Therapeutic Colonoscopy Research Articles

Colorectal cancer screening by fecal immunochemical test or colonoscopy in France: how many people are actually covered? Focus on the Provence-Alpes-Côte d'Azur region.

BackgroundColorectal cancer (CRC) screening with fecal immunochemical test (FIT) remains low in France, particularly in the Provence-Alpes-Côte-d’Azur (PACA) region. The aim of this study was to compare insured persons (50–74 years) who had FIT and/or colonoscopy in PACA with the general French population.MethodsFIT and colonoscopy rates were calculated according to SP-France and National Health Data System data.ResultsThe rate of FIT in 2016–2017 was lower in PACA than in France (25.6 vs. 29.1%, P < 0.001). Conversely, in 2013–2017, the rate of colonoscopy in the past 5 years was higher in PACA than in France (23.1 vs. 20.1%, P < 0.001). Total rate for FIT within 2 years and/or colonoscopy within 5 years was 46.0% in PACA vs. 46.5% in France (P < 0.001). Overuse was higher for diagnostic (1.21) than therapeutic colonoscopies (1.05). Therapeutic colonoscopy occurred more with FIT than without (47.88 vs. 38.7%, P < 0.001). According to USA criteria, persons with FIT within 2 years and/or sigmoidoscopy and/or colonoscopy within 10 years was 59.4% in PACA vs. 54.7% in France (P < 0.001).ConclusionLow participation in FIT in France must be improved to increase the rate of therapeutic colonoscopies and reduce the incidence of CRC. The higher colonoscopy rate in PACA could explain the lower CRC mortality. Efforts should be focused on the more than 40% of French insured who are not screened by either FIT or colonoscopy.

A Novel Dynamic Rigidizing Overtube Significantly Eases Difficult Colonoscopy

Colonoscopy is a common procedure for colorectal cancer screening and evaluation of large intestinal pathology such as inflammatory bowel disease and lower gastrointestinal bleeding 1 Kasper DL Fauci AS Hauser SL et al. Harrison's principles of internal medicine 19/E (Vol.1 & Vol.2). 19th ed. McGraw-Hill Professional, 2015 Google Scholar . Colonoscopy allows both viewing of the large intestine up to the cecum and performance of procedures such as polypectomy and control of GI bleeding. 2 Haycock A Cohen J Saunders BP et al. Cotton and Williams’ practical gastrointestinal endoscopy: the fundamentals. John Wiley & Sons, Ltd, 2014 Google Scholar A successful screening colonoscopy involves viewing the entire colon including the cecum and being able to safely perform therapeutic procedures such as polypectomy and control of bleeding. 3 Rees CJ Bevan R Zimmermann-Fraedrich K et al. Expert opinions and scientific evidence for colonoscopy key performance indicators. Gut. 2016; 65: 2045-2060 Google Scholar There are various barriers to successfully completing a colonoscopy including colon looping, poor bowel prep, and patient intolerance of the procedure. 4 Wong JYY Ho KY. Robotics for advanced therapeutic colonoscopy. Clin Endosc. 2018; 51: 552-557 Google Scholar , 5 Serper M Gawron AJ Smith SG et al. Patient factors that affect quality of colonoscopy preparation. Clin Gastroenterol Hepatol. 2014; 12: 451-457 Google Scholar For the practicing endoscopist, looping of the colon can be a significant barrier to successful completion of colonoscopy. This often leads to suboptimal outcomes including prolonged anesthesia, limited examination and therapy, and overall diminished patient care.

Delayed Bleeding After Endoscopic Resection of Colorectal Polyps: Identifying High-Risk Patients.

Delayed post-polypectomy bleeding (DPPB) is a potentially severe complication of therapeutic colonoscopy which can result in hospital readmission and re-intervention. Over the last decade, rates of DPPB reported in the literature have fallen from over 2% to 0.3–1.2%, largely due to improvements in resection technique, a shift towards cold snare polypectomy, better training, adherence to guidelines on periprocedural antithrombotic management, and the use of antithrombotics with more favourable bleeding profiles. However, as the complexity of polypectomy undertaken worldwide increases, so does the importance of identifying patients at increased risk of DPPB. Risk factors can be categorised according to patient, polyp and personnel related factors, and their integration together to provide an individualised risk score is an evolving field. Strategies to reduce DPPB include safe practices relevant to all patients undergoing colonoscopy, as well as specific considerations for patients identified to be high risk. This narrative review sets out an evidence-based summary of factors that contribute to the risk of DPPB before discussing pragmatic interventions to mitigate their risk and improve patient safety.

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

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

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

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

CUERPO EXTRAÑO PUNZANTE LOCALIZADO EN APÉNDICE CECAL, DE DOS MESES DE EVOLUCIÓN. EXTRACCIÓN POR COLONOSCOPIA - INFORME DE CASO.

Introduction Ingestion of foreign bodies implies a 35% risk of possible complications, which are associated with their type (blunt or sharp) and their size. Although in most of them, it is expected that they pass along the gastrointestinal tract without difficulty or complications, the management will depend on the characteristics of the swallowed object, time of evolution and symptoms of the patient. Case description We present the clinical case of a 58-year-old female patient with a recent gastric bypass surgical history, who accidentally ingested a piece of dental equipment two months earlier during a dental procedure, remaining asymptomatic until she came to our office. In radiographic controls for confirmation, location and evolution, the presence of a 2 cm sharp object was evidenced, apparently located in the cecal appendix, which does not progress distally. For the management, initial expectant management was proposed, which was completed with therapeutic colonoscopy for its extraction, the technique recommends that the sharp object should be grasped by the pointed end, distal to the wall, which reduces the risk of perforation related to the procedure or damage of the mucosa during extraction, the case is completed with successful resolution and without complications. Conclusion Less invasive therapeutic management such as colonoscopy should be considered first line in this type of case, when there are no signs or radiological findings of perforation or clinical instability, due to its low incidence of complications and a high success rate.

Safety of Endoscopy in Peritoneal Dialysis Patients.

INTRODUCTION:Endoscopic procedures can provoke peritonitis in patients receiving peritoneal dialysis (PD). The aim of this study was to assess the development of peritonitis after endoscopic procedures in PD patients.METHODS:We retrospectively reviewed the data from PD patients who underwent endoscopies in 3 tertiary hospitals between 2008 and 2018. The patients were grouped into nonprophylactic, prophylactic, and prior antibiotic therapy groups. The incidence of peritonitis within 7 days of endoscopy was assessed. We also examined the factors associated with peritonitis.RESULTS:There were 1,316 endoscopies performed in 570 PD patients. The peritonitis rate after endoscopy was 3.0%. Specifically, the peritonitis rate was 1.8% for esophagogastroduodenoscopies, 4.2% for the colonoscopy group, and 5.3% for the sigmoidoscopy group. The prior antibiotic therapy group showed a significantly higher risk of peritonitis (odds ratio = 4.6; 95% confidence interval: 2.2–9.6; P < 0.01). Prophylactic antibiotics were not associated with reducing peritonitis. Therapeutic colonoscopies such as polypectomy were associated with an increased risk of developing peritonitis (odds ratio = 6.5; 95% confidence interval: 1.6–25.9). However, biopsies were not associated with an increased risk of peritonitis.DISCUSSION:Prophylactic antibiotics did not reduce the risk of peritonitis after endoscopy in PD patients. Therapeutic colonoscopies such as polypectomy and prior antibiotic therapy before endoscopy were associated with an increased risk of peritonitis.

Current status of diagnostic and therapeutic colonoscopy in Japan: The Japan Endoscopic Database Project.

The Japan Endoscopy Database Project was initiated to develop the world's largest endoscopy data repository. This study describes the first phase of the colonoscopy project in Japan. Data were aggregated offline by integrating information from the endoscopy database software from January 2015 through March 2017. The study population included all patients who underwent colonoscopy at eight centers. A total of 31,395 patients who underwent 38,497 colonoscopy procedures were registered. The majority of procedures were performed for screening (n = 14,156), followed by fecal immunochemical test positivity (n = 3960), abdominal symptoms (n = 3864), post-colorectal surgery surveillance (n = 3431), post-endoscopic treatment surveillance (n = 3757), thorough pre-treatment examination (n = 2822), and therapeutic purposes (n = 6507). In the screening group, advanced cancers, early cancers, and adenomas were diagnosed endoscopically in 2.1%, 1.3%, and 28.7% of cases, respectively, while in the fecal immunochemical test-positive group, they were diagnosed in 2.5%, 1.9%, and 41.6% of cases, respectively. The incidence of complications was 0.177% and 0.152% in the screening and fecal immunochemical test-positive groups, respectively. The therapeutic procedures included 1446 cold forceps polypectomy procedures, 4770 cold snare polypectomy procedures, 368 hot biopsies, 2998 hot snare polypectomy procedures, 9775 endoscopic or piecemeal endoscopic mucosal resections, and 1660 endoscopic submucosal dissections. A total of 173 procedure-related complications (0.82%) occurred in 21,017 therapeutic procedures performed in 15,744 patients. The first phase of the Japan Endoscopy Database Project established the proportions of the diagnostic and therapeutic colonoscopy procedures, and complication rates in real-world settings.

Joint ACPGBI and The Duke's Club statement on colonoscopy training.

Colorectal surgeons across the UK currently undertake a large proportion of routine diagnostic and therapeutic colonoscopy in most NHS Trusts [1]. Meanwhile, the new UK General Surgical curriculum now includes an indicative requirement of 200 diagnostic colonoscopies for surgical trainees who have declared a colorectal subspecialty interest (hereafter termed 'colorectal trainees'), indicating the JCST's (Joint Committee on Surgical Training) commitment to colonoscopy training. However, several studies have reported a marked deficiency in colonoscopy training opportunities and accreditation for surgical trainees compared with gastroenterology trainees [2-4].

Feature Point Tracking-Based Localization of Colon Capsule Endoscope.

In large bowel investigations using endoscopic capsules and upon detection of significant findings, physicians require the location of those findings for a follow-up therapeutic colonoscopy. To cater to this need, we propose a model based on tracking feature points in consecutive frames of videos retrieved from colon capsule endoscopy investigations. By locally approximating the colon as a cylinder, we obtained both the displacement and the orientation of the capsule using geometrical assumptions and by setting priors on both physical properties of the intestine and the image sample frequency of the endoscopic capsule. Our proposed model tracks a colon capsule endoscope through the large intestine for different prior selections. A discussion on validating the findings in terms of intra and inter capsule and expert panel validation is provided. The performance of the model is evaluated based on the average difference in multiple reconstructed capsule’s paths through the large intestine. The path difference averaged over all videos was as low as cm, with min and max error corresponding to 1.2 and 6.0 cm, respectively. The inter comparison addresses frame classification for the rectum, descending and sigmoid, splenic flexure, transverse, hepatic, and ascending, with an average accuracy of 86%.

Tissue mRNA for S100A4, S100A6, S100A8, S100A9, S100A11 and S100P Proteins in Colorectal Neoplasia: A Pilot Study.

S100 proteins are involved in the pathogenesis of sporadic colorectal carcinoma through different mechanisms. The aim of our study was to assess tissue mRNA encoding S100 proteins in patients with non-advanced and advanced colorectal adenoma. Mucosal biopsies were taken from the caecum, transverse colon and rectum during diagnostic and/or therapeutic colonoscopy. Another biopsy was obtained from adenomatous tissue in the advanced adenoma group. The tissue mRNA for each S100 protein (S100A4, S100A6, S100A8, S100A9, S100A11 and S100P) was investigated. Eighteen biopsies were obtained from the healthy mucosa in controls and the non-advanced adenoma group (six individuals in each group) and thirty biopsies in the advanced adenoma group (ten patients). Nine biopsies were obtained from advanced adenoma tissue (9/10 patients). Significant differences in mRNA investigated in the healthy mucosa were identified between (1) controls and the advanced adenoma group for S100A6 (p = 0.012), (2) controls and the non-advanced adenoma group for S100A8 (p = 0.033) and (3) controls and the advanced adenoma group for S100A11 (p = 0.005). In the advanced adenoma group, differences between the healthy mucosa and adenomatous tissue were found in S100A6 (p = 0.002), S100A8 (p = 0.002), S100A9 (p = 0.021) and S100A11 (p = 0.029). Abnormal mRNA expression for different S100 proteins was identified in the pathological adenomatous tissue as well as in the morphologically normal large intestinal mucosa.

Colonic perforation due to diagnostic or therapeutic colonoscopy

<h3>ЦЕЛЬ ИССЛЕДОВАНИЯ</h3> Провести анализ причин, способов и результатов лечения перфорации толстой кишки при диагностической и лечебной колоноскопии. <h3>МАТЕРИАЛ И МЕТОДЫ</h3> Исследование носило мультицентровой ретроспективный характер. Включено 50 случаев (диагностическая колоноскопия (ДК) — 11, лечебная колоноскопия (ЛК) —39. <h3>РЕЗУЛЬТАТЫ</h3> Перфорация толстой кишки чаще происходила при ДК у лиц более пожилого возраста, чем при ЛК (72,4±6,1 по сравнению с 60,1±11,8 года, <i>p</i>=0,001). Средний размер перфорационного отверстия также был больше при ДК, чем при ЛК (21,6±13,3 мм и 8,6±10,1 мм соответственно, <i>p</i>=0,001). Эндоскопическое клипирование выполнено в 29 (ДК — 1, ЛК — 28) случаях и было неэффективным в 2 (6,9%) случаях. Хирургическое лечение проведено в 21 случае (ДК — 10, ЛК — 11), включая 100% отсроченных перфораций. Средний размер дефекта при хирургическом лечении был больше, чем при клипировании (16,2±15,8 и 8,03±6,7 мм соответственно, <i>p</i>=0,015). <h3>ВЫВОДЫ</h3> Для перфорации толстой кишки при диагностической колоноскопии характерен более пожилой возраст пациентов и больший размер дефекта. Факторами риска необходимости выполнения хирургического вмешательства являются перфорация при проведении диагностической колоноскопии и отсроченный характер перфорации.

From Intention to Action: Operationalizing AGA Diversity Policy to Combat Racism and Health Disparities in Gastroenterology

From Intention to Action: Operationalizing AGA Diversity Policy to Combat Racism and Health Disparities in Gastroenterology

Novel technique using an echo probe cover prevents oral-fecal transmission of SARS-CoV-2 during urgent colonoscopies.

While routine examinations are postponed during the COVID-19 pandemic, urgent therapeutic colonoscopies are mandatory for lower gastrointestinal (GI) bleeding and colorectal ileus. SARS-CoV-2 RNA has been identified in anal/rectal swabs and stools of COVID-19 patients, even after viral clearance from the upper respiratory tract [1] [2]. Feces often overflow during colonoscopy, leading to viral dissemination. Thus, a high risk of infection is associated with colonoscopy, as well as upper GI endoscopy [3]. Reported contamination of endoscopists’ face shields [4] indicates that endoscopy rooms become contaminated. A novel means of blocking patient – generated droplets is therefore required. We introduce a new precautionary technique using an echo probe cover to prevent oral–fecal transmission of SARS-CoV-2 during emergency colonoscopies ([Fig. 1], [Video 1]).

Manejo del cáncer colorrectal durante la pandemia por SARS-CoV-2

El virus SARS-CoV-2 (Severe Respiratory Acute Síndrome por Coronavirus-2) es un beta-coronavirus, que se transmite de persona a persona a través de aerosoles generados por tos o estornudos y por contacto directo con las manos contaminadas a través de las mucosas, causando principalmente compromiso respiratorio. Su origen se considera la ciudad de Wuhan en China y debido a su alta transmisibilidad se convirtió rápidamente en una pandemia, afectando de diferentes formas un gran porcentaje de la población, incluido el personal de la salud, con gran morbi-mortalidad. Esto ha llevado a tomar medidas estrictas con respecto a la disponibilidad del recurso sanitario para atender a la población afectada, así como a la prevención y el manejo de la contaminación de los pacientes no infectados que requieren seguir siendo atendidos por otro tipo de patologías, como es el caso de los pacientes oncológicos. &#x0D; En este trabajo pretendemos revisar el manejo de los pacientes con cáncer colorrectal a la luz de la pandemia, del momento ideal de ser llevados a cirugía, de las opciones del abordaje quirúrgico, de la pertinencia de la colonoscopia diagnóstica y terapéutica, así como de la importancia que reviste la experiencia del cirujano y la institución en el manejo multidisciplinario de la patología colorrectal y de la pandemia de COVID-19. Considerando que la literatura actual está basada en recomendaciones de expertos con bajo grado de evidencia, la intención es presentar algunas sugerencias motivadas en la experiencia de nuestras propias instituciones, guiadas por la literatura disponible y en constante evolución.

Comparison of Effectiveness between Abdominal Vibration Stimulation and Walking Exercise for Bowel Cleansing before Therapeutic Colonoscopy.

Adequate bowel preparation is important for successful colonoscopy. We aimed to evaluate the clinical feasibility and effectiveness of abdominal vibration stimulation in bowel preparation before therapeutic colonoscopy. A single center, prospective, randomized, investigator-blinded study was performed between January 2016 and December 2016. Patients for therapeutic colonoscopy were prospectively enrolled and assigned to either the vibrator group or walking group. Patients who refused to participate in this study as part of the experimental group consented to register in the control group instead. During the preparation period, patients assigned to the walking group walked ≥3,000 steps, whereas those assigned to the vibrator group received abdominal vibrator stimulation and restricted walking. All patients received the same colon cleansing regimen: 4-L split-dose polyethylene glycol (PEG) solution. Three hundred patients who received PEG solution for therapeutic colonoscopy were finally enrolled in this study (n=100 per group). Bowel cleansing with abdominal vibration stimulation showed almost similar results to that with walking exercise (Boston Bowel Preparation Scale score for the entire colon: vibrator vs walking vs control, 7.38±1.55 vs 7.39±1.55 vs 6.17±1.15, p<0.001). There were no significant differences between the vibrator group and walking group regarding instances of diarrhea after taking PEG, time to first diarrhea after taking PEG, total procedure time, and patient satisfaction. This study indicates that, compared with conventional walking exercise, abdominal vibration stimulation achieved similar rates of bowel cleansing adequacy and colonoscopy success without compromising safety or patient satisfaction.

Comparison of Effectiveness between Abdominal Vibration Stimulation and Walking Exercise for Bowel Cleansing before Therapeutic Colonoscopy

Background/AimsAdequate bowel preparation is important for successful colonoscopy. We aimed to evaluate the clinical feasibility and effectiveness of abdominal vibration stimulation in bowel preparation before therapeutic colonoscopy.MethodsA single center, prospective, randomized, investigator-blinded study was performed between January 2016 and December 2016. Patients for therapeutic colonoscopy were prospectively enrolled and assigned to either the vibrator group or walking group. Patients who refused to participate in this study as part of the experimental group consented to register in the control group instead. During the preparation period, patients assigned to the walking group walked ≥3,000 steps, whereas those assigned to the vibrator group received abdominal vibrator stimulation and restricted walking. All patients received the same colon cleansing regimen: 4-L split-dose polyethylene glycol (PEG) solution.ResultsThree hundred patients who received PEG solution for therapeutic colonoscopy were finally enrolled in this study (n=100 per group). Bowel cleansing with abdominal vibration stimulation showed almost similar results to that with walking exercise (Boston Bowel Preparation Scale score for the entire colon: vibrator vs walking vs control, 7.38±1.55 vs 7.39±1.55 vs 6.17±1.15, p<0.001). There were no significant differences between the vibrator group and walking group regarding instances of diarrhea after taking PEG, time to first diarrhea after taking PEG, total procedure time, and patient satisfaction.ConclusionsThis study indicates that, compared with conventional walking exercise, abdominal vibration stimulation achieved similar rates of bowel cleansing adequacy and colonoscopy success without compromising safety or patient satisfaction.

Adenoma miss rate of polypectomy-referring hospitals is high in Korea.

Background/AimsWe evaluated the miss rates of polyps, adenomas, and advanced neoplasia of polypectomy-referring hospitals and risk factors for missed adenomas.MethodsWe compared medical records and electronic images of initial colonoscopies from polypectomy-referring hospitals with those of corresponding therapeutic colonoscopies from Seoul St. Mary’s Hospital obtained from May 2014 to February 2016.ResultsA total of 147 patients (56.6 ± 12.1 years, 37 females) were included. The mean number of polyps and adenomas detected on initial colonoscopy was 2.4 ± 1.7 and 1.7 ± 1.4, respectively. The mean number of additionally detected polyps and adenomas per patient during therapeutic colonoscopy was 1.4 ± 1.8 and 1.0 ± 1.5, respectively. Pooled miss rate for polyps, adenomas, and advanced neoplasia was 36%, 37%, and 11%, respectively. Pooled miss rate for adenomas was significantly higher for right-sided, non-pedunculated, and small (< 1 cm) adenomas (p = 0.031, p = 0.000, and p = 0.000, respectively). The miss rate of polyps, adenomas, and advanced neoplasia per patient was 60%, 49%, and 7%, respectively. Multivariate analysis revealed age and number of adenoma on initial colonoscopy were significantly related with risk for adenoma-missing (p = 0.005 and p = 0.023, respectively).ConclusionsAmong patients referred for polypectomy, adenoma is missed in one of two patients and advanced neoplasm is missed in one of 13. Patients with advanced age or multiple adenoma on initial colonoscopy have a higher possibility of missed adenoma. Total colon exploration should be performed carefully during therapeutic colonoscopy.

1878 Migration of Over-the-Scope Clip (OTSC) Resulting in Intestinal Obstruction

INTRODUCTION: Iatrogenic perforations are a known and feared complication of diagnostic and therapeutic colonoscopy. Over-the-scope clips (OTSCs) have recently been utilized for management of these perforations. We present the case of a 40-year-old male patient treated with over-the-scope (Ovesco®) clip for an iatrogenic post-polypectomy perforation with subsequent intestinal obstruction occurring as a result of migration of the clip. CASE DESCRIPTION/METHODS: A 40-year-old male with familial adenomatous polyposis and total proctocolectomy, ileoanal anastomosis and a J pouch had an ileoscopy performed for polyp surveillance. A 3 cm flat polyp was removed with Eleview® injection lift technique. A hole like defect was noted in the postpolypectomy site that developed into an obvious small 2-3 mm perforation. To repair the defect, a one 14/6 mm type gc over-the-scope clip (Ovesco®) and a 12/6 mm type gc over-the-scope clip (Ovesco®) was successfully placed. Four months later the patient presented to the emergency department with severe anal pain. He felt a hard metallic object in the anal canal. He denied any fevers, chills, nausea, vomiting, or abdominal pain. Rectal tenderness was found on digital rectal examination. A CT abdomen and pelvis showed an object of metallic density at the anal verge with nonobstructive bowel gas pattern. Colonoscopy revealed two over-the-scope clips approximately 2 cm from the anal verge embedded in the mucosa (Figure 1) which were removed. The patient did well post procedure and was discharged home the next day. DISCUSSION: The Ovesco® clip (Ovesco, Tübingen, Germany) is a novel endoscopic method to achieve mechanical compression of gastrointestinal tissue with current indications including closure of fistulas, iatrogenic perforations, hemostasis and non-variceal gastrointestinal bleeding. Iatrogenic perforations during colonoscopy have an incidence ranging from 0.1% to 0.3% of cases. These complications carry a high mortality rate and in the past warranted surgical intervention. However, with the advances in therapeutic endoscopy many perforations can be managed effectively with endoclips, OTSCs and/or endosuturing. These new techniques do come with device-specific risks. Fischer et al. reported the first case of OTSC-induced bowel obstruction. Here we present another case of bowel obstruction as a result of OTSC placement for a perforation, treated with surgical intervention. All gastroenterologists should be aware of clinical scenarios in which the Ovesco clip can be used.

242 Demographic and Historical Risk Factors Associated With Incomplete, Missed, and Cancelled Colonoscopies

INTRODUCTION: Access to colonoscopy is critical for colorectal cancer screening. Cancelled colonoscopy appointments have a major impact on overall healthcare costs, provider workflow, and delays in colorectal cancer screening and diagnosis. We aimed to discover individual and systemic factors associated with the occurrence of incomplete, missed or cancelled colonoscopy appointments at our institution. METHODS: This was a retrospective observational study using the Cleveland Clinic Florida database. Patients scheduled for screening or diagnostic colonoscopy from January to June 2018 were included. There were two case groups: those that missed or cancelled colonoscopy appointments and those that had incomplete colonoscopies due to poor bowel preparation. A control group consisted of a random sample of 200 patients that had completed colonoscopies during the same time period. We excluded patients that underwent therapeutic colonoscopies. We performed descriptive analysis within each group, univariate analysis between the control group and case groups, and odds ratio. We used a 95% CI and P-values of less than 0.05 for statistical significance. RESULTS: 4,499 colonoscopies were scheduled from January to June 2018. There were 369 (8.2%) missed/cancelled colonoscopies and 117 (2.6%) incomplete colonoscopies. Control group included a random sample of 200 completed colonoscopies. The total sample size was 686. Factors associated with a decreased risk of missed colonoscopies included white race (OR 0.56; P = 0.001), history of polyps (OR 0.52, P &lt; 0.001), previous colonoscopy (OR 0.32; P &lt; 0.0001), diagnosis of IBD (OR 0.21, P = 0.001), and married status (0.52; P = 0.001) (Table 1). Patients of black race (OR 2.1; P = 0.01) and patients with international addresses (OR 2.34; P = 0.04) were more likely to have incomplete colonoscopies (Table 2). Incomplete colonoscopies were more likely to be performed and re-scheduled than cancelled colonoscopies (67.5% vs. 44%; P &lt; 0.001). Monday was the most common day for cancellations (12.6%). Difficulty understanding or tolerating bowel preparation (39.2%) was the most common reason for cancellation (Figure 1). CONCLUSION: Patient demographics, particularly patients visiting from international locations, were major risk factors for missed and incomplete colonoscopies. Many patients appeared to have difficulty understanding bowel preparation instructions. Future efforts should be made to focus on improving bowel preparation education. This will lead to improvement in healthcare utilization.