RESUMO
The future private gastroenterology practice will be a large multidisciplinary practice including a clinic, AEC, pathology services, infusion services, anesthesia services, pharmacy services, and imaging centers. Delivery of gastrointestinal (GI) services will be a team-based clinic with AEC access and improved quality of care. Competing technologies will drive practices to promote the value of colonoscopy as the best screening test for colon cancer. Artificial intelligence (AI) may significantly alter our approach to clinic and endoscopic services. The creative and intellectual capital of practice leaders will continue to define the private GI practice of the future.
Assuntos
Gastroenterologia , Instituições de Assistência Ambulatorial , Inteligência Artificial , Colonoscopia , Previsões , HumanosAssuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Endoscopia Gastrointestinal , Controle de Infecções/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Agendamento de Consultas , COVID-19 , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/transmissão , Humanos , Equipamento de Proteção Individual , Pneumonia Viral/diagnóstico , Pneumonia Viral/transmissão , SARS-CoV-2RESUMO
BACKGROUND: Current bowel preparations for colonoscopy include a clear liquid diet (CLD) along with consumption of a laxative. This dietary restriction along with large volume bowel preparations are barriers to compliance and willingness among patients in scheduling screening examinations. The aim of our study was to compare the efficacy and tolerability of a low-volume split dose magnesium citrate bowel preparation in patients on a low-residue diet (LRD) with those on a CLD. METHODS: In this single center, single blinded, randomized controlled trial, patients scheduled for outpatient colonoscopies were assigned to either a CLD or a LRD 1 day before the examination. Both groups received a split dose magnesium citrate preparation. The quality of the preparation was rated using the Boston Bowel Preparation Scale (BBPS). Patient satisfaction and side effects were evaluated using a questionnaire. RESULTS: We were unable to detect a significant difference in the BBPS scores between the LRD and CLD groups (P=0.581). A significantly higher percentage of patients in the LRD group rated the diet as easy compared with the CLD group (P<0.001). Satisfaction scores were significantly higher in the LRD group, compared with the CLD group (P<0.001). The side effect profiles of both arms were similar. CONCLUSIONS: There was no significant difference between LRD and CLD in patients using a magnesium citrate bowel preparation for screening and surveillance colonoscopies. Patient satisfaction scores were higher with a LRD compared with a CLD. We believe the LRD should be the recommended diet in patients using a standard bowel preparation for screening and surveillance colonoscopy.
Assuntos
Catárticos/administração & dosagem , Ácido Cítrico/administração & dosagem , Colonoscopia/métodos , Dieta , Compostos Organometálicos/administração & dosagem , Feminino , Humanos , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Satisfação do Paciente , Método Simples-CegoRESUMO
In the United States, sedation and analgesia are the standard of practice when endoscopic procedures are performed in the ambulatory endoscopy center. Over the last 30 years, there has been a dramatic shift of endoscopic procedures from the hospital outpatient department to ambulatory endoscopy centers. This article will discuss sedation and analgesia in the ambulatory endoscopy center as it relates to optimizing safety, patient expectations, and efficiency.
Assuntos
Instituições de Assistência Ambulatorial , Sedação Consciente/métodos , Sedação Profunda/métodos , Endoscopia Gastrointestinal/métodos , Monitorização Intraoperatória/métodos , Analgésicos Opioides/uso terapêutico , Antídotos/uso terapêutico , Benzodiazepinas/uso terapêutico , Eficiência , Flumazenil/uso terapêutico , Humanos , Hipnóticos e Sedativos/uso terapêutico , Naloxona/uso terapêutico , Antagonistas de Entorpecentes/uso terapêutico , Segurança do Paciente , Propofol/uso terapêuticoAssuntos
Instituições de Assistência Ambulatorial/organização & administração , Endoscopia Gastrointestinal , Instituições de Assistência Ambulatorial/economia , Instituições de Assistência Ambulatorial/legislação & jurisprudência , Instituições de Assistência Ambulatorial/normas , Análise Custo-Benefício , Endoscopia Gastrointestinal/economia , Endoscopia Gastrointestinal/legislação & jurisprudência , Endoscopia Gastrointestinal/normas , Custos de Cuidados de Saúde , Humanos , Relações Interprofissionais , Marketing de Serviços de Saúde , Uso Significativo , Medicare , Patient Protection and Affordable Care Act , Garantia da Qualidade dos Cuidados de Saúde , Mecanismo de Reembolso , Estados UnidosAssuntos
Adenoma/diagnóstico , Pólipos do Colo/diagnóstico , Colonoscopia/normas , Neoplasias Colorretais/diagnóstico , Estudos de Tempo e Movimento , Humanos , Programas de Rastreamento/normas , Programas de Rastreamento/estatística & dados numéricos , Garantia da Qualidade dos Cuidados de Saúde/normas , Sensibilidade e EspecificidadeAssuntos
Gastroenterologia/organização & administração , Administração da Prática Médica/organização & administração , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Humanos , Padrões de Prática Médica , Indicadores de Qualidade em Assistência à Saúde , Reembolso de Incentivo , Estados UnidosRESUMO
Colorectal cancer is a common disease in the United States. The majority of sporadic colorectal cancers develop from adenomatous polyps. In the United States, the incidence of colorectal cancer is declining, most likely because of colonoscopic polypectomy. Adenoma detection rate is affected by the quality of prep, careful mucosal inspection, and withdrawal time. In this issue of the Journal, there is intriguing evidence that the timing of colonoscopy, morning vs. afternoon, affects adenoma detection rate. Physician fatigue is postulated as a factor leading to lower polyp detection rates in the afternoon compared with the morning. Further, prospective studies are needed to confirm these findings and determine the effect on clinical practice.
Assuntos
Adenoma/diagnóstico , Agendamento de Consultas , Colonoscopia/métodos , Neoplasias Colorretais/diagnóstico , Adenoma/patologia , Assistência Ambulatorial/normas , Assistência Ambulatorial/tendências , Competência Clínica , Colonoscopia/efeitos adversos , Neoplasias Colorretais/patologia , Erros de Diagnóstico , Feminino , Humanos , Masculino , Medição de Risco , Sensibilidade e Especificidade , Fatores de TempoRESUMO
BACKGROUND & AIMS: Screening colonoscopy can prevent cancer by removal of adenomatous polyps. Recent evidence suggests that insufficient time for inspection during overly rapid colonoscope withdrawal may compromise adenoma detection. We conducted a study of the effect of a minimum prespecified time for instrument withdrawal and careful inspection on adenoma detection rates during screening colonoscopy. METHODS: Baseline data consisted of neoplasia detection rates during 2053 screening colonoscopies performed without a specified withdrawal protocol. During a subsequent 13-month period we performed 2325 screening colonoscopies using dedicated inspection techniques and a minimum 8-minute withdrawal time. With colonoscopists comprising the study population, we compared overall and individual rates of neoplasia detection in postintervention procedures with those in baseline examinations. RESULTS: As compared with baseline subjects, postintervention subjects had higher rates of any neoplasia (34.7% vs 23.5%, P < .0001) and of advanced neoplastic lesions per patient screened (0.080 +/- 0.358 vs 0.055 +/- 0.241, P < .01). Twenty-five percent of advanced neoplastic lesions detected in postintervention examinations were 9 mm or less in diameter, versus 10% in baseline examinations (P < .001). Endoscopists with mean withdrawal times of 8 minutes or longer had higher rates of detection of any neoplasia (37.8% vs 23.3%, P < .0001) and of advanced neoplasia (6.6% vs 4.5%, P = .13) compared with those with mean withdrawal times of less than 8 minutes. CONCLUSIONS: After implementing a protocol of careful inspection during a minimum of 8 minutes to withdraw the colonoscope, we observed significantly greater rates of overall and advanced neoplasia detection during screening colonoscopy.
Assuntos
Adenoma/diagnóstico , Neoplasias do Colo/diagnóstico , Colonoscopia/métodos , Programas de Rastreamento/métodos , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de TempoRESUMO
BACKGROUND: Colonoscopy is commonly used to screen for neoplasia. To assess the performance of screening colonoscopy in everyday practice, we conducted a study of the rates of detection of adenomas and the amount of time taken to withdraw the colonoscope among endoscopists in a large community-based practice. METHODS: During a 15-month period, 12 experienced gastroenterologists performed 7882 colonoscopies, of which 2053 were screening examinations in subjects who had not previously undergone colonoscopy. We recorded the numbers, sizes, and histologic features of the neoplastic lesions detected during screening, as well as the duration of insertion and of withdrawal of the colonoscope during the procedure. We compared rates of detection of neoplastic lesions among gastroenterologists who had mean colonoscopic withdrawal times of less than 6 minutes with the rates of those who had mean withdrawal times of 6 minutes or more. According to experts, 6 minutes is the minimum length of time to allow adequate inspection during instrument withdrawal. RESULTS: Neoplastic lesions (mostly adenomatous polyps) were detected in 23.5% of screened subjects. There were large differences among gastroenterologists in the rates of detection of adenomas (range of the mean number of lesions per subject screened, 0.10 to 1.05; range of the percentage of subjects with adenomas, 9.4 to 32.7%) and in their times of withdrawal of the colonoscope from the cecum to the anus (range, 3.1 to 16.8 minutes for procedures during which no polyps were removed). As compared with colonoscopists with mean withdrawal times of less than 6 minutes, those with mean withdrawal times of 6 minutes or more had higher rates of detection of any neoplasia (28.3% vs. 11.8%, P<0.001) and of advanced neoplasia (6.4% vs. 2.6%, P=0.005). CONCLUSIONS: In this large community-based gastroenterology practice, we observed greater rates of detection of adenomas among endoscopists who had longer mean times for withdrawal of the colonoscope. The effect of variation in withdrawal times on lesion detection and the prevention of colorectal cancer in the context of widespread colonoscopic screening is not known. Ours was a preliminary study, so the generalizability and implications for clinical practice need to be determined by future studies.
Assuntos
Adenoma/diagnóstico , Neoplasias do Colo/diagnóstico , Colonoscopia/métodos , Adenoma/patologia , Pólipos Adenomatosos/diagnóstico , Competência Clínica , Neoplasias do Colo/patologia , Colonoscopia/normas , Feminino , Gastroenterologia , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade da Assistência à Saúde , Fatores de TempoRESUMO
In the United States sedation and analgesia is the standard of practice when performing upper and lower gastrointestinal endoscopy. Many of these endoscopic procedures are performed in ambulatory endoscopy centers, including ambulatory surgery centers. This article reviews new Joint Commission on Accreditation of Healthcare Organizations standards for sedation and analgesia, drugs used for sedation and analgesia (including side effects), patient assessment and monitoring (before, during, and postprocedure), and discharge of patients from the ambulatory endoscopy center.