Factors Associated with Polyp Detection Rate in European Colonoscopy Practice: Findings of The European Colonoscopy Quality Investigation (ECQI) Group.

Background: The European Colonoscopy Quality Investigation (ECQI) Group aims to raise awareness for improvement in colonoscopy standards across Europe. We analysed data collected on a sample of procedures conducted across Europe to evaluate the achievement of the polyp detection rate (PDR) target. We also investigated factors associated with PDR, in the hope of establishing areas that could lead to a quality improvement. Methods: 6445 form completions from 12 countries between 2 June 2016 and 30 April 2018 were considered for this analysis. We performed an exploratory analysis looking at PDR according to European Society of Gastrointestinal Endoscopy (ESGE) definition. Stepwise multivariable logistic regression analysis was conducted to determine the most influential associated factors after adjusting for the other pre-specified variables. Results: In our sample there were 3365 screening and diagnostic procedures performed in those over 50 years. The PDR was 40.5%, which is comparable with the ESGE minimum standard of 40%. The variables found to be associated with PDR were in descending order: use of high-definition equipment, body mass index (BMI), patient gender, age group, and the reason for the procedure. Use of HD equipment was associated with a significant increase in the reporting of flat lesions (14.3% vs. 5.7%, p < 0.0001) and protruded lesions (34.7% vs. 25.4%, p < 0.0001). Conclusions: On average, the sample of European practice captured by the ECQI survey meets the minimum PDR standard set by the ESGE. Our findings support the ESGE recommendation for routine use of HD colonoscopy.

[Prevention of gastrointestinal cancer]. / Prävention gastrointestinaler Tumore.

Throughout the past decades, considerable progress has been made in the (early) diagnosis and treatment of gastrointestinal cancers. However, the prognosis for advanced stages of gastrointestinal tumors remains limited for many patients and approximately one third of all tumor patients die as a result of gastrointestinal tumors. The prevention and early detection of gastrointestinal tumors is therefore of great importance.For this reason, we summarize the current state of knowledge and recommendations for the primary, secondary and tertiary prevention of esophageal, stomach, pancreas, liver and colorectal cancer in the following.

The Offer of Advanced Imaging Techniques Leads to Higher Acceptance Rates for Screening Colonoscopy - a Prospective Study.

BACKGROUND: Colonoscopy plays a fundamental role in early diagnosis and management of colorectal cancer and requires public and professional acceptance to ensure the ongoing success of screening programs. The aim of the study was to prospectively assess whether patient acceptance rates to undergo screening colonoscopy could be improved by the offer of advanced imaging techniques. MATERIALS AND METHODS: Overall, 372 randomly selected patients were prospectively included. A standardized questionnaire was developed that inquired of the patients their knowledge regarding advanced imaging techniques. Second, several media campaigns and information events were organized reporting about advanced imaging techniques, followed by repeated evaluation. After one year the evaluation ended. RESULTS: At baseline, 64% of the patients declared that they had no knowledge about new endoscopic methods. After twelve months the overall grade of information increased significantly from 14% at baseline to 34%. The percentage of patients who decided to undergo colonoscopy because of the offer of new imaging methods also increased significantly from 12% at baseline to 42% after 12 months. CONCLUSIONS: Patients were highly interested in the offer of advanced imaging techniques. Knowledge about these techniques could relatively easy be provided using local media campaigns. The offer of advanced imaging techniques leads to higher acceptance rates for screening colonoscopies.

Capsule colonoscopy increases uptake of colorectal cancer screening.

BACKGROUND: Screening colonoscopy effectiveness is hampered by limited adherence by the general population. The present prospective study was performed to evaluate whether adding capsule colonoscopy to the endoscopic screening options increases uptake. METHODS: Invitation letters were sent to 2150 persons above the age of 55 insured with a German medical insurance company in the area of Rinteln, Lower Saxony with a baseline spontaneous annual screening colonoscopy uptake of 1 %. Both capsule or conventional colonoscopy were offered. Interested persons were given information about the two screening options by four local gastroenterologists and examinations were then performed according to screenees' final choice. RESULTS: 154 persons sought further information, and 34 and 90 underwent conventional and capsule colonoscopy, respectively. Colonoscopy uptake was thus increased by the invitation process by 60 % (1.6 % vs. 1 %; p = 0.075), while the option of capsule endoscopy led to a fourfold increase of screening uptake (4.2 % vs. 1 %, p < 0.001). Despite similar age distribution in both sex groups, uptake in men was significantly higher (5.6 % vs. 2.8 %, p = 002). However, overall adenoma yield was not different in both groups. CONCLUSIONS: The present study suggests that offering the option of capsule colonoscopy increases uptake of endoscopic colorectal cancer screening. However, capsule endoscopy sensitivity for adenoma detection needs to be improved.

Bacteremia after diagnostic conventional laparoscopy and minilaparoscopy: a prospective study in 100 patients.

BACKGROUND/GOALS: Diagnostic laparoscopy under sedoanalgesia is a valuable tool in the work-up of liver diseases and is helpful as a staging procedure. The rate of bacteremia caused by this procedure is unknown, in particular when performed as minilaparoscopy. STUDY: A 100 consecutive patients having undergone diagnostic laparoscopy carried out either conventionally (group I, n=50) or as minilaparoscopy (group II, n=50) were prospectively enrolled in this study. Blood cultures were drawn before and within 5 minutes after the procedure. Risk factors for bacteremia were evaluated. RESULTS: Bacterial growth occurred in 4 blood cultures drawn immediately after laparoscopy. No patient developed fever or other signs of infection in the follow-up. Risk factors predisposing to bacteremia could not be identified. CONCLUSIONS: Conventional diagnostic laparoscopy under sedoanalgesia and minilaparoscopy are associated with a low rate of bacteremia as in diagnostic upper endoscopy.

Capsule endoscopy versus standard tests in influencing management of obscure digestive bleeding: results from a German multicenter trial.

BACKGROUND: Capsule endoscopy (CE) is a new modality for obscure digestive bleeding (OBD), but little is known about its influence on management and outcome. PATIENTS AND METHODS: Fifty-six patients (male/female 26/30; mean age 63 yr) with ODB, and negative upper and lower gastrointestinal (GI) endoscopy were included in this multicenter study. The diagnostic yield of CE was compared to three other tests (OT: push enteroscopy, enteroclysis, angiography), and patients were followed up for at least 6 months. Parameters were analyzed that led to major management changes such as surgical or endoscopic intervention or specific medical therapy, as well as their correlation to further bleeding. RESULTS: CE had a diagnostic yield higher than OT (68% vs 38%). Major management changes and an improvement in bleeding activity were observed in 21 and 44 patients, respectively. The number and type of positive findings on CE were associated with significant management changes (p < 0.05). The number of positive findings detected by CE as well as by OT correlated with further bleeding episodes (p < 0.05). However, clinical parameters (lowest hemoglobin (Hb) value, number of blood transfusions) were also significantly associated with outcome. Diagnoses of specific diseases (tumor, Crohn, NSAID ulcer) by CE led to a favorable outcome in 64% of cases, whereas negative CE cases were associated with no further bleeding in 80%. CONCLUSION: CE helps with management decisions and can replace other more complex and risky standard tests. Nevertheless, clinical parameters are equally important for predicting further bleeding and should also be used to decide on further management.

Diagnosis of liver cirrhosis: a comparison of modified ultrasound and laparoscopy in 100 consecutive patients.

BACKGROUND/GOALS: Liver cirrhosis, the final stage of chronic liver disease, is characterized by an unfavorable prognosis and an increased risk of hepatocellular carcinoma and also requires an appropriate management. Laparoscopy, the gold standard in the diagnosis of cirrhosis, is hampered by its invasiveness. Therefore, a noninvasive method for diagnosing liver cirrhosis would be of great benefit. STUDY: A consecutive series of 100 patients, sent to our gastroenterological unit for diagnostic laparoscopy, underwent a standardized ultrasonographic examination prior to laparoscopy. RESULTS: Conventional ultrasonographic examination revealed a sensitivity of 55% and a specificity of 86% in the diagnosis of cirrhosis. Considering the assessment of the transmission of heart pulsation on the liver surface, the corresponding values improved by increasing to 85% and 93%. CONCLUSION: Evaluating the transmission of heart pulsation on the liver surface improves the ability of ultrasound to diagnose liver cirrhosis; therefore, it should be an integral part of routine sonographic examination of the liver.

High frequency of colorectal adenoma in patients with duodenal adenoma but without familial adenomatous polyposis.

BACKGROUND: Duodenal adenomas are extremely common in patients with familial adenomatous polyposis. However, it is uncertain whether patients with duodenal adenomas without familial adenomatous polyposis are at greater risk for colorectal neoplasia and, therefore, should routinely undergo surveillance colonoscopy. The aim of this study was to determine whether there is a correlation between non-papillary duodenal adenoma without familial adenomatous polyposis and colorectal adenoma. METHODS: Twenty-five patients with non-papillary duodenal adenomas without familial adenomatous polyposis, seen from January 1990 to April 2003, were retrospectively evaluated. RESULTS: Non-papillary duodenal polyps were diagnosed by endoscopy in the 25 patients. Of these, 21 underwent colonoscopy and one underwent proctoscopy. The mean age of these 22 patients (12 women, 10 men) was 69 years (range 50-83 years). Sixteen of the 22 patients (72.7%) with duodenal adenomas had associated colorectal adenomas. A total of 38 adenomas and one colorectal cancer were detected. The mean size of the polyps was 6.2 mm (range 3-15 mm). The adenomas were removed by snare excision or with a biopsy forceps. CONCLUSIONS: Based on the results of this uncontrolled, retrospective study, the frequency of colorectal adenomas in patients with duodenal polyps without familial adenomatous polyposis appears to be increased compared with the general population. All patients with duodenal polyps should undergo surveillance colonoscopy for colorectal adenomas. A prospective study to definitively establish the frequency of colorectal adenomas in these patients is warranted.

Sensibilidade das provas laboratoriais hepáticas em pacientes com coledocolitíase / Sensitivity of serum liver enzymes in patients with choledocholithiasis

As provas laboratoriais hepáticas são largamente utilizadas no diagnóstico pré-operatório da coledocolitíase. Neste estudo, pretendeu-se verificar sua sensibilidade numa população de pacientes com coledocolitíase submetidos à papilotomia endoscópica através da análise retrospectiva de 223 casos. Todos os pacientes foram submetidos a avaliação funcional hepática préviamente à colangiopancreatografia endoscópica retrógrada...

Litotripsia endoscópica à laser em cálculos difíceis näo responsivos à litotripsia extracorpórea por ondas de choque / Endoscopic laser lithotripsy for difficult bile duct stones after unsuccessful extracorporeal shock wave lithotripsy

Introduçao: Em torno de 97 por cento dos casos de coledocolitíase podem ser resolvidos através da papilotomia endoscópica aliada à litotripsia mecânica intracoledociana ou à litotripsia extracorpórea por ondas de choque. Neste estudo avaliou-se o papel da litotripsia intracoledociana à laser após insucesso dos métodos de litotripsia citados acima, em pacientes com "cálculos coledocianos difíceis", ou seja, aqueles que nao respondem à terapêutica endoscópica habitual, ou por seu tamanho, ou por se situarem proximal a uma estenose. Métodos: Dezoito pacientes (l5M, 3H; idade mediana = 69 (28-83) anos) foram tratados por litotripsia à laser, por via endoscópica transpapilar, após insucesso de litotripsia mecânica ou extracorpórea. Utilizou-se um sistema de raios laser capaz de diferenciar tecido humano de cálculos biliares a base de Rodamina 6 G. Resultados: Dezessete pacientes foram tratados endoscopicamente e um por via percutânea após insucesso do método transpapilar, devido a uma estenose biliar. Em 14 (78 por cento) a via biliar foi liberada de cálculos após uma média de 1,56 sessoes de terapia com laser. Em outros dois pacientes, ocorreu fragmentaçao parcial dos cálculos, possibilitando o uso de litotripsia mecânica ou eletrohidráulica. No geral, a terapêutica foi bem sucedida em 89 por cento dos casos. Um paciente apresentou colangite como complicaçao e a mortalidade nessa série foi de zero. Conclusao: Conclui-se que a litotripsia por laser é uma alternativa eficaz e segura para uma populaçao altamente selecionada com cálculos coledocianos gigantes ou proximal a estenoses ("cálculos difíceis") e com considerável risco cirúrgico.