Abstract Purpose Unsatisfactory bowel preparation has been reported in up to 33 % of screening colonoscopies. Patients’ lack of understanding about how a good bowel preparation can be achieved is one ...of the major causes. Patient education has been explored as a possible intervention to improve this important endpoint and has yielded mixed results. We compared the proportion of satisfactory bowel preparations and adenoma detection rates between patients who viewed and did not view an educational video on colonoscopy, Methods An educational video on colonoscopy, accessible via internet, was issued to all patients with planned procedures between 2010 and 2014. Viewing status of the video was verified through a unique code linked to each patient’s medical record. Excellent, good or adequate bowel preparations were defined as “satisfactory” whereas fair, poor or inadequate bowel preparations were defined as “unsatisfactory”. Results A total of 2530 patients undergoing their first outpatient screening colonoscopy were included.1251 patients viewed the educational video and 1279 patients did not see the video. Multivariate analysis revealed higher rates of satisfactory bowel preparation in the educational video group 92.3 % (95% CI: 84.8-96.3) vs 87.4% (95% CI: 76.4-93.7), p<0.001. Need for a repeat colonoscopy within three years was also higher in patients who did not see the video 6.6 %(95% CI: 2.8-14.7) vs 3.3 %(95% CI: 1.3-7.8),p<0.001. CONCLUSION: Patient centered educational video improves bowel preparation quality and may reduce the need for an earlier repeat procedure in patients undergoing screening colonoscopy.
Background EUS-guided Trucut biopsy (TCB) enables the acquisition of tissue cores for histologic assessment. Touch imprint cytology (TIC) can be performed at the time of a biopsy to assess the ...adequacy of the sample; however, limited information is available on the diagnostic value of TIC of these specimens. Objective To investigate the diagnostic accuracy of TIC compared with a TCB. Patients and Design Consecutive EUS-guided TCB and TIC (n = 109) were retrospectively and independently reviewed by a surgical pathologist (for the TCB) and a cytopathologist (for TIC) blinded to the final diagnoses. Setting University of Iowa Hospitals and Clinics, Iowa. Main Outcome Measurements Diagnostic accuracy of a TCB, TIC, and combined TCB + TIC. Results The diagnostic accuracy of a TCB was 92.7% (95% CI, 83.1%-97.3%), TIC was 82.6% (95% CI, 74.3%-88.6%), and TCB + TIC was 95.4% (95% CI, of 89.4%-98.3%). The diagnostic accuracy of a TCB alone was superior to TIC alone ( P = .038); a TCB was diagnostic in 14 cases that were nondiagnostic by TIC. The addition of TIC allowed for the identification of 3 malignancies (2.8%) that were not identified on TCB alone. In 22 cases, TIC was considered diagnostic, but a TCB provided additional specific diagnostic information. Limitations Retrospective study and relatively low numbers. Conclusions TIC is a valuable tool for use in a EUS-guided TCB; TIC is independently diagnostically accurate, which allows for confidence in a rapid preliminary diagnosis, and it provides additional diagnostic value when combined with TCB.
We present the case of a 64-year old male with Crohn’s disease, who has intriguing endoscopic findings. Upon initial diagnosis at age 20, he received steroid therapy, but has not required any further ...medical intervention. He has remained relatively asymptomatic and keeps a healthy lifestyle. At routine colonoscopy, we identified pseudopolyps as well as tissue bridges within the colon, giving an unusual “swiss cheese” appearance. This case exemplifies the heterogeneity of Crohn’s disease, emphasizing the possibility of finding evidence of ongoing disease despite lack of symptoms.
Incorporating quality metrics into training Rizk, Maged K., MD; Vargo, John J., MD, MPH, AGAF, FACG, FACP, FASGE
Techniques in gastrointestinal endoscopy,
2012, January 2012, 2012-1-00, Letnik:
14, Številka:
1
Journal Article
There have been a number of factors that have led to a reexamination of how health care is delivered with the specific goals of improving quality and reducing cost. As gastroenterologists who are ...also proceduralists, it is imperative that we not only respond to these increasing pressures but also lead in what is a noble and necessary endeavor. The training of future gastroenterologists must take into account such realities. This chapter attempts to provide the groundwork as to how to incorporate quality metrics into training.
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