4%, RR:1.14, 95% CI: 1.04 to 1.25, p = 0.004). Supplementary education for outpatients based on the standard of care can significantly improve the quality of bowel preparation.

Colonoscopy quality and endoscopist factors: what are the required endoscopist conditions for high-quality colonoscopy to reduce colorectal cancer incidence and mortality?

To maximize the effectiveness of colonoscopy in decreasing the incidence and mortality of colorectal cancer (CRC), high-quality colonoscopy procedures are essential. Considering that the colonoscopy quality varies among endoscopists, it is important to understand the endoscopist factors that influence the colonoscopy quality. In this paper, we reviewed the endoscopist factors related to colonoscopy quality. There are several quality indicators of colonoscopy, among which the adenoma detection rate is the most established indicator with evidence of its correlation with post-colonoscopy CRC. With respect to lesion detectability during colonoscopy, there are other measurements such as the sessile serrated lesion detection rate; however, further evidence on their relationships with post-colonoscopy CRC is needed. Previous studies that have examined the endoscopist characteristics influencing colonoscopy quality have suggested that several factors, including experience, the volume of colonoscopy procedures, and endoscopist specialty, are related to lesion detectability. However, discrepancies exist regarding the studies’ results; in particular, the influence of endoscopist specialty on coloscopy quality is controversial. Some recent studies have demonstrated that endoscopist specialty is not related to lesion detectability when considering confounding factors. Furthermore, it has been reported that nurse endoscopists can provide high-quality colonoscopy after training. It may be possible for endoscopists to improve their colonoscopy quality, regardless of specialty. Training, monitoring, and feedback of colonoscopy quality measurements are useful interventions for endoscopists to ensure high-quality procedures. Owing to the continuous development of endoscopic technologies, it is believed that training is useful for both inexperienced and experienced endoscopists.

Prospective comparison of an adult, an intermediate pediatric and a long pediatric colonoscope in the training process of gastrointestinal fellows to achieve high-quality practice in colonoscopy.

BackgroundFew data are available on the influence of colonoscope type on the training process and quality of colonoscopy. We conducted this prospective observational cohort study to investigate scope suitability for starting colonoscopy training, in relation to technical competence, quality indicators, and the patient’s comfort during diagnostic colonoscopy.MethodsA total of 126 consecutive patients were enrolled in the study and assigned to one of 3 groups: adult colonoscope ([AC], n=41); intermediate pediatric colonoscope ([IPC], n=43); and long pediatric colonoscope ([LPC], n=42). Primary outcomes were completeness of the examination and minutes to the cecum. Secondary outcomes included patient tolerance, position change, use of abdominal compression, loop formation, kind of loop, and overall difficulty of the procedure.ResultsCecal intubation rates were not statistically different between the groups: AC/87.8%; IPC/81.4%; and LPC/92.8%. Terminal ileal intubation rate differed significantly among the 3 groups (P=0.015) with LPC having the higher rate (66.7% vs. 60.9%/AC and 37.2%/IPC). There were significant differences in positional changes (fewer with LPC/1.36 vs. AC/2.15 and IPC/2.09, P=0.027) and midazolam administered doses (lower with LPC/0.52 vs. AC/1.07 and IPC/0.93, P=0.032). Loop formation with subsequent resolution was significantly associated with more pain for the patient with all of the 3 colonoscope types.ConclusionsThe LPC performs better in trainee hands than AC and IPC in terms of reaching competency, and quality indicators show less discomfort for the patients during colonoscopic procedures (lower midazolam dose and fewer positional changes). It could be considered the most suitable scope for starting high-quality colonoscopy training.

Artificial intelligence for the assessment of bowel preparation

A reliable assessment of bowel preparation is important to ensure high-quality colonoscopy. Current bowel preparation scoring systems are limited by interobserver variability. This study aimed to demonstrate objective assessment of bowel preparation adequacy using an artificial intelligence (AI)/convolutional neural network (CNN) algorithm developed from colonoscopy videos. Two CNNs were developed using a training set of 73,304 images from 200 colonoscopies. First, a binary CNN was developed and trained to distinguish video frames that were appropriate versus inappropriate for scoring with the Boston Bowel Preparation Scale (BBPS). A second multiclass CNN was developed and trained on 26,950 appropriate frames that were expertly annotated with BBPS segment scores (0-3). We validated the algorithm using 252 10-second video clips that were assigned BBPS segment scores by 2 experts. The algorithm provided mean BBPS scores based on the algorithm (AI-BBPS) by calculating mean BBPS based on each frame's scoring. We maximized the algorithm's performance by choosing a dichotomized AI-BBPS score that closely matched dichotomized BBPS scores (ie, adequate vs inadequate). We tested the mean BBPS score based on the algorithm AI-BBPS against human rating using 30 independent 10-second video clips (test set 1) and 10 full withdrawal colonoscopy videos (test set 2). In the validation set, the algorithm demonstrated an area under the curve of .918 and accuracy of 85.3% for detection of inadequate bowel cleanliness. In test set 1, sensitivity for inadequate bowel preparation was 100% and agreement between raters and AI was 76.7% to 83.3%. In test set 2, sensitivity for inadequate bowel preparation for each segment was 100% and agreement between raters and AI was 68.9% to 89.7%. Agreement between raters alone versus raters and AI were similar (κ= .694 and .649, respectively). The algorithm assessment of bowel cleanliness as measured with the BBPS showed good performance and agreement with experts including full withdrawal colonoscopies.

Polyp Detection from Colorectum Images by Using Attentive YOLOv5.

Background: High-quality colonoscopy is essential to prevent the occurrence of colorectal cancers. The data of colonoscopy are mainly stored in the form of images. Therefore, artificial intelligence-assisted colonoscopy based on medical images is not only a research hotspot, but also one of the effective auxiliary means to improve the detection rate of adenomas. This research has become the focus of medical institutions and scientific research departments and has important clinical and scientific research value. Methods: In this paper, we propose a YOLOv5 model based on a self-attention mechanism for polyp target detection. This method uses the idea of regression, using the entire image as the input of the network and directly returning the target frame of this position in multiple positions of the image. In the feature extraction process, an attention mechanism is added to enhance the contribution of information-rich feature channels and weaken the interference of useless channels; Results: The experimental results show that the method can accurately identify polyp images, especially for the small polyps and the polyps with inconspicuous contrasts, and the detection speed is greatly improved compared with the comparison algorithm. Conclusions: This study will be of great help in reducing the missed diagnosis of clinicians during endoscopy and treatment, and it is also of great significance to the development of clinicians’ clinical work.

Adenoma Detection Rates for 45- to 49-Year-Old Screening Population

Adenoma Detection Rates for 45- to 49-Year-Old Screening Population

Effectiveness and safety of 1L PEG-ASC preparation for colonoscopy in patients with inflammatory bowel diseases

IntroductionThe effectiveness of bowel cleansing is a key element for high-quality colonoscopy. Recently, a 1 L polyethylene glycol plus ascorbate (PEG-ASC) solution has been introduced, but effectiveness and safety of this preparation have not been assessed in IBD patients. This study aims to evaluate effectiveness and safety of 1 L PEG-ASC solution in patients with IBD compared to controls. MethodsWe retrospectively analysed prospectively collected data on a cohort of 411 patients performing a colonoscopy after preparation with 1 L PEG-ASC, consecutively enrolled in 5 Italian centres. ResultsOverall, 185/411 (45%) were patients with IBD and 226/411 (55%) served as controls. A significantly higher cleansing success was achieved in IBD patients (92.9% vs 85.4%, p = 0.02). The multiple regression model showed that presence of IBD (OR=2.514, 95%CI=1.165–5.426; P = 0.019), lower age (OR=0.981, 95%CI=0.967–0.996; P = 0.014), split preparation (OR=2.430, 95%CI=1.076–5.492; P = 0.033), absence of diabetes (OR=2.848, 95%CI=1.228–6.605; P = 0.015), and of chronic constipation (OR=3.350, 95%CI=1.429–7.852; P = 0.005), were independently associated with cleansing success. The number of treatment-emergent adverse events (TEAEs) (51 vs 62%, p = 0.821), and of patients with TEAEs (22.2% vs 21.2%, p = 0.821), were similar in IBD patients and in controls, respectively. ConclusionsResults from this study support the effectiveness and safety of 1 L PEG-ASC solution in IBD patients, which may improve the definition of endoscopic outcomes both in Crohn’s disease and ulcerative colitis.

Association of Adenoma Detection Rate and Adenoma Characteristics With Colorectal Cancer Mortality After Screening Colonoscopy

Background & AimsThe adenoma detection rate (ADR) and characteristics of previously resected adenomas are associated with colorectal cancer (CRC) incidence and mortality. However, the combined effect of both factors on CRC mortality is unknown. Patients and methodsUsing data of the Austrian quality assurance program for screening colonoscopy, we evaluated the combined effect of ADR and lesion characteristics on subsequent risk for CRC mortality. We analyzed mortality rates for individuals with low-risk adenomas (1–2 adenomas <10 mm), individuals with high-risk adenomas (advanced adenomas or ≥3 adenomas), and after negative colonoscopy (negative colonoscopy or small hyperplastic polyps) performed by endoscopists with an ADR <25% compared with ≥25%. Cox regression was used to determine the association of combined risk groups with CRC mortality, adjusted for age and sex. ResultsWe evaluated 259,885 colonoscopies performed by 361 endoscopists. A total of 165 CRC-related deaths occurred during the follow-up period, up to 12.2 years. In all risk groups, CRC mortality was higher when colonoscopy was performed by an endoscopist with an ADR <25%. Compared with negative colonoscopy with an ADR ≥25%, CRC mortality was similar for individuals with low-risk adenomas irrespective of ADR (for ADR ≥25%: adjusted hazard ratio [HR], 1.22; 95% confidence interval [CI], 0.59–2.49; for ADR <25%: adjusted HR, 1.25; 95% CI, 0.64–2.43) and after negative colonoscopy with ADR <25% (adjusted HR, 1.27; 95% CI, 0.81–2.00). Individuals with high-risk adenomas were at significantly higher risk for CRC death if colonoscopy was performed by an endoscopist with an ADR <25% (adjusted HR, 2.25; 95% CI, 1.18–4.31) but not if performed by an endoscopist with an ADR ≥25% (adjusted HR, 1.35; 95% CI, 0.61–3.02). ConclusionsOur study adds important evidence for mandatory assessment and monitoring of performance quality in screening colonoscopy. High-quality colonoscopy was associated with a lower risk for CRC death, and the impact of ADR was strongest for individuals with high-risk adenomas.

Impact of cumulative experience on the quality of screening colonoscopy: A 13-year observational study.

To investigate trends in quality of screening colonoscopy (using the Global Rating Score) in the 13 years since introduction of the Bowel Cancer Screening Programme in England. An English Bowel Cancer Screening Programme colonoscopy service from 2007 to 2019. A retrospective observational study was undertaken using a prospectively collected database in order to analyse trends in screening endoscopies (including patients following positive faecal occult blood test or with high-risk findings on flexible sigmoidoscopy). The Global Rating Score quality indicators for Bowel Cancer Screening Programme colonoscopy were used as outcome measures, and trends over time were analysed. These included caecal intubation rate, adenoma detection rate, colorectal cancer detection rate, proportion of patients with minimal or mild discomfort scores, proportion of patients who required intravenous sedation, and adverse events. There were 5352 colonoscopies included, performed by 3 endoscopists; 73.8% were index procedures (i.e. first Bowel Cancer Screening Programme colonoscopy) and the remainder were follow-up or surveillance colonoscopies. The mean age of patients was 66 (standard deviation 5) years, and 59.8% were male. Mean age increased over time (R2=0.033; p < 0.001). There were significant trends over time towards higher caecal intubation rate (p = 0.015), higher adenoma detection rate (p < 0.001), lower proportion requiring intravenous sedation (p < 0.001). There were no significant trends in comfort scores (p = 0.606), adverse events (p = 0.503) or colorectal cancer detection (p = 0.089). There was a consistent improvement in the Global Rating Score for Bowel Cancer Screening Programme colonoscopies since the start of the programme, even when quality was already high at the start. Patients can expect high-quality colonoscopy when participating in the Bowel Cancer Screening Programme.

A comprehensive intervention to enhance inpatient colon preparation quality for colonoscopy.

Adequate colon preparation is a critical component of high-quality colonoscopy especially for inpatients undergoing colonoscopy for acute indications. Inpatient colonoscopy has a high incidence of inadequate preparations. We report implementation of a multifaceted quality improvement intervention to improve inpatient colonoscopy preparations. Bowel preparation quality from inpatient colonoscopies performed for the 12 months prior to the comprehensive intervention were compared to colonoscopies performed for 12 months following the intervention. The intervention had multiple components including: 1) EMR-based colonoscopy preparation order set; 2) automated EMR alerts prompting nursing assessment of preparation progress; 3) standardized nursing charting processes for tracking preparation progress; and 4) standardized education for nursing staff and ordering providers on adequate colon preparation, assessment of colon preparation quality, and use of the above processes; and print and video patient education materials. Two hundred thirty-eight inpatient colonoscopies were performed in the preintervention assessment period and 163 colonoscopies in the postintervention period. Median preintervention Boston Bowel Preparation Score (BBPS) was 6 and 26% of patients had inadequate colon preparation. Median postintervention BBPS was 8 with 16% inadequate colon preparation (P=0.016). The postintervention group had less ASA class I patients and used a lower dose of fentanyl than the preintervention group. There were no other significant differences between the pre- and postintervention groups. Implementation of a comprehensive colon preparation quality intervention resulted in significantly improved inpatient colon preparation quality and decreased frequency of inadequate preparations. The intervention consisting of an EMR-based order-set, nursing alerts and charting process, and patient education materials is continually being refined.

Colonoscopy quality indicators in patients with and without prior colonic resection: A single-centre prospective comparative study.

Effective colonoscopy relies on meeting rigorous quality control thresholds. Some earlier studies evaluating colonoscopy key performance indicators (KPIs) have excluded patients who have previously undergone colonic resection (i.e., they have a nonintact colon); such patients also deserve high-quality colonoscopy. This study aimed to compare colonoscopy KPIs between patients with nonintact and intact colons. Consecutive colonoscopies performed at Whanganui Hospital (New Zealand) between September 2016 and March 2020 were included. The primary outcome was the caecal or ileal intubation rate (CIIR). Secondary outcomes were the adenoma detection rate (ADR), polyp detection rate (PDR), colonoscope withdrawal time (CWT) and caecal or ileal intubation time (CIIT). In total, 3017 colonoscopies were performed: 322 in nonintact colons and 2695 in intact colons. CIIR was significantly higher in nonintact than in intact colons (98.4% vs. 95.0%; P=0.0086). When all colonoscopies were included, the CIIR was 95.4%; this value decreased to 95.0% when nonintact colonoscopies were excluded. However, the ADR (39.9% vs. 38.8%; P=0.77) and PDR (58.4% vs. 59.1%; P=0.86) were similar for both nonintact and intact colons. CWT (P<0.0001) and CIIT (P<0.0001) were significantly shorter in participants with nonintact colons. The CIIR exceeded recommended targets and was 3.4% higher in patients with nonintact than intact colons. Patients with nonintact colons comprise a small proportion of the overall colonoscopy cohort and it is unlikely that this small difference is relevant for most endoscopists or endoscopy units. The ADR and PDR were similar among patients with nonintact and intact colons, despite nonintact colonoscopies being significantly quicker. Patients with nonintact colons deserve high-quality colonoscopy and therefore their KPIs should be included in colonoscopy performance reports.

Long-Term Incidence of Advanced Colorectal Neoplasia in Patients with Serrated Polyposis Syndrome: Experience in a Single Academic Centre

Simple SummarySerrated polyposis syndrome is characterized by the development of large and/or multiple serrated polyps throughout the colorectum and is associated with an increased risk of colorectal cancer (CRC). Even though CRC incidence is low under adequate endoscopic follow-up, a substantial risk of advanced neoplasia (AN) has been described. Nevertheless, very few studies have focused on long-term surveillance. The main aim of this study was to evaluate the incidence of AN in a single-centre cohort followed over 10 years. Within endoscopic surveillance we did not find any CRC and we observed that five-year cumulative incidences of AN were much lower than in other studies. However, a significant reduction of these incidences during follow-up was not proven. Individuals at higher risk of AN were those who fulfilled both 2010 WHO criteria I and III. Our results suggest that at least patients at lower risk might benefit from the extension of surveillance intervals.Serrated polyposis syndrome (SPS) implies a slightly elevated risk of colorectal cancer (CRC) during endoscopic follow-up, but its natural course is still not well known. The main objective of this study was to describe the long-term risk of developing advanced neoplasia (AN) in these patients. Until October 2020, individuals who fulfilled 2010 WHO criteria I and/or III for SPS were retrospectively recruited. We selected those under endoscopic surveillance after resection of all lesions >3 mm in a high-quality colonoscopy. We excluded patients with total colectomy at diagnosis and those with any interval between colonoscopies >3.5 years. We defined AN as advanced serrated polyp (≥10 mm and/or with dysplasia), advanced adenoma, or CRC. In 109 patients, 342 colonoscopies were performed (median = 3, median interval = 1.8 years) during a median follow-up after colonic clearance of 5.0 years. Five-year cumulative incidences of AN were 21.6% globally, and 5.6%, 10.8%, and 50.8% in patients who fulfilled criterion I, III, and both, respectively (p < 0.001). No CRC was diagnosed and only 1 (0.9%) patient underwent surgery. In conclusion, cumulative incidences of AN could be lower than previously described, at least in patients who fulfil the 2010 WHO criterion III alone. Therefore, low-risk individuals might benefit from less stringent surveillance.

Equity of colonoscopy provision and quality in Māori and New Zealand Europeans: a comparative retrospective study.

High-quality colonoscopy is essential for investigating suspected colorectal cancer and relies on endoscopists meeting key performance indicator (KPI) targets. The rising demand for colonoscopy raises concerns that Māori populations could be under-served. This study aimed to compare rates of colonoscopy provision and colonoscopy KPIs between Māori and New Zealand (NZ) European patients. This retrospective comparative study was conducted at Whanganui Hospital (NZ). Consecutive colonoscopies performed between September 2016 and March 2020 were included. Primary outcome was the rate of colonoscopy provision for the population. Secondary outcomes were the colonoscopy completion rate (CCR), colonoscope withdrawal time (CWT), polyp detection rate (PDR) and adenoma detection rate (ADR). Subgroup analysis of ADR in index symptomatic colonoscopies was also performed. A total of 2962 colonoscopies were analysed (385 Māori; 2577 NZ European). Rates of colonoscopy provision in participants aged ≥40 were significantly lower among Māori (6.1% versus 9.1%; P < 0.0001). The CCR (P=1.00), CWT (P=0.28) and PDR (P=0.24) were similar. Whilst the ADR in the overall cohort was significantly lower in Māori (32.7% versus 40.0%; P=0.028), this was not observed when stratified by 10-year age cohorts. The ADR was similar on subgroup analysis of index symptomatic colonoscopies (P=0.42). This study found inequities in access to colonoscopy services for Māori compared to NZ European patients. Among those that did receive colonoscopy, there were no differences in colonoscopy quality after age stratification. Improving equity will require the addition of colonoscopy provision rates to other mandatory KPIs and reporting these by ethnicity in all endoscopy units.

Improvement in adenoma detection using a novel artificial intelligence-aided polyp detection device.

Background and study aims Detecting colorectal neoplasia is the goal of high-quality screening and surveillance colonoscopy, as reflected by high adenoma detection rate (ADR) and adenomas per colonoscopy (APC). The aim of our study was to evaluate the performance of a novel artificial intelligence (AI)-aided polyp detection device, Skout, with the primary endpoints of ADR and APC in routine colonoscopy. Patients and methods We compared ADR and APC in a cohort of outpatients undergoing routine high-resolution colonoscopy with and without the use of a real-time, AI-aided polyp detection device. Patients undergoing colonoscopy with Skout were enrolled in a single-arm, unblinded, prospective trial and the results were compared with a historical cohort. All resected polyps were examined histologically. Results Eighty-three patients undergoing screening and surveillance colonoscopy at an outpatient endoscopy center were enrolled and outcomes compared with 283 historical control patients. Overall, ADR with and without Skout was 54.2 % and 40.6 % respectively ( P = 0.028) and 53.6 % and 30.8 %, respectively, in screening exams ( P = 0.024). Overall, APC rate with and without Skout was 1.46 and 1.01, respectively, ( P = 0.104) and 1.18 and 0.50, respectively, in screening exams ( P = 0.002). Overall, true histology rate (THR) with and without Skout was 73.8 % and 78.4 %, respectively, ( P = 0.463) and 75.0 % and 71.0 %, respectively, in screening exams ( P = 0.731). Conclusion We have demonstrated that our novel AI-aided polyp detection device increased the ADR in a cohort of patients undergoing screening and surveillance colonoscopy without a significant concomitant increase in hyperplastic polyp resection. AI-aided colonoscopy has the potential for improving the outcomes of patients undergoing colonoscopy.

The Impact of Patient Education Level on Split-Dose Colonoscopy Bowel Preparation for CRC Prevention

IntroductionAGA guidelines emphasize split-dose bowel preparation (BP) to ensure high-quality colonoscopy for the prevention of colorectal cancer (CRC). Split dose results in higher-quality preparation, but understanding instructions might be more difficult. Lower education levels may negatively influence BP quality. The confounding role of education level on BP quality was investigated.MethodsThis was a cross-sectional study of 60 patients given split-dose BP. Patients consented and were asked three Likert scale questions based on BP instructions before the procedure. Compliance was self-reported. BP adequacy and the number of adenomas were recorded. BP was characterized as adequate (excellent, good) or inadequate (fair, poor). Data was analyzed with chi-square, odds ratio, Mann-Whitney, and regression analysis.ResultsThirty-one (52%) patients were high school graduates, 21 (38%) completed some college, and 6 (10%) were college graduates. College-educated patients had adequate BP (72%) more often than high school graduates (51%) (p = 0.02). Adenoma findings were not significantly different. The Likert scale mean ranks for patient understanding and reviewing of instructions were comparable between the two groups. Patient rating of scheduler explanations of the importance of following instructions was significantly better in the college group (mean ranks 2.59 and 1.83, respectively; p = 0.018).DiscussionPatient education level significantly affected the success of BP. Split BP can be more complex to comprehend, and instructions should consider patient education level. Specific intervention programs should be implemented to advise patients with less education that poor preparation may result in missed advanced neoplasias and subsequent procedures.

Patient-centered approaches to targeting incomplete bowel preparations for inpatient colonoscopies.

BackgroundA high-quality colonoscopy bowel prep is vital to completing the procedure. Adequate inpatient bowel preparation has been consistently difficult to achieve because of multiple factors. Incomplete bowel prep can lead to repeated colonoscopies, poor patient experience, increased costs, and prolonged hospitalization. This study aimed to develop patient-centered interventions to optimize bowel prep for inpatients undergoing colonoscopy.MethodsThe Model for Improvement and Donabedian frameworks guided this project. An interdisciplinary team compiled quality improvement tools that identified areas for improvement. Interventions development included a nursing tip sheet for troubleshooting symptoms, a standardized order label and a patient educational placemat. Plan-Do-Study-Act (PDSA) cycles were carried out to test and analyze the effects of the interventions. The project aim was a 30% reduction in incomplete inpatient colonoscopies from poor bowel prep. Process measures included the number of colonoscopy split prep order labels, and placemats used. The balancing measure was the number of repeat colonoscopies.ResultsPrior to the intervention, 44% (44/99) of inpatient colonoscopies had poor bowel prep resulting in 10 repeat procedures (10%). Post intervention, 60% (28/47) of the colonoscopies used the standardized label, 66% of physician orders used 2-L split prep, and 80% of patients were provided with the educational placemat. Of the 47 colonoscopies audited post intervention, there was a significant decrease in poor prep (27.7% [13/47], P=0.038) for colonoscopies. The percentage of repeated colonoscopies decreased to 4% (2/47).ConclusionDeveloping simple and easy-to-use patient-centered interventions can effectively improve colonoscopy preparation for hospitalized patients.

CURRENT PRACTICE OF TRISULFATE APPLYING FOR BOWEL CLEANSING IN ACCORDING TO CLINICAL SAFETY POSITIONS

High-quality bowel cleansing is the basis for effective colon examination. Inadequate preparation of the colon can be the reason for nondetection of colorectal polyps during the examination and reach 12%. The objective of this publication is to present current literature data based on the principles of evidence-based medicine that address the safety of using trisulfate in preparation for colonoscopy. It was found that the drug for intestinal cleansing, which is a low-volume one-liter hyperosmotic based on a combination of sodium, potassium and magnesium sulfate salts, has a high efficiency of preparing the intestine for colonoscopy. The percentage of patients with successful bowel preparation using trisulfate is 97%. At the same time, the drug has an acceptable safety profile, including for patients from risk groups. The results of this review indicate that the new low-volume one-liter trisulfate is an effective remedy for providing one of the most important indicators of highquality colonoscopy - bowel cleansing and has a high safety profile.