The European Society of Gastrointestinal Endoscopy and United European Gastroenterology present a short list of key performance measures for lower gastrointestinal endoscopy. We recommend that ...endoscopy services across Europe adopt the following seven key performance measures for lower gastrointestinal endoscopy for measurement and evaluation in daily practice at a center and endoscopist level: 1 rate of adequate bowel preparation (minimum standard 90%); 2 cecal intubation rate (minimum standard 90%); 3 adenoma detection rate (minimum standard 25%); 4 appropriate polypectomy technique (minimum standard 80%); 5 complication rate (minimum standard not set); 6 patient experience (minimum standard not set); 7 appropriate post-polypectomy surveillance recommendations (minimum standard not set). Other identified performance measures have been listed as less relevant based on an assessment of their importance, scientific acceptability, feasibility, usability, and comparison to competing measures.
OBJECTIVESThe response rate to initial invitation to population-based primary screening colonoscopy within the NordICC trial (NCT 00883792) in Poland is around 50%. The aim of this study was to ...compare the effect of a reinvitation letter and invitation to an educational intervention on participation in screening colonoscopy in nonresponders to initial invitation.
METHODSWithin the NordICC trial framework, individuals living in the region of Warsaw, who were drawn from Population Registries and assigned randomly to the screening group, received an invitation letter and a reminder with a prespecified screening colonoscopy appointment date. One thousand individuals, aged 55 to 64 years, who did not respond to both the invitation and the reminding letter were assigned randomly in a 1 : 1 ratio to the reinvitation group (REI) and the educational meeting group (MEET). The REI group was sent a reinvitation letter and reminder 6 and 3 weeks before the new colonoscopy appointment date, respectively. The MEET group was sent an invitation 6 weeks before an educational meeting date. Outcome measures were participation in screening colonoscopy within 6 months and response rate within 3 months from the date of reinvitation or invitation to an educational meeting.
RESULTSThe response rate and the participation rate in colonoscopy were statistically significantly higher in the REI group compared with the MEET group (16.5 vs. 4.3%; P<0.001 and 5.2 vs. 2.1%; P=0.008, respectively).
CONCLUSIONA simple reinvitation letter results in a higher response rate and participation rate to screening colonoscopy than invitation to tailored educational meeting in nonresponders to previous invitations. (NCT01183156).
Background
The peroral “pull” technique and the direct “push” procedure are the two main methods for percutaneous endoscopic gastrostomy (PEG) placement. Although pull‐PEG is generally recommended as ...the first‐line modality, many oncological patients require a push‐PEG approach to prevent tumor seeding or overcome tumor‐related obstruction.
Objective
We aimed to compare the efficacy and safety of both PEG procedures in cancer patients.
Methods
We retrospectively analyzed all consecutive PEG procedures within a tertiary oncological center. Patients were followed up with the hospital databases and National Cancer Registry to assess the technical success rate for PEG placement, the rate of minor and major adverse events (AEs), and 30‐day mortality rates. We compared those outcomes between the two PEG techniques. Finally, risk factors for PEG‐related adverse events were analyzed using a multivariable Cox proportional‐hazard regression model adjusted for patients' sex, age, performance status (ECOG), Body Mass Index (BMI), diabetes, chemoradiotherapy (CRT) status (pre‐/current‐/post‐treatment), and type of PEG.
Results
We included 1055 PEG procedures (58.7% push‐PEG/41.4% pull‐PEG) performed in 994 patients between 2014 and 2021 (mean age 62.0 ±10.7 yrs.; 70.2% males; indication: head‐and‐neck cancer 75.9%/other cancer 24.1%). The overall technical success for PEG placement was 96.5%. Although the “push” technique had a higher rate of all AEs (21.4% vs. 7.1%, Hazard Ratio HR = 2.9; 95% CI = 1.9–4.3, p < 0.001), most of these constituted minor AEs (71.9%), such as tube dislodgement. The methods had no significant difference regarding major AEs and 30‐day mortality rates. Previous CRT was associated with an increased risk of major AEs (hazard ratio = 2.7, 95% CI = 1.0–7.2, p = 0.042).
Conclusion
The risk of major AEs was comparable between the push‐ and pull‐PEG techniques in cancer patients. Due to frequent tube dislodgement in push‐PEG, the pull technique may be more suitable for long‐term feeding. Previous CRT increases the risk of major AEs, favoring early (“prophylactic”) PEG placement when such treatment is expected.
Objectives Aspirin may be involved in microscopic colitis (MC) development, but there are no data on colon histology in asymptomatic aspirin users. We prospectively assessed colonic and rectal mucosa ...from aspirin users, searching for MC features. Methods From colonoscopy screenees, two biopsy samples were taken from each of three locations: ascending colon, transverse colon and rectum. A pathologist measured chronicity of inflammation and activity indicators, epithelial cell height and subepithelial collagen layer width. Intraepithelial lymphocytes (IELs), intralaminal eosinophils and apoptotic cells/100 crypts were counted. Panel data models were used to analyse associations between aspirin use, biopsy location and microscopic parameters. Results Of 100 screenees (age: 40–65 years), 42 were current aspirin users. Median duration of aspirin usage was 48 months (range: 36–60) with dosage ranging from 75–325 mg/day. We observed reduced epithelium polymorphs in subjects who used aspirin for <48 months versus non-users (p=0.008). Paneth cell metaplasia was significantly less frequent in aspirin users versus non-users (p=0.006). Inflammatory cells in lamina propria (eosinophils) and epithelium (IELs) were most abundant in the ascending colon and decreased distally (ascending colon vs transverse colon and transverse colon vs rectum). Cryptitis was more frequent in the ascending colon vs the rectum. Conclusions We observed no specific MC features in asymptomatic chronic low-dose aspirin users. We found subtle physiological and histopathological differences between the bowel segments.
Objective. The aim of this analysis was to retrospectively review video recordings of malignant polyps <10 mm in search for suspicious macroscopic features in white light endoscopy. Methods. Database ...entries and recordings of screening colonoscopies from a single tertiary referral center between June 2009 and December 2012 were reviewed. Malignant polyps <10 mm were analyzed. The recordings were reviewed by two expert endoscopists in search for suspicious morphological features: irregular contours, central depression, contact bleeding, shape deformity, central depression, chicken skin sign, circumscribed area with abnormal vascular and/or surface pattern. Then, six experienced endoscopists watched the recordings in search of listed features. Next, video recordings of these malignant polyps were mixed with randomly drawn video recordings of 20 non-malignant polyps matched by size and reviewed by 14 blinded endoscopists to assess the sensitivity and specificity for the diagnosis of malignant polyps. Results. Five of the 8651 (0.06%) subjects who underwent screening colonoscopy during the study period were diagnosed with a malignant polyp <10 mm. Only one of them was ad hoc identified by performing endoscopist as suspicious. On recordings review performed by the experts, each of the four remaining polyps presented at least one suspicious macroscopic feature. Presence of these features was confirmed by experienced endoscopists. The sensitivity and specificity for the diagnosis of malignant polyp were 73.21% and 85.35%, respectively, if at least two suspicious macroscopic features defined malignant polyp. Conclusions. On careful white light endoscopy examination small malignant colorectal polyps show suspicious macroscopic features, which were frequently unrecognized by examining endoscopists.
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