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Improving Delivery of Colonoscopy Surveillance Recommendations With theCreation and Insertion of a Standardized Polyp Guideline AlgorithmCorlan O. Adebajo, Michael D. Leise, Dawn L. Francis
Background: The provision of a recommendation for follow-up colonoscopy in patients withcolon polyps is a standard quality benchmark in colonoscopy. This can be difficult to includein a procedural report because histology of the colon polyp is unknown at the time of theprocedure. As a result, follow-up recommendations are often given by the referring providerA standardized algorithm for surveillance colonoscopy intervals to be included in colonoscopyprocedural reports could provide needed guidance for referring providers. Aim: To commun-icate correct surveillance guidelines to primary care physicians through the creation andattachment of an algorithm for determining colonoscopy surveillance intervals for adultswho have polyps detected during an average risk screening colonoscopy. Research Designand Methods: We performed a retrospective chart review to evaluate if the creation of analgorithm that could be inserted at the end of a colonoscopy procedure dictation at therequest of the performing endoscopist would improve the rate at which endoscopists providedfollow-up recommendations for surveillance colonoscopy in patients who had a colon polypremoved during an average risk screening colonoscopy. The algorithm was introduced onApril 1, 2010 and over the course of the following two months e-mail reminders andprompts in the endoscopy room were provided. We reviewed procedural reports prior toimplementation in March of 2010 and post-implementation in July of 2010. The Fisher'sexact test was used to assess the change in recommendation rates for colonoscopy surveillanceintervals in patients who had colon polyps detected on average risk screening colonoscopy.Results: Of the 352 charts 145 charts met inclusion criteria (83 pre-intervention and 62post-intervention). The data analysis revealed an increase in the rate of communication ofsurveillance guidelines from 0.17 (14/83) during the pre-period to 0.47 (29/62) duringthe post-period (p=.0002). Conclusions: Development of a standardized polyp guidelineembedded in colonoscopy reports significantly improves the delivery of colonoscopy surveil-lance guidelines to primary care providers. Staff reminders and regular monitoring areimportant to achieve high polyp template compliance rates. In the future, an automatedcolonoscopy surveillance guideline may provide for near-perfect delivery of follow-up recom-mendations.
Surveillance guidelines for average risk patients found to have polyps on screening colonos-copy
Endoscopic Findings of GERD and Treatment Effects of Proton PumpInhibitors (PPIs) in Asthma PatientsYun Bin Lee, Dong Ho Lee, Cheol Min Shin, Nayoung Kim
Backgroud/Aim: GERD symptoms are classified as typical GERD symptoms, such as heartburnand regurgitation, and atypical GERD symptoms, such as chronic cough, asthma, chestpain, dysphagia, globus sensation in Montreal classification. Concerns about atypical GERDsymptoms are increasing. The objective of this study was to investigate endoscopic findingsof GERD in asthma patients and to assess the effect of gastric acid suppression with theproton pump inhibitor (PPI) on symptom improvement and asthma outcomes. Methods:
Consecutive patients who visited Bundang Seoul National University Hospital betweenOctober 2003 and May 2010 with GERD symptoms during follow up for asthma. Patientenrolled to this study were asked about esophageal/extra-esophageal GERD symptoms.Endoscopic findings were described according to Los Angeles classification. Patients weredevided to Low-dose group (a half of standard dose) and Standard-dose group dependingon PPI dose. The improvement of GERD-symptoms and follow-up pulmonary function testwere investigated after administration of PPIs. Results: A total of 45 patients were included.13 patients were male and 32 patients female. Mean age of patients enrolled was 55.6±14.7.Patients with both of esophageal symptoms and extra-esophageal symptoms were 25 patients(55.6%), and 20 patients (44.4%) had extra-esophageal symptoms only. Esophagitis onendoscopy were identified in 18 patients of 25 patients (72%) who had both of esophagealsymptoms and extra-esophageal symptoms, and in 18 patients of 20 patients (90%) who hadextra-esophageal symptoms only. The degree of endoscopic esophagitis was not significantlydifferent between group with esophageal/extra-esophageal symptoms and group with extra-esophageal symptoms only. The improvement of esophageal symptoms or extra-esophagealsymptoms was seen in 44 patients (97.8%) except 1 patient after administration of PPIs.The number of patients devided to Low-dose group was 7 patients (15.6%) and that ofpatients devided to Standard-dose group was 38 patients (84.4%). The follow-up pulmonaryfunction test were improved in 3 patients (3 of 7, 42.9%) of Low-dose group, and in 24patients (24 of 38, 63.2%) of Standard-dose group. The improvement of pulmonary functiontest was not significantly associated with dosage of PPIs. Conclusion: The frequency ofendoscopic esophagitis was higher in patients with extra-esophageal symptoms only thanpatients with both of esophageal/extra-esophageal symptoms. This suggests that the treatmentof GERD, such as PPIs, and endoscopic examination is needed in asthma patients in casewithout esophageal GERD symptoms considering possibility of GERD. The trend was seenthat treatment effect of Standard-dose group was better than Low-dose group, but significantdifference of treatment effect between Low-dose group and Standard-dose group was not seen.
Discriminating Irritable Bowel Syndrome From Inflammatory Bowel Disease:What is the Role of Biomarkers in Daily Practice?Alain Schoepfer, Stephan R. Vavricka, Alex Straumann, Christoph Beglinger
Background and Aims: Discriminating irritable bowel syndrome (IBS) from inflammatorybowel disease (IBD) can be a clinical challenge as symptoms can overlap. We and othershave recently shown that fecal calprotectin (FC) is more accurate for discriminating IBSfrom IBD compared to C-reactive protein (CRP) and blood leukocytes. Data on the biomarkersused in daily gastroenterological practice are lacking. We therefore aimed to assess whichbiomarkers are used by gastroenterologists in their daily practice for discriminating IBSfrom IBD. Methods: A questionnaire was sent to all board certified gastroenterologists inSwitzerland focusing on demographic informations, number of IBS patients treated in thetime period from May 2009 to April 2010, and the specific biomarkers evaluated fordiscriminating IBS from IBD. Results: Response rate was 57% (153/270). Mean physician'sage was 50±9years, mean duration of gastroenterologic practice 14±8years, 52% of themwere working in private practice and 48% in hospitals. Thirty-nine percent had taken careof more than 100 IBS patients in the last 12 months, 37% had seen 41-100 and 24% hadseen 1-40 IBS patients. Gastroenterologists in private practice more frequently took care ofat least 40 IBS patients in a year compared to hospital-based gastroenterologists (P<0.001).The following biomarkers were determined for discriminating IBS from IBD: CRP 100%,FC 79%, hematogram (red blood cells and leukocytes) 70%, iron status (ferritin, transferrinsaturation) 59%, erythrocyte sedimentation rate 2.7%, protein electrophoresis 0.7%, andalpha-1 antitrypsin clearance 0.7%. There was a trend for using FC more often in privatepractice than in hospital (P = 0.08). Twenty-four percent of gastroenterologists had usedFC in the workup of more than 70% of patients classified as IBS, 22% had used FC in 30-70% of IBS patients, 39% in less than 30%, and 15% had never used FC for the work-upof suspected IBS. Eighty-nine percent of gastroenterologists considered FC to be superiorto CRP for discriminating IBS from IBD, 87% thought that patient's compliance for fecalsampling is high, and 51% judged the fee of USD 60 for a FC test as appropriate. Conclusions:FC is widely used in clinical practice to discriminate IBS from IBD. In accordance with thescientific evidence, the majority of gastroenterologists consider FC to be more accurate thanCRP for discriminating IBS from IBD. Gastroenterologists in private practice take care ofsignificantly more IBS patients than colleagues in hospital.
Attitude of Endoscopists and Endoscopy Personnel Towards QualityAssuranceVincent de Jonge, Ernst J. Kuipers, Monique van Leerdam
Introduction Quality assurance (QA) programs are mandatory to ensure an optimal andsafe endoscopy. The effectiveness of QA programs is strongly dependent on the support ofthe endoscopy staff and should therefore closely follow their concerns and demands. More-over, close collaboration and an optimal team culture is a prerequisite for successful QA.Little is known about the attitude of endoscopy personnel to QA. The aim of the study wasto identify differences in attitude to and priorities in QA between different personnel of theendoscopy unit. Methods A survey was sent to all registered GE (n=319) and endoscopynurses (n=670) in the Netherlands. It contained 36 questions about the expected effects ofa nationwide QA program and its required contents. Answers were given on a 5-point Likert-scale. Results 202 GE and 294 nurses (response rate: 63% and 44%) completed the survey(37% male; mean age: 47 years; median years in practice: 20 years, interquartile range: 10-29). Responders were more often male (37 vs. 23%, p<0.01), but were as often employedat an academic center (14 vs. 18%, p=0.12). Among responders, GE were more often males(79 vs. 8%, p<0.01) and employed at an academic center (24 vs. 8%, p<0.01) comparedto nurses. Of the respondents, 445 (90%) had a positive attitude towards QA. GE weregenerally more positive than nurses (95 vs. 87%, p<0.01). Overall, 302 persons (61%)regarded the implementation of a nation-wide QA program feasible (GE: 73%, nurses: 54%,p<0.01). A positive influence of a QA program was expected on the overall quality of theunit by 335 respondents (68%; GE: 66%, nurses: 70%, p=0.38). The capacity would increase