Water exchange method for colonoscopy: learning curve of an experienced colonoscopist in a U.S. community practice setting.

Science.gov (United States)

Fischer, Leonard S; Lumsden, Antoinette; Leung, Felix W

2012-07-01

Water exchange colonoscopy has been reported to reduce examination discomfort and to provide salvage cleansing in unsedated or minimally sedated patients. The prolonged insertion time and perceived difficulty of insertion associated with water exchange have been cited as a barrier to its widespread use. To assess the feasibility of learning and using the water exchange method of colonoscopy in a U.S. community practice setting. Quality improvement program in nonacademic community endoscopy centers. Patients undergoing sedated diagnostic, surveillance, or screening colonoscopy. After direct coaching by a knowledgeable trainer, an experienced colonoscopist initiated colonoscopy using the water method. Whenever >5 min elapsed without advancing the colonoscope, conversion to air insufflation was made to ensure timely completion of the examination. Water Method Intention-to-treat (ITT) cecal intubation rate (CIR). Female patients had a significantly higher rate of past abdominal surgery and a significantly lower ITTCIR. The ITTCIR showed a progressive increase over time in both males and females to 85-90%. Mean insertion time was maintained at 9 to 10 min. The overall CIR was 99%. Use of water exchange did not preclude cecal intubation upon conversion to usual air insufflation in sedated patients examined by an experienced colonoscopist. With practice ITTCIR increased over time in both male and female patients. Larger volumes of water exchanged were associated with higher ITTCIR and better quality scores of bowel preparation. The data suggest that learning water exchange by a busy colonoscopist in a community practice setting is feasible and outcomes conform to accepted quality standards.

Virtual colonoscopy with electron beam CT: correlation with barium enema, colonoscopy and pathology

International Nuclear Information System (INIS)

Hong, Hye Suk; Kim, Min Jung; Chung, Jae Joon; Kim, Myeong Jin; Lee, Jong Tae; Yoo, Hyung Sik

1998-01-01

To perform virtual colonoscopy using electron beam tomography(EBT) in patients in whom a colonic mass was present, and to compare the results with those obtained using barium enema, colonoscopy and gross pathologic specimens. Materials and Methods : Ten patients in whom colonic masses were diagnosed by either barium enema or colonoscopy were involved in this study. There were nine cases of adenocarcinoma and one of tubulovillous adenoma. Using EBT preoperative abdominopelvic CT scans were performed. Axial scans were then three-dimensionally reconstructed to produce virtual colonoscopic images and were compared with barium enema, colonoscopy and gross pathologic specimens. Virtual colonoscopic images of the masses were classified as either 1)polyploid, 2)sessile,3)fungating, or 4)annular constrictive. We also determined whether ulcers were present within the lesions and whether there was obstruction. Results : After virtual colonoscopy, two lesions were classified as polyploid, one as sessile, five as fungating and two as annular constrictive. Virtual colonoscopic images showed good correlation with the findings of barium enema, colonoscopy and gross pathologic specimens. Three of six ulcerative lesions were observed on colonoscopy; in seven adenocarcinomas with partial or total luminal obstruction, virtual colonoscopy visualized the colon beyond the obstructed sites. In one case, barium contrast failed to pass through the obstructed portion and in six cases, the colonoscope similarly failed. Conclusion : Virtual colonoscopies correlated well with barium enema, colonoscopy and gross pathologic specimens. They provide three dimensional images of colonic masses and are helpful for the evaluation of obstructive lesions

Development and comparison of projection and image space 3D nodule insertion techniques

Science.gov (United States)

Robins, Marthony; Solomon, Justin; Sahbaee, Pooyan; Samei, Ehsan

2016-04-01

This study aimed to develop and compare two methods of inserting computerized virtual lesions into CT datasets. 24 physical (synthetic) nodules of three sizes and four morphologies were inserted into an anthropomorphic chest phantom (LUNGMAN, KYOTO KAGAKU). The phantom was scanned (Somatom Definition Flash, Siemens Healthcare) with and without nodules present, and images were reconstructed with filtered back projection and iterative reconstruction (SAFIRE) at 0.6 mm slice thickness using a standard thoracic CT protocol at multiple dose settings. Virtual 3D CAD models based on the physical nodules were virtually inserted (accounting for the system MTF) into the nodule-free CT data using two techniques. These techniques include projection-based and image-based insertion. Nodule volumes were estimated using a commercial segmentation tool (iNtuition, TeraRecon, Inc.). Differences were tested using paired t-tests and R2 goodness of fit between the virtually and physically inserted nodules. Both insertion techniques resulted in nodule volumes very similar to the real nodules (values were all <0.97 for both insertion techniques. These data imply that these techniques can confidently be used as a means of inserting virtual nodules in CT datasets. These techniques can be instrumental in building hybrid CT datasets composed of patient images with virtually inserted nodules.

Repeat Colonoscopy within 6 Months after Initial Outpatient Colonoscopy in Ontario: A Population-Based Cross-Sectional Study

Directory of Open Access Journals (Sweden)

Lawrence Paszat

2017-01-01

Full Text Available Background. The goal of this study is to examine utilization of early repeat colonoscopy ≤ 6 months after an index procedure. Methods. We identified persons having repeat colonoscopy ≤ 6 months following outpatient colonoscopy without prior colonoscopy ≤ 5 years or prior diagnosis of colorectal cancer (CRC. We modeled repeat colonoscopy using a generalized estimating equation with an exchangeable correlation structure to account for clustering of patients by endoscopist. Results. The population included 334,663 persons, 7,892 (2.36% of whom had an early repeat colonoscopy within 6 months. Overall, endoscopist prior year colonoscopy volume was inversely related to repeat ≤ 6 months. Repeat colonoscopy ≤ 6 months varied by the clinical setting of the index colonoscopy (adjusted OR = 1.41 (95% CI 1.29–1.55 at nonhospital facilities compared to teaching or community hospitals. Among those who had polypectomy or biopsy, the adjusted OR for early repeat ≤ 6 months was elevated among those whose index colonoscopy was at a nonhospital facility (OR 1.44, 95% CI 1.30–1.60, compared to those at a teaching hospital or community hospital. Conclusions. Repeat colonoscopy ≤ 6 months after an index procedure is associated with the clinical setting of the index colonoscopy.

Simple New Screw Insertion Technique without Extraction for Broken Pedicle Screws.

Science.gov (United States)

Kil, Jin-Sang; Park, Jong-Tae

2018-05-01

Spinal transpedicular screw fixation is widely performed. Broken pedicle screw rates range from 3%-7.1%. Several techniques have been described for extraction of broken pedicle screws. However, most of these techniques require special instruments. We describe a simple, modified technique for management of broken pedicle screws without extraction. No special instruments or drilling in an adjacent pedicle are required. We used a high-speed air drill with a round burr. With C-arm fluoroscopy guidance, the distal fragment of a broken pedicle screw was palpated using free-hand technique through the screw entry hole. A high-speed air drill with a round burr (not a diamond burr) was inserted through the hole. Drilling began slowly and continued until enough space was obtained for new screw insertion. Using this space, we performed new pedicle screw fixation medially alongside the distal fragment of the broken pedicle screw. We performed the insertion with a previously used entry hole and pathway in the pedicle. The same size pedicle screw was used. Three patients were treated with this modified technique. New screw insertion was successful in all cases after partial drilling of the distal broken pedicle screw fragment. There were no complications, such as screw loosening, dural tears, or root injury. We describe a simple, modified technique for management of broken pedicle screws without extraction. This technique is recommended in patients who require insertion of a new screw. Copyright © 2017. Published by Elsevier Inc.

Splenic injury after colonoscopy

DEFF Research Database (Denmark)

Petersen, C.R.; Adamsen, S.; Gocht-Jensen, P.

2008-01-01

the colonoscopy, ranging from 4 hours to 7 days, before presenting with signs of splenic injury. In all cases the spleen was torn, and the amount of blood in the peritoneal cavity ranged from 1500 mL to 5000 mL. Two patients died postoperatively. The number of cases reported after 2000 indicates......Splenic injury is a rare and serious complication of colonoscopy. The most likely mechanism is tension on the splenocolic ligament and adhesions. Eight cases were identified among claims for compensation submitted to the Danish Patient Insurance Association during the period 1992-2006, seven...... that this potentially lethal complication might be more common than was previously assumed, and it is possibly under-reported. Preventive measures include good colonoscopic technique to avoid loop formation and the use of excessive force; and it is possible that emerging endoscopic technologies will lead to a reduced...

Unsedation colonoscopy can be not that painful: Evaluation of the effect of "Lamaze method of colonoscopy".

Science.gov (United States)

Yu, Shao-Ping; Lin, Xiao-Dong; Wu, Guang-Yao; Li, Song-Hu; Wen, Zong-Quan; Cen, Xiao-Hong; Huang, Xian-Guang; Huang, Mei-Ting

2015-10-25

To evaluate the pain relieving effect of intervention with "Lamaze method of colonoscopy" in the process of colonoscopy. Five hundred and eighty-five patients underwent colonoscopy were randomly divided into three groups, Lamaze group, anesthetic group and control group. Two hundred and twenty-four patients of Lamaze group, the "Lamaze method of colonoscopy" were practiced in the process of colonoscopy. The Lamaze method of colonoscopy is modified from the Lamaze method of childbirth, which helped patients to relieve pain through effective breathing control. One hundred and seventy-eight patients in anesthetic group accepted sedation colonoscopy. For 183 patients in control group, colonoscopy was performed without any intervention. The satisfactory of colon cleaning, intestinal lesions, intubation time, success ratio, pain grading and complications were recorded. All data were statistically analyzed. There were no significant differences at base line of the three groups (P > 0.05). Anesthetic group shows advantage in intubation time than the other two groups (P advantage in intubation time than that in control group (P > 0.05). The anesthetic group showed an apparent advantage in relieving pain (P promotion in clinical practice.

High Efficacy of Repeating Colonoscopy by an Advanced Endoscopist after an Incomplete Colonoscopy

OpenAIRE

Ana Ponte; Rolando Pinho; Adélia Rodrigues; Luísa Proença; Joana Silva; Jaime P. Rodrigues; Mafalda Sousa; João Carlos Silva; João Carvalho

2018-01-01

Background and Aims: This study aims to evaluate the role of an advanced endoscopist to study the entire colon after an incomplete colonoscopy. Methods: All patients with an elective incomplete colonoscopy performed under deep sedation in our department between January 2010 and October 2016 were included. Patients with a colonic stenosis, an inadequate bowel preparation, or a colonoscopy performed without deep sedation were excluded. Included patients were followed up to evaluate if and what ...

Post-colonoscopy colorectal cancer rate in the era of high-definition colonoscopy.

Science.gov (United States)

Iwatate, Mineo; Kitagawa, Tomoyuki; Katayama, Yasumi; Tokutomi, Naohiko; Ban, Shinichi; Hattori, Santa; Hasuike, Noriaki; Sano, Wataru; Sano, Yasushi; Tamano, Masaya

2017-11-14

To investigate the post-colonoscopy colorectal cancer (PCCRC) rate for high-definition (HD) colonoscopy compared with that for standard-definition colonoscopy reported previously. Using medical records at Sano Hospital (SH) and Dokkyo Medical University Koshigaya Hospital (DMUKH), we retrospectively obtained data on consecutive patients diagnosed as having CRC between January 2010 and December 2015. The definition of PCCRC was diagnosis of CRC between 7 and 36 mo after initial high-definition colonoscopy that had detected no cancer, and patients were divided into a PCCRC group and a non-PCCRC group. The primary outcome was the rate of PCCRC for HD colonoscopy. The secondary outcomes were factors associated with PCCRC and possible reason for occurrence of early and advanced PCCRC. Among 892 CRC patients, 11 were diagnosed as having PCCRC and 881 had non-PCCRC. The PCCRC rate was 1.7% (8/471) at SH and 0.7% (3/421) at DMUKH. In comparison with the non-PCCRC group, the PCCRC group had a significantly higher preponderance of smaller tumors (39 mm vs 19 mm, P = 0.002), a shallower invasion depth (T1 rate, 25.4% vs 63.6%, P = 0.01), a non-polypoid macroscopic appearance (39.0% vs 85.7%, P = 0.02) and an earlier stage (59.7% vs 90.9%, P = 0.03). Possible reasons for PCCRC were "missed or new" in 9 patients (82%), "incomplete resection" in 1 (9%), and "inadequate examination'" in 1 (9%). Among 9 "missed or new" PCCRC, the leading cause was non-polypoid shape for early PCCRC and blinded location for advanced PCCRC. The PCCRC rate for HD colonoscopy was 0.7%-1.7%, being lower than that for standard-definition colonoscopy (1.8%-9.0%) reported previously employing the same methodology.

The role of colonoscopy in managing diverticular disease of the colon.

Science.gov (United States)

Tursi, Antonio

2015-03-01

Diverticulosis of the colon is frequently found on routine colonoscopy, and the incidence of diverticular disease and its complications appears to be increasing. The role of colonoscopy in managing this disease is still controversial. Colonoscopy plays a key role in managing diverticular bleeding. Several techniques have been effectively used in this field, but band ligation seems to be the best in preventing rebleeding. Colonoscopy is also effective in posing a correct differential diagnosis with other forms of chronic colitis involving colon harbouring diverticula (in particular with Crohn's disease or Segmental Colitis Associated with Diverticulosis). The role of colonoscopy to confirm diagnosis of uncomplicated diverticulitis is still under debate, since the risk of advanced colonic neoplasia in patients admitted for acute uncomplicated diverticulitis is not increased as compared to the average-risk population. On the contrary, colonoscopy is mandatory if patients complain of persistent symptoms or after resolution of an episode of complicated diverticulitis. Finally, a recent endoscopic classification, called Diverticular Inflammation and Complications Assessment (DICA), has been developed and validated. This classification seems to be a promising tool for predicting the outcome of the colon harboring diverticula, but further, prospective studies have to confirm its predictive role on the outcome of the disease.

Superiority of split dose midazolam as conscious sedation for outpatient colonoscopy.

Science.gov (United States)

Lee, Hyuk; Kim, Jeong Hwan

2009-08-14

To elucidate the efficacy and safety of a split dose of midazolam in combination with meperidine for colonoscopy. Eighty subjects undergoing outpatient colonoscopy were randomly assigned to group A or B. Group A (n = 40) received a split dose of midazolam in combination with meperidine. Group B (n = 40) received a single dose of midazolam in combination with meperidine. Outcome measurements were level of sedation, duration of sedation and recovery, degree of pain and satisfaction, procedure-related memory, controllability, and adverse events. Group A had a lower frequency of significant hypoxemia (P = 0.043) and a higher sedation score on withdrawal of the endoscope from the descending colon than group B (P = 0.043). Group B recovered from sedation slightly sooner than group A (P memory, except insertion-related memory, were lower in group A one week after colonoscopic examination (P = 0.018 and P sedation status during colonoscopic examination and a reduction in procedure-related pain and memory, but resulted in longer recovery time.

Colonoscopy

Science.gov (United States)

... regular activities the next day. Avoid driving, operating machinery, drinking alcohol, and making important decisions for at ... of colonoscopy may include any of the following: Heavy or ongoing bleeding from biopsy or removal of ...

COLONOSCOPY AND CARCINOEMBRYONIC ANTIGEN VARIATIONS

Directory of Open Access Journals (Sweden)

Rita G SOUSA

2014-03-01

Full Text Available Context Colonoscopy is essential for synchronous and metachronous cancer detection. Carcinoembryonic antigen is a colorectal cancer tumor marker, important as a follow-up tool in patients with previous colorectal cancer. False-positive carcinoembryonic antigen elevation results in multiples exams and in patient anxiety. In literature, there is reference to transient carcinoembryonic antigen increase with colonoscopy. Objective To evaluate the influence of bowel preparation and colonoscopy in carcinoembryonic antigen blood levels. Methods We prospectively studied subjects that underwent routine colonoscopy in our institution. Blood samples were collected (1 before bowel cleaning, (2 before colonoscopy and (3 immediately after colonoscopy. Blood carcinoembryonic antigen levels were determined by “Sandwich” immunoassay. The statistical methods used were the paired t-test and ANOVA. Results Thirty-seven patients (22M/15F were included; age range 28-84 (mean 56 years. Mean carcinoembryonic antigen values were 1.9, 2 and 1.8 for (1, (2 and (3, respectively. An increase in value (2 compared with (1 was observed in 20/37 patients (P = 0.018, mainly in younger patients and in patients requiring more endoluminal interventions. In 29/37 patients, the CEA value decreased from (2 to (3 (P = 1.3x10-7. Conclusions A trend for carcinoembryonic antigen increase after bowel cleaning was observed, especially in younger patients and in patients with more endoluminal interventions, but without clinical meaning.

Left-colon water exchange preserves the benefits of whole colon water exchange at reduced cecal intubation time conferring significant advantage in diagnostic colonoscopy - a prospective, randomized controlled trial.

Science.gov (United States)

Wang, Xiangping; Luo, Hui; Xiang, Yi; Leung, Felix W; Wang, Limei; Zhang, Linhui; Liu, Zhiguo; Wu, Kaichun; Fan, Daiming; Pan, Yanglin; Guo, Xuegang

2015-07-01

Whole-colon water exchange (WWE) reduces insertion pain, increases cecal intubation success and adenoma detection rate, but requires longer insertion time, compared to air insufflation (AI) colonoscopy. We hypothesized that water exchange limited to the left colon (LWE) can speed up insertion with equivalent results. This prospective, randomized controlled study (NCT01735266) allocated patients (18-80 years) to WWE, LWE or AI group (1:1:1). The primary outcome was cecal intubation time. Three hundred subjects were randomized to the WWE (n = 100), LWE (n = 100) or AI group (n = 100). Ninety-four to ninety-five per cent of patients underwent diagnostic colonoscopy. Baseline characteristics were balanced. The median insertion time was shorter in LWE group (4.8 min (95%CI: 3.2-6.2)) than those in WWE (7.5 min (95%CI: 6.0-10.3)) and AI (6.4 min (95%CI: 4.2-9.8)) (both p rates in unsedated patients of the two water exchange methods (WWE 99%, LWE 99%) were significantly higher than that (89.8%) in AI group (p = 0.01). The final success rates were comparable among the three groups after sedation was given. Maximum pain scores and number of patients needing abdominal compression between WWE and LWE groups were comparable, both lower than those in AI group (p higher in WWE group. By preserving the benefits of WWE and reducing insertion time, LWE is appropriate for diagnostic colonoscopy, especially in settings with tight scheduling of patients. The higher PDR in the right colon in WWE group deserves to be further investigated.

Virtual colonoscopy - changes for screening examination?

International Nuclear Information System (INIS)

Rust, G.F.; Reiser, M.

2002-01-01

In principle, virtual colonoscopy is capable to be used as method for early detection of colorectal cancer (CRC), even if the accuracy of the method and radiation exposure are matters discussion in the radiological community. Virtual colonoscopy is able to detect any pathology which is relevant for early detection of CRC especially when using multislice CT, but also with single slice CT. The diagnosis of small lesions, less than 7 mm in diameter (polyps and flat lesions) is still problematic as it is in conventional colonoscopy. The exposure to x-rays in asymptomatic patients, without any increased risk of developing cancer is highly problematic and should be reduced to a minimum. Using special post processing filters on the volume dataset it can be shown that a tube current of 20 mAs is sufficient without any loss in accuracy. Measurements on the Alderson-phantom showed, that an effective dose exposure of 1.2 mSv is obtained using these reduced mAs values. It has to be differentiated between virtual colonoscopy for early detection of polyps and CRC in individual patients or as a screening examination of a large population. Virtual colonoscopy as a screening examination necessitates reduction of radiation dose, a high degree of automatisation in 3D reconstructions as well as the assessment of the entire mucosa. High risk patients, whom refuse fibreoptic colonoscopy should undergo virtual colonoscopy. Virtual colonoscopy has a good chance to become an accepted tool for general screening, if efficient dose reduction, complete visualization of the colon mucosa and automatisation of the post processing procedures can be achieved. (orig.) [de

Comparison of bougie-guided insertion of Proseal tm laryngeal mask airway with digital technique in adults

Directory of Open Access Journals (Sweden)

Anand Kuppusamy

2010-01-01

Full Text Available The Proseal TM laryngeal mask airway (PLMA TM , Laryngeal Mask Company, UK was designed to improve ventilatory characteristics and offer protection against regurgitation and gastric insufflation. The PLMA is a modified laryngeal mask airway with large ventral cuff, dorsal cuff and a drain tube. These modifications improve seal around glottis and enable better ventilatory characteristics. The drain tube prevents gastric distension and offers protection against aspiration. There were occasional problems, like failed insertion and inadequate ventilation, in placing PLMA TM using the classical digital technique. To overcome these problems, newer placement techniques like thumb insertion technique, introducer tool placement and gum elastic bougie (GEB-aided placement were devised. We compared classical digital placement of PLMA TM with gum elastic bougie-aided technique in 60 anaesthetised adult patients (with 30 patients in each group with respect to number of attempts to successful placement, effective airway time, airway trauma during insertion, postoperative airway morbidity and haemodynamic response to insertion. The number of attempts to successful placement, airway trauma during insertion and haemodynamic response to insertion were comparable among the two groups, while effective airway time and oropharyngeal leak pressure were significantly higher in bougie- guided insertion of PLMA. Postoperatively, sore throat was more frequent with digital technique while dysphagia was more frequent with bougie-guided technique. Hence gum elastic bougie guided, laryngoscope aided insertion of PLMA is an excellent alternate to classical digital technique.

Quality in colonoscopy: European perspectives and practice

NARCIS (Netherlands)

Rees, Colin J.; Rajasekhar, Praveen T.; Rutter, Matthew D.; Dekker, Evelein

2014-01-01

Colonoscopy is the 'gold standard' investigation of the colon. High quality colonoscopy is essential to diagnose early cancer and reduce its incidence through the detection and removal of pre-malignant adenomas. In this review, we discuss the key components of a high quality colonoscopy, review

STUDY ON VIRTUAL COLONOSCOPY

Directory of Open Access Journals (Sweden)

Aithagani Rama Chandraiah

2016-10-01

Full Text Available BACKGROUND Current options available in the investigations of colorectal carcinoma include screening using digital rectal examination, sigmoidoscopy, barium enema and fiberoptic colonoscopy, virtual colonoscopy. The aim of the study was to prospectively evaluate patient acceptance of virtual colonoscopy compared with that of conventional colonoscopy when performed in patients with or suspected of having colorectal disease. MATERIALS AND METHODS The study had been conducted on patients attending Department of Radiology for a period of 1 year. Patients with primary or secondary complaints of pain abdomen, lump in abdomen, bleeding per rectum, loose motions/constipation, altered bowel habits, loss of appetite and weight and anaemia, so total number of cases were 51. RESULTS In our study, the patients were in age groups of 21-70 years. Both sexes were represented in our study. Male preponderance was noted in 51 patients. Cases of adenoma were more commonly found 37 (72.78%. The sensitivity of the CT colonography for the polyps more than 10 mm is 100%, polyps 6-9 mm is 90%, less than 6 mm is 80%. Our study consists of 51 patients; among them, 30 patients showed acceptance for CT colonography, 10 patients for optical colonoscopy. Our study consists of 51 patients, the polyps (more than 10 mm detected in 2D viewing were 24, 2D and 3D viewing of 24, the polyps (less than 10 mm detected in 2D viewing were 15, 2D and 3D viewing were 17. 3D viewing resulted in increased sensitivity for identification of patients with larger polyps more than 1 cm, (70-85% sensitivity and patients with smaller polyps less than 1 cm (increased sensitivity 75-88%. CONCLUSIONS Multislice CT (64 colonography is a good alternative to other colorectal screening tests because it has high sensitivity for polyps 10 mm or more in diameter is relatively safe, clinical effective, minimally invasive, cost effective and filter for therapeutic optical colonoscopy.

Preliminary development of the Active Colonoscopy Training Model

Directory of Open Access Journals (Sweden)

Choi J

2011-06-01

Full Text Available JungHun Choi1, Kale Ravindra1, Randolph Robert1, David Drozek21Mechanical Engineering, Ohio University, Athens, OH, USA; 2College of Osteopathic Medicine, Ohio University, Athens, OH, USAAbstract: Formal colonoscopy training requires a significant amount of time and effort. In particular, it requires actual patients for a realistic learning experience. The quality of colonoscopy training varies, and includes didactic courses and procedures proctored by skilled surgeons. A colonoscopy training model is occasionally used as part of the training method, but the effects are minute due to both the simple and tedious training procedures. To enhance the educational effect of the colonoscopy training model, the Active Colonoscopy Training Model (ACTM has been developed. ACTM is an interactive colonoscopy training device which can create the environment of a real colonoscopy procedure as closely as possible. It comprises a configurable rubber colon, a human torso, sensors, a display, and the control part. The ACTM provides audio and visual interaction to the trainee by monitoring important factors, such as forces caused by the distal tip and the shaft of the colonoscope and the pressure to open up the lumen and the localization of the distal tip. On the computer screen, the trainee can easily monitor the status of the colonoscopy, which includes the localization of the distal tip, maximum forces, pressure inside the colon, and surgery time. The forces between the rubber colon and the constraints inside the ACTM are measured and the real time display shows the results to the trainee. The pressure sensors will check the pressure at different parts of the colon. The real-time localized distal tip gives the colonoscopy trainee easier and more confident operation without introducing an additional device in the colonoscope. With the current need for colonoscopists and physicians, the ACTM can play an essential role resolving the problems of the current

Comparison of four techniques of nasogastric tube insertion in anaesthetised, intubated patients: A randomized controlled trial

Directory of Open Access Journals (Sweden)

Mohan Chandra Mandal

2014-01-01

Full Text Available Background and Aims: Insertion of nasogastric tubes (NGTs in anaesthetised, intubated patients with a conventional method is sometimes difficult. Different techniques of NGT insertion have been tried with varying degree of success. The aim of this prospective, randomised, open-label study was to evaluate three modified techniques of NGT insertion comparing with the conventional method in respect of success rate, time taken for insertion and the adverse events. Methods: In the operation theatre of general surgery, the patients were randomly allocated into four groups: Group C (control group, n = 54, Group W (ureteral guide wire group, n = 54, Group F (neck flexion with lateral pressure, n = 54 and Group R (reverse Sellick′s manoeuvre, n = 54. The number of attempts for successful NGT insertion, time taken for insertion and adverse events were noted. Results: All the three modified techniques were found more successful than the conventional method on the first attempt. The least time taken for insertion was noted in the reverse Sellick′s method. However, on intergroup analysis, neck flexion and reverse Sellick′s methods were comparable but significantly faster than the other two methods with respect to time taken for insertion. Conclusion: Reverse Sellick′s manoeuver, neck flexion with lateral neck pressure and guide wire-assisted techniques are all better alternatives to the conventional method for successful, quick and reliable NGT insertion with permissible adverse events in anaesthetised, intubated adult patients. Further studies after eliminating major limitations of the present study are warranted to establish the superiority of any one of these modified techniques.

Polyp prevalence at colonoscopy among Nigerians: A prospective ...

African Journals Online (AJOL)

Polyp prevalence at colonoscopy among Nigerians: A prospective observational study. ... Materials and Methods: This is a prospective study of all colonoscopy examinations performed at the endoscopy unit of our hospital from January, 2007 to December 2013. The patient demographics, indications for colonoscopy, ...

A novel colonoscopy reporting system enabling quality assurance

NARCIS (Netherlands)

van Doorn, Sascha C.; van Vliet, Joost; Fockens, Paul; Dekker, Evelien

2014-01-01

The quality of colonoscopy can only be measured if colonoscopy reports include all key quality indicators. In daily practice, reporting is often incomplete and not standardized. This study describes a novel, structured colonoscopy reporting system, which aims to generate standardized and complete

The corner of the gastroenterologist: What colonoscopy can do, what to ask to radiologist

International Nuclear Information System (INIS)

Bennato, Raffaele; Balzano, Antonio

2007-01-01

Colonoscopy is the diagnostic technique of choice for most colonic diseases and allows to explore the entire colonic mucosal surface and to visualize the mucosa of terminal ileum. When it is done with appropriate indications, significantly more clinically relevant diagnoses are made. Moreover, colonoscopy keeps an operative role in the treatment of some acute and chronic colonic diseases and it is the most effective colorectal cancer screening modality. The endoscopic exploration of colon is not infallible and presents rare complications. Programs of endoscopic training and practice, monitoring of quality indicators and continuous technological development are improving endoscopic diagnostic and therapeutic role. Appropriate indications for colonoscopy, its limits and complications and questions for the radiologist are discussed

What to Expect During a Colonoscopy

Medline Plus

Full Text Available ... for Clinical Research and Education, underscores the lifesaving importance of colorectal screening by colonoscopy. The video instills confidence in patients about the effectiveness, safety and importance of colonoscopy. Featuring the experience of a female ...

Technological advances for improving adenoma detection rates: The changing face of colonoscopy.

Science.gov (United States)

Ishaq, Sauid; Siau, Keith; Harrison, Elizabeth; Tontini, Gian Eugenio; Hoffman, Arthur; Gross, Seth; Kiesslich, Ralf; Neumann, Helmut

2017-07-01

Worldwide, colorectal cancer is the third commonest cancer. Over 90% follow an adenoma-to-cancer sequence over many years. Colonoscopy is the gold standard method for cancer screening and early adenoma detection. However, considerable variation exists between endoscopists' detection rates. This review considers the effects of different endoscopic techniques on adenoma detection. Two areas of technological interest were considered: (1) optical technologies and (2) mechanical technologies. Optical solutions, including FICE, NBI, i-SCAN and high definition colonoscopy showed mixed results. In contrast, mechanical advances, such as cap-assisted colonoscopy, FUSE, EndoCuff and G-EYE™, showed promise, with reported detections rates of up to 69%. However, before definitive recommendations can be made for their incorporation into daily practice, further studies and comparison trials are required. Copyright © 2017 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

Dual energy virtual CT colonoscopy with dual source computed tomography. Initial experience

International Nuclear Information System (INIS)

Karcaaltincaba, M.; Karaosmanoglu, D.; Akata, D.; Sentuerk, S.; Oezmen, M.; Alibek, S.

2009-01-01

Purpose: To describe the technique of DE MDCT colonoscopy and to assess its feasibility. Materials and Methods: 8 patients were scanned with DSCT with a DE scan protocol and dose modulation software. Analysis was performed using dedicated DE software. Prone non-contrast images and DE supine images after contrast injection were obtained. Results: DE colonoscopic images were successfully obtained in 7 patients, but the FOV did not cover all colonic segments in 1 patient, thus resulting in a technical success rate was 87.5%. Streak artifacts were present in the pelvic region in 2 patients. Virtual unenhanced images and iodine map images were obtained for all patients. In 1 patient a polypoid non-enhancing structure was noted on the iodine map, and conventional colonoscopy revealed impacted stool. Enhancing rectal cancer in 1 patient was correctly shown on the iodine map. Iodine maps helped to differentiate stool fragments/retained fluid by the absence of enhancement when compared to prone CT images. The major advantage of DE colonoscopy was the lack of misregistration. Conclusion: DE MDCT colonoscopy is technically feasible and may obviate the need for unenhanced prone images. It may be possible to perform noncathartic DECT colonoscopy. The major limitation is the limited FOV of tube B. The dose should be optimized to reduce streak artifacts in the pelvic region. (orig.)

The big picture: does colonoscopy work?

Science.gov (United States)

Hewett, David G; Rex, Douglas K

2015-04-01

Colonoscopy for average-risk colorectal cancer screening has transformed the practice of gastrointestinal medicine in the United States. However, although the dominant screening strategy, its use is not supported by randomized controlled trials. Observational data do support a protective effect of colonoscopy and polypectomy on colorectal cancer incidence and mortality, but the level of protection in the proximal colon is variable and operator-dependent. Colonoscopy by high-level detectors remains highly effective, and ongoing quality improvement initiatives should consider regulatory factors that motivate changes in physician behavior. Copyright © 2015 Elsevier Inc. All rights reserved.

Small bowel obstruction complicating colonoscopy: a case report

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Hunter Iain A

2008-05-01

Full Text Available Abstract Introduction This report describes a rare complication of colonoscopy and reviews the literature with regard to other rare causes of acute abdominal presentations following colonoscopy. Case presentation After a therapeutic colonoscopy a 60-year-old woman developed an acute abdomen. At laparotomy she was discovered to have small bowel obstruction secondary to incarceration through a congenital band adhesion. Conclusion Although there is no practical way in which such rare complications can be predicted, this case report emphasises the wide array of pathologies that can result in acute abdominal symptoms following colonoscopy.

Is water exchange superior to water immersion for colonoscopy? A systematic review and meta-analysis.

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Chen, Zhihao; Li, Zhengqi; Yu, Xinying; Wang, Guiqi

2018-06-05

Recently, water exchange (WE) instead of water immersion (WI) for colonoscopy has been proposed to decrease pain and improve adenoma detection rate (ADR). This systematic review and meta-analysis is conducted to assess whether WE is superior to WI based on the published randomized controlled trials (RCTs). We searched studies from PubMed, Cochrane Central Register of Controlled Trials, EMBASE, and MEDLINE. Only RCTs were eligible for our study. The pooled risk ratios (RRs), pooled mean difference (MD), and pooled 95% confidence intervals (CIs) were calculated by using the fixed-effects model or random-effects model based on heterogeneity. Five RCTs consisting of 2229 colonoscopies were included in this study. WE was associated with a significantly higher ADR than WI (RR = 1.18; CI = 1.05-1.32; P = 0.004), especially in right colon (RR = 1.31; CI = 1.07-1.61; P = 0.01). Compared with WI, WE was confirmed with lower pain score, higher Boston Bowel Preparation Scale score, but more infused water during insertion. There was no statistical difference between WE and WI in cecal intubation rate and the number of patients who had willingness to repeat the examination. Furthermore, both total procedure time and cecal intubation time in WE were significantly longer than that in WI (MD = 2.66; CI = 1.42-3.90; P < 0.0001; vs MD = 4.58; CI = 4.01-5.15; P < 0.0001). This meta-analysis supports the hypothesis that WE is superior to WI in improving ADR, attenuating insertion pain and providing better bowel cleansing, but inferior in time and consumption of infused water consumption during insertion.

Virtual CT-colonoscopy resources in large intestine neoplasia

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Chalyk Yu.V.

2011-12-01

Full Text Available The research goal is to state possibility of virtual colonoscopy and to determine the localization and nature of neoplasms in the large intestine. Materials and methods: 38 patients have been examined by the method of virtual colonoscopy. The preceding stage of diagnosis by total fibrocolonoscopy has not been a success. Results: Virtual colonoscopy has been performed in 94.7% of patients. The same tumors have been identified in the proximal colon, direct examination of which has not been possible. Conclusion: Virtual colonoscopy is the method of choice for topical diagnosis of tumors of the colon

Colonic gas explosion during therapeutic colonoscopy with electrocautery

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Ladas, Spiros D; Karamanolis, George; Ben-Soussan, Emmanuel

2007-01-01

Therapeutic colonoscopy with electrocautery is widely used around the world. Adequate colonic cleansing is considered a crucial factor for the safety of this procedure. Colonic gas explosion, although rare, is one of the most frightening iatrogenic complications during colonoscopy with electrocautery. This complication is the result of an accumulation of colonic gases to explosive concentrations, but may be prevented by meticulous bowel preparation. The purpose of this review is to discuss the indications and the types of bowel preparations for therapeutic colonoscopy, and to contribute recommendations for the adequate bowel preparation for colonoscopy with electrocautery. PMID:17879396

The comparative cost-effectiveness of colorectal cancer screening using faecal immunochemical test vs. colonoscopy.

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Wong, Martin C S; Ching, Jessica Y L; Chan, Victor C W; Sung, Joseph J Y

2015-09-04

Faecal immunochemical tests (FITs) and colonoscopy are two common screening tools for colorectal cancer(CRC). Most cost-effectiveness studies focused on survival as the outcome, and were based on modeling techniques instead of real world observational data. This study evaluated the cost-effectiveness of these two tests to detect colorectal neoplastic lesions based on data from a 5-year community screening service. The incremental cost-effectiveness ratio (ICER) was assessed based on the detection rates of neoplastic lesions, and costs including screening compliance, polypectomy, colonoscopy complications, and staging of CRC detected. A total of 5,863 patients received yearly FIT and 4,869 received colonoscopy. Compared with FIT, colonoscopy detected notably more adenomas (23.6% vs. 1.6%) and advanced lesions or cancer (4.2% vs. 1.2%). Using FIT as control, the ICER of screening colonoscopy in detecting adenoma, advanced adenoma, CRC and a composite endpoint of either advanced adenoma or stage I CRC was US$3,489, US$27,962, US$922,762 and US$23,981 respectively. The respective ICER was US$3,597, US$439,513, -US$2,765,876 and US$32,297 among lower-risk subjects; whilst the corresponding figure was US$3,153, US$14,852, US$184,162 and US$13,919 among higher-risk subjects. When compared to FIT, colonoscopy is considered cost-effective for screening adenoma, advanced neoplasia, and a composite endpoint of advanced neoplasia or stage I CRC.

Impact of cap-assisted colonoscopy on the learning curve and quality in colonoscopy: a randomized controlled trial.

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Tang, Zhouwen; Zhang, Daniel S; Thrift, Aaron P; Patel, Kalpesh K

2018-03-01

Colonoscopy competency assessment in trainees traditionally has been informal. Comprehensive metrics such as the Assessment of Competency in Endoscopy (ACE) tool suggest that competency thresholds are higher than assumed. Cap-assisted colonoscopy (CAC) may improve competency, but data regarding novice trainees are lacking. We compared CAC versus standard colonoscopy (SC) performed by novice trainees in a randomized controlled trial. All colonoscopies performed by 3 gastroenterology fellows without prior experience were eligible for the study. Exclusion criteria included patient age 90 years, pregnancy, prior colon resection, diverticulitis, colon obstruction, severe hematochezia, referral for EMR, or a procedure done without patient sedation. Patients were randomized to either CAC or SC in a 1:1 fashion. The primary outcome was the independent cecal intubation rate (ICIR). Secondary outcomes were cecal intubation time, polyp detection rate, polyp miss rate, adenoma detection rate, ACE tool scores, and cumulative summation learning curves. A total of 203 colonoscopies were analyzed, 101 in CAC and 102 in SC. CAC resulted in a significantly higher cecal intubation rate, at 79.2% in CAC compared with 66.7% in SC (P = .04). Overall cecal intubation time was significantly shorter at 13.7 minutes for CAC versus 16.5 minutes for SC (P =.02). Cecal intubation time in the case of successful independent fellow intubation was not significantly different between CAC and SC (11.6 minutes vs 12.7 minutes; P = .29). Overall ACE tool motor and cognitive scores were higher with CAC. Learning curves for ICIR approached the competency threshold earlier with cap use but reached competency for only 1 fellow. The polyp detection rate, polyp miss rate, and adenoma detection rate were not significantly different between groups. CAC resulted in significant improvement in ICIR, overall ACE tool scores, and trend toward competency on learning curves when compared with SC in colonoscopy

Appendiceal Abscesses Reduced in Size by Drainage of Pus from the Appendiceal Orifice during Colonoscopy: A Report of Three Cases

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Shinjiro Kobayashi

2014-11-01

Full Text Available Interval appendectomy (IA for appendiceal abscesses is useful for avoiding extended surgery and preventing postoperative complications. However, IA has problems in that it takes time before an abscess is reduced in size in some cases and in that elective surgery may result in a delay in treatment in patients with a malignant tumor of the appendix. In order to rule out malignancy, we performed colonoscopy on three patients with an appendiceal abscess that did not decrease in size 5 or more days after IA. After malignancy had been ruled out by examination of the area of the appendiceal orifice, the appendiceal orifice was compressed with a colonoscope, and a catheter was inserted through the orifice. Then, drainage of pus was observed from the appendiceal orifice into the cecal lumen. Computed tomography performed 3 days after colonoscopy revealed a marked reduction in abscess size in all patients. No endoscopy-related complication was noted. Colonoscopy in patients with an appendiceal abscess may not only differentiate malignant tumors, but also accelerate reduction in abscess size.

Improving the Yield of Histological Sampling in Patients With Suspected Colorectal Cancer During Colonoscopy by Introducing a Colonoscopy Quality Assurance Program.

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Gado, Ahmed; Ebeid, Basel; Abdelmohsen, Aida; Axon, Anthony

2011-08-01

Masses discovered by clinical examination, imaging or endoscopic studies that are suspicious for malignancy typically require biopsy confirmation before treatment is initiated. Biopsy specimens may fail to yield a definitive diagnosis if the lesion is extensively ulcerated or otherwise necrotic and viable tumor tissue is not obtained on sampling. The diagnostic yield is improved when multiple biopsy samples (BSs) are taken. A colonoscopy quality-assurance program (CQAP) was instituted in 2003 in our institution. The aim of this study was to determine the effect of instituting a CQAP on the yield of histological sampling in patients with suspected colorectal cancer (CRC) during colonoscopy. Initial assessment of colonoscopy practice was performed in 2003. A total of five patients with suspected CRC during colonoscopy were documented in 2003. BSs confirmed CRC in three (60%) patients and were nondiagnostic in two (40%). A quality-improvement process was instituted which required a minimum six BSs with adequate size of the samples from any suspected CRC during colonoscopy. A total of 37 patients for the period 2004-2010 were prospectively assessed. The diagnosis of CRC was confirmed with histological examination of BSs obtained during colonoscopy in 63% of patients in 2004, 60% in 2005, 50% in 2006, 67% in 2007, 100% in 2008, 67% in 2009 and 100% in 2010. The yield of histological sampling increased significantly ( p quality assurance and improvement program increased the yield of histological sampling in patients with suspected CRC during colonoscopy.

Modestly increased use of colonoscopy when copayments are waived.

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Khatami, Shabnam; Xuan, Lei; Roman, Rolando; Zhang, Song; McConnel, Charles; Halm, Ethan A; Gupta, Samir

2012-07-01

Colorectal cancer (CRC) screening with colonoscopy often requires expensive copayments from patients. The 2010 Patient Protection and Affordable Care Act mandated elimination of copayments for CRC screening, including colonoscopy, but little is known about the effects of copayment elimination on use. The University of Texas employee, retiree, and dependent health plan instituted and promoted a waiver of copayments for screening colonoscopies in fiscal year (FY) 2009; we examined the effects of removing cost sharing on colonoscopy use. We conducted a retrospective cohort study of 59,855 beneficiaries of the University of Texas employee, retiree, and dependent health plan, associated with 16 University of Texas health and nonhealth campuses, ages 50-64 years at any point in FYs 2002-2009 (267,191 person-years of follow-up evaluation). The primary outcome was colonoscopy incidence among individuals with no prior colonoscopy. We compared the age- and sex-standardized incidence ratios for colonoscopy in FY 2009 (after the copayment waiver) with the expected incidence for FY 2009, based on secular trends from years before the waiver. The annual incidence of colonoscopy increased to 9.5% after the copayment was waived, compared with an expected incidence of 8.0% (standardized incidence ratio, 1.18; 95% confidence interval, 1.14-1.23; P screening results in a statistically significant, but modest (1.5%), increase in use. Additional strategies beyond removing financial disincentives are needed to increase use of CRC screening. Copyright © 2012 AGA Institute. Published by Elsevier Inc. All rights reserved.

Impact of bowel preparation type on the quality of colonoscopy: a multicenter community-based study

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Daniel Martin

2016-04-01

Full Text Available Background: High-quality bowel preparation is crucial for achieving the goals of colonoscopy. However, choosing a bowel preparation in clinical practice can be challenging because of the many formulations. This study aims to assess the impact the type of bowel preparation on the quality of colonoscopy in a community hospital setting. Methods: A retrospective, observational study was conducted utilizing a colonoscopy screening/surveillance database in central Illinois during the period of January 1, 2010, to March 31, 2014. Patients without bowel preparation assessment were excluded from this study. Controlling for the confounders, generalized linear models were used to estimate the adjusted impact [odds ratio (OR] of bowel preparation type on the quality of preparation (excellent, good, fair, and poor, and on the detection of advanced adenoma. The association between the time of withdrawal after insertion and the quality of preparation was also examined using a linear model. Results: A total of 28,368 colonoscopies; half the patients were male, and the average age was 61±9 years. Polyethylene glycol (PEG was used in the majority (70.2% of bowel preparations, followed by sodium sulfate (21.4%, sodium phosphate (2.5%, magnesium sulfate (0.4%, and others. Compared with PEG, magnesium sulfate had a poorer quality of bowel preparations (OR=0.6, 95% CI 0.4–0.9; p<0.05, whereas the quality of bowel preparation was significantly improved by using sodium sulfate (OR=5.7, 95% CI 5.4–6.1; p<0.001 and sodium phosphate (OR=2.1, 95% CI 1.8–2.5; p<0.001. For those who had adequate bowel preparation, the better quality of preparation significantly increased the detection rate of advanced adenoma (5.0, 3.6, and 2.9% for excellent, good, and fair, respectively. Conclusion: When possible, sodium sulfate–based preparations should be recommended in the community setting for colonoscopy because of their high quality of bowel preparation.

Factors affecting successful colonoscopy procedures: Single-center experience.

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Kozan, Ramazan; Yılmaz, Tonguç Utku; Baştuğral, Uygar; Kerimoğlu, Umut; Yavuz, Yücel

2018-01-01

Colonoscopy is a gold standard procedure for several colon pathologies. Successful colonoscopy means demonstration of the ileocecal valve and determination of colon polyps. Here we aimed to evaluate our colonoscopy success and results. This retrospective descriptive study was performed in İstanbul Eren hospital endoscopy unit between 2012 and 2015. Colonoscopy results and patient demographics were obtained from the hospital database. All colonoscopy procedures were performed under general anesthesia and after full bowel preparation. In all, 870 patients were included to the study. We reached to the cecum in 850 (97.8%) patients. We were unable to reach the cecum in patients who were old and obese and those with previous lower abdominal operations. Angulation, inability to move forward, and tortuous colon were the reasons for inability to reach the cecum. Total 203 polyp samplings were performed in 139 patients. We performed 1, 2, and 3 polypectomies in 97, 28, and 10 patients, respectively. There were 29 (3.3%) colorectal cancers in our series. There was no mortality or morbidity in our study. General anesthesia and full bowel preparation may be the reason for increased success of colonoscopy. Increased experience and patient-endoscopist cooperation increased the rate of cecum access and polyp resection and decreased the complication rate.

Aromatherapy for reducing colonoscopy related procedural anxiety and physiological parameters: a randomized controlled study.

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Hu, Pei-Hsin; Peng, Yen-Chun; Lin, Yu-Ting; Chang, Chi-Sen; Ou, Ming-Chiu

2010-01-01

Colonoscopy is generally tolerated, some patients regarding the procedure as unpleasant and painful and generally performed with the patient sedated and receiving analgesics. The effect of sedation and analgesia for colonoscopy is limited. Aromatherapy is also applied to gastrointestinal endoscopy to reduce procedural anxiety. There is lack of information about aromatherapy specific for colonoscopy. In this study, we aimed to performed a randomized controlled study to investigate the effect of aromatherapy on relieve anxiety, stress and physiological parameters of colonoscopy. A randomized controlled trail was carried out and collected in 2009 and 2010. The participants were randomized in two groups. Aromatherapy was then carried out by inhalation of Sunflower oil (control group) and Neroli oil (Experimental group). The anxiety index was evaluated by State Trait Anxiety Inventory-state (STAI-S) score before aromatherapy and after colonoscopy as well as the pain index for post-procedural by visual analogue scale (VAS). Physiological indicators, such as blood pressure (systolic and diastolic blood pressure), heart rate and respiratory rate were evaluated before and after aromatherapy. Participates in this study were 27 subjects, 13 in control group and 14 in Neroli group with average age 52.26 +/- 17.79 years. There was no significance of procedural anxiety by STAI-S score and procedural pain by VAS. The physiological parameters showed a significant lower pre- and post-procedural systolic blood pressure in Neroli group than control group. Aromatic care for colonoscopy, although with no significant effect on procedural anxiety, is an inexpensive, effective and safe pre-procedural technique that could decrease systolic blood pressure.

The Soft Seal disposable laryngeal mask airway in adults: comparison of two insertion techniques without intra-oral manipulation.

Science.gov (United States)

Kuvaki, B; Küçükgüçlü, S; Iyilikçi, L; Tuncali, B E; Cinar, O

2008-10-01

We investigated whether insertion of the disposable Soft Seal laryngeal mask airway (SSLM) was successful without intra-oral digital manipulation. One hundred patients undergoing anaesthesia using the SSLM were randomly assigned into two groups. Insertion was performed by either a direct or a rotational technique, both without intra-oral digital manipulation. The primary outcome measure was successful insertion at first attempt. Other outcomes included insertion time, fibreoptic assessment of the airway view and airway morbidity. The first attempt success rate was higher (98%) with the direct technique than with the rotational technique (75%; p = 0.002) but insertion time was faster with the latter method (mean [range] 15 [8-50] s) than with the direct method (20 [8-56] s; p = 0.035). Fibreoptic assessment and airway morbidity were similar in both groups. We conclude that the SSLM can be successfully inserted without intra-oral digital manipulation.

Quality is the key for emerging issues of population-based colonoscopy screening

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Jin Young Yoon

2018-01-01

Full Text Available Colonoscopy is currently regarded as the gold standard and preferred method of screening for colorectal cancer (CRC. However, the benefit of colonoscopy screening may be blunted by low participation rates in population-based screening programs. Harmful effects of population-based colonoscopy screening may include complications induced by colonoscopy itself and by sedation, psychosocial distress, potential over-diagnosis, and socioeconomic burden. In addition, harmful effects of colonoscopy may increase with age and comorbidities. As the risk of adverse events in population-based colonoscopy screening may offset the benefit, the adverse events should be managed and monitored. To adopt population-based colonoscopy screening, consensus on the risks and benefits should be developed, focusing on potential harm, patient preference, socioeconomic considerations, and quality improvement of colonoscopy, as well as efficacy for CRC prevention. As suboptimal colonoscopy quality is a major pitfall of population-based screening, adequate training and regulation of screening colonoscopists should be the first step in minimizing variations in quality. Gastroenterologists should promote quality improvement, auditing, and training for colonoscopy in a population-based screening program.

Computed Tomographic Virtual Colonoscopy to Screen for Colorectal Neoplasia in asymptomatic adults

International Nuclear Information System (INIS)

Pickhardt, Perry J.; Choi, J Richard; Hwang, Inku and others

2004-01-01

We evaluated the performance characteristics of computed tomographic (CT) virtual colonospy for the detection of colorectal neoplasia in an average-risk screening population. A total of 1233 symptomatic adults (mean age, 57.8 years) underwent same-day virtual and optical colonoscopy. Radiologists used the three-dimensional endoluminal display for the initial detection of polyps on CT virtual colonoscopy. For the initial examination of each colonic segment, the colonoscopists were unaware of the findings on virtual colonoscopy, which were revealed to them before any subsequent reexamination. The sensitivity and specificity of virtual colonoscopy and the sensitivity of optical colonoscopy were calculated with the use of the findings of the final, unblinded optical colonoscopy as the reference standard. The sensitivity of virtual colonoscopy for adenomatous polyps was 93.8 percent for polyps at least 10 mm in diameter, 93.9 percent for polyps at least 8 mm in diameter, and 88.7 percent for polyps at least 6 mm in diameter. The sensitivity of optical colonoscopy for adenomatous polyps was 87.5 percent, 91.5 percent, and 92.3 percent for the three sizes of polyps, respectively. The specificity of virtual colonoscopy for adenomatous polyps was 96.0 percent for polyps at least 10 mm in diameter, 92.2 percent for polyps at least 8 mm in diameter, and 79.6 percent for polyps at least 6 mm in diameter.Two polyps were malignant; both were detected on virtual colonoscopy, and one of them was missed on optical colonoscopy before the results on virtual colonoscopy were revealed. CT virtual colonoscopy with the use of a three-dimensional approach is an accurate screening method for the detection of colorectal neoplasia in symptomatic average-risk adults and compares favorably with optical colonoscopy in terms of the detection of clinically relevant lesions

Automatic polyp detection in colonoscopy videos

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Yuan, Zijie; IzadyYazdanabadi, Mohammadhassan; Mokkapati, Divya; Panvalkar, Rujuta; Shin, Jae Y.; Tajbakhsh, Nima; Gurudu, Suryakanth; Liang, Jianming

2017-02-01

Colon cancer is the second cancer killer in the US [1]. Colonoscopy is the primary method for screening and prevention of colon cancer, but during colonoscopy, a significant number (25% [2]) of polyps (precancerous abnormal growths inside of the colon) are missed; therefore, the goal of our research is to reduce the polyp miss-rate of colonoscopy. This paper presents a method to detect polyp automatically in a colonoscopy video. Our system has two stages: Candidate generation and candidate classification. In candidate generation (stage 1), we chose 3,463 frames (including 1,718 with-polyp frames) from real-time colonoscopy video database. We first applied processing procedures, namely intensity adjustment, edge detection and morphology operations, as pre-preparation. We extracted each connected component (edge contour) as one candidate patch from the pre-processed image. With the help of ground truth (GT) images, 2 constraints were implemented on each candidate patch, dividing and saving them into polyp group and non-polyp group. In candidate classification (stage 2), we trained and tested convolutional neural networks (CNNs) with AlexNet architecture [3] to classify each candidate into with-polyp or non-polyp class. Each with-polyp patch was processed by rotation, translation and scaling for invariant to get a much robust CNNs system. We applied leave-2-patients-out cross-validation on this model (4 of 6 cases were chosen as training set and the rest 2 were as testing set). The system accuracy and sensitivity are 91.47% and 91.76%, respectively.

A novel summary report of colonoscopy: timeline visualization providing meaningful colonoscopy video information.

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Cho, Minwoo; Kim, Jee Hyun; Kong, Hyoun Joong; Hong, Kyoung Sup; Kim, Sungwan

2018-05-01

The colonoscopy adenoma detection rate depends largely on physician experience and skill, and overlooked colorectal adenomas could develop into cancer. This study assessed a system that detects polyps and summarizes meaningful information from colonoscopy videos. One hundred thirteen consecutive patients had colonoscopy videos prospectively recorded at the Seoul National University Hospital. Informative video frames were extracted using a MATLAB support vector machine (SVM) model and classified as bleeding, polypectomy, tool, residue, thin wrinkle, folded wrinkle, or common. Thin wrinkle, folded wrinkle, and common frames were reanalyzed using SVM for polyp detection. The SVM model was applied hierarchically for effective classification and optimization of the SVM. The mean classification accuracy according to type was over 93%; sensitivity was over 87%. The mean sensitivity for polyp detection was 82.1%, and the positive predicted value (PPV) was 39.3%. Polyps detected using the system were larger (6.3 ± 6.4 vs. 4.9 ± 2.5 mm; P = 0.003) with a more pedunculated morphology (Yamada type III, 10.2 vs. 0%; P < 0.001; Yamada type IV, 2.8 vs. 0%; P < 0.001) than polyps missed by the system. There were no statistically significant differences in polyp distribution or histology between the groups. Informative frames and suspected polyps were presented on a timeline. This summary was evaluated using the system usability scale questionnaire; 89.3% of participants expressed positive opinions. We developed and verified a system to extract meaningful information from colonoscopy videos. Although further improvement and validation of the system is needed, the proposed system is useful for physicians and patients.

Evaluation of Colonoscopy Skills – How Well Are We Doing?

Directory of Open Access Journals (Sweden)

Rachid Mohamed

2011-01-01

Full Text Available Colonoscopy is a complex task that requires the interplay of motor and cognitive skill sets. Traditional teaching of colonoscopy involves observation in an apprenticeship model. Individual trainees vary in their rate of their skill acquisition, and this trial-and-error method often results in frustration and anxiety for both the educator and the learner. Currently, there are no guidelines to determine the competence or proficiency of an individual for colonoscopy. Furthermore, there is a paucity of information regarding formal training curricula for colonoscopy skills acquisition. The present study investigated a formal and validated educational framework for colonoscopy teaching and compared it with the traditional apprenticeship model in first-year trainees.

Prospective comparison of double contrast barium enema plus flexible sigmoidoscopy v colonoscopy in rectal bleeding: barium enema v colonoscopy in rectal bleeding.

OpenAIRE

Irvine, E J; O'Connor, J; Frost, R A; Shorvon, P; Somers, S; Stevenson, G W; Hunt, R H

1988-01-01

Rectal bleeding often heralds serious colonic disease. The literature suggests that colonoscopy is superior to barium enema plus sigmoidoscopy, although no good comparative studies exist. Seventy one patients with overt rectal bleeding had prospectively flexible sigmoidoscopy, double contrast barium enema and colonoscopy completed independently. Against the gold standard, the sensitivity and specificity of colonoscopy were 0.69 and 0.78 respectively for a spectrum of colonic lesions, while fo...

User's perspectives of barriers and facilitators to implementing quality colonoscopy services in Canada: a study protocol.

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Jobin, Gilles; Gagnon, Marie Pierre; Candas, Bernard; Dubé, Catherine; Ben Abdeljelil, Anis; Grenier, Sonya

2010-11-02

Colorectal cancer (CRC) represents a serious and growing health problem in Canada. Colonoscopy is used for screening and diagnosis of symptomatic or high CRC risk individuals. Although a number of countries are now implementing quality colonoscopy services, knowledge synthesis of barriers and facilitators perceived by healthcare professionals and patients during implementation has not been carried out. In addition, the perspectives of various stakeholders towards the implementation of quality colonoscopy services and the need of an efficient organisation of such services have been reported in the literature but have not been synthesised yet. The present study aims to produce a comprehensive synthesis of actual knowledge on the barriers and facilitators perceived by all stakeholders to the implementation of quality colonoscopy services in Canada. First, we will conduct a comprehensive review of the scientific literature and other published documentation on the barriers and facilitators to implementing quality colonoscopy services. Standardised literature searches and data extraction methods will be used. The quality of the studies and their relevance to informing decisions on colonoscopy services implementation will be assessed. For each group of users identified, barriers and facilitators will be categorised and compiled using narrative synthesis and meta-analytical techniques. The principle factors identified for each group of users will then be validated for its applicability to various Canadian contexts using the Delphi study method. Following this study, a set of strategies will be identified to inform decision makers involved in the implementation of quality colonoscopy services across Canadian jurisdictions. This study will be the first to systematically summarise the barriers and facilitators to implementation of quality colonoscopy services perceived by different groups and to consider the local contexts in order to ensure the applicability of this

Audit of colonoscopy practice in Lagos University Teaching Hospital

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Adedapo Osinowo

2016-01-01

Full Text Available Introduction: Recent procurement of new endoscopies and accessories led to the reactivation of diagnostic and therapeutic colonoscopy services at our center. A preliminary audit is deemed necessary after a 2-year period of open access colonoscopy. Objective: To assess the pattern of indications, diagnostic yield, and selected key performance indicators in the practice of colonoscopy at our tertiary hospital. Patients and Methods: The endoscopy reports of all patients that underwent colonoscopy from January 2012 to April 2014 were reviewed. The demographic data, indications, and endoscopic findings were recorded. Information on cecal intubation, colonoscopy withdrawal time, polyp detection, adverse events, and bowel preparation quality were also extracted and analyzed. Results: Colonoscopy was performed in 149 patients. They were 81 males and 68 females, aged between 18 and 101 years with a mean of 46.9 ± 22.7 years. 126 (84.5% patients had a colonoscopy for symptomatic conditions while 5 (4% were for screening. Bowel preparation was assessed to be excellent in 81 (54.4%, adequate in 42 (28.2%, and inadequate in 26 (17.4% patients, respectively. The cecal intubation rate (CIR was 80.2%, polyp detection rate 7.4%, average colonoscopy withdrawal time was 6 min 53 s, overall diagnostic yield 55.9% and there were no adverse events. Tumors were seen in 19 patients (10.1%; 13 were located in the rectum, three in the sigmoid and three in the descending colon. Conclusion: The audit revealed that our CIR could be improved by a more effective bowel preparation, increased expertise, and procedure volume of endoscopists. Tumors of the colorectum were detected in 10.1% of patients.

Adenoma detection in patients undergoing a comprehensive colonoscopy screening

International Nuclear Information System (INIS)

Raju, Gottumukkala S; Vadyala, Vikram; Slack, Rebecca; Krishna, Somashekar G; Ross, William A; Lynch, Patrick M; Bresalier, Robert S; Hawk, Ernest; Stroehlein, John R

2013-01-01

Measures shown to improve the adenoma detection during colonoscopy (excellent bowel preparation, cecal intubation, cap fitted colonoscope to examine behind folds, patient position change to optimize colon distention, trained endoscopy team focusing on detection of subtle flat lesions, and incorporation of optimum endoscopic examination with adequate withdrawal time) are applicable to clinical practice and, if incorporated are projected to facilitate comprehensive colonoscopy screening program for colon cancer prevention. To determine adenoma and serrated polyp detection rate under conditions designed to optimize quality parameters for comprehensive screening colonoscopy. Retrospective analysis of data obtained from a comprehensive colon cancer screening program designed to optimize quality parameters. Academic medical center. Three hundred and forty-three patients between the ages of 50 years and 75 years who underwent first screening colonoscopy between 2009 and 2011 among 535 consecutive patients undergoing colonoscopy. Comprehensive colonoscopy screening program was utilized to screen all patients. Cecal intubation was successful in 98.8% of patients. The Boston Bowel Preparation Scale for quality of colonoscopy was 8.97 (95% confidence interval [CI]; 8.94, 9.00). The rate of adenoma detection was 60% and serrated lesion (defined as serrated adenomas or hyperplastic polyps proximal to the splenic flexure) detection was 23%. The rate of precancerous lesion detection (adenomas and serrated lesions) was 66%. The mean number of adenomas per screening procedure was 1.4 (1.2, 1.6) and the mean number of precancerous lesions (adenomas or serrated lesions) per screening procedure was 1.6 (1.4, 1.8). Retrospective study and single endoscopist experience. A comprehensive colonoscopy screening program results in high-quality screening with high detection of adenomas, advanced adenomas, serrated adenomas, and multiple adenomas

Automatic and unbiased assessment of competence in colonoscopy

DEFF Research Database (Denmark)

Preisler, Louise; Svendsen, Morten Bo Søndergaard; Søndergaard, Bo

2016-01-01

is the first clinical descriptive report of a novel colonoscopy assessment tool based on Magnetic Endoscopic Imaging (MEI) data and the aim was to gather validity evidence based on the data collected using the "Colonoscopy Progression Score" (CoPS). Methods: We recorded 137 colonoscopy procedures performed...... sources of validity evidence were explored: response process (data collection), internal structure (reliability), relationship to other variables (i. e. operator experience), and consequences of testing (pass/fail). Results: Identical set-ups at all three locations ensured uniform data collection...

Peri-colonic haematoma following routine colonoscopy

OpenAIRE

Felicity Page; Olfunso Adedeji

2016-01-01

Introduction: We present a case of an extra-luminal haematoma following routine colonoscopy. This case highlights an uncommon but potentially life threatening complication in which there is little published literature to date. Presentation of case: A 73 year old male presented with abdominal pain and a reduction in haemoglobin following an uneventful colonoscopy. The imaging had been required as part of colorectal cancer follow up. Initial differential diagnosis included colonic perforatio...

Cecal intubation rate during colonoscopy at a tertiary hospital in ...

African Journals Online (AJOL)

Background: Colonoscopy is useful in the diagnosis, treatment of colorectal diseases, and for colorectal cancer screening program. Complete colonoscopy is therefore crucial for the success of any screening program. One important measure of the quality of colonoscopy is the cecal intubation rate (CIR). Aim: This was to ...

Do patients undergo prostate examination while having a colonoscopy?

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Hammett, Tess; Hookey, Lawrence C; Kawakami, Jun

2009-01-01

To determine the rate at which physicians report performing a digital rectal examination and comment on the prostate gland before performing colonoscopy in men 50 to 70 years of age. A retrospective chart review of all men 50 to 70 years of age who had a colonoscopy in Kingston, Ontario, in 2005 was completed. It was noted whether each physician described performing a digital rectal examination before the colonoscopy, and if so, whether he or she commented on the prostate. In 2005, 846 eligible colonoscopies were performed by 17 physicians in Kingston, Ontario. In 29.2% of cases, the physician made no comment about having performed a digital rectal examination; in 55.8% of cases, the physician commented on having completed a digital rectal examination but said nothing about the prostate; and in 15.0% of cases, the physician made a comment regarding the prostate. No physician consistently commented on the prostate for all patients, and in no circumstances was direct referral to another physician or follow-up suggested. A colonoscopy presents an ideal opportunity for physicians to use a digital rectal examination to assess for prostate cancer. Physicians performing colonoscopies in men 50 to 70 years of age should pay special attention to the prostate while performing a digital rectal examination before colonoscopy. This novel concept may help maximize resources for cancer screening and could potentially increase the detection rate of clinically palpable prostate cancer.

Use of a Nasal Speculum for Chest-Drain Insertion: A Simple Technique

OpenAIRE

Saxena, Pankaj; Konstantinov, Igor E.; Newman, Mark A.J.

2006-01-01

Tube thoracostomy is a very commonly performed procedure in cardiothoracic surgery. Insertion of a chest drain requires expertise to minimize complications. We describe a simple technique of using a nasal speculum to perform this procedure.

The Effect of a Glass Ceramic Insert in Sandwich Technique on Microleakage in Class II Composite Resin Restorations

Directory of Open Access Journals (Sweden)

Hila Hajizadeh

2015-06-01

Full Text Available Introduction: The aim of the present study was to evaluate the effect of glass ceramic insert in the sandwich technique to reduce microleakage in class II composite resin restorations. Methods: Sixty sound human upper second premolars were selected and randomly divided into six groups (n=10. Class II box-only cavities were prepared in distal aspects of each tooth with gingival margin located approximately 0.5 mm below the CEJ. Group A (Control was restored incrementally with Tetric Ceram and a total-etch bonding technique. Group B and C were restored with sandwich technique using a compomer (Compoglass F or flowable composite resin (Tetric Flow as the lining material at gingival floor, respectively. Group D, E and F were represented in the same way as group A, B and C and a glass ceramic insert was added to the composite bulk. The specimens were thermo-mechanically cycled, and then immersed in 0.5 % basic fuschin for 24 hours. Dye penetration was detected using a sectioning technique. Results: No significant difference was found between total-etch bonding and sandwich techniques. The placement of an insert caused an increase in   microleakage in all groups significantly (P < 0.05. Group D (no liner/ with glass insert showed the highest amount of microleakage and Group A (no liner/ without glass insert resulted in the lowest amount of total microleakage. Conclusion: Placement of glass ceramic insert could not decrease gingival leakage. According to the limitation of this study a composite resin restorations with incremental technique is recommended

Adenoma detection rate varies greatly during colonoscopy training

NARCIS (Netherlands)

van Doorn, Sascha C.; Klanderman, Robert B.; Hazewinkel, Yark; Fockens, Paul; Dekker, Evelien

2015-01-01

The adenoma detection rate (ADR) is considered the most important quality indicator for colonoscopy and varies widely among colonoscopists. It is unknown whether the ADR of gastroenterology consultants can already be predicted during their colonoscopy training. To evaluate the ADR of fellows in

Colonoscopy training for nurse endoscopists : A feasibility study

NARCIS (Netherlands)

Koornstra, Jan J.; Corporaal, Sietske; Giezen-Beintema, Wiesje M.; de Vries, Sietske E.; van Dullemen, Hendrik M.

Background: Screening by using colonoscopy is recommended in many countries to reduce the risk of death from colorectal cancer. Given the limited supply of medical endoscopists, nurse endoscopists may represent an economic alternative. Objective: To develop a colonoscopy training program for nurse

Location of colorectal cancer: colonoscopy versus surgery. Yield of colonoscopy in predicting actual location.

Science.gov (United States)

Blum-Guzman, Juan Pablo; Wanderley de Melo, Silvio

2017-07-01

 Recent studies suggest that differences in biological characteristics and risk factors across cancer site within the colon and rectum may translate to differences in survival. It can be challenging at times to determine the precise anatomical location of a lesion with a luminal view during colonoscopy. The aim of this study is to determine if there is a significant difference between the location of colorectal cancers described by gastroenterologists in colonoscopies and the actual anatomical location noted on operative and pathology reports after colon surgery.  A single-center retrospective analysis of colonoscopies of patient with reported colonic masses from January 2005 to April 2014 (n = 380) was carried. Assessed data included demography, operative and pathology reports. Findings were compared: between the location of colorectal cancers described by gastroenterologists in colonoscopies and the actual anatomical location noted on operative reports or pathology samples.  We identified 380 colonic masses, 158 were confirmed adenocarcinomas. Of these 123 underwent surgical resection, 27 had to be excluded since no specific location was reported on their operative or pathology report. An absolute difference between endoscopic and surgical location was found in 32 cases (33 %). Of these, 22 (23 %) differed by 1 colonic segment, 8 (8 %) differed by 2 colonic segments and 2 (2 %) differed by 3 colonic segments.  There is a significant difference between the location of colorectal cancers reported by gastroenterologists during endoscopy and the actual anatomical location noted on operative or pathology reports after colon surgery. Endoscopic tattooing should be used when faced with any luminal lesions of interest.

Accuracy of Referring Provider and Endoscopist Impressions of Colonoscopy Indication.

Science.gov (United States)

Naveed, Mariam; Clary, Meredith; Ahn, Chul; Kubiliun, Nisa; Agrawal, Deepak; Cryer, Byron; Murphy, Caitlin; Singal, Amit G

2017-07-01

Background: Referring provider and endoscopist impressions of colonoscopy indication are used for clinical care, reimbursement, and quality reporting decisions; however, the accuracy of these impressions is unknown. This study assessed the sensitivity, specificity, positive and negative predictive value, and overall accuracy of methods to classify colonoscopy indication, including referring provider impression, endoscopist impression, and administrative algorithm compared with gold standard chart review. Methods: We randomly sampled 400 patients undergoing a colonoscopy at a Veterans Affairs health system between January 2010 and December 2010. Referring provider and endoscopist impressions of colonoscopy indication were compared with gold-standard chart review. Indications were classified into 4 mutually exclusive categories: diagnostic, surveillance, high-risk screening, or average-risk screening. Results: Of 400 colonoscopies, 26% were performed for average-risk screening, 7% for high-risk screening, 26% for surveillance, and 41% for diagnostic indications. Accuracy of referring provider and endoscopist impressions of colonoscopy indication were 87% and 84%, respectively, which were significantly higher than that of the administrative algorithm (45%; P 90%) for determining screening (vs nonscreening) indication, but specificity of the administrative algorithm was lower (40.3%) compared with referring provider (93.7%) and endoscopist (84.0%) impressions. Accuracy of endoscopist, but not referring provider, impression was lower in patients with a family history of colon cancer than in those without (65% vs 84%; P =.001). Conclusions: Referring provider and endoscopist impressions of colonoscopy indication are both accurate and may be useful data to incorporate into algorithms classifying colonoscopy indication. Copyright © 2017 by the National Comprehensive Cancer Network.

Clinical and Molecular Characteristics of Post-Colonoscopy Colorectal Cancer: A Population-based Study.

Science.gov (United States)

Stoffel, Elena M; Erichsen, Rune; Frøslev, Trine; Pedersen, Lars; Vyberg, Mogens; Koeppe, Erika; Crockett, Seth D; Hamilton, Stanley R; Sørensen, Henrik T; Baron, John A

2016-11-01

Colonoscopy provides incomplete protection from colorectal cancer (CRC), but determinants of post-colonoscopy CRC are not well understood. We compared clinical features and molecular characteristics of CRCs diagnosed at different time intervals after a previous colonoscopy. We performed a population-based, cross-sectional study of incident CRC cases in Denmark (2007-2011), categorized as post-colonoscopy or detected during diagnostic colonoscopy (in patients with no prior colonoscopy). We compared prevalence of proximal location and DNA mismatch repair deficiency (dMMR) in CRC tumors, relative to time since previous colonoscopy, using logistic regression and cubic splines to assess temporal variation. Of 10,365 incident CRCs, 725 occurred after colonoscopy examinations (7.0%). These were more often located in the proximal colon (odds ratio [OR], 2.34; 95% confidence interval [CI], 1.90-2.89) and were more likely to have dMMR (OR, 1.26; 95% CI, 1.00-1.59), but were less likely to be metastatic at presentation (OR, 0.65; 95% CI, 0.48-0.89) compared with CRCs diagnosed in patients with no prior colonoscopy. The highest proportions of proximal and/or dMMR tumors were observed in CRCs diagnosed 3-6 years after colonoscopy, but these features were still more frequent among cancers diagnosed up to 10 years after colonoscopy. The relative excess of dMMR tumors was most pronounced in distal cancers. In an analysis of 85 cases detected after colonoscopy, we found BRAF mutations in 23% of tumors and that 7% of cases had features of Lynch syndrome. Colonoscopy exams were incomplete in a higher proportion of cases diagnosed within <1 year (in 38%) than in those diagnosed within 1-10 years after colonoscopy (16%). In a study of incident CRC cases in Denmark, we observed that tumors found in patients who have undergone colonoscopy are more often proximal and have dMMR compared to CRCs detected in patients without previous colonoscopies. The excess of right-sided tumors and

Comparison of complications between pediatric peripherally inserted central catheter placement techniques

International Nuclear Information System (INIS)

Dasgupta, Niloy; Lungren, Matthew P.; Patel, Manish N.; Racadio, John M.; Johnson, Neil D.

2016-01-01

Peripherally inserted central catheter (PICC) is among the most common procedures performed in children in the hospital setting. PICC insertion can be simplified with the use of a sheathed needle as an alternative to the modified Seldinger technique. To retrospectively evaluate PICC placement for the technique used and the incidence of complications at a large pediatric tertiary care center. We retrospectively reviewed all PICC placements at a single institution over a 4-year period. We reviewed patient records for demographic data, PICC placement technique, catheter size and number of lumens, and the incidence of complications (i.e. multiple attempted puncture sites, phlebitis and vessel thrombosis). We analyzed complication rates between two placement techniques using a chi-square test. We identified 8,816 successful PICC placements, 4,749 (53.9%) in males and 4,067 (46.1%) in females. The average age of the patients for which a line was placed was 5.6 years (range 1 day to 45 years). A direct sheathed needle puncture technique was used in 8,362 (94.9%) placements and a modified Seldinger technique was used in 454 (5.1%). Complications occurred in 312 (3.7%) of direct sheathed needle puncture placements versus 17 (3.7%) of modified Seldinger placements (P = 0.99). Multiple puncture sites were required in 175 (2.1%) attempted direct sheathed needle puncture placements compared with 8 (1.7%) attempted modified Seldinger placements (P = 0.63). Phlebitis occurred in 94 (1.1%) direct sheathed needle puncture lines versus 5 (1.1%) modified Seldinger placed lines (P = 0.96). Vessel thrombosis occurred in 43 (0.5%) direct sheathed needle puncture lines versus 4 (0.9%) modified Seldinger placed lines (P = 0.30). The direct peel-away sheathed needle vessel puncture technique and the modified Seldinger technique used to place PICC lines in children have similar complication rates. (orig.)

Comparison of complications between pediatric peripherally inserted central catheter placement techniques

Energy Technology Data Exchange (ETDEWEB)

Dasgupta, Niloy; Lungren, Matthew P. [Lucile Packard Children' s Hospital Stanford, Department of Radiology, Palo Alto, CA (United States); Patel, Manish N.; Racadio, John M.; Johnson, Neil D. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati, OH (United States)

2016-09-15

Peripherally inserted central catheter (PICC) is among the most common procedures performed in children in the hospital setting. PICC insertion can be simplified with the use of a sheathed needle as an alternative to the modified Seldinger technique. To retrospectively evaluate PICC placement for the technique used and the incidence of complications at a large pediatric tertiary care center. We retrospectively reviewed all PICC placements at a single institution over a 4-year period. We reviewed patient records for demographic data, PICC placement technique, catheter size and number of lumens, and the incidence of complications (i.e. multiple attempted puncture sites, phlebitis and vessel thrombosis). We analyzed complication rates between two placement techniques using a chi-square test. We identified 8,816 successful PICC placements, 4,749 (53.9%) in males and 4,067 (46.1%) in females. The average age of the patients for which a line was placed was 5.6 years (range 1 day to 45 years). A direct sheathed needle puncture technique was used in 8,362 (94.9%) placements and a modified Seldinger technique was used in 454 (5.1%). Complications occurred in 312 (3.7%) of direct sheathed needle puncture placements versus 17 (3.7%) of modified Seldinger placements (P = 0.99). Multiple puncture sites were required in 175 (2.1%) attempted direct sheathed needle puncture placements compared with 8 (1.7%) attempted modified Seldinger placements (P = 0.63). Phlebitis occurred in 94 (1.1%) direct sheathed needle puncture lines versus 5 (1.1%) modified Seldinger placed lines (P = 0.96). Vessel thrombosis occurred in 43 (0.5%) direct sheathed needle puncture lines versus 4 (0.9%) modified Seldinger placed lines (P = 0.30). The direct peel-away sheathed needle vessel puncture technique and the modified Seldinger technique used to place PICC lines in children have similar complication rates. (orig.)

Cultural, economic, and psychological predictors of colonoscopy in a national sample.

Science.gov (United States)

Halbert, Chanita Hughes; Barg, Frances K; Guerra, Carmen E; Shea, Judy A; Armstrong, Katrina; Ferguson, Monica; Weathers, Benita; Coyne, James; Troxel, Andrea B

2011-11-01

Although colorectal cancer (CRC) is the second leading cause of cancer death among adults in the US and colonoscopy is efficacious in reducing morbidity and mortality from CRC, screening rates are sub-optimal. Understanding the socioeconomic, cultural, and health care context within which decisions about colonoscopy are made allows physicians to address patients' most salient beliefs and values and other constraints when making screening recommendations. To evaluate the direct and interactive effects of socioeconomics, health care variables, psychological characteristics, and cultural values on colonoscopy use. National survey completed between January-August 2009 in a random sample of African American, white, and Hispanic adults ages 50-75 without cancer (n = 582). Self-reported colonoscopy use. Only 59% of respondents reported having a colonoscopy. The likelihood of colonoscopy increased with having health insurance (OR = 2.82, 95% CI = 1.24, 6.43, p = 0.004), and increasing age (OR = 1.40, 95% CI = 1.11, 1.77, p = 0.001). In addition, respondents with greater self-efficacy were more likely to have a colonoscopy (OR = 2.41, 95% CI = 1.35, 4.29, p = 0.003). Programs that help patients to overcome access and psychological barriers to screening are needed.

Effect Supermint oil (Peppermint oil on children's pain during Colonoscopy

Directory of Open Access Journals (Sweden)

M Najafi

2014-04-01

Full Text Available Introduction: Pain during colonoscopy, especially in children, including the challenges faced by the medical team. The aim of study was investigation the analgesic effect Supermint oil (peppermint oil on pain in children during colonoscopy. Methods and Materials: In this clinical trial study, 101 children (7-14 years old candidate colonoscopy were randomly divided into two groups, respectively. About half an hour before the colonoscopy case group (n=51 was administrated oral drops Supermint oil (peppermint oil. Patients were filled a pediatric pain questionnaire. In control group (n=50 filled a questionnaire without any administration. Data were analyzed using SPSS version 11.5 and (T-test and Paired sample t-test, Corraletion,Man withney. Results: Mean value of pain, duration of colonoscopy in control group was 5/60+1/85 and in case group was 4/20+1/70 and this diference was significant (P

Achieving a complete colonic evaluation in patients with incomplete colonoscopy is worth the effort.

Science.gov (United States)

Ridolfi, Timothy J; Valente, Michael A; Church, James M

2014-03-01

Patients with an incomplete colonoscopy are potentially at risk for missed lesions. The purpose of this work was to identify the percentage of patients completing colonic evaluation after incomplete colonoscopy, the manner in which the evaluation was completed, and the incidence of significant pathology. This was a retrospective analysis of prospectively collected data. The study was conducted in an outpatient colonoscopy clinic in the colorectal surgery department of a tertiary referral center. Patients included those undergoing incomplete colonoscopy from a database of 25,645 colonoscopies performed from 1982 to 2009. Procedures aimed at completing colorectal evaluation were included in the study. Reason for incompletion, secondary study, its success, and findings were measured. A total of 242 patients with incomplete colonoscopies were identified; 166 (69%) were women. The average age of patients was 59 years. Most frequent causes for incomplete colonoscopy were inadequate preparation (34%), pain (30%), and tortuosity (20%). The scope could not pass the splenic flexure in 165 patients (71%). A total of 218 patients (90%) were offered completion studies, and 179 patients (82%) complied. Seventy-three of 82 patients who had a surveillance colonoscopy had a follow-up (89%), compared with 72 (87%) of 83 with symptoms and 40 (74%) of 54 who had a screening. Barium enema (BE) was performed in 74 (41%), repeat colonoscopy in 71 (40%), CT colonography in 17 (9%), and colonoscopy under general anesthesia in 9 patients (5%). Resection with intraoperative/perioperative colonoscopy was required in 8 patients (4%). Repeat colonoscopy found 32 lesions (24 tubular adenomas, 4 tubulovillous adenomas, and 4 sessile serrated polyps) in 17 patients (24%). Radiology demonstrated new abnormalities in 11 (12%) of 91 patients, prompting 7 colonoscopies. In 3 patients, colonoscopy showed an inverted appendix, a tubulovillous adenoma, and a sigmoid stricture. Overall, clinically

High Definition Colonoscopy Combined with i-SCAN Imaging Technology Is Superior in the Detection of Adenomas and Advanced Lesions Compared to High Definition Colonoscopy Alone.

Science.gov (United States)

Bowman, Erik A; Pfau, Patrick R; Mitra, Arnab; Reichelderfer, Mark; Gopal, Deepak V; Hall, Benjamin S; Benson, Mark E

2015-01-01

Background. Improved detection of adenomatous polyps using i-SCAN has mixed results in small studies. Utility of i-SCAN as a primary surveillance modality for colorectal cancer screening during colonoscopy is uncertain. Aim. Comparing high definition white light endoscopy (HDWLE) to i-SCAN in their ability to detect adenomas during colonoscopy. Methods. Prospective cohort study of 1936 average risk patients who had a screening colonoscopy at an ambulatory procedure center. Patients underwent colonoscopy with high definition white light endoscopy withdrawal versus i-SCAN withdrawal during endoscopic screening exam. Primary outcome measurement was adenoma detection rate for i-SCAN versus high definition white light endoscopy. Secondary measurements included polyp size, pathology, and morphology. Results. 1007 patients underwent colonoscopy with i-SCAN and 929 with HDWLE. 618 adenomas were detected in the i-SCAN group compared to 402 in the HDWLE group (p definition white light endoscopy.

Quality of colonoscopy and spectrum of lower gastrointestinal disease as determined by colonoscopy

International Nuclear Information System (INIS)

Rehman, K.U.; Qureshi, M.O.; Salih, M.

2015-01-01

To document the quality of colonoscopy practice and the pattern of colonic disease including polyp detection rate at Shifa International Hospital, Islamabad, Pakistan. Study Design: An observational study. Place and Duration of Study: Shifa International Hospital, Islamabad, Pakistan, from May 2013 to June 2014. Methodology: This retrospective study recorded demographics of patients, indications and quality indices of 505 colonoscopies performed during the study period. Preparation was done with low residue diet and polyethylene glycol. Conscious sedation was generally used. Quality indices studied were compared with guideline standard. Results:Out of 505 colonoscopy patients, 305 were males and 200 were females. The indications for colonoscopic examination were lower gastrointestinal bleeding (26.5%, n=134), screening for colorectal cancer (14.1%, n=71), chronic diarrhea (12.9%, n=65), abdominal pain (10.9%, n=55), anemia (9.1%, n=46), constipation (7.3%, n=37), hematochezia and diarrhea (6.3%, n=32), altered bowel habits (5.1%, n=26), weight loss (3.6%, n=18), colonic thickening on CT scan (3.0%, n=15) and others (1.2%, n=6). Bowel preparation was adequate (in 92%, n=465) cases. Cecal intubation rate was 88.71% (n=448). Endoscopic diagnoses were hemorrhoids (36.2%, n=183), normal (22%, n=111), polyps (11.3%, n=57), ulcerative colitis (8.7%, n=44), cancer (4%, n=20), diverticulosis (3.4%, n=17), infective colitis (2.6%, n=13), intestinal TB (2.6%, n=13), non-specific colitis (2.2%, n=11), proctitis (1.8%, n=9) and others (5.3%, n=27). Conclusion: There is room for improvement in quality of colonoscopy, cecal intubation rate is slightly below the recommended standard and polyp detection rate is quite low however, it is not clear if the low rate of polyp detection is due to missed lesions or low population incidence. Time to reach caecum and withdrawal time should clearly be documented in the notes which can help to evaluate quality of the procedure in a better way

An automatic measure of progression during colonoscopy correlates to patient experienced pain

DEFF Research Database (Denmark)

Preisler, Louise; Bulut, Mustafa; Svendsen, Morten Soendergaard

2018-01-01

recordings were used for evaluation. We demonstrated a moderate correlation between CoPS and patient experienced pain, Pearson's r = -0.47 (p ... progression. CoPS deliver a numeric score and a graphic map. A high score expresses a rapid and smooth progression. Aims of study were to explore the correlation between CoPS and patient experienced pain and to identity locations associated with pain. METHODS AND MATERIALS: Patients listed for colonoscopy.......61 Passage of the sigmoid colon, right and left flexures were associated with pain for 51%, 33% and 25% of the patients, respectively. CONCLUSION: A moderate correlation between CoPS and patient experienced pain suggest that CoPS measure inserting skills but might also be a measure of a gentle performance...

EFFECT OF PLACEMENT TECHNIQUES, FLOWABLE COMPOSITE , LINER AND FIBRE INSERTS ON MARGINAL MICROLEAKAGE OF CLASS II COMPOSITE RESTORATIONS

Directory of Open Access Journals (Sweden)

Anupriya

2015-08-01

Full Text Available AIM : T he aim of this study was to evaluate effect of placement techniques, flow able composite, and fiber inserts in marginal adaptation of class II composite restorations. MATERIALS AND METHODS : 120 class II box cavities were prepared on both mesial and distal surfaces of extracted human molars. The prepared teeth were randomly assigned to 6 groups : 1 bulk insertion . ( S ingle increment, 2 O blique incremental placement technique, 3 Centripetal incremental placement technique . 4 S plit horizontal incremental placement technique . 5 flow able composite as gingival increment 6 ribbond fiber insert in gingival increment . The preparations were restored with a total etch adhesive (Adper Single Bond, 3M ESPE and nano composite (Z350, 3M ESPE. Specimens were isola ted with nail varnish except for a 2 - mm - wide rim around the restoration and thermocycled (1,000 thermal cycles, 5°C/55°C; 30 - second dwell time. The specimens were immersed in a solution of 2% methylene blue dye for 24 hours. The teeth were sectioned longi tudinally, observed under stereomicroscope and evaluated for microleakage using an ordinal scale of 0 to 4. The microleakage scores obtained from gingival walls were analyzed with Kruskal - Wallis and Mann Whitney nonparametric tests. RESULTS: Among all plac ement techniques split incremental technique showed least microleakage scores . The group that used flowable composite liner did not show significant reduction in microleakage and group with fiber inserts showed significant decrease in microleakage scores. CONCLUSION : None of the techniques eliminated marginal microleakage in class II composite restorations . However, the split incremental technique and group with fiber inserts showed significantly lower microleakage at gingival margin when compared to other groups

RHYTHM DISTURBANCES DURING COLONOSCOPY

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D. Jordanov

2012-08-01

Full Text Available Purpose: The purpose of this study is to assess the risk of inducing rhythm disturbances of the heart during colonoscopy.Patients and methods used: 80 patients had undergone colonoscopyper formed by two experienced specialists of endoscopy for the period from March to December 2011. The endoscopies were performed without premedication and sedation. Holter was placed on each patient one hour before the endoscopic examination, and the record continued one hour after the manipulation. The blood pressure was measured before, during and after the procedure.Results: During colonoscopy 25 patients (31,25% manifested rhythm disorders. In 15 patients (18,75% sinus tachycardia occurred. In 7 patients (8,75% suptraventricular extra systoles were observed and in 3 patients (3,75% - ventricular extra systoles. No ST-T changes were found. Highest values of the blood pressure were measured before and during the endoscopy, but the values did not exceed 160/105 mmHg. In 10 patients (12,5% a hypotensive reaction was observed, bur the values were not lower than 80/ 50. In 2 patients there was a short bradycardia with a heart frequency 50-55 /min.Conclusions: Our results showed that the rhythm disorders during lower colonoscopy occur in approximately 1/3 of the examined patients, there is an increase or decrease of the blood pressure in some patients, but that doesn’t require physician’s aid and the examination can be carried out safely without monitoring.

Splenic Trauma during Colonoscopy: The Role of Intra-Abdominal Adhesions

OpenAIRE

Chime, Chukwunonso; Ishak, Charbel; Kumar, Kishore; Kella, Venkata; Chilimuri, Sridhar

2018-01-01

Splenic rupture following colonoscopy is rare, first reported in 1974, with incidence of 1–21/100,000. It is critical to anticipate splenic trauma during colonoscopy as one of the causes of abdominal pain after colonoscopy especially when located in the left upper quadrant or left shoulder. Postoperative adhesions is a predisposing factor for splenic injury, and management is either operative or nonoperative, based on hemodynamic stability and/or extravasation which can be seen on contrast-en...

Pedicle Screw Insertion Accuracy Using O-Arm, Robotic Guidance, or Freehand Technique: A Comparative Study.

Science.gov (United States)

Laudato, Pietro Aniello; Pierzchala, Katarzyna; Schizas, Constantin

2018-03-15

A retrospective radiological study. The aim of this study was to evaluate the accuracy of pedicle screw insertion using O-Arm navigation, robotic assistance, or a freehand fluoroscopic technique. Pedicle screw insertion using either "O-Arm" navigation or robotic devices is gaining popularity. Although several studies are available evaluating each of those techniques separately, no direct comparison has been attempted. Eighty-four patients undergoing implantation of 569 lumbar and thoracic screws were divided into three groups. Eleven patients (64 screws) had screws inserted using robotic assistance, 25 patients (191 screws) using the O-arm, while 48 patients (314 screws) had screws inserted using lateral fluoroscopy in a freehand technique. A single experienced spine surgeon assisted by a spinal fellow performed all procedures. Screw placement accuracy was assessed by two independent observers on postoperative computed tomography (CTs) according to the A to D Rampersaud criteria. No statistically significant difference was noted between the three groups. About 70.4% of screws in the freehand group, 69.6% in the O arm group, and 78.8% in the robotic group were placed completely within the pedicle margins (grade A) (P > 0.05). About 6.4% of screws were considered misplaced (grades C&D) in the freehand group, 4.2% in the O-arm group, and 4.7% in the robotic group (P > 0.05). The spinal fellow inserted screws with the same accuracy as the senior surgeon (P > 0.05). The advent of new technologies does not appear to alter accuracy of screw placement in our setting. Under supervision, spinal fellows might perform equally well to experienced surgeons using new tools. The lack of difference in accuracy does not imply that the above-mentioned techniques have no added advantages. Other issues, such as surgeon/patient radiation, fiddle factor, teaching suitability, etc., outside the scope of our present study, need further assessment. 3.

Clinical outcomes of surveillance colonoscopy for patients with sessile serrated adenoma

Directory of Open Access Journals (Sweden)

Sung Jae Park

2018-01-01

Full Text Available Background/Aims: Sessile serrated adenomas (SSAs are known to be precursors of colorectal cancer (CRC. The proper interval of follow-up colonoscopy for SSAs is still being debated. We sought to determine the proper interval of colonoscopy surveillance in patients diagnosed with SSAs in South Korea. Methods: We retrospectively reviewed the medical records of patients diagnosed with SSAs who received 1 or more follow-up colonoscopies. The information reviewed included patient baseline characteristics, SSA characteristics, and colonoscopy information. Results: From January 2007 to December 2011, 152 SSAs and 8 synchronous adenocarcinomas were identified in 138 patients. The mean age of the patients was 62.2 years and 60.1% patients were men. SSAs were located in the right colon (i.e., from the cecum to the hepatic flexure in 68.4% patients. At the first follow-up, 27 SSAs were identified in 138 patients (right colon, 66.7%. At the second follow-up, 6 SSAs were identified in 65 patients (right colon, 66.7%. At the 3rd and 4th follow-up, 21 and 11 patients underwent colonoscopy, respectively, and no SSAs were detected. The total mean follow-up duration was 33.9 months. The mean size of SSAs was 8.1±5.0 mm. SSAs were most commonly found in the right colon (126/185, 68.1%. During annual follow-up colonoscopy surveillance, no cancer was detected. Conclusions: Annual colonoscopy surveillance is not necessary for identifying new CRCs in all patients diagnosed with SSAs. In addition, the right colon should be examined more carefully because SSAs occur more frequently in the right colon during initial and follow-up colonoscopies.

Colonoscopy: Evaluating indications and diagnostic yield

International Nuclear Information System (INIS)

Al-Shamali, Mohammed A.; Hasan, F.; Siddiqe, I.; Al-Nakeeb, B.; Kalaoui, M.; Khajah, A.

2001-01-01

Colonoscopic procedure is an accepted modality for the evaluation ofcolonic disease. Open-access versus restricted-access colonoscopy has beenargued over in the recent literature. The aim of this retrospective analysisis to identify the yield of the major indications for the procedure, and thepattern of colon pathology in our community. We retrospectively analyzed ourexperience in 3000 colonoscopies over a five-year period. The patientscomprised 1145 females (38%) and 1855 males (62%) and their ages ranged from9 months to 95 years (mean 39.2). There were 2283 patients (76%) who wereaged less than 55 years. Complete examination to the cecum was possible in2850 cases (95%). Pathological findings were identified in 640 patients(21%). The diagnostic yield of patients referred for lower abdominal pain andsurveillance was low, at 7% and 17%, respectively. The yield was high forthose with lower gastrointestinal bleeding (47%), non-bloody diarrhea (35%),iron deficiency anemia (30%), mass lesions identified by radiology (53%) andpolyps identified by radiology (70%). Inflammatory bowel disease wasdiagnosed in 220 patients, carcinoma in 64 patients and colonic polyps in 139patients. Colonic diseases are not uncommon in our part of the world.Colonoscopy is a rewarding procedure in those patients referred with lowergastrointestinal bleeding, mass lesions, polyps and diarrhea. The procedureis less rewarding in patients with lower abdominal pain and in thoseundergoing surveillance colonoscopy. Patient selection on the basis of thepresenting complaint may help to utilize the limited resource available togastroenterologists. About 63% of the procedures were done for indicationsfound to have a low yield. Inflammatory bowel disease is seen with increasingfrequency in our population. (author)

Indications for colonoscopy

African Journals Online (AJOL)

symptoms,I endoscopic examination of the colon in patients with suspected colonic disease is not as univer- sally accepted. It remains current practice for many of these patients to be ... disease.2 In addition colonoscopy can act as both a diag- nostic and a ... tic method in cases of suspected colonic disease.' While this may ...

Improved haptic interface for colonoscopy simulation.

Science.gov (United States)

Woo, Hyun Soo; Kim, Woo Seok; Ahn, Woojin; Lee, Doo Yong; Yi, Sun Young

2007-01-01

This paper presents an improved haptic interface of the KAIST-Ewha colonoscopy simulator II. The haptic interface enables the distal portion of the colonoscope to be freely bent while guaranteeing enough workspace and reflective forces for colonoscopy simulation. Its force-torque sensor measures profiles of the user. Manipulation of the colonoscope tip is monitored by four deflection sensors, and triggers computation to render accurate graphic images corresponding to the angle knob rotation. Tack switches are attached on the valve-actuation buttons of the colonoscope to simulate air-injection or suction, and the corresponding deformation of the colon.

ORIGINAL ARTICLE: Will An Additional Observer Enhance Adenoma Detection During Colonoscopy?

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Kevin D Mullen

2012-07-01

Full Text Available Background: Due to varied level of experience, the detection rate of adenoma on colonoscopy is different. In presence of both fellows and attending the incidence rates of adenoma are shown to increase in a small study reported by Rogart et al [4]. Based on similar hypothesis, a study was undertaken with much larger sample size to improve the power of the study. Aims and objective: To know if presence of additional observer will enhance adenoma detection during colonoscopy. Material and Methods: 2236 consecutive colonoscopies performed at Metro Health Medical Centre, Cleveland, Ohio were included in the study from July 2005 to August 2006. Cases with history of colorectal, surgical resection of colon, inflammatory bowel diseases and hereditary polyposis syndrome were excluded. Inpatient colonoscopies were also excluded. With all usual precautions for colonoscopy and after giving polyethylene glycol electrolyte (PEGEL colonoscopies were performed by one of the nine experienced staff attending using an Olympus colonoscope and Evis Exera processors. All colonoscopies performed by fellows were supervised by an attending throughout the procedure. Advanced adenomas were defined as adenomas greater than 1 cm size. Statistical analysis was done using Tall hassee, FL software; Fisher’s exact test, unpaired t test and multiple logistic regression analysis were performed. p-value of <0.05 is considered as statistically significant. Results: Of the total 2236 colonoscopies included in the study, 1527 were performed by fellows under supervision of attending and 709 by the attending. There was no significant difference in patient demographics, caecal intubation or poor preparation colonoscopies. The mean age of the group was 55 years in both of the groups. There was no statistically significant different in the polyp detection rate (35% Vs 36.8% as well as overall adenoma detection rate (28.4% Vs 27.7% between these two groups of performers. However

Bibliographic review, indication guidelines of colonoscopy and its application in Costa Rica

International Nuclear Information System (INIS)

Vargas Perez, Carmen

2013-01-01

strategies or protocols to colonoscopy. The various diagnostic methods for the detection od CRC are explained. The fecal immunohistochemical tests (FIT) to detect blood in the stool have been more specific that guaiac fecal occult blood tests (gFOBT), because of they react only with human hemoglobin. Reasonable evidence has existed that the FIT has been superior than gFOBT with respect to acceptance of the population, the detection rate and positive predictive value of adenomas and CRC. Mortality by CRC has decreased with the screening of FIT screening. The double contrast barium enema has been a valid cost-effective technique in the programs of early detection and diagnostic of colonic pathologies [es

Laparoscopic Splenectomy for Traumatic Splenic Injury after Screening Colonoscopy

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Salim Abunnaja

2012-09-01

Full Text Available Colonoscopy is a widespread diagnostic and therapeutic procedure. The most common complications include bleeding and perforation. Splenic rupture following colonoscopy is rarely encountered and is most likely secondary to traction on the splenocolic ligament. Exploratory laparotomy and splenectomy is the most commonly employed therapeutic intervention for this injury reported in the literature. We present the case of a patient with this potentially fatal complication who was treated successfully at our institution. To our knowledge it is the first report in the literature of laparoscopic splenectomy as a successful minimally invasive treatment of splenic rupture following colonoscopy. The patient was a 62-year-old female who underwent screening colonoscopy with polypectomies at the cecum, descending colon and rectum. Immediately following the procedure she developed abdominal pain and had a syncopal episode. Clinical, laboratory and imaging findings were suggestive of hemoperitoneum and a ruptured spleen. A diagnostic laparoscopy was emergently performed and revealed a grade IV splenic laceration and hemoperitoneum. Laparoscopic splenectomy was completed safely and effectively. The patient’s postoperative recovery was uneventful. We conclude that splenic rupture after colonoscopy is a rare but dangerous complication. A high index of suspicion is required to recognize it early. Awareness of this potential complication can lead to optimal patient outcome. Laparoscopic splenectomy may be a feasible treatment option.

Efficacy of prokinetic agents in improving bowel preparation for colonoscopy.

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Mishima, Yuko; Amano, Yuji; Okita, Koichi; Takahashi, Yoshiko; Moriyama, Nobuyuki; Ishimura, Norihisa; Furuta, Kenji; Ishihara, Shunji; Adachi, Kyoichi; Kinoshita, Yoshikazu

2008-01-01

Colonoscopy plays an important role in the diagnosis and treatment of gastrointestinal illness in both Western countries and Japan. However, preparative bowel cleansing for colonoscopy is frequently troublesome for elderly and/or constipated patients, since they must drink larger volumes of lavage solution for adequate cleansing. We investigated the use of prokinetic agents for improving the efficacy and tolerability of bowel cleansing prior to colonoscopy. 613 patients were divided into two groups according to oral lavage solution used (polyethylene glycol or magnesium citrate), and were further randomized to receive either vehicle (100 ml water) alone, vehicle with 5 mg mosapride citrate, or vehicle with 50 mg itopride hydrochloride 30 min before administration of lavage solution. Experimental parameters included bowel cleansing quality, times to first defecation and completion of bowel cleansing, and incidence of uncomfortable abdominal symptoms during colonoscopy preparation. Administration of mosapride citrate or itopride hydrochloride prior to oral lavage solution did not significantly improve bowel cleansing quality. However, statistically significantly fewer uncomfortable abdominal symptoms were found in patients who received mosapride citrate or itopride hydrochloride versus vehicle alone. Prokinetic agents effectively decreased the incidence of uncomfortable abdominal symptoms experienced during colonoscopy preparation. Copyright 2008 S. Karger AG, Basel.

Colonoscopy can miss diverticula of the left colon identified by barium enema.

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Niikura, Ryota; Nagata, Naoyoshi; Shimbo, Takuro; Akiyama, Junichi; Uemura, Naomi

2013-04-21

To identify the diagnostic value of colonoscopy for diverticulosis as determined by barium enema. A total of 65 patients with hematochezia who underwent colonoscopy and barium enema were analyzed, and the diagnostic value of colonoscopy for diverticula was assessed. The receiver operating characteristic area under the curve was compared in relation to age (barium enema. Colonoscopy had a sensitivity of 91% and specificity of 90%. No significant differences were found in the receiver operating characteristic area under the curve (ROC-AUC) for age group or sex. The ROC-AUC of the left colon was significantly lower than that of the right colon (0.81 vs 0.96, P = 0.02). Colonoscopy identified 486 colonic diverticula, while barium enema identified 1186. The detection ratio for the entire colon was therefore 0.41 (486/1186). The detection ratio in the left colon (0.32, 189/588) was significantly lower than that of the right colon (0.50, 297/598) (P barium enema, only half the number of colonic diverticula can be detected by colonoscopy in the entire colon and even less in the left colon.

Methods for certification in colonoscopy - a systematic review

DEFF Research Database (Denmark)

Preisler, Louise; Svendsen, Morten Bo Søndergaard; Svendsen, Lars Bo

2018-01-01

INTRODUCTION: Reliable, valid, and feasible assessment tools are essential to ensure competence in colonoscopy. This study aims to provide an overview of the existing assessment methods and the validity evidence that supports them. METHODS: A systematic search was conducted in October 2016. Pubmed......, EMBASE, and PsycINFO were searched for studies evaluating assessment methods to ensure competency in colonoscopy. Outcome variables were described and evidence of validity was explored using a contemporary framework. RESULTS: Twenty-five observational studies were included in the systematic review. Most...... studies were based on small sample sizes. The studies were categorized after outcome measures into five groups: Clinical process related outcome metrics (n = 2), direct observational colonoscopy assessment (n = 8), simulator based metrics (n = 11), automatic computerized metrics (n = 2), and self...

Cost Effectiveness of Screening Colonoscopy Depends on Adequate Bowel Preparation Rates - A Modeling Study.

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James Kingsley

Full Text Available Inadequate bowel preparation during screening colonoscopy necessitates repeating colonoscopy. Studies suggest inadequate bowel preparation rates of 20-60%. This increases the cost of colonoscopy for our society.The aim of this study is to determine the impact of inadequate bowel preparation rate on the cost effectiveness of colonoscopy compared to other screening strategies for colorectal cancer (CRC.A microsimulation model of CRC screening strategies for the general population at average risk for CRC. The strategies include fecal immunochemistry test (FIT every year, colonoscopy every ten years, sigmoidoscopy every five years, or stool DNA test every 3 years. The screening could be performed at private practice offices, outpatient hospitals, and ambulatory surgical centers.At the current assumed inadequate bowel preparation rate of 25%, the cost of colonoscopy as a screening strategy is above society's willingness to pay (<$50,000/QALY. Threshold analysis demonstrated that an inadequate bowel preparation rate of 13% or less is necessary before colonoscopy is considered more cost effective than FIT. At inadequate bowel preparation rates of 25%, colonoscopy is still more cost effective compared to sigmoidoscopy and stool DNA test. Sensitivity analysis of all inputs adjusted by ±10% showed incremental cost effectiveness ratio values were influenced most by the specificity, adherence, and sensitivity of FIT and colonoscopy.Screening colonoscopy is not a cost effective strategy when compared with fecal immunochemical test, as long as the inadequate bowel preparation rate is greater than 13%.

Usefulness of colonoscopy in ischemic colitis.

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Lozano-Maya, M; Ponferrada-Díaz, A; González-Asanza, C; Nogales-Rincón, O; Senent-Sánchez, C; Pérez-de-Ayala, V; Jiménez-Aleixandre, P; Cos-Arregui, E; Menchén-Fernández-Pacheco, P

2010-07-01

the ischemic colitis is intestinal the most frequent cause of ischemia. With this work we determine the demographic and clinical characteristics, and the usefulness of the colonoscopy in the patients with ischemic colitis diagnosed in our centre in relation to a change of therapeutic attitude. retrospective study in which were selected 112 patients diagnosed with ischemic colitis by colonoscopy and biopsy, in a period of five years. It was analyzed: age, sex, reason for examination, factors of cardiovascular risk, endoscopic degree of ischemia, change in the therapeutic attitude, treatment and outcome. the average age was of 73.64 + or - 12.10 years with an equal incidence in women (50.9%) and the men (49.1%). The associated factors were the HTA (61.1%), tobacco (37.2%) and antecedents of cardiovascular episode (52.2%). The most frequent reason for colonoscopy was rectorrhagia (53.6%) followed of the abdominal pain (30.4%), being urgent the 65.3%. Colonoscopy allowed a change in the therapeutic attitude in the 50 increasing in the urgent one to the 65.75%. Global mortality was of 27.67%. The serious ischemic colitis (25%) was more frequent in men (64.3%) in urgent indication (85.71%) and attends with high mortality (53.57%). Surgical treatment in the 57.14% was made with a good evolution in the 50%, whereas the patients with mild or moderate ischemic colitis had a better prognosis (favourable evolution in 80.95%) with smaller requirement of the surgical treatment (4.76%), p change of attitude according to the result of the same one. The evidence of a serious colitis supposed an increase of the necessity of surgery and worse prognosis.

The bubbling neck: A rare complication from colonoscopy.

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Andrejevic, P; Gatt, D

2012-04-01

A 70 year old lady presented to the emergency department complaining of "bubbling neck'' and abdominal discomfort. She underwent diagnostic colonoscopy six hours before admission. Clinical examination showed a haemodynamically stable patient and imaging revealed free air in all body compartments. We report a rare case of micro perforation during diagnostic colonoscopy with massive distribution of air in all body compartments, which was successfully treated conservatively. © JSCR.

Insertion of central venous catheters for hemodialysis using angiographic techniques in patients with previous multiple catheterizations

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Kotsikoris, Ioannis, E-mail: gkotsikoris@gmail.com [Department of Vascular Surgery, “Erythros Stauros” General Hospital (Greece); Zygomalas, Apollon, E-mail: azygomalas@upatras.gr [Department of General Surgery, University Hospital of Patras (Greece); Papas, Theofanis, E-mail: pfanis@otenet.gr [Department of Vascular Surgery, “Erythros Stauros” General Hospital (Greece); Maras, Dimitris, E-mail: dimmaras@gmail.com [Department of Vascular Surgery, “Erythros Stauros” General Hospital (Greece); Pavlidis, Polyvios, E-mail: polpavlidis@yahoo.gr [Department of Vascular Surgery, “Erythros Stauros” General Hospital (Greece); Andrikopoulou, Maria, E-mail: madric@gmail.com [Department of Vascular Surgery, “Erythros Stauros” General Hospital (Greece); Tsanis, Antonis, E-mail: atsanis@gmail.com [Department of Interventional Radiology, “Erythros Stauros” General Hospital (Greece); Alivizatos, Vasileios, E-mail: valiviz@hol.gr [Department of General Surgery and Artificial Nutrition Unit, “Agios Andreas” General Hospital of Patras (Greece); Bessias, Nikolaos, E-mail: bessias@otenet.gr [Department of Vascular Surgery, “Erythros Stauros” General Hospital (Greece)

2012-09-15

Introduction: Central venous catheter placement is an effective alternative vascular access for dialysis in patients with chronic renal failure. The purpose of this study was to evaluate the insertion of central venous catheters for hemodialysis using angiographic techniques in patients with previous multiple catheterizations in terms of efficacy of the procedure and early complications. Materials and methods: Between 2008 and 2010, the vascular access team of our hospital placed 409 central venous catheters in patients with chronic renal failure. The procedure was performed using the Seldinger blind technique. In 18 (4.4%) cases it was impossible to advance the guidewire, and so the patients were transported to the angiography suite. Results: Using the angiographic technique, the guidewire was advanced in order to position the central venous catheter. The latter was inserted into the subclavian vein in 12 (66.6%) cases, into the internal jugular vein in 4 (22.2%) and into the femoral vein in 2 (11.1%) cases. There was only one complicated case with severe arrhythmia in 1 (5.5%) patient. Conclusion: Our results suggest that insertion of central venous catheters using angiographic techniques in hemodialysis patients with previous multiple catheterizations is a safe and effective procedure with few complications and high success rates.

Insertion of central venous catheters for hemodialysis using angiographic techniques in patients with previous multiple catheterizations

International Nuclear Information System (INIS)

Kotsikoris, Ioannis; Zygomalas, Apollon; Papas, Theofanis; Maras, Dimitris; Pavlidis, Polyvios; Andrikopoulou, Maria; Tsanis, Antonis; Alivizatos, Vasileios; Bessias, Nikolaos

2012-01-01

Introduction: Central venous catheter placement is an effective alternative vascular access for dialysis in patients with chronic renal failure. The purpose of this study was to evaluate the insertion of central venous catheters for hemodialysis using angiographic techniques in patients with previous multiple catheterizations in terms of efficacy of the procedure and early complications. Materials and methods: Between 2008 and 2010, the vascular access team of our hospital placed 409 central venous catheters in patients with chronic renal failure. The procedure was performed using the Seldinger blind technique. In 18 (4.4%) cases it was impossible to advance the guidewire, and so the patients were transported to the angiography suite. Results: Using the angiographic technique, the guidewire was advanced in order to position the central venous catheter. The latter was inserted into the subclavian vein in 12 (66.6%) cases, into the internal jugular vein in 4 (22.2%) and into the femoral vein in 2 (11.1%) cases. There was only one complicated case with severe arrhythmia in 1 (5.5%) patient. Conclusion: Our results suggest that insertion of central venous catheters using angiographic techniques in hemodialysis patients with previous multiple catheterizations is a safe and effective procedure with few complications and high success rates

Outpatient provider concentration and commercial colonoscopy prices.

Science.gov (United States)

Pozen, Alexis

2015-01-01

The objective was to evaluate the magnitude of various contributors to outpatient commercial colonoscopy prices, including market- and provider-level factors, especially market share. We used adjudicated fee-for-service facility claims from a large commercial insurer for colonoscopies occurring in hospital outpatient department or ambulatory surgery center from October 2005 to December 2012. Claims were matched to provider- and market-level data. Linear fixed effects regressions of negotiated colonoscopy price were run on provider, system, and market characteristics. Markets were defined as counties. There were 178,433 claims from 169 providers (104 systems). The mean system market share was 76% (SD = 0.34) and the mean real (deflated) price was US$1363 (SD = 374), ranging from US$169 to US$2748. For every percentage point increase in a system or individual facility's bed share, relative price increased by 2 to 4 percentage points; this result was stable across a number of specifications. Market population and price were also consistently positively related, though this relation was small in magnitude. No other factor explained price as strongly as market share. Price variation for colonoscopy was driven primarily by market share, of particular concern as the number of mergers increases in wake of the recession and the Affordable Care Act. Whether variation is justified by better quality care requires further research to determine whether quality is subsumed in prices. © The Author(s) 2015.

Procedural Skills Education – Colonoscopy as a Model

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Maitreyi Raman

2008-01-01

Full Text Available Traditionally, surgical and procedural apprenticeship has been an assumed activity of students, without a formal educational context. With increasing barriers to patient and operating room access such as shorter work week hours for residents, and operating room and endoscopy time at a premium, alternate strategies to maximizing procedural skill development are being considered. Recently, the traditional surgical apprenticeship model has been challenged, with greater emphasis on the need for surgical and procedural skills training to be more transparent and for alternatives to patient-based training to be considered. Colonoscopy performance is a complex psychomotor skill requiring practioners to integrate multiple sensory inputs, and involves higher cortical centres for optimal performance. Colonoscopy skills involve mastery in the cognitive, technical and process domains. In the present review, we propose a model for teaching colonoscopy to the novice trainee based on educational theory.

Racial/Ethnic Minorities Ineligible for Direct Access Colonoscopy (DAC): Identifying Patients Who Fall Through the Cracks.

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Miller, Sarah J; Sly, Jamilia R; Itzkowitz, Steven H; Jandorf, Lina

2015-03-01

Patients ineligible for direct access colonoscopy (DAC) are typically referred for a pre-colonoscopy consultation with gastroenterology (GI). However, the referral from primary care to GI creates the potential for patients to drop out of treatment. The primary objective of the current study was to examine the proportion of participants deemed ineligible for DAC that (1) attended an appointment with GI and (2) completed a screening colonoscopy. The second aim of the study was to examine predictors of screening colonoscopy adherence. Participants (N = 144) were average-risk patients who received a primary care referral for a screening colonoscopy and were deemed ineligible for DAC between 2008 and 2012. Following the primary care visit, participants completed a questionnaire that assessed demographics and psychological factors. Medical chart review determined whether participants completed the screening colonoscopy via the GI referral. Of the 144 participants, only 19 (13 %) completed the screening colonoscopy via the GI referral. Multiple regression analyses revealed that decisional balance was the only unique predictor of screening colonoscopy adherence. Patients deemed ineligible for DAC are highly unlikely to complete a screening colonoscopy. Interventions are needed to increase screening colonoscopy adherence in this vulnerable population.

Examining the Impact of Latino Nativity, Migration, and Acculturation Factors on Colonoscopy Screening.

Science.gov (United States)

Costas-Muñiz, Rosario; Jandorf, Lina; Philip, Errol; Cohen, Noah; Villagra, Cristina; Sriphanlop, Pathu; Schofield, Elizabeth; DuHamel, Katherine

2016-10-01

Latinos are a diverse population comprised of multiple countries of origin with varying cultural profiles. This study examines differences in colonoscopy completion across place of birth and migration-related factors in a sample of predominantly Dominican and Puerto Rican Latinos living in New York City after receiving a recommendation for colonoscopy screening and navigation services. The sample included 702 Latinos recruited for two cancer screening projects targeting Latinos eligible for colonoscopy who seek healthcare in New York City. Participants completed a survey that included sociodemographic, health-related questions, psychosocial assessments and cancer screening practices, in Spanish or English. Migration, acculturation, and language factors were found to predict colonoscopy completion. The results indicated that Latinos born in the Dominican Republic and Central America were more likely to complete a screening colonoscopy than their counterparts born in the US. Further, those who emigrated at an older age, who have resided in the US for less than 20 years, preferred Spanish and those with lower US acculturation levels were also more likely to complete a screening colonoscopy. The findings suggest that Latinos who are less acculturated to the US are more likely to complete a screening colonoscopy after receiving a physician recommendation for colonoscopy screening. The results provide important information that can inform clinical practice and public health interventions. Continued attention to cultural and migration influences are important areas for cancer screening intervention development.

[Colonoscopy quality control as a requirement of colorectal cancer screening].

Science.gov (United States)

Quintero, Enrique; Alarcón-Fernández, Onofre; Jover, Rodrigo

2013-11-01

The strategies used in population-based colorectal screening strategies culminate in colonoscopy and consequently the success of these programs largely depends on the quality of this diagnostic test. The main factors to consider when evaluating quality are scientific-technical quality, safety, patient satisfaction, and accessibility. Quality indicators allow variability among hospitals, endoscopy units and endoscopists to be determined and can identify those not achieving recommended standards. In Spain, the working group for colonoscopy quality of the Spanish Society of Gastroenterology and the Spanish Society of Gastrointestinal Endoscopy have recently drawn up a Clinical Practice Guideline that contains the available evidence on the quality of screening colonoscopy, as well as the basic requirements that must be met by endoscopy units and endoscopists carrying out this procedure. The implementation of training programs and screening colonoscopy quality controls are strongly recommended to guarantee the success of population-based colorectal cancer screening. Copyright © 2013 Elsevier España, S.L. and AEEH y AEG. All rights reserved.

Quality Assessment of Colonoscopy Reporting: Results from a Statewide Cancer Screening Program

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Jun Li

2010-01-01

Full Text Available This paper aimed to assess quality of colonoscopy reports and determine if physicians in practice were already documenting recommended quality indicators, prior to the publication of a standardized Colonoscopy Reporting and Data System (CO-RADS in 2007. We examined 110 colonoscopy reports from 2005-2006 through Maryland Colorectal Cancer Screening Program. We evaluated 25 key data elements recommended by CO-RADS, including procedure indications, risk/comorbidity assessments, procedure technical descriptions, colonoscopy findings, specimen retrieval/pathology. Among 110 reports, 73% documented the bowel preparation quality and 82% documented specific cecal landmarks. For the 177 individual polyps identified, information on size and morphology was documented for 87% and 53%, respectively. Colonoscopy reporting varied considerately in the pre-CO-RADS period. The absence of key data elements may impact the ability to make recommendations for recall intervals. This paper provides baseline data to assess if CO-RADS has an impact on reporting and how best to improve the quality of reporting.

Focal Colonic FDG Activity with PET/CT: Guidelines for Recommendation of Colonoscopy

International Nuclear Information System (INIS)

Liu, Tianye; Behr, Spencer; Khan, Sana; Osterhoff, Robert; Aparici, Carina Mari

2015-01-01

Focal 18 F-fluorodeoxyglucose (FDG) colonic activity can be incidentally seen in positron emission tomography/computed tomography (PET/CT) scans. Its clinical significance is still unclear. The purpose of this study was to assess the significance of focal FDG activity in PET/CT scans by correlating the imaging findings to colonoscopy results, and come up with some guidelines for recommendation of follow-up colonoscopy. A total of 133 patients who underwent both 18 F-FDG PET/CT for different oncological indications and colonoscopy within 3 months were retrospectively studied. Imaging, colonoscopy and pathology results were analyzed. Of the 133 FDG-PET/CT scans, 109/133 (82%) did not show focal colonic FDG activity, and 24/133 (18%) did. Of the 109/133 PET/CTs without focal colonic FDG activity, 109/109 (100%) did not have evidence of colon cancer after colonoscopy and histology. Of the 24/133 PET/CTs with focal colonic FDG activity, 10/24 (42%) had pathologic confirmation of colon cancer and 14/24 (58%) did not have evidence of colon cancer after colonoscopy and histological analysis. Sensitivity was 10/10 (100%), specificity 109/123 (89%), positive predictive value (PPV) 10/24 (42%) and negative predictive value (NPV) 109/109 (100%). Incidental focal 18 FDG activity in PET/CT imaging shows a high sensitivity, specificity and NPV for malignancy, with a not so high PPV of 42%. Although some people would argue that a 42% chance of malignancy justifies colonoscopy, this maybe is not possible in all cases. However, the high sensitivity of the test does not allow these studies to be overlooked. We provide our recommendations as per when to send patients with focal FDG colonic activity to have further characterization with colonoscopy

Magnetic air capsule robotic system: proof of concept of a novel approach for painless colonoscopy.

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Valdastri, P; Ciuti, G; Verbeni, A; Menciassi, A; Dario, P; Arezzo, A; Morino, M

2012-05-01

Despite being considered the most effective method for colorectal cancer diagnosis, colonoscopy take-up as a mass-screening procedure is limited mainly due to invasiveness, patient discomfort, fear of pain, and the need for sedation. In an effort to mitigate some of the disadvantages associated with colonoscopy, this work provides a preliminary assessment of a novel endoscopic device consisting in a softly tethered capsule for painless colonoscopy under robotic magnetic steering. The proposed platform consists of the endoscopic device, a robotic unit, and a control box. In contrast to the traditional insertion method (i.e., pushing from behind), a "front-wheel" propulsion approach is proposed. A compliant tether connecting the device to an external box is used to provide insufflation, passing a flexible operative tool, enabling lens cleaning, and operating the vision module. To assess the diagnostic and treatment ability of the platform, 12 users were asked to find and remove artificially implanted beads as polyp surrogates in an ex vivo model. In vivo testing consisted of a qualitative study of the platform in pigs, focusing on active locomotion, diagnostic and therapeutic capabilities, safety, and usability. The mean percentage of beads identified by each user during ex vivo trials was 85 ± 11%. All the identified beads were removed successfully using the polypectomy loop. The mean completion time for accomplishing the entire procedure was 678 ± 179 s. No immediate mucosal damage, acute complications such as perforation, or delayed adverse consequences were observed following application of the proposed method in vivo. Use of the proposed platform in ex vivo and preliminary animal studies indicates that it is safe and operates effectively in a manner similar to a standard colonoscope. These studies served to demonstrate the platform's added advantages of reduced size, front-wheel drive strategy, and robotic control over locomotion and orientation.

Prospective Audit of Colonoscopy Practice in a Lebanese University Hospital

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Rita Slim

2008-01-01

Full Text Available Background Colonoscopy has a great impact on diagnosis and management of the diseases of the colon. In general it's a safe and accurate procedure. No evaluation has been done of any endoscopic practices in a country where the practice of medicine is totally private. Objectives Prospective audit of technical success and complication rates of both therapeutic and diagnostic colonoscopy. Setting One endoscopy unit of a Lebanese university hospital. Patients and design 407 consecutive colonoscopies were evaluated over a 6-month period. Data were recorded for age and sex of the patients, indication of the colonoscopy, presence of comorbidities, patients risk stratification, administrated dose of anesthetic drugs. Data concerning the procedure itself were also monitored. Intervention Completion rate as well as complications reported during or post colonoscopy. All patients were called back by phone 48 hours and 1 month later to identify any related post-procedural complication. Results 407 patients underwent colonoscopy. All patients were sedated with midazolam, propofol and fentanyl. The overall caecal intubation rate was 99.99%. 70 snare polypectomies and 29 cold forceps excision were performed as well as 5 coagulations with Argon Plasma Coagulation. The most important post-procedural complication was chemical colitis in 2 cases. Limitations Patients and endoscopists satisfaction was not evaluated. It's an audit of a single tertiary French affiliated hospital. It does not necessarily reflect what's really happening on a national level. Conclusion This audit enabled us to change some of our practices; i.e. rinsing method of endoscopes. It stimulated the team to keep a high performance level without neglecting the risk of potential complications.

Value of Virtual Colonoscopy with 64 Row CT in Evaluation of Colorectal Cancer

International Nuclear Information System (INIS)

Zaleska-Dorobisz, Urszula; Łasecki, Mateusz; Nienartowicz, Ewa; Pelak, Joanna; Słonina, Joanna; Olchowy, Cyprian; Ścieżka, Marek; Sąsiadek, Marek

2014-01-01

Virtual colonoscopy (VC) enables three-dimensional view of walls and internal lumen of the colon as a result of reconstruction of multislice CT images. The role of VC in diagnosis of the colon abnormalities systematically increases, and in many medical centers all over the world is carried out as a screening test of patients with high risk of colorectal cancer. We analyzed results of virtual colonoscopy of 360 patients with clinical suspicion of colorectal cancer. Sensitivity and specificity of CT colonoscopy for detection of colon cancers and polyps were assessed. Results of our research have shown high diagnostic efficiency of CT colonoscopy in detection of focal lesions in large intestine of 10 mm or more diameter. Sensitivity was 85.7%, specificity 89.2%. Virtual colonoscopy is noninvasive and well tolerated by patients imaging method, which permits for early detection of the large intestine lesions with specificity and sensitivity similar to classical colonoscopy in screening exams in patients suspected for colorectal cancer. Good preparation of the patients for the examination is very important for proper diagnosis and interpretation of this imaginge procedure

Impact of Fellowship Training Level on Colonoscopy Quality and Efficiency Metrics.

Science.gov (United States)

Bitar, Hussein; Zia, Hassaan; Bashir, Muhammad; Parava, Pratyusha; Hanafi, Muhammad; Tierney, William; Madhoun, Mohammad

2018-04-18

Previous studies have described variable effects of fellow involvement on the adenoma detection rate (ADR), but few have stratified this effect by level of training. We aimed to evaluate the "fellow effect" on multiple procedural metrics including a newly defined adenoma management efficiency index, which may have a role in documenting colonoscopy proficiency for trainees. We also describe the impact of level of training on moderate sedation use. We performed a retrospective review of 2024 patients (mean age 60.9 ± 10. 94% males) who underwent outpatient colonoscopy between June 2012 and December 2014 at our Veterans Affairs Medical Center. Colonoscopies were divided into 5 groups. The first 2 groups were first year fellows in the first 6 months and last 6 months of the training year. Second and third year fellows and attending only procedures accounted for one group each. We collected data on doses of sedatives used, frequency of adjunctive agent use, procedural times as well as location, size and histology of polyps. We defined the adenoma management efficiency index as average time required per adenoma resected during withdrawal. 1675 colonoscopies involved a fellow. 349 were performed by the attending alone. There was no difference in ADR between fellows according to level of training (P=0.8), or between fellows compared with attending-only procedures (P=0.67). Procedural times decreased consistently during training, and declined further for attending only procedures. This translated into improvement in the adenoma management efficiency index (fellow groups by ascending level of training 23.5 minutes vs 18.3 minutes vs 13.7 minutes vs 13.4 minutes vs attending group 11.7 minutes; PEfficiency of detecting and resecting polyps improved throughout training without reaching attending level. Fellow involvement led to greater use of moderate sedation, which may relate to a longer procedure duration and an evolving experience in endoscopic technique. Copyright �

Cecal Intubation Rate During Colonoscopy at a Tertiary Hospital in ...

African Journals Online (AJOL)

2016-06-14

Jun 14, 2016 ... diseases, and for colorectal cancer screening program. Complete colonoscopy is therefore crucial for the success of any screening program. One important measure of the quality of colonoscopy is the cecal intubation rate (CIR). Aim: This was to assess the CIR at our endoscopy unit and evaluate the factors ...

Haptic interface of the KAIST-Ewha colonoscopy simulator II.

Science.gov (United States)

Woo, Hyun Soo; Kim, Woo Seok; Ahn, Woojin; Lee, Doo Yong; Yi, Sun Young

2008-11-01

This paper presents an improved haptic interface for the Korea Advanced Institute of Science and Technology Ewha Colonoscopy Simulator II. The haptic interface enables the distal portion of the colonoscope to be freely bent while guaranteeing sufficient workspace and reflective forces for colonoscopy simulation. Its force-torque sensor measures the profiles of the user. Manipulation of the colonoscope tip is monitored by four deflection sensors and triggers computations to render accurate graphic images corresponding to the rotation of the angle knob. Tack sensors are attached to the valve-actuation buttons of the colonoscope to simulate air injection or suction as well as the corresponding deformation of the colon. A survey study for face validation was conducted, and the result shows that the developed haptic interface provides realistic haptic feedback for colonoscopy simulations.

Pneumoperitoneum after virtual colonoscopy: causes, risk factors, and management.

Science.gov (United States)

Baccaro, Leopoldo M; Markelov, Alexey; Wilhelm, Jakub; Bloch, Robert

2014-06-01

Computed tomographic virtual colonoscopy (CTVC) is a safe and minimally invasive modality when compared with fiberoptic colonoscopy for evaluating the colon and rectum. We have reviewed the risks for colonic perforation by investigating the relevant literature. The objectives of this study were to assess the risk of colonic perforation during CTVC, describe risk factors, evaluate ways to reduce the incidence complications, and to review management and treatment options. A formal search of indexed publications was performed through PubMed. Search queries using keywords "CT colonography," "CT virtual colonoscopy," "virtual colonoscopy," and "perforation" yielded a total of 133 articles. A total of eight case reports and four review articles were selected. Combining case reports and review articles, a total of 25 cases of colonic perforation after CTVC have been reported. Causes include, but are not limited to, diverticular disease, irritable bowel diseases, obstructive processes, malignancies, and iatrogenic injury. Both operative and nonoperative management has been described. Nonoperative management has been proven safe and successful in minimally symptomatic and stable patients. Colonic perforation after CTVC is a rare complication and very few cases have been reported. Several risk factors are recurrent in the literature and must be acknowledged at the time of the study. Management options vary and should be tailored to each individual patient.

Impact of patient education on quality of bowel preparation in outpatient colonoscopies.

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Modi, Chintan; Depasquale, Joseph R; Digiacomo, W Scott; Malinowski, Judith E; Engelhardt, Kristen; Shaikh, Sohail N; Kothari, Shivangi T; Kottam, Raghu; Shakov, Rada; Maksoud, Charbel; Baddoura, Walid J; Spira, Robert S

2009-01-01

High-quality bowel preparation is essential for successful outpatient colonoscopy. Currently, the rate of adequate bowel preparation for outpatient colonoscopy in the USA is low. Patients often fail to adhere to recommended preparation instructions. Limited literature exists on evaluating educational intervention as a means of improving the quality of bowel preparation prior to outpatient colonoscopy. Our objective was to determine the effect of an educational intervention on the quality of outpatient colonoscopy preparation. The secondary objective was to determine whether the quality of bowel preparation improves overall colonoscopy outcomes as measured by rate of polyp detection and caecal intubation time. A single-blinded, prospective, randomised, controlled trial was conducted in two inner-city gastroenterology clinics in the USA. One hundred and sixty-four subjects were enrolled and randomly assigned to one of two groups. The control group subjects received verbal and written instructions for colonoscopy. The intervention group subjects received the same instructions and were then asked to answer a questionnaire. The subjects' responses were reviewed and an additional explanation of the preparation process provided. An attending gastroenterologist determined the quality of each bowel preparation at the time of colonoscopy using the Universal Preparation Assessment Scale. The educational intervention had no impact on the overall quality of bowel preparation (P=0.12). However, the type of food (liquid vs solid) consumed during the 24 hours prior to the procedure (P=0.04) and the time since the last solid meal (P=0.03) did have an impact on preparation quality. Other significant factors included elapsed time to first bowel movement from the initiation of bowel preparation (P=0.05) and age younger than 55 (P=0.02). Adequate bowel preparation was associated with shorter total procedure (P=0.001) and caecal intubation (P=0.01) times. Our study failed to demonstrate

Trends in quality of screening colonoscopy in Austria.

Science.gov (United States)

Waldmann, Elisabeth; Gessl, Irina; Sallinger, Daniela; Jeschek, Philip; Britto-Arias, Martha; Heinze, Georg; Fasching, Elisabeth; Weiss, Werner; Gschwantler, Michael; Trauner, Michael; Ferlitsch, Monika

2016-12-01

Background and study aim: Screening colonoscopy only effectively prevents colorectal cancer if performed with high quality. The aim of this study was to analyze the detection rates of premalignant colorectal lesions in screening colonoscopies performed within a nationwide quality control program for screening colonoscopy in Austria. Methods: Data from electronic records of the screening program from its implementation in 2007 until December 2014 were analyzed in order to calculate detection rates for adenomas, advanced adenomas, polyps, and proximal lesions, and rates of cecal intubation, sedation, complications, and adequate bowel preparation. Results were evaluated to identify trends and changes in quality parameters over the 8-year study period. Results: During the study period, 301 endoscopists provided data from 159 246 screening colonoscopies. Mean age of screened individuals was 61.1 years, and 49.1 % were women. Significant increases over time were found for age- and sex-adjusted adenoma detection rates (ADRs), which increased from a mean of 22.2 % (SD 10.7 %) in 2007/2008 to 24.2 % (SD 11.6 %) in 2013/2014. On average, each endoscopist increased their individual ADR by + 1.5 percentage points per 2-year period (95 % confidence interval [CI] 0.9 - 2.2 percentage points; P  Austria between 2007 and 2014. Although, overall ADR increased significantly during the study period, there was a decrease in the rate of advanced adenoma detection. © Georg Thieme Verlag KG Stuttgart · New York.

Assessment of colonoscopy by use of magnetic endoscopic imaging

DEFF Research Database (Denmark)

Nerup, Nikolaj; Preisler, Louise; Svendsen, Morten Bo Søndergaard

2015-01-01

and a difficult case. SETTING: Center for Clinical Education, Capital Region of Denmark. MAIN OUTCOME MEASUREMENTS: By using magnetic endoscopic imaging, we developed a colonoscopy progression score (CoPS). A pass/fail score was established by using the contrast-group method. RESULTS: We found significant...... differences in performance between the 2 groups using the CoPS in both case scenarios (easy: P heterogeneity of the experienced group resulted in a high passing score for the difficult case, which led to the failing of the less experienced...... in the group. The CoPS does not consider polyp detection rate, tissue damage, or patient discomfort. CONCLUSIONS: We developed a score of progression in colonoscopy, based on magnetic endoscopic imaging. With the same tool, a map of progression in colonoscopy can be provided. The CoPS and map of progression...

Microdamage of the cortical bone during mini-implant insertion with self-drilling and self-tapping techniques: a randomized controlled trial.

Science.gov (United States)

Yadav, Sumit; Upadhyay, Madhur; Liu, Sean; Roberts, Eugene; Neace, William P; Nanda, Ravindra

2012-05-01

The purpose of this research was to evaluate microdamage accumulation after mini-implant placement by self-drilling (without a pilot hole) and self-tapping (screwed into a pilot hole) insertion techniques. The null hypothesis was that the mini-implant insertion technique would have no influence on microcrack accumulation and propagation in the cortical bones of the maxillae and mandibles of adult hounds. Mini-implants (n = 162; diameter, 1.6 mm; length, 6 mm) were placed in the maxillae and mandibles of 9 hounds (12-14 months old) with self-drilling and self-tapping insertion techniques. The techniques were randomly assigned to the left or the right side of each jaw. Each hound received 18 mini-implants (10 in the mandible, 8 in the maxilla). Histomorphometric parameters including total crack length and crack surface density were measured. The null hypothesis was rejected in favor of an alternate hypothesis: that the self-drilling technique results in more microdamage (microcracks) accumulation in the adjacent cortical bone in both the maxilla and the mandible immediately after mini-implant placement. A cluster level analysis was used to analyze the data on the outcome measured. Since the measurements were clustered within dogs, a paired-samples t test was used to analyze the average differences between insertion methods at both jaw locations. A significance level of 0.05 was used for both analyses. The self-drilling technique resulted in greater total crack lengths in both the maxilla and the mandible (maxilla: mean difference, 18.70 ± 7.04 μm/mm(2); CI, 13.29-24.11; mandible: mean difference, 22.98 ± 6.43 μm/mm(2); CI, 18.04-27.93; P hounds in both the maxilla and the mandible by the self-drilling insertion technique compared with the self-tapping technique. Copyright © 2012 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.

Narrative message targets within the decision-making process to undergo screening colonoscopy among Latinos: a qualitative study.

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Hennelly, Marie Oliva; Sly, Jamilia R; Villagra, Cristina; Jandorf, Lina

2015-06-01

Colorectal cancer (CRC) is a preventable yet leading cause of cancer mortality among Latinos in the USA. Cultural targeting and narrative messaging are two strategies to increase the low screening colonoscopy rates among Latinos. This study identifies key messages for educational interventions aiming to increase screening colonoscopy used among Latinos and proposes a model to understand the relationship between factors involved in colonoscopy decision-making. Individual in-depth interviews were conducted with 12 Latino participants primarily of Puerto Rican descent on the topics of CRC knowledge, barriers and facilitators to colonoscopy use, and the use of narrative in colorectal health messaging. Knowledge about colorectal anatomy and the anesthesia component of colonoscopy procedure is low. Fear of procedure-related pain and fear of treatment-related burden following a cancer diagnosis are significant barriers to colonoscopy. Fear of disease-related suffering and death following a cancer diagnosis and fear of regret are strong facilitators and can be augmented by cancer narratives. Storytelling is commonly used in Latino culture and is an acceptable method to educate the Latino community about CRC screening via colonoscopy. Machismo is a unique barrier to colonoscopy for Latino men via homophobia and reluctance to seek healthcare. A preliminary model to understand factors in colonoscopy decision-making among Latinos is presented. Counseling practices and educational interventions that use culturally targeted narrative health messaging to mediate fears and increase colonoscopy knowledge may increase screening colonoscopy use among Latinos.

Diverticular disease at colonoscopy in Lagos State, Nigeria.

Science.gov (United States)

Oluyemi, Aderemi; Odeghe, Emuobor

2016-01-01

The upsurge in the reported cases of diverticular disease (DD) has led to a re-appraisal of the earlier held views that it was a rare entity in Nigeria. The advent of colonoscopy has contributed in no small way to this change. We sought to determine the clinical characteristics, indications for colonoscopy, and intra-procedural findings among these patients. A retrospective cross-sectional study was carried out on the colonoscopy records from four private endoscopy units based in Lagos State, Nigeria. The records were drawn from a 5-year period (August 2010 to July 2015). The endoscopy logs and reports were reviewed, and the bio data, indications, and colonoscopy findings were gleaned. A total of 265 colonoscopies were carried out in the stated period. Of these, 28 (10.6%) had DD. Of the patients with DD, 5 (17.9%) were females while 23 (82.1%) were males. Their ages ranged from 46 to 94 years (mean = 68.2 ± 11 years). Fifteen patients had been referred for the procedure on account of hematochezia alone (15 = 53.6%). Other reasons for referral included abdominal pain alone (2 = 7%), hematochezia plus abdominal pain (5 = 17.9%), and change in bowel habits (3 = 10.8%). Ten (35%) patients had pan-colonic involvement. Regional disease involved the right side alone in only one case (3.5%) while the other combinations of sites are as follows; 6 (21.4%) in the sigmoid colon alone, 2 (7%) in the descending colon alone, 5 (17.9%) in the sigmoid-descending colon, 4 (14.3%) in the sigmoid-descending-transverse colon, thus the sigmoid colon was involved in 25 (89.3%) cases. Five cases (17.9%) had endoscopic features suggestive of diverticulitis. DD should no longer be regarded as a rare problem in the Nigerian patient. The study findings support the notion of higher prevalence among the elderly, in males, and of sigmoid colon involvement.

Factors Associated with Anxiety About Colonoscopy: The Preparation, the Procedure, and the Anticipated Findings.

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Shafer, L A; Walker, J R; Waldman, C; Yang, C; Michaud, V; Bernstein, C N; Hathout, L; Park, J; Sisler, J; Restall, G; Wittmeier, K; Singh, H

2018-03-01

Previous research has assessed anxiety around colonoscopy procedures, but has not considered anxiety related to different aspects related to the colonoscopy process. Before colonoscopy, we assessed anxiety about: bowel preparation, the procedure, and the anticipated results. We evaluated associations between patient characteristics and anxiety in each area. An anonymous survey was distributed to patients immediately prior to their outpatient colonoscopy in six hospitals and two ambulatory care centers in Winnipeg, Canada. Anxiety was assessed using a visual analog scale. For each aspect, logistic regression models were used to explore associations between patient characteristics and high anxiety. A total of 1316 respondents completed the questions about anxiety (52% female, median age 56 years). Anxiety scores > 70 (high anxiety) were reported by 18% about bowel preparation, 29% about the procedure, and 28% about the procedure results. High anxiety about bowel preparation was associated with female sex, perceived unclear instructions, unfinished laxative, and no previous colonoscopies. High anxiety about the procedure was associated with female sex, no previous colonoscopies, and confusing instructions. High anxiety about the results was associated with symptoms as an indication for colonoscopy and instructions perceived as confusing. Fewer people had high anxiety about preparation than about the procedure and findings of the procedure. There are unique predictors of anxiety about each colonoscopy aspect. Understanding the nuanced differences in aspects of anxiety may help to design strategies to reduce anxiety, leading to improved acceptance of the procedure, compliance with preparation instructions, and less discomfort with the procedure.

The accuracy of the lateral vertebral notch-referred pedicle screw insertion technique in subaxial cervical spine: a human cadaver study.

Science.gov (United States)

Luo, Jiaquan; Wu, Chunyang; Huang, Zhongren; Pan, Zhimin; Li, Zhiyun; Zhong, Junlong; Chen, Yiwei; Han, Zhimin; Cao, Kai

2017-04-01

This is a cadaver specimen study to confirm new pedicle screw (PS) entry point and trajectory for subaxial cervical PS insertion. To assess the accuracy of the lateral vertebral notch-referred PS insertion technique in subaxial cervical spine in cadaver cervical spine. Reported morphometric landmarks used to guide the surgeon in PS insertion show significant variability. In the previous study, we proposed a new technique (as called "notch-referred" technique) primarily based on coronal multiplane reconstruction images (CMRI) and cortical integrity after PS insertion in cadavers. However, the PS position in cadaveric cervical segment was not confirmed radiologically. Therefore, the difference between the pedicle trajectory and the PS trajectory using the notch-referred technique needs to be illuminated. Twelve cadaveric cervical spines were conducted with PS insertion using the lateral vertebral notch-referred technique. The guideline for entry point and trajectory for each vertebra was established based on the morphometric data from our previous study. After 3.5-mm diameter screw insertion, each vertebra was dissected and inspected for pedicle trajectory by CT scan. The pedicle trajectory and PS trajectory were measured and compared in axial plane. The perforation rate was assessed radiologically and was graded from ideal to unacceptable: Grade 0 = screw in pedicle; Grade I = perforation of pedicle wall less than one-fourth of the screw diameter; Grade II = perforation more than one-fourth of the screw diameter but less than one-second; Grade III = perforation more than one-second outside of the screw diameter. In addition, pedicle width between the acceptable and unacceptable screws was compared. A total of 120 pedicle screws were inserted. The perforation rate of pedicle screws was 78.3% in grade 0 (excellent PS position), 10.0% in grade I (good PS position), 8.3% in grade II (fair PS position), and 3.3% in grade III (poor PS position). The

What to Expect During a Colonoscopy

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Full Text Available ... Earn your CME from the convenience of your home or office by accessing ACG's web-based educational ... ACG Blog Follow ACG on Twitter Patients ACG Home / Media / What to Expect During a Colonoscopy What ...

Socioeconomic and other predictors of colonoscopy preparation quality.

Science.gov (United States)

Lebwohl, Benjamin; Wang, Timothy C; Neugut, Alfred I

2010-07-01

Suboptimal bowel preparation prior to colonoscopy is a common occurrence, with a deleterious impact on colonoscopy effectiveness. Established risk factors for suboptimal bowel preparation have been proposed, but social factors, such as socioeconomic status and marital status, have not been investigated. The aim of this study was to evaluate sociodemographic factors, including insurance status and marital status, as predictive of suboptimal preparation. We analyzed a database of 12,430 consecutive colonoscopies during a 28-month period at Columbia University Medical Center. We collected the following variables: age, gender, indication for colonoscopy, location (inpatient vs. outpatient), race, marital status, and Medicaid status. Preparation quality was recorded and dichotomized as optimal or suboptimal. We employed multivariate regression to determine independent risk factors for suboptimal bowel preparation. Among the 10,921 examinations in which bowel preparation was recorded, suboptimal preparation occurred in 34% of Medicaid patients versus 18% of non-Medicaid patients (P Married patients had decreased rates of suboptimal preparation (OR 0.89, 95% CI 0.80-0.98). Other variables associated with suboptimal preparation included increased age (OR per 10 years 1.09, 95% CI 1.05-1.14), male gender (OR 1.44, 95% CI 1.31-1.59), inpatient status (OR 1.51, 95% CI 1.26-1.80), and later time of day (OR 1.89, 95% CI 1.71-2.09). Unmarried status and Medicaid status are predictive of suboptimal bowel preparation. Future studies are warranted to identify how these social conditions predict bowel preparation quality and to implement interventions to optimize bowel preparation in vulnerable populations.

Determinants of polyp Size in patients undergoing screening colonoscopy

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Maisonneuve Patrick

2011-09-01

Full Text Available Abstract Background Pre-existing polyps, especially large polyps, are known to be the major source for colorectal cancer, but there is limited available information about factors that are associated with polyp size and polyp growth. We aim to determine factors associated with polyp size in different age groups. Methods Colonoscopy data were prospectively collected from 67 adult gastrointestinal practice sites in the United States between 2002 and 2007 using a computer-generated endoscopic report form. Data were transmitted to and stored in a central data repository, where all asymptomatic white (n = 78352 and black (n = 4289 patients who had a polyp finding on screening colonoscopy were identified. Univariate and multivariate analysis of age, gender, performance site, race, polyp location, number of polyps, and family history as risk factors associated with the size of the largest polyp detected at colonoscopy. Results In both genders, size of the largest polyp increased progressively with age in all age groups (P P Conclusions In both genders there is a significant increase in polyp size detected during screening colonoscopy with increasing age. Important additional risk factors associated with increasing polyp size are gender, race, polyp location, and number of polyps, with polyp multiplicity being the strongest risk factor. Previous family history of bowel cancer was not a risk factor.

Stress perception among patients in pre-colonoscopy period and those undergoing chemotherapy treatment

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Graziela de Souza Alves da Silva

2015-05-01

Full Text Available Objective: comparing the perception of stress among patients with colorectal cancer undergoing chemotherapy with those in pre-colonoscopy period. Methods: a comparative descriptive study developed with 144 people receiving chemotherapy and 100 patients in the pre-colonoscopy period, using biosocial and clinical data, Stress Assessment Tool and Perceived Stress Scale. Results: a predominance of females (73%, aged over 65 (50% were predominant for the pre-colonoscopy period patients. In patients receiving chemotherapy, gender parity with ages ranging from 40-64 years (68.1% was observed. Pre-colonoscopy patients showed higher perceived stress compared to those receiving chemotherapy (p <0.001. Conclusion: the phase of diagnostic definition represents greater stress to patients in comparison to period of treatment, even despite the characteristic manifestations of chemotherapy.

Benefits of Barium Enema in Patients with Incomplete Colonoscopy. Prospective Study of 45 Cases

International Nuclear Information System (INIS)

Gispert, S.; Mayolas, N.; Hidalgo, A.

2003-01-01

To evaluate the usefulness of barium enema in patients with incomplete colonoscopy. There was carried out a prospective 10-month study of 45 patients with incomplete colonoscopy (27 men and 18 women), who were later examined by means of barium enema (33 conventional, 12 double-contrast) in order to check for additional pathology in portions of the colon not visualized by colonoscopy. Barium enema diagnosed six possible additional lesions (13.3%) in portions of the colon not visualized by incomplete colonoscopy (four neoplasia and two non-neoplasia). Regarding the neoplasia two were true positives and two false positives. Both true positives were adenocarcinomas (one synchronous caecum, and another in splenic angle). The two false positives corresponded to fecal matter stuck to the intestinal wall. Regarding the non-neoplasia, multiple stenosis was detected in a patient with Crohn's disease and an enterocolic fistula was found in a patient with sigmoid colon neoplasia. The diagnostic yield of barium enema in the detection of additional pathology in colon portions not visualized by colonoscopy was of 9%. Barium enema following incomplete colonoscopy permits a complete colon evaluation in most cases, and it offers additional diagnostic information. (Author) 21 refs

Current sedation and monitoring practice for colonoscopy: an International Observational Study (EPAGE)

DEFF Research Database (Denmark)

Froehlich, F; Harris, JK; Wietlisbach, V

2006-01-01

centers. Oxygen desaturation (LT /= 85 %) occurred in 5 % of patients, of whom 80 % were moderately sedated. On average, three staff members were involved in procedures. An anesthesiologist was present during 27 % of colonoscopies, and during 85 % of colonoscopies using deep sedation. CONCLUSIONS...

Assessment of colonic disease by multi-slice CT pneumocolon after incomplete colonoscopy

International Nuclear Information System (INIS)

Zhao Zehua; Liu Wenjin; Xu Songsen; Wang Kang; Wang Weizhong

2004-01-01

Objective: To evaluate the use of preoperative MSCT in patients with clinically suspected colorectal disease after incomplete colonoscopy. Methods: After incomplete colonoscopy, 31 patients underwent MSCT before and after intravenous injection of iodinated contrast agent. CT virtual colonography (CTVC), multiplanar reformation (MPR), shaded surface display (SSD), and Raysum images were obtained by using 4 different software in workstation. The results of MSCT were compared with the findings of colonoscopy, intraoperative colon palpation, and postoperative pathology. Results: After incomplete colonoscopy, MSCT was successfully performed in all 31 cases. Postoperative pathology revealed 22 colorectal cancers (one synchronous cancers, two with polyps) and 9 benign disease. 22 colonic carcinomas were all correctly diagnosed by MSCT (including synchronous disease), 2 benign diseases were misdiagnosed as malignancy, and one polyp was missed. Conclusion: MSCT is a feasible and useful method for evaluating the entire colon before surgery in patients with occlusive disease. (author)

Colorectal Cancer Surveillance after Index Colonoscopy: Guidance from the Canadian Association of Gastroenterology

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Desmond Leddin

2013-01-01

Full Text Available BACKGROUND: Differences between American (United States [US] and European guidelines for colonoscopy surveillance may create confusion for the practicing clinician. Under- or overutilization of surveillance colonoscopy can impact patient care.

The impact of diet liberalization on bowel preparation for colonoscopy

OpenAIRE

Walter, James; Francis, Gloria; Matro, Rebecca; Kedika, Ramalinga; Grosso, Rachael; Keith, Scott W.; Kastenberg, David

2017-01-01

Background and study aims?Dietary restrictions are integral to colonoscopy preparation and impact patient satisfaction. Utilizing split-dose, lower-volume polyethylene glycol 3350-electrolyte solution (PEG-ELS), this study compared colon preparation adequacy of a low-residue diet to clear liquids using a validated grading scale. Patients and methods?This was a prospective, randomized, single-blinded, single-center non-inferiority study evaluating diet the day prior to outpatient colonoscopy. ...

Elimination of waste: creation of a successful Lean colonoscopy program at an academic medical center.

Science.gov (United States)

Damle, Aneel; Andrew, Nathan; Kaur, Shubjeet; Orquiola, Alan; Alavi, Karim; Steele, Scott R; Maykel, Justin

2016-07-01

Lean processes involve streamlining methods and maximizing efficiency. Well established in the manufacturing industry, they are increasingly being applied to health care. The objective of this study was to determine feasibility and effectiveness of applying Lean principles to an academic medical center colonoscopy unit. Lean process improvement involved training endoscopy personnel, observing patients, mapping the value stream, analyzing patient flow, designing and implementing new processes, and finally re-observing the process. Our primary endpoint was total colonoscopy time (minutes from check-in to discharge) with secondary endpoints of individual segment times and unit colonoscopy capacity. A total of 217 patients were included (November 2013-May 2014), with 107 pre-Lean and 110 post-Lean intervention. Pre-Lean total colonoscopy time was 134 min. After implementation of the Lean process, mean colonoscopy time decreased by 10 % to 121 min (p = 0.01). The three steps of the process affected by the Lean intervention (time to achieve adequate sedation, time to recovery, and time to discharge) decreased from 3.7 to 2.4 min (p Lean patient satisfaction surveys demonstrated an average score of 4.5/5.0 (n = 73) regarding waiting time, 4.9/5.0 (n = 60) regarding how favorably this experienced compared to prior colonoscopy experiences, and 4.9/5.0 (n = 74) regarding professionalism of staff. One hundred percentage of respondents (n = 69) stated they would recommend our institution to a friend for colonoscopy. With no additional utilization of resources, a single Lean process improvement cycle increased productivity and capacity of our colonoscopy unit. We expect this to result in increased patient access and revenue while maintaining patient satisfaction. We believe these results are widely generalizable to other colonoscopy units as well as other process-based interventions in health care.

The Effect of Music on Pain, Anxiety and Vital Signs of Children during Colonoscopy

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M Najafi

2014-04-01

Full Text Available Introduction: This study aimed to investigate the effect of music on pain, anxiety and vital signs in children undergoing colonoscopy.   Method and Materials: This randomized study was carried out on 101 children (7 to 14 years old requiring colonoscopy. Children were randomly allocated to a control or case group. The case group was played relaxing music (by Clayderman during the procedure. Spiegelberger and pain questionaires were administered immediately after the colonoscopy. Pulse rate, blood pressure and percent blood oxygen saturation were recorded for each subject. The control group was treated in an identical manner, but was not played music during the procedure. Data were analyzed using SPSS software.   Results: Satisfaction, anxiety, pain, and blood pressure were significantly different between the groups                (P0.05.   Conclusion: Music can reduce anxiety and pain during colonoscopy.   Key words: Anxiety, Music,Vital signs, Colonoscopy

Colonoscopy conversion after flexible sigmoidoscopy screening: results from the UK bowel scope screening programme.

Science.gov (United States)

Siau, Keith; Yew, Andrew; Ishaq, Sauid; Jewes, Sarah; Shetty, Sharan S; Brookes, Matthew; Veitch, Andrew; McKaig, Brian; Murugananthan, Aravinth

2017-12-05

In the UK Bowel Scope screening programme (BSSP), patients progress to colonoscopy based on high-risk features on flexible sigmoidoscopy (FS). To assess practice of colonoscopy conversion and predictors of additional adenoma detection on colonoscopy. The Bowel Cancer Screening database was interrogated and collated with endoscopic and histological findings from patients undergoing colonoscopy following FS between August 2013 and August 2016. Multivariate analysis was performed to identify predictors of new adenomas. Wolverhampton bowel cancer screening centre, covering Wolverhampton, Dudley, Cannock and Walsall, with a combined catchment population of 1 million. This is the first UK site to fully roll-out BSSP. FS was performed on 11,711 patients, with an adenoma detection rate (ADR) of 8.5%, and conversion to colonoscopy in 421 (3.6%). The additional ADR at colonoscopy was 35.2%, with one additional malignant diagnosis (0.26%). The adenoma miss rate was 3.6%. On multivariate analysis, a polyp ≥10mm was the only high-risk indication associated with additional ADR at colonoscopy (odds ratio [OR] 3.68, 95% confidence interval [CI]:1.51-3.65, p<0.001), in addition to male gender (OR 2.36, 95% CI:1.46-3.83, p<0.001). Predictors of detection of a new adenoma ≥10mm included: villous adenoma (p=0.002), polyp≥10mm (p=0.007) and male gender (p=0.039). Presence of any conversion criteria was associated with the detection of any proximal adenoma (p<0.001) and adenoma ≥10mm (p=0.031). Male gender, ≥10mm polyps and villous-preponderant histology at FS were predictors of <10mm and ≥10mm adenomas at colonoscopy. Further data are required to assess the role for gender-based stratification of conversion criteria. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Evaluation of a fecal immunochemistry test prior to colonoscopy for outpatients with various indications

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Szilagyi A

2017-11-01

Full Text Available Andrew Szilagyi,1 Xiaoqing Xue2 1Division of Gastroenterology, 2Division of Emergency Medicine, Jewish General Hospital, McGill University School of Medicine, Montreal, Quebec, Canada Background: Stool tests can predict advanced neoplasms prior to colonoscopy. Results of immunochemical stool tests to predict findings at colonoscopy for various indications are less often reported. We compared pre-colonoscopy stool tests with findings in patients undergoing colonoscopy for different indications. Patients and methods: Charts of patients undergoing elective or semi-urgent colonoscopy were reviewed. Comparison of adenoma detection rates and pathological findings was made between prescreened and non-prescreened, and between stool-positive and stool-negative cases. Demographics, quality of colonoscopy, and pathological findings were recorded. Odds ratios (ORs and 95% confidence intervals (CIs were assessed. Statistical significance was accepted at p≤0.05.Results: Charts of 325 patients were reviewed. Among them, stool tests were done on 144 patients: 114 were negative and 30 were positive. Findings were similar in the pretest and non-pretest groups. Detection of advanced adenomas per patient was higher in the stool-positive group compared to the stool-negative group (23.4% vs 3.5%, p=0.0016, OR =7.6 [95% CI: 2–29.3]. Five advanced adenomas (without high-grade dysplasia or adenocarcinoma and several cases of multiple adenomas were missed in the negative group. Sensitivity and specificity for advanced polyps was 63.6% and 82.7%, respectively. The negative predictive value was 96.5%. Male gender was independently predictive of any adenoma. Conclusion: The stool immunochemical test best predicted advanced neoplasms and had a high negative predictive value in this small cohort. Whether this test can be applied to determine the need for colonoscopy in groups other than average risk would require more studies. Keywords: fecal, blood, risks, colonoscopy

Patient experience of CT colonography and colonoscopy after fecal occult blood test in a national screening programme

Energy Technology Data Exchange (ETDEWEB)

Plumb, Andrew A.; Taylor, Stuart A.; Halligan, Steve [University College London, Centre for Medical Imaging, Division of Medicine, London (United Kingdom); Ghanouni, Alex; Von Wagner, Christian [University College London, Health Behaviour Research Centre, Department of Epidemiology and Public Health, London (United Kingdom); Rees, Colin J. [Durham University School of Medicine, Pharmacy and Health, Durham (United Kingdom); Hewitson, Paul [University of Oxford, Health Services Research Unit, Nuffield Department of Population Health, Oxford (United Kingdom); Nickerson, Claire; Wright, Suzanne [Fulwood House, NHS Cancer Screening Programmes, Sheffield (United Kingdom)

2017-03-15

To investigate patient experience of CT colonography (CTC) and colonoscopy in a national screening programme. Retrospective analysis of patient experience postal questionnaires. We included screenees from a fecal occult blood test (FOBt) based screening programme, where CTC was performed when colonoscopy was incomplete or deemed unsuitable. We analyzed questionnaire responses concerning communication of test risks, test-related discomfort and post-test pain, as well as complications. CTC and colonoscopy responses were compared using multilevel logistic regression. Of 67,114 subjects identified, 52,805 (79 %) responded. Understanding of test risks was lower for CTC (1712/1970 = 86.9 %) than colonoscopy (48783/50975 = 95.7 %, p < 0.0001). Overall, a slightly greater proportion of screenees found CTC unexpectedly uncomfortable (506/1970 = 25.7 %) than colonoscopy (10,705/50,975 = 21.0 %, p < 0.0001). CTC was tolerated well as a completion procedure for failed colonoscopy (unexpected discomfort; CTC = 26.3 %: colonoscopy = 57.0 %, p < 0.001). Post-procedural pain was equally common (CTC: 288/1970,14.6 %, colonoscopy: 7544/50,975,14.8 %; p = 0.55). Adverse event rates were similar in both groups (CTC: 20/2947 = 1.2 %; colonoscopy: 683/64,312 = 1.1 %), but generally less serious with CTC. Even though CTC was reserved for individuals either unsuitable for or unable to complete colonoscopy, we found only small differences in test-related discomfort. CTC was well tolerated as a completion procedure and was extremely safe. CTC can be delivered across a national screening programme with high patient satisfaction. (orig.)

Validation of the second-generation Olympus colonoscopy simulator for skills assessment.

Science.gov (United States)

Haycock, A V; Bassett, P; Bladen, J; Thomas-Gibson, S

2009-11-01

Simulators have potential value in providing objective evidence of technical skill for procedures within medicine. The aim of this study was to determine face and construct validity for the Olympus colonoscopy simulator and to establish which assessment measures map to clinical benchmarks of expertise. Thirty-four participants were recruited: 10 novices with no prior colonoscopy experience, 13 intermediate (trainee) endoscopists with fewer than 1000 previous colonoscopies, and 11 experienced endoscopists with more than 1000 previous colonoscopies. All participants completed three standardized cases on the simulator and experts gave feedback regarding the realism of the simulator. Forty metrics recorded automatically by the simulator were analyzed for their ability to distinguish between the groups. The simulator discriminated participants by experience level for 22 different parameters. Completion rates were lower for novices than for trainees and experts (37 % vs. 79 % and 88 % respectively, P variable stiffness function ( P = 0.004), number of sigmoid N-loops ( P = 0.02); size of sigmoid N-loops ( P = 0.01), and time to remove alpha loops ( P = 0.004). Out of 10, experts rated the realism of movement at 6.4, force feedback at 6.6, looping at 6.6, and loop resolution at 6.8. The Olympus colonoscopy simulator has good face validity and excellent construct validity. It provides an objective assessment of colonoscopic skill on multiple measures and benchmarks have been set to allow its use as both a formative and a summative assessment tool. Georg Thieme Verlag KG Stuttgart. New York.

Syncope as the Presenting Feature of Splenic Rupture after Colonoscopy

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Daniel Jamorabo

2014-01-01

Full Text Available Splenic rupture is a rare, catastrophic complication of colonoscopy and an exceptional cause of syncope. This injury is believed to be from direct trauma or tension on the splenocolic ligament with subsequent capsule avulsion or else from direct instrument-induced splenic injury. Diagnosis requires a high index of suspicion that may be absent because presentation can be subtle, nonspecific, and delayed anywhere from hours to days and therefore not easily attributed to a recent endoscopy. We describe a case of syncope as the initial manifestation of splenic rupture after colonoscopy. Our patient’s pain was delayed; his discomfort was mild and not localized to the left upper quadrant. Clinicians should consider syncope, lightheadedness, and drop in hemoglobin in absence of rectal bleeding following a colonoscopy as possible warning signs of imminent or emergent splenic injury.

Biliary and pancreatic stenting: Devices and insertion techniques in therapeutic endoscopic retrograde cholangiopancreatography and endoscopic ultrasonography

Science.gov (United States)

Mangiavillano, Benedetto; Pagano, Nico; Baron, Todd H; Arena, Monica; Iabichino, Giuseppe; Consolo, Pierluigi; Opocher, Enrico; Luigiano, Carmelo

2016-01-01

Stents are tubular devices made of plastic or metal. Endoscopic stenting is the most common treatment for obstruction of the common bile duct or of the main pancreatic duct, but also employed for the treatment of bilio-pancreatic leakages, for preventing post- endoscopic retrograde cholangiopancreatography pancreatitis and to drain the gallbladder and pancreatic fluid collections. Recent progresses in techniques of stent insertion and metal stent design are represented by new, fully-covered lumen apposing metal stents. These stents are specifically designed for transmural drainage, with a saddle-shape design and bilateral flanges, to provide lumen-to-lumen anchoring, reducing the risk of migration and leakage. This review is an update of the technique of stent insertion and metal stent deployment, of the most recent data available on stent types and characteristics and the new applications for biliopancreatic stents. PMID:26862364

CT colonography versus colonoscopy in the follow-up of patients after diverticulitis - A prospective, comparative study

International Nuclear Information System (INIS)

Hjern, F.; Jonas, E.; Holmstroem, B.; Josephson, T.; Mellgren, A.; Johansson, C.

2007-01-01

Aim: To assess whether computed tomography colonography (CTC) is a viable alternative to colonoscopy or double contrast barium enema in the follow-up of patients after diverticulitis. Material and methods: Fifty patients underwent CTC followed immediately by colonoscopy. Results were blinded to the examiners. Findings of diverticular disease and patient acceptance were evaluated. Results: Bowel preparation and distension were good in the majority of CTC and colonoscopy examinations. Diverticular disease was found in 96% of patients at CTC and in 90% at colonoscopy. The rate of agreement between CTC and colonoscopy for diverticular findings in the sigmoid colon was good (κ = 0.64). No complications were seen. Patients found colonoscopy more uncomfortable (p < 0.03), more painful (p < 0.001), and more difficult (p < 0.01) than CTC. Of the patients favouring one examination, 74% preferred CTC. Conclusion: CTC appears to have a better diagnostic potential for imaging of diverticular disease-specific findings, when compared with colonoscopy. Also, CTC was less uncomfortable and was preferred by a majority of patients. CTC seems to be a reasonable alternative in follow-up of patients with symptomatic diverticular disease

Techniques for virtual lung nodule insertion: volumetric and morphometric comparison of projection-based and image-based methods for quantitative CT

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Robins, Marthony; Solomon, Justin; Sahbaee, Pooyan; Sedlmair, Martin; Choudhury, Kingshuk Roy; Pezeshk, Aria; Sahiner, Berkman; Samei, Ehsan

2017-09-01

Virtual nodule insertion paves the way towards the development of standardized databases of hybrid CT images with known lesions. The purpose of this study was to assess three methods (an established and two newly developed techniques) for inserting virtual lung nodules into CT images. Assessment was done by comparing virtual nodule volume and shape to the CT-derived volume and shape of synthetic nodules. 24 synthetic nodules (three sizes, four morphologies, two repeats) were physically inserted into the lung cavity of an anthropomorphic chest phantom (KYOTO KAGAKU). The phantom was imaged with and without nodules on a commercial CT scanner (SOMATOM Definition Flash, Siemens) using a standard thoracic CT protocol at two dose levels (1.4 and 22 mGy CTDIvol). Raw projection data were saved and reconstructed with filtered back-projection and sinogram affirmed iterative reconstruction (SAFIRE, strength 5) at 0.6 mm slice thickness. Corresponding 3D idealized, virtual nodule models were co-registered with the CT images to determine each nodule’s location and orientation. Virtual nodules were voxelized, partial volume corrected, and inserted into nodule-free CT data (accounting for system imaging physics) using two methods: projection-based Technique A, and image-based Technique B. Also a third Technique C based on cropping a region of interest from the acquired image of the real nodule and blending it into the nodule-free image was tested. Nodule volumes were measured using a commercial segmentation tool (iNtuition, TeraRecon, Inc.) and deformation was assessed using the Hausdorff distance. Nodule volumes and deformations were compared between the idealized, CT-derived and virtual nodules using a linear mixed effects regression model which utilized the mean, standard deviation, and coefficient of variation (Mea{{n}RHD} , ST{{D}RHD} and C{{V}RHD}{) }~ of the regional Hausdorff distance. Overall, there was a close concordance between the volumes of the CT-derived and

2017 WSES guidelines for the management of iatrogenic colonoscopy perforation

OpenAIRE

de’Angelis, Nicola; Di Saverio, Salomone; Chiara, Osvaldo; Sartelli, Massimo; Martínez-Pérez, Aleix; Patrizi, Franca; Weber, Dieter G.; Ansaloni, Luca; Biffl, Walter; Ben-Ishay, Offir; Bala, Miklosh; Brunetti, Francesco; Gaiani, Federica; Abdalla, Solafah; Amiot, Aurelien

2018-01-01

Iatrogenic colonoscopy perforation (ICP) is a severe complication that can occur during both diagnostic and therapeutic procedures. Although 45–60% of ICPs are diagnosed by the endoscopist while performing the colonoscopy, many ICPs are not immediately recognized but are instead suspected on the basis of clinical signs and symptoms that occur after the endoscopic procedure. There are three main therapeutic options for ICPs: endoscopic repair, conservative therapy, and surgery. The therapeutic...

Development and Testing of an Automated 4-Day Text Messaging Guidance as an Aid for Improving Colonoscopy Preparation.

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Walter, Benjamin Michael; Klare, Peter; Neu, Bruno; Schmid, Roland M; von Delius, Stefan

2016-06-21

In gastroenterology a sufficient colon cleansing improves adenoma detection rate and prevents the need for preterm repeat colonoscopies due to invalid preparation. It has been shown that patient education is of major importance for improvement of colon cleansing. Objective of this study was to assess the function of an automated text messaging (short message service, SMS)-supported colonoscopy preparation starting 4 days before colonoscopy appointment. After preevaluation to assess mobile phone usage in the patient population for relevance of this approach, a Web-based, automated SMS text messaging system was developed, following which a single-center feasibility study at a tertiary care center was performed. Patients scheduled for outpatient colonoscopy were invited to participate. Patients enrolled in the study group received automated information about dietary recommendations and bowel cleansing during colonoscopy preparation. Data of outpatient colonoscopies with regular preparation procedure were used for pair matching and served as control. Primary end point was feasibility of SMS text messaging support in colonoscopy preparation assessed as stable and satisfactory function of the system. Secondary end points were quality of bowel preparation according to the Boston Bowel Preparation Scale (BBPS) and patient satisfaction with SMS text messaging-provided information assessed by a questionnaire. Web-based SMS text messaging-supported colonoscopy preparation was successful and feasible in 19 of 20 patients. Mean (standard error of the mean, SEM) total BBPS score was slightly higher in the SMS group than in the control group (7.3, SEM 0.3 vs 6.4, SEM 0.2) and for each colonic region (left, transverse, and right colon). Patient satisfaction regarding SMS text messaging-based information was high. Using SMS for colonoscopy preparation with 4 days' guidance including dietary recommendation is a new approach to improve colonoscopy preparation. Quality of colonoscopy

Evaluating screening colonoscopy quality in an uninsured urban population following patient navigation

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Keith Naylor

2017-03-01

Full Text Available Patient navigation (PN increases screening colonoscopy completion in minority and uninsured populations. However, colonoscopy quality is under-reported in the setting of PN and quality indicators have often failed to meet benchmark standards. This study investigated screening colonoscopy quality indicators after year-one of a PN initiative targeting the medically uninsured. This was a retrospective analysis of 296 outpatient screening colonoscopies. Patients were 45 to 75 years of age with no history of bowel cancer, inflammatory bowel disease, or colorectal surgery. The screening colonoscopy quality indicators: adenoma detection rate (ADR, cecal intubation rate (CIR, and bowel preparation quality were compared in 89 uninsured Federally Qualified Health Center (FQHC patients who received PN and 207 University Hospital patients who received usual care. The FQHC PN and University Hospital cohorts were similar in female sex (69% vs. 70%; p = 0.861 and African American race (61% vs. 61%; p = 0.920. The FQHC PN cohort was younger (57 years vs. 60 years; p < 0.001. There was no difference in ADR (33% vs. 32%; p = 0.971 or CIR (96% vs. 95%; p = 0.900 comparing the FQHC PN and University Hospital cohorts. The FQHC PN patients had a greater likelihood of an optimal bowel preparation on multivariate logistic regression (odds ratio 4.17; 95% confidence interval 1.07 to 16.20. Uninsured FQHC patients who received PN were observed to have intra-procedure quality indicators that exceeded bench-mark standards for high-quality screening colonoscopy and were equivalent to those observed in an insured University Hospital patient population.

Evaluation of a fecal immunochemistry test prior to colonoscopy for outpatients with various indications.

Science.gov (United States)

Szilagyi, Andrew; Xue, Xiaoqing

2017-01-01

Stool tests can predict advanced neoplasms prior to colonoscopy. Results of immunochemical stool tests to predict findings at colonoscopy for various indications are less often reported. We compared pre-colonoscopy stool tests with findings in patients undergoing colonoscopy for different indications. Charts of patients undergoing elective or semi-urgent colonoscopy were reviewed. Comparison of adenoma detection rates and pathological findings was made between prescreened and non-prescreened, and between stool-positive and stool-negative cases. Demographics, quality of colonoscopy, and pathological findings were recorded. Odds ratios (ORs) and 95% confidence intervals (CIs) were assessed. Statistical significance was accepted at p ≤0.05. Charts of 325 patients were reviewed. Among them, stool tests were done on 144 patients: 114 were negative and 30 were positive. Findings were similar in the pretest and non-pretest groups. Detection of advanced adenomas per patient was higher in the stool-positive group compared to the stool-negative group (23.4% vs 3.5%, p =0.0016, OR =7.6 [95% CI: 2-29.3]). Five advanced adenomas (without high-grade dysplasia or adenocarcinoma) and several cases of multiple adenomas were missed in the negative group. Sensitivity and specificity for advanced polyps was 63.6% and 82.7%, respectively. The negative predictive value was 96.5%. Male gender was independently predictive of any adenoma. The stool immunochemical test best predicted advanced neoplasms and had a high negative predictive value in this small cohort. Whether this test can be applied to determine the need for colonoscopy in groups other than average risk would require more studies.

Chronic methadone use, poor bowel visualization and failed colonoscopy: A preliminary study

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Verma, Siddharth; Fogel, Joshua; Beyda, David J; Bernstein, Brett; Notar-Francesco, Vincent; Mohanty, Smruti R

2012-01-01

AIM: To examine effects of chronic methadone usage on bowel visualization, preparation, and repeat colonoscopy. METHODS: In-patient colonoscopy reports from October, 2004 to May, 2009 for methadone dependent (MD) patients were retrospectively evaluated and compared to matched opioid naive controls (C). Strict criteria were applied to exclude patients with risk factors known to cause constipation or gastric dysmotility. Colonoscopy reports of all eligible patients were analyzed for degree of bowel visualization, assessment of bowel preparation (good, fair, or poor), and whether a repeat colonoscopy was required. Bowel visualization was scored on a 4 point scale based on multiple prior studies: excellent = 1, good = 2, fair = 3, or poor = 4. Analysis of variance (ANOVA) and Pearson χ2 test were used for data analyses. Subgroup analysis included correlation between methadone dose and colonoscopy outcomes. All variables significantly differing between MD and C groups were included in both univariate and multivariate logistic regression analyses. P values were two sided, and < 0.05 were considered statistically significant. RESULTS: After applying exclusionary criteria, a total of 178 MD patients and 115 C patients underwent a colonoscopy during the designated study period. A total of 67 colonoscopy reports for MD patients and 72 for C were included for data analysis. Age and gender matched controls were randomly selected from this population to serve as controls in a numerically comparable group. The average age for MD patients was 52.2 ± 9.2 years (range: 32-72 years) years compared to 54.6 ± 15.5 years (range: 20-81 years) for C (P = 0.27). Sixty nine percent of patients in MD and 65% in C group were males (P = 0.67). When evaluating colonoscopy reports for bowel visualization, MD patients had significantly greater percentage of solid stool (i.e., poor visualization) compared to C (40.3% vs 6.9%, P < 0.001). Poor bowel preparation (35.8% vs 9.7%, P < 0.001) and

Stent-in-Stent Technique for the Treatment of Proximal Bronchial Restenosis after Insertion of Metallic Stents: A Report of Two Cases

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Benjamin Bondue

2016-01-01

Full Text Available Endoscopic treatment of a bronchial restenosis previously treated by insertion of a partially covered self-expandable metallic stent (SEMS can be difficult. Classically, after recanalization of the bronchus, the stent is removed and replaced by a more adapted one. We report on two cases of proximal bronchial restenosis treated by insertion of an additional stent inside the lumen of the previously inserted stent using the stent-in-stent (SIS technique. The indications for the initial stent were malignancy in Patient 1 and posttransplant bronchial stenosis in Patient 2. Restenosis occurred at the proximal end of the stent within months in both cases. Stent removal and insertion of a new stent were considered, but this option was discarded because of an excessive risk of bronchial perforation and preference towards an alternative approach. In both cases, a second customized SEMS was placed using the SIS technique after ablation of the proximal end stenosis of the stent by argon plasma coagulation and/or dilation with a balloon. Recanalization of the bronchus was achieved in both cases without complications. The SIS technique is a valuable alternative to removal of SEMS in case of proximal bronchial restenosis.

The Polyp Manager: a new tool for optimal polyp documentation during colonoscopy. A pilot study.

Science.gov (United States)

van de Meeberg, Maartje M.; Ouwendijk, Rob J. Th.; ter Borg, Pieter C. J.; van den Hazel, Sven J.; van de Meeberg, Paul C.

2016-01-01

Background and study aims: Conventional reporting of polyps is often incomplete. We tested the Polyp Manager (PM), a new software application permitting the endoscopist to document polyps in real time during colonoscopy. We studied completeness of polyp descriptions, user-friendliness and the potential time benefit. Patients and methods: In two Dutch hospitals colonoscopies were performed with PM (as a touchscreen endoscopist-operated device or nurse-operated desktop application). Completeness of polyp descriptions was compared to a historical group with conventional reporting (CRH). Prospectively, we compared user-friendliness (VAS-scores) and time benefit of the endoscopist-operated PM to conventional reporting (CR) in one hospital. Duration of colonoscopy and time needed to report polyps and provide a pathology request were measured. Provided that using PM does not prolong colonoscopy, the sum of the latter two was considered as a potential time-benefit if the PM were fully integrated into a digital reporting system. Results: A total of 144 regular colonoscopies were included in the study. Both groups were comparable with regard to patient characteristics, duration of colonoscopy and number of polyps. Using the PM did reduce incomplete documentation of the following items in CRH-reports: location (96 % vs 82 %, P = 0.01), size (95 % vs 89 %, P = 0.03), aspect (71 % vs 36 %, P < 0.001) and completeness of removal (61 % vs 37 %, P < 0.001). In the prospective study 23 PM-colonoscopies where compared to 28 CR-colonoscopies. VAS-scores were significantly higher in the endoscopist-operated PM group. Time to report was 01:27 ± 01:43 minutes (median + interquartile range) in the entire group (PM as CR), reflecting potential time benefit per colonoscopy. Conclusions: The PM is a user-friendly tool that seems to improve completeness of polyp reporting. Once integrated with digital reporting systems, it is probably time saving as

Leadership training to improve adenoma detection rate in screening colonoscopy: A randomised trial

NARCIS (Netherlands)

M.F. Kaminski (Michal); J. Anderson (John); R.M. Valori (Roland ); E. Kraszewska (Ewa); M. Rupinski (Maciej); J. Pachlewski (Jacek); E. Wronska (Ewa); M. Bretthauer (Michael); S. Thomas-Gibson (Siwan); E.J. Kuipers (Ernst); J. Regula (J.)

2016-01-01

textabstractObjective Suboptimal adenoma detection rate (ADR) at colonoscopy is associated with increased risk of interval colorectal cancer. It is uncertain how ADR might be improved. We compared the effect of leadership training versus feedback only on colonoscopy quality in a countrywide

A low-volume polyethylene glycol solution was associated with an increased suboptimal bowel preparation rate but had similar recommendations for an early repeat colonoscopy, procedure times, and adenoma detection rates.

Directory of Open Access Journals (Sweden)

Sam C Hankins

Full Text Available Low-volume polyethylene glycol (PEG bowel preparations are better tolerated by patients than high-volume preparations and may achieve similar preparation quality. However, there is little data comparing their effects on a recommendation for an early repeat colonoscopy (because of a suboptimal preparation, procedure times, adenoma detection rate (ADR, and advanced adenoma detection rate (AADR.This is a retrospective cohort study of outpatient colonoscopies performed during a one-year period at a single academic medical center in which low-volume MoviPrep® (n = 1841 or high-volume Colyte® (n = 1337 was used. All preparations were split-dosed. Appropriate covariates were included in regression models assessing suboptimal preparation quality (fair, poor, or inadequate, procedure times, recommendation for an early repeat colonoscopy, ADR, and AADR.MoviPrep® was associated with an increase in having a suboptimal bowel preparation (OR 1.36; 95% CI: 1.06-1.76, but it was not associated with differences in insertion (p = 0.43, withdrawal (p = 0.22, or total procedure times (p = 0.10. The adjusted percentage with a suboptimal preparation was 11.7% for patients using MoviPrep® and 8.8% for patients using Colyte®. MoviPrep® was not associated with a significant difference in overall ADR (OR 0.93; 95% CI: 0.78-1.11, AADR (OR 1.18; 95% CI: 0.87-1.62, or recommendation for early repeat colonoscopy (OR 1.16; 95% CI: 0.72-1.88.MoviPrep® was associated with a small absolute increase in having a suboptimal preparation, but did not affect recommendations for an early repeat colonoscopy, procedure times, or adenoma detection rates. Mechanisms to reduce financial barriers limiting low-volume preparations should be considered because of their favorable tolerability profile.

Data Insertion in Bitcoin's Blockchain

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Andrew Sward

2018-04-01

Full Text Available This paper provides the first comprehensive survey of methods for inserting arbitrary data into Bitcoin’s blockchain. Historical methods of data insertion are described, along with lesser-known techniques that are optimized for efficiency. Insertion methods are compared on the basis of efficiency, cost, convenience of data reconstruction, permanence, and potentially negative impact on the Bitcoin ecosystem.

Variation in use of surveillance colonoscopy among colorectal cancer survivors in the United States

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Salz Talya

2010-09-01

Full Text Available Abstract Background Clinical practice guidelines recommend colonoscopies at regular intervals for colorectal cancer (CRC survivors. Using data from a large, multi-regional, population-based cohort, we describe the rate of surveillance colonoscopy and its association with geographic, sociodemographic, clinical, and health services characteristics. Methods We studied CRC survivors enrolled in the Cancer Care Outcomes Research and Surveillance (CanCORS study. Eligible survivors were diagnosed between 2003 and 2005, had curative surgery for CRC, and were alive without recurrences 14 months after surgery with curative intent. Data came from patient interviews and medical record abstraction. We used a multivariate logit model to identify predictors of colonoscopy use. Results Despite guidelines recommending surveillance, only 49% of the 1423 eligible survivors received a colonoscopy within 14 months after surgery. We observed large regional differences (38% to 57% across regions. Survivors who received screening colonoscopy were more likely to: have colon cancer than rectal cancer (OR = 1.41, 95% CI: 1.05-1.90; have visited a primary care physician (OR = 1.44, 95% CI: 1.14-1.82; and received adjuvant chemotherapy (OR = 1.75, 95% CI: 1.27-2.41. Compared to survivors with no comorbidities, survivors with moderate or severe comorbidities were less likely to receive surveillance colonoscopy (OR = 0.69, 95% CI: 0.49-0.98 and OR = 0.44, 95% CI: 0.29-0.66, respectively. Conclusions Despite guidelines, more than half of CRC survivors did not receive surveillance colonoscopy within 14 months of surgery, with substantial variation by site of care. The association of primary care visits and adjuvant chemotherapy use suggests that access to care following surgery affects cancer surveillance.

What is the diagnostic yield of colonoscopy in patients with a referral ...

African Journals Online (AJOL)

Eighty seven (60.4%) patients had a normal colonoscopy, 20 (13.9%) diverticular disease, 14 (9.7%) polyps of which 6 (4.2%) were neoplastic, and 9 (6.3%) had colorectal cancer. Conclusions: Constipation is associated with CRC. The presence of constipation should be a criterion for colonoscopy regardless of age or any ...

Heat generation during implant placement in low-density bone: effect of surgical technique, insertion torque and implant macro design.

Science.gov (United States)

Marković, Aleksa; Mišić, Tijana; Miličić, Biljana; Calvo-Guirado, Jose Luis; Aleksić, Zoran; Ðinić, Ana

2013-07-01

The study aimed to investigate the effect of surgical technique, implant macrodesign and insertion torque on bone temperature changes during implant placement. In the in vitro study, 144 self-tapping (blueSKY(®) 4 × 10 mm; Bredent) and 144 non-self-tapping (Standard implant(®) 4.1 × 10 mm; Straumann) were placed in osteotomies prepared in pig ribs by lateral bone condensing or bone drilling techniques. The maximum insertion torque values of 30, 35 and 40 Ncm were used. Real-time bone temperature measurement during implant placement was performed by three thermocouples positioned vertically, in tripod configuration around every osteotomy, at a distance of 5 mm from it and at depths of 1, 5 and 10 mm. Data were analysed using Kruskal-Wallis, Mann-Whitney U-tests and Regression analysis. Significant predictor of bone temperature at the osteotomy depth of 1 mm was insertion torque (P = 0.003) and at the depth of 10-mm implant macrodesign (P = 0.029), while no significant predictor at depth of 5 mm was identified (P > 0.05). Higher insertion torque values as well as non-self-tapping implant macrodesign were related to higher temperatures. Implant placement in sites prepared by bone drilling induced significantly higher temperature increase (P = 0.021) compared with bone condensing sites at the depth of 5 mm, while no significant difference was recorded at other depths. Compared with 30 Ncm, insertion torque values of 35 and 40 Ncm produced significantly higher temperature increase (P = 0.005; P = 0.003, respectively) at the depth of 1 mm. There was no significant difference in temperature change induced by 35 and 40 Ncm, neither by implant macrodesign at all investigated depths (P > 0.05). Placement of self-tapping implants with low insertion torque into sites prepared by lateral bone condensing technique might be advantageous in terms of thermal effect on bone. © 2012 John Wiley & Sons A/S.

A Case of Taenia asiatica Infection Diagnosed by Colonoscopy.

Science.gov (United States)

Kim, Heung Up; Chung, Young-Bae

2017-02-01

A case of Taenia asiatica infection detected by small bowel series and colonoscopy is described. The patient was a 42-year-old Korean man accompanied by discharge of movable proglottids via anus. He used to eat raw pig liver but seldom ate beef. Small bowel series radiologic examinations showed flat tape-like filling defects on the ileum. By colonoscopy, a moving flat tapeworm was observed from the terminal ileum to the ascending colon. The tapeworm was identified as T. asiatica by mitochondrial DNA sequencing. The patient was prescribed with a single oral dose (16 mg/kg) of praziquantel.

Bowel preparations for colonoscopy: an RCT.

Science.gov (United States)

Di Nardo, Giovanni; Aloi, Marina; Cucchiara, Salvatore; Spada, Cristiano; Hassan, Cesare; Civitelli, Fortunata; Nuti, Federica; Ziparo, Chiara; Pession, Andrea; Lima, Mario; La Torre, Giuseppe; Oliva, Salvatore

2014-08-01

The ideal preparation regimen for pediatric colonoscopy remains elusive, and available preparations continue to represent a challenge for children. The aim of this study was to compare the efficacy, safety, tolerability, and acceptance of 4 methods of bowel cleansing before colonoscopy in children. This randomized, investigator-blinded, noninferiority trial enrolled all children aged 2 to 18 years undergoing elective colonoscopy in a referral center for pediatric gastroenterology. Patients were randomly assigned to receive polyethylene glycol (PEG) 4000 with simethicon (PEG-ELS group) or PEG-4000 with citrates and simethicone plus bisacodyl (PEG-CS+Bisacodyl group), or PEG 3350 with ascorbic acid (PEG-Asc group), or sodium picosulfate plus magnesium oxide and citric acid (NaPico+MgCit group). Bowel cleansing was evaluated according to the Boston Bowel Preparation Scale. The primary end point was overall colon cleansing. Tolerability, acceptability, and compliance were also evaluated. Two hundred ninety-nine patients were randomly allocated to the 4 groups. In the per-protocol analysis, PEG-CS+Bisacodyl, PEG-Asc, and NaPico+MgCit were noninferior to PEG-ELS in bowel-cleansing efficacy of both the whole colon (P = .910) and colonic segments. No serious adverse events occurred in any group. Rates of tolerability, acceptability, and compliance were significantly higher in the NaPico+MgCit group. Low-volume PEG preparations (PEG-CS+Bisacodyl, PEG-Asc) and NaPico+MgCit are noninferior to PEG-ELS in children, representing an attractive alternative to high-volume regimens in clinical practice. Because of the higher tolerability and acceptability profile, NaPico+MgCit would appear as the most suitable regimen for bowel preparation in children. Copyright © 2014 by the American Academy of Pediatrics.

Predictors for cecal insertion time: the impact of abdominal visceral fat measured by computed tomography.

Science.gov (United States)

Nagata, Naoyoshi; Sakamoto, Kayo; Arai, Tomohiro; Niikura, Ryota; Shimbo, Takuro; Shinozaki, Masafumi; Noda, Mitsuhiko; Uemura, Naomi

2014-10-01

Several factors affect the risk for longer cecal insertion time. The aim of this study was to identify the predictors of longer insertion time and to evaluate the effect of visceral fat measured by CT. This is a retrospective observational study. Outpatients for colorectal cancer screening who underwent colonoscopies and CT were enrolled. Computed tomography was performed in individuals who requested cancer screening and in those with GI bleeding. Information on obesity indices (BMI, visceral adipose tissue, and subcutaneous adipose tissue area), constipation score, history of abdominal surgery, poor preparation, fellow involvement, diverticulosis, patient discomfort, and the amount of sedation used was collected. The cecal insertion rate was 95.2% (899/944), and 899 patients were analyzed. Multiple regression analysis showed that female sex, lower BMI, lower visceral adipose tissue area, lower subcutaneous adipose tissue area, higher constipation score, history of surgery, poor bowel preparation, and fellow involvement were independently associated with longer insertion time. When obesity indices were considered simultaneously, smaller subcutaneous adipose tissue area (p = 0.038), but not lower BMI (p = 0.802) or smaller visceral adipose tissue area (p = 0.856), was associated with longer insertion time; the other aforementioned factors remained associated with longer insertion time. In the subanalysis of normal-weight patients (BMI abdominal fat, female sex, constipation, history of abdominal surgery, poor preparation, and fellow involvement were predictors of longer cecal insertion time. Among the obesity indices, high subcutaneous fat accumulation was the best predictive factor for easier passage of the colonoscope, even when body weight was normal.

A Benchmark for Endoluminal Scene Segmentation of Colonoscopy Images

Directory of Open Access Journals (Sweden)

David Vázquez

2017-01-01

Full Text Available Colorectal cancer (CRC is the third cause of cancer death worldwide. Currently, the standard approach to reduce CRC-related mortality is to perform regular screening in search for polyps and colonoscopy is the screening tool of choice. The main limitations of this screening procedure are polyp miss rate and the inability to perform visual assessment of polyp malignancy. These drawbacks can be reduced by designing decision support systems (DSS aiming to help clinicians in the different stages of the procedure by providing endoluminal scene segmentation. Thus, in this paper, we introduce an extended benchmark of colonoscopy image segmentation, with the hope of establishing a new strong benchmark for colonoscopy image analysis research. The proposed dataset consists of 4 relevant classes to inspect the endoluminal scene, targeting different clinical needs. Together with the dataset and taking advantage of advances in semantic segmentation literature, we provide new baselines by training standard fully convolutional networks (FCNs. We perform a comparative study to show that FCNs significantly outperform, without any further postprocessing, prior results in endoluminal scene segmentation, especially with respect to polyp segmentation and localization.

Withdrawal times and associated factors in colonoscopy: a quality assurance multicenter assessment.

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Overholt, Bergein F; Brooks-Belli, Linda; Grace, Michael; Rankin, Kristin; Harrell, Royce; Turyk, Mary; Rosenberg, Fred B; Barish, Robert W; Gilinsky, Norman H

2010-04-01

To evaluate the use and impact of the recommended withdrawal time of at least 6 minutes from the cecum in colonoscopy in multiple gastroenterology endoscopy ambulatory surgery centers serving a wide geographical area. An observational prospective multicenter quality assurance review was conducted in 49 ambulatory surgery centers in 17 states with 315 gastroenterologists. There was no intervention with this quality assessment program as care of patients and the routine of gastroenterologists continued as standard practice. Multivariable analysis was applied to the database to examine factors affecting withdrawal time and polyp detection. There were 15,955 consecutive qualified patients receiving colonoscopies in a designated 4-week period. Gastroenterologists with average withdrawal times of 6 minutes or more in patients with no polyps were 1.8 times more likely to detect 1 or more polyps and had a significantly higher rate (Pquality assurance assessment from standard colonoscopy practices of 315 gastroenterologists in 49 endoscopic ambulatory surgery centers serving a wide geographical area provides support for the merits of a colonoscopy withdrawal time from the cecum of 6 minutes or more to improve the detection of polyps.

One-day bowel preparation with polyethylene glycol 3350: an effective regimen for colonoscopy in children.

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Adamiak, Tonya; Altaf, Muhammad; Jensen, Michael K; Sultan, Mutaz; Ramprasad, Jonathan; Ciecierega, Thomas; Sherry, Karen; Miranda, Adrian

2010-03-01

Polyethylene glycol (PEG) 3350 is commonly used and has been proven safe and effective for the treatment of chronic constipation and as a 4-day bowel preparation in children. A 1-day PEG 3350 bowel preparation regimen has been recently developed for adults; however, data regarding its use in children are lacking. To evaluate the safety and effectiveness of a 1-day PEG 3350 regimen for bowel preparation in children before colonoscopy. Retrospective review. Tertiary-care center. This study involved all children prescribed a 1-day PEG 3350 bowel preparation regimen before colonoscopy at our center in 2008. We reviewed medical records of patients (PEG 3350 preparation regimen was 13.7 years (range 1.08-17.92 years). Fifty-two percent were male; 48% were female. The most common indications for colonoscopy included abdominal pain (65%), bloody stools (29%), diarrhea (21%), and weight loss (18%). The 1-day bowel preparation regimen was effective in 253 patients (93%). The indication for colonoscopy, the age of the child, or a history of constipation did not significantly alter the success rate of colonoscopy. A retrospective study at one tertiary-care center. The 1-day PEG 3350 bowel preparation regimen is safe and effective and should be considered for use as preparation for colonoscopy in children. 2010 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

Charity colonoscopy event to commemorate the 185th anniversary of Singapore General Hospital.

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Ng, Kheng Hong; Lim, Jit Fong; Ho, Kok Sun; Ooi, Boon Swee; Tang, Choong Leong; Eu, Kong Weng

2008-03-01

Colorectal cancer is now the cancer with the highest incidence in Singapore. However, the overall mortality rate is still about 50% because the majority of the patients present at a late stage of disease. A charity event of screening colonoscopy was offered to the public in conjunction with the 185th anniversary of Singapore General Hospital. The aim of this event was to raise awareness about early detection of colorectal cancer and the safety of colonoscopy. We conducted a one-off free screening event for colorectal cancer using colonoscopy. Four hundred and ninety individuals responded to a multimedia advertisement for the event. Of these, 220 individuals were selected for the screening based on National Guidelines for colorectal cancer screening and financial status. One hundred and fifty-two individuals turned up for the colonoscopy. The median age was 55 years (range, 22 to 82), with 84 males. Significant pathology was found in 33% of the individuals (n = 51). Colorectal polyps were detected in 34 individuals (22%). A total of 45 polyps were removed, with 20 hyperplastic polyps and 25 adenomas. Eight out of 25 adenomas were located proximal to the splenic flexure. Rectal cancer was diagnosed in 1 individual (0.6%). One individual had a large dysplastic rectosigmoid ulcer and refused further intervention. There were no significant complications from any of the colonoscopies. Colonoscopy is an invaluable screening modality as it has a high pick-up rate for colorectal polyp and cancer in an asymptomatic population. It is also proven to be safe in our study. It has the added advantage over flexible sigmoidoscopy of detecting a significant number of proximal lesions. Also, therapeutic polypectomy can be performed in the same setting.

''Push-pull'' gastrostomy: a new technique for percutaneous gastrostomy tube insertion in the neonate and young infant

International Nuclear Information System (INIS)

Cahill, A.M.; Kaye, R.D.; Fitz, C.R.; Towbin, R.B.

2001-01-01

Objective. To evaluate a newly developed method combining antegrade and retrograde techniques for percutaneous gastrostomy tube (PGT) insertion in the neonate and young infant. Materials and methods. From January 1994 to December 2000, 85 children (47 male, 38 female), mean age 4.5 months (range 0.44-9.13 months) underwent PGT insertion using the ''push-pull'' technique. With the addition, 57 children had a jejunostomy tube placed as well at or within 24 h of the PGT procedure. The mean weight was 3.74 kg, range 1.5-7.0 kg. The indications for the procedure included failure to thrive in 40 patients (25 %), static encephalopathy in 21 (25 %), neurological/congenital abnormalities in 12 (14 %), aspiration in 7 (8 %), and cardiac problems in 5 (6 %). Results. Eighty-five PGTs were successfully inserted in 85 children. One procedure was initially unsuccessful due to failed conscious sedation and was completed under general anesthesia. Four of 85 patients initially had attempted antegrade placement that failed, and the procedure was successfully completed using the ''push-pull'' method. One major complication occurred: a gastrocolic fistula at day 5 post-procedure, which was surgically repaired without sequelae. Tube-related problems included; tube dislodgement (n = 1) and procedure-related stomal infection (n = 3). Conclusion. The ''push-pull'' gastrostomy technique is a safe, effective method of percutaneous gastrostomy tube placement in neonates. It facilitates successful placement of the PGT in patients in whom the classic antegrade method is not possible. It has become the procedure of choice in this group. (orig.)

Developing a tool to preserve eye contact with patients undergoing colonoscopy for pain monitoring

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Niv Y

2012-08-01

Full Text Available Yaron Niv, Yossi TalDepartment of Gastroenterology, Rabin Medical Center, Tel Aviv University, IsraelAbstract: Colonoscopy has become the leading procedure for early detection and prevention of colorectal cancer. Patients’ experience of colonic endoscopic procedures is scarcely reported, even though it is considered a major factor in colorectal cancer screening participation. Pain due to air inflation or stretching the colon with an endoscope is not rare during examination and may be the main obstacle to cooperation and participation in a screening program. We propose a four-stage study for developing a tool dedicated to pain monitoring during colonoscopy, as follows: (1 comparison of patient, nurse, and endoscopist questionnaire responses about patient pain and technical details of the procedure using the PAINAD tool during colonoscopy; (2 observation of the correlation between patients’ facial expressions and other parameters (using the short PAINAD; (3 development of a device for continuous monitoring of the patient’s facial expression during the procedure; (4 assessment of the usability of such a tool and its contribution to the outcomes of colonoscopy procedures. Early intervention by the staff performing the procedure, in reaction to alerts encoded by this tool, may prevent adverse events during the procedure.Keywords: pain scoring, colonoscopy, pain monitoring, facial expression

Comorbid Illness, Bowel Preparation, and Logistical Constraints Are Key Reasons for Outpatient Colonoscopy Nonattendance

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Deepti Chopra

2016-01-01

Full Text Available Background. Colonoscopy nonattendance is a challenge for outpatient clinics globally. Absenteeism results in a potential delay in disease diagnosis and loss of hospital resources. This study aims to determine reasons for colonoscopy nonattendance from a Canadian perspective. Design. Demographic data, reasons for nonattendance, and patient suggestions for improving compliance were elicited from 49 out of 144 eligible study participants via telephone questionnaire. The 49 nonattenders were compared to age and sex matched controls for several potential contributing factors. Results. Nonattendance rates were significantly higher in winter months; the OR of nonattendance was 5.2 (95% CI, 1.6 to 17.0, p<0.001 in winter versus other months. Being married was positively associated with attendance. There was no significant association between nonattendance and any of the other variables examined. The top 3 reasons for nonattendance were being too unwell to attend the procedure, being unable to complete bowel preparation, or experiencing logistical challenges. Conclusions. Colonoscopy attendance rates appear to vary significantly by season and it may be beneficial to book more colonoscopies in the summer or overbook in the winter. Targets for intervention include more tailored teaching sessions, reminders, taxi chits, and developing a hospital specific colonoscopy video regarding procedure and bowel preparation requirements.

Patients with History of Colonoscopy Are Less Likely to Achieve High Quality Preparation After Implementing Split-Dose Bowel Preparation.

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Madhoun, M F; Bitar, H; Parava, P; Bashir, M H; Zia, H

2017-01-01

Anecdotally, we observed that patients who had previous colonoscopies were less likely to follow newly implemented split-dose bowel preparation (SDBP) instructions. We investigated whether the indication for colonoscopy is an independent factor for achieving high quality bowel preparation among patients asked to follow SDBP. We performed a retrospective study of data from 1478 patients who received outpatient colonoscopies in 2014 (the year of SDBP implementation) at our Veterans Affairs Medical Center. We collected information related to demographics and factors known to affect bowel preparations. Reasons for colonoscopy were dichotomized into surveillance (previous colonoscopy) vs. non-surveillance (positive occult blood test or screening). Bowel preparation quality was scored using the Boston Bowel Preparation Scale (BBPS), and was categorized as either excellent vs. not excellent (BBPS≥7 vs. BBPSquality was excellent in 60% of colonoscopies and adequate in 84% of colonoscopies. Thirty-six percent (535) were surveillance colonoscopies. In multivariate logistic regression analysis, more patients in the non-surveillance group achieved excellent (OR 0.8 ; 95% CI [0.7-0.8], P <0.0001) and adequate (OR 0.8 ; 95% CI [0.7-0.9], P <0.006) bowel preparation than did patients in the surveillance group. Patients with a prior colonoscopy might not follow the split-dose bowel preparation instructions. Educational interventions emphasizing the benefits of SDBP in this group of patients may help ensure compliance and prevent the habitual use of day-before preparations. © Acta Gastro-Enterologica Belgica.

Association Between Socioeconomic Status and Participation in Colonoscopy Screening Program in First Degree Relatives of Colorectal Cancer Patients.

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Chouhdari, Arezoo; Yavari, Parvin; Pourhoseingholi, Mohammad Amin; Sohrabi, Mohammad-Reza

2016-04-01

Approximately 15% to 25% of colorectal cancer (CRC) cases have positive family history for disease. Colonoscopy screening test is the best way for prevention and early diagnosis. Studies have found that first degree relatives (FDRs) with low socioeconomic status are less likely to participate in colonoscopy screening program. The aim of this study is to determine the association between socioeconomic status and participation in colonoscopy screening program in FDRs. This descriptive cross-sectional, study has been conducted on 200 FDRs who were consulted for undergoing colonoscopy screening program between 2007 and 2013 in research institute for gastroenterology and liver disease of Shahid Beheshti University of Medical Sciences, Tehran, Iran. They were interviewed via phone by a valid questionnaire about socioeconomic status. For data analysis, chi-square, exact fisher and multiple logistic regression were executed by SPSS 19. The results indicated 58.5% participants underwent colonoscopy screening test at least once to the time of the interview. There was not an association between participation in colonoscopy screening program and socioeconomic status to the time of the interview in binomial analysis. But statistical significance between intention to participate and educational and income level were found. We found, in logistic regression analysis, that high educational level (Diploma and University degree in this survey) was a predictor to participate in colonoscopy screening program in FDRs. According to this survey low socioeconomic status is an important factor to hinder participation of FDRs in colonoscopy screening program. Therefore, planned interventions for elevation knowledge and attitude in FDRs with low educational level are necessary. Also, reducing colonoscopy test costs should be a major priority for policy makers.

Optimizing time management after perforation by colonoscopy results in better outcome for the patients.

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Rumstadt, Bernhard; Schilling, Dieter

2008-01-01

Perforation during colonoscopy is a rare but severe complication. The aim of this study was to assess the time management and laparoscopic therapy of this complication and to evaluate patient outcomes. A retrospective analysis was done on 15 patients operated for a perforation from colonoscopy between January 2000 and December 2006. Three perforations occurred during diagnostic and 12 perforations during interventional colonoscopy. Two perforations occurred as transmural thermal injury to the colon wall. Peritonitis was found in 4 cases and significantly correlated with the mean time between perforation and operation. Twelve perforations were oversewn laparoscopically and 3 perforations were oversewn by laparotomy. After laparoscopic treatment, hospital stay was significantly shorter than after laparotomy. One patient had a postoperative wound infection, mortality was 0%. Laparoscopic oversewing is a safe and effective method in the treatment of perforation from colonoscopy. Optimizing the time range between perforation and laparoscopic therapy results in a better outcome for the patients.

Risk perception among Brazilian individuals with high risk for colorectal cancer and colonoscopy

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Santos Erika M

2011-07-01

Full Text Available Abstract Background Risk perception is considered a motivating factor for adopting preventive behaviors. This study aimed to verify the demographic characteristics and cancer family history that are predictors of risk perception and to verify if risk perception is a predictor of colonoscopy adherence. Methods Individuals with a family colorectal cancer history as indicated by a proband with cancer were interviewed by telephone. They responded to a questionnaire covering demographic characteristics, colonoscopy history and four questions on risk perception. Tests of multiple linear regression and logistic regression were used to identify associations between dependent and independent variables. Results The 117 participants belonged to 62 families and had a mean age of 45.2 years. The majority of these individuals were female (74.4% and from families who met the Amsterdam Criteria (54.7%. The average risk perception was 47.6%, with a median of 50%. The average population perception of individual risk was 55.4%, with a median of 50%. Variables associated with a higher risk perception were age, gender, religion, school level, income, and death of a family member. The variable predicting colonoscopy was receiving medical information regarding risk (odds ratio OR 8.40. Conclusions We found that family cancer history characteristics (number of relatives with cancer, risk classification are associated with adequate risk perception. Risk perception does not predict colonoscopy in this sample. The only variable that predicted colonoscopy was receiving medical information recommending screening.

UK key performance indicators and quality assurance standards for colonoscopy.

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Rees, Colin J; Thomas Gibson, Siwan; Rutter, Matt D; Baragwanath, Phil; Pullan, Rupert; Feeney, Mark; Haslam, Neil

2016-12-01

Colonoscopy should be delivered by endoscopists performing high quality procedures. The British Society of Gastroenterology, the UK Joint Advisory Group on GI Endoscopy, and the Association of Coloproctology of Great Britain and Ireland have developed quality assurance measures and key performance indicators for the delivery of colonoscopy within the UK. This document sets minimal standards for delivery of procedures along with aspirational targets that all endoscopists should aim for. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Optimism and barriers to colonoscopy in low-income Latinos at average risk for colorectal cancer.

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Efuni, Elizaveta; DuHamel, Katherine N; Winkel, Gary; Starr, Tatiana; Jandorf, Lina

2015-09-01

Colorectal cancer (CRC) screening continues to be underused, particularly by Latinos. CRC and colonoscopy fear, worry, and fatalism have been identified as screening barriers in Latinos. The study purpose was to examine the relationship of optimism, fatalism, worry, and fear in the context of Latinos referred for CRC screening. Our sample included 251 Latinos between the ages of 50 and 83 years who had no personal or immediate family history of CRC, no personal history of gastrointestinal disorder, no colonoscopy in the past 5 years, and received a referral for a colonoscopy. Face-to-face interviews were performed, and data were analyzed using regression models. Greater optimism (β = -1.72, p optimism (β = -0.09, p < 0.05), higher fatalism (β = 0.28, p < 0.01), and female gender (β = 0.9, p < 0.05) were associated with greater worry. Interventions that address fatalism and promote optimistic beliefs may reduce worry among Latinos referred for colonoscopy. Interventions that alleviate colonoscopy fear because of family history of cancer particularly among Latino women may help improve distress about CRC screening. Copyright © 2014 John Wiley & Sons, Ltd.

Comparison of Colonoscopy Quality Measures Across Various Practice Settings and the Impact of Performance Scorecards.

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Inra, Jennifer A; Nayor, Jennifer; Rosenblatt, Margery; Mutinga, Muthoka; Reddy, Sarathchandra I; Syngal, Sapna; Kastrinos, Fay

2017-04-01

Quality performance measures for screening colonoscopy vary among endoscopists. The impact of practice setting is unknown. We aimed to (1) compare screening colonoscopy performance measures among three different US practice settings; (2) evaluate factors associated with adenoma detection; and (3) assess a scorecard intervention on performance metrics. This multi-center prospective study compared patient, endoscopist, and colonoscopy characteristics performed at a tertiary care hospital (TCH), community-based hospital (CBH), and private practice group (PPG). Withdrawal times (WT), cecal intubation, and adenoma detection rates (ADR) were compared by site at baseline and 12 weeks following scorecard distribution. Generalized linear mixed models identified factors associated with adenoma detection. Twenty-eight endoscopists performed colonoscopies on 1987 asymptomatic, average-risk individuals ≥50 years. Endoscopist and patient characteristics were similar across sites. The PPG screened more men (TCH: 42.8%, CBH: 45.0%, PPG: 54.2%; p scorecard distribution. Adenoma detection was associated with increasing patient age, male gender, WT, adequate preparation, but not practice setting. Each practice performed high-quality screening colonoscopy. Scorecards did not improve performance metrics. Preparation quality varies among practice settings and can be modified to improve adenoma detection.

Delivering colonoscopy screening for low-income populations in Suffolk County: strategies, outcomes, and benchmarks.

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Lane, Dorothy S; Messina, Catherine R; Cavanagh, Mary F; Anderson, Joseph C

2013-08-01

Current and pending legislation provides colorectal cancer screening reimbursement for previously uninsured populations. Colonoscopy is currently the screening method most frequently recommended by physicians for insured patients. The experience of the SCOPE (Suffolk County Preventive Endoscopy) demonstration project (Project SCOPE) at Stony Brook University Medical Center provides a model for delivering colonoscopy screening to low-income populations to meet anticipated increasing demands. Project SCOPE, based in the Department of Preventive Medicine, featured internal collaboration with the academic medical center's large gastroenterology practice and external collaboration with the Suffolk County Department of Health Services' network of community health centers. Colonoscopies were performed by faculty gastroenterologists or supervised fellows. Measures of colonoscopy performance were compared with quality indicators and differences between faculty and supervised fellows were identified. During a 40-month screening period, 800 initial colonoscopies were performed. Approximately 21% of women screened were found to have adenomatous polyps compared with 36% of men. Five cancers were detected. The majority of the population screened (70%) were members of minority populations. African American individuals had a higher percentage of proximally located adenomas (78%) compared with white individuals (65%) and Hispanics (49%), based on the location of the most advanced lesion. Hispanic individuals had a 36% lower risk of adenomas compared with white individuals. Performance measures including the percentage of procedures with adequate bowel preparation, cecum reached, scope withdrawal time, and adenoma detection rate met quality benchmarks when performed by either faculty or supervised fellows. Project SCOPE's operational strategies demonstrated a feasible method for an academic medical center to provide high-quality screening colonoscopy for low-income populations. �

Providing Hospitalized Patients With an Educational Booklet Increases the Quality of Colonoscopy Bowel Preparation.

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Ergen, William F; Pasricha, Trisha; Hubbard, Francie J; Higginbotham, Tina; Givens, Tonya; Slaughter, James C; Obstein, Keith L

2016-06-01

Inadequate bowel preparation is a problem frequently encountered by gastroenterologists who perform colonoscopies on hospitalized patients. A method is needed to increase the quality of bowel preparation in inpatients. An educational booklet has been shown to increase the overall quality of bowel preparation for outpatients. We performed a prospective study to evaluate the effects of an educational booklet on the quality of bowel preparation in a group of hospitalized patients. We performed a randomized, single-blind, controlled trial of all inpatients at a tertiary care medical center scheduled for inpatient colonoscopy from October 2013 through March 2014. They were randomly assigned to groups that were (n = 45) or were not (controls, n = 40) given the booklet before bowel preparation the evening before their colonoscopy. All patients received a standard bowel preparation (clear liquid diet the day before the procedure, followed by split-dose GoLYTELY). At the colonoscopy, the Boston Bowel preparation scale (BBPS) was used to assess bowel preparation. The primary outcome measure was adequate bowel preparation (a total BBPS score ≥6 with all segment scores ≥2). Secondary outcomes assessed included total BBPS score, BBPS segment score, and a total BBPS score of 0. There were no differences between the groups in age, race, sex, body mass index, history of colonoscopy, history of polyps, or time of colonoscopy. Twenty-eight patients who received the booklet (62%) and 14 who did not (35%) had an adequate bowel preparation (P = .012). The number needed to treat to attain adequate bowel preparation was 4. After adjusting for age and history of prior colonoscopies, the odds of achieving an adequate bowel preparation and a higher total BBPS score after receipt of the booklet were 3.14 (95% confidence interval, 1.29-7.83) and 2.27 (95% confidence interval, 1.05-4.88), respectively. Three patients in the booklet group and 9 in the no-booklet group had a BBPS score

Difficult colonoscopy: air, carbon dioxide, or water insufflation?

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Chaubal, Alisha; Pandey, Vikas; Patel, Ruchir; Poddar, Prateik; Phadke, Aniruddha; Ingle, Meghraj; Sawant, Prabha

2018-04-01

This study aimed to compare tolerance to air, carbon dioxide, or water insufflation in patients with anticipated difficult colonoscopy (young, thin, obese individuals, and patients with prior abdominal surgery or irradiation). Patients with body mass index (BMI) less than 18 kg/m 2 or more than 30 kg/m 2 , or who had undergone previous abdominal or pelvic surgeries were randomized to air, carbon dioxide, or water insufflation during colonoscopy. The primary endpoint was cecal intubation with mild pain (less than 5 on visual analogue scale [VAS]), without use of sedation. The primary end point was achieved in 32.7%, 43.8%, and 84.9% of cases with air, carbon dioxide and water insufflation ( P carbon dioxide, and water insufflation ( P carbon dioxide for pain tolerance. This was seen in the subgroups with BMI 30 kg/m 2 .

Effect of psychological preparation on anxiety level before colonoscopy in outpatients referred to Golestan Hospital in Ahvaz

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Hatam Boustani; Sirus Pakseresht; Mohammad-Reza Haghdoust; Saeid Qanbari; Hadis Mehregan-Nasab

2017-01-01

BACKGROUND:Gastrointestinal disorders are common complaints for which endoscopy and colonoscopy are the most important diagnostic procedures.Anxiety is an unpleasant,ambiguous feeling of apprehension and fear of unknown origin that occurs during stressful situations or injury.Lack of sufficient information and fear of pain can cause anxiety prior to a colonoscopy,reducing the number of patients willing to undergo the procedure and increasing colonoscopy time.The aim of this study was to evaluate the efficacy of psychological preparation on anxiety before colonoscopy in patients presenting to Golestan Hospital during the years 1994 and 1995.MATERIAL and METHODS:This study was a double-blind clinical trial of patients presenting to the colonoscopy unit in Golestan Hospital in 1994 and 1995.A total of 80 patients were divided into two groups:intervention and control.A primary assessment of anxiety was performed using Spielberger's State-Trait Anxiety Inventory.Before the colonoscopy,the State-Trait Anxiety Inventory was completed by the patients again.The effectiveness of psychological preparation before colonoscopy and its effect on anxiety were evaluated using statistical software SPSS 20.RE SULTS:The mean age of participants was 46.33 ± 12.2 years in the intervention group and 44.8 ± 12.26 years in the control group.In this study,there were 41 males (51.3％) and 39 females (48.7％);15 patients (18.7％) were single and the rest married.In terms of demographic variables,there were no significant differences between the two groups (p ＞ 0.05).The average scores of state and trait anxiety in the intervention group showed a statistically significant difference before and after the intervention (p =0.000).CONCLUSION:Trait and state anxiety levels after psychological preparation showed a statistically significant reduction.This indicates the effectiveness of intervention programs to reduce anxiety before colonoscopy.

Educational Colonoscopy Video Enhances Bowel Preparation Quality and Comprehension in an Inner City Population.

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Pillai, Ajish; Menon, Radha; Oustecky, David; Ahmad, Asyia

2017-07-24

Quality of bowel preparation and patient knowledge remains a major barrier for completing colorectal cancer screening. Few studies have tested unique ways to impact patient understanding centering on interactive computer programs, pictures, and brochures. Two studies explored instructional videos but focused on patient compliance and anxiety as endpoints. Furthermore, excessive video length and content may limit their impact on a broad patient population. No study so far has studied a video's impact on preparation quality and patient understanding of the colonoscopy procedure. We conducted a single blinded prospective study of inner city patients presenting for a first time screening colonoscopy. During their initial visit patients were randomized to watch an instructional colonoscopy video or a video discussing gastroesophageal reflux disease (GERD). All patients watched a 6 minutes long video with the same spokesperson, completed a demographic questionnaire (Supplemental Digital Content 1, http://links.lww.com/JCG/A352) and were enrolled only if screened within 30 days of their visit. On the day of the colonoscopy, patients completed a 14 question quiz of their knowledge. Blinded endoscopist graded patient preparations based on the Ottawa scale. All authors had access to the study data and reviewed and approved the final manuscript. Among the 104 subjects enrolled in the study, 56 were in the colonoscopy video group, 48 were in GERD video group, and 12 were excluded. Overall, 48% were male and 52% female; 90% of patients had less than a high school education, 76% were African American, and 67% used a 4 L split-dose preparation. There were no differences between either video group with regard to any of the above categories. Comparisons between the 2 groups revealed that the colonoscopy video group had significantly better Ottawa bowel preparation score (4.77 vs. 6.85; P=0.01) than the GERD video group. The colonoscopy video group also had less-inadequate repeat

Is Travel Time to Colonoscopy Associated With Late-Stage Colorectal Cancer Among Medicare Beneficiaries in Iowa?

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Charlton, Mary E; Matthews, Kevin A; Gaglioti, Anne; Bay, Camden; McDowell, Bradley D; Ward, Marcia M; Levy, Barcey T

2016-09-01

Colorectal cancer (CRC) screening has been shown to decrease the incidence of late-stage colorectal cancer, yet a substantial proportion of Americans do not receive screening. Those in rural areas may face barriers to colonoscopy services based on travel time, and previous studies have demonstrated lower screening among rural residents. Our purpose was to assess factors associated with late-stage CRC, and specifically to determine if longer travel time to colonoscopy was associated with late-stage CRC among an insured population in Iowa. SEER-Medicare data were used to identify individuals ages 65 to 84 years old diagnosed with CRC in Iowa from 2002 to 2009. The distance between the centroid of the ZIP code of residence and the ZIP code of colonoscopy was computed for each individual who had continuous Medicare fee-for-service coverage for a 3- to 4-month period prior to diagnosis, and a professional claim for colonoscopy within that time frame. Demographic characteristics and travel times were compared between those diagnosed with early- versus late-stage CRC. Also, demographic differences between those who had colonoscopy claims identified within 3-4 months prior to diagnosis (81%) were compared to patients with no colonoscopy claims identified (19%). A total of 5,792 subjects met inclusion criteria; 31% were diagnosed with early-stage versus 69% with late-stage CRC. Those divorced or widowed (vs married) were more likely to be diagnosed with late-stage CRC (OR: 1.20, 95% CI: 1.06-1.37). Travel time was not associated with diagnosis of late-stage CRC. Among a Medicare-insured population, there was no relationship between travel time to colonoscopy and disease stage at diagnosis. It is likely that factors other than distance to colonoscopy present more pertinent barriers to screening in this insured population. Additional research should be done to determine reasons for nonadherence to screening among those with access to CRC screening services, given that over

The effect of auricular acupuncture on pain during colonoscopy with midazolam and pethidine

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Kusumastuti, R.; Srilestari, A.; Abdurrohim, K.; Abdullah, M.

2017-08-01

Colonoscopy is the standard procedure for colorectal cancer screening. One of its common complications is abdominal pain. Analgesia has not provided favorable outcomes so various complementary practices have been developed, including auricular acupuncture. In this study, a randomized controlled trial of 56 patients who underwent colonoscopy was conducted to determine the effect of acupuncture on the pain experienced during colonoscopy. Subjects were divided into two groups: The first received acupuncture combined with midazolam and pethidine, while the second were administered placebo puncture in addition to midazolam and pethidine. The median Critical Care Pain Observation Tool (CPOT) score was lower in the auricular acupuncture group than in the placebo puncture group(0.7 [0-4.83] vs. 1.9 [0-6.20] p = 0.010), while there were no significant differences to median Visual Analog Scale (VAS) scores (29 [0-100] vs. 44.5 [0-100] p = 0.147), heart rate changes (-2.58 [14.31] vs.-2.43 [12.28]; p = 0.970), or the mean time to the cecum (16 [8-51] vs. 22 [5-63] p = 0.206). Auricular acupuncture combined with midazolam and pethidine was found to be effective at reducing pain during colonoscopy.

Use of high-flow nasal cannula in obese patients receiving colonoscopy under intravenous propofol sedation: A case series

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Chi Chan Lee

Full Text Available Intravenous sedation during colonoscopy has become the standard practice in the United States given its higher patient satisfaction and procedural quality. This practice is not free of side effects as a significant proportion of patients undergoing this procedure tend to have respiratory depression and desaturation events. Obesity, as it relates to higher levels of body mass index (BMI has a positive correlation with the incidence of hypoxemia. During colonoscopy High flow nasal cannula (HFNC may potentially improve oxygen performance in patients receiving colonoscopy under intravenous sedation. Here we present 3 cases of patients undergoing adjunctive oxygen therapy with HFNC during colonoscopy with intravenous sedation. We found patients to have lower number of desaturation events and were satisfied with their experience. Keywords: High BMI (body mass index, HFNC (high-flow nasal cannula, Colonoscopy, Intravenous sedation, Obesity

Transmural Colonic Infarction after Routine Colonoscopy in a Young Patient without Risk Factors

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Maurizio Zizzo

2016-09-01

Full Text Available Colonoscopy is one of the most widely used procedures in medical practice for the diagnosis and treatment of many benign and malignant diseases of the colorectal tract. Colonscopy has become the reference procedure for screening and surveillance of colorectal cancer. The overall rate of adverse events is estimated to be about 2.8 per 1,000 procedures, while complications requiring hospitalization are about 1.9 per 1,000 colonoscopies. Mortality from all causes and colonoscopy-specific mortality are estimated to be 0.07 and 0.007%, respectively. An exceptional fearsome postcolonoscopy complication is colon ischemia (CI; only few cases have been reported worldwide. We present the case of a 43-year-old woman who presented to the emergency department complaining of abdominal pain; fever and rectal bleeding appeared 12 h after a voluntary ‘screening’ colonoscopy. She had no risk factors for CI. Her laboratory tests showed alterations in inflammatory markers and a computed tomography scan showed a circumferential thickening in the left colon and free fluid in the abdomen. After 12 h of observation and conservative therapy, the clinical state of the patient worsened with the rising of signs of peritonitis. Laparoscopy showed that colon infarction extended from the distal third of the transverse colon to the proximal rectum. Laparotomy, resection of the pathological colon and terminal colostomy were performed. The specimen examined confirmed an extended ischemic colitis and transmural infarction on the antimesocolic side, in the absence of a vasculitis. The patient underwent recanalization after 8 months. CI after colonoscopy is a rare and alarming complication that must be known and taken into account in the differential diagnosis of symptomatic cases after colonoscopy, particularly in patients with known risk factors. The diagnosis is mainly based on clinical data, imaging and especially endoscopy. Treatment is almost always conservative but, in

Colonoscopy and computerised tomography scan are not sufficient to localise right sided colonic lesions accurately.

LENUS (Irish Health Repository)

Solon, Jacqueline Gemma

2009-11-23

: Aim: accurate pre-operative localisation of colonic lesions is critical especially in laparoscopic colectomy where tactile localisation is absent particularly in screen-detected tumours. The study aimed to evaluate the accuracy of colonoscopy and double-contrast computerised tomography (CT) to localise lesions treated by right hemicolectomy. Method: a retrospective chart review was performed of patients treated by right hemicolectomy under the colorectal service between July 2003 and October 2006. Pre-operative tumour location determined by CT scan and colonoscopy were compared with the intra-operative and histopathologic findings. Results: of 101 patients, 73 (73%) were for adenoma or cancer, with a final diagnosis of adenocarcinoma in 59 (59%). Pre-operative localisation was inaccurate in 29% of lesions using both CT and colonoscopy. In the transverse colon colonoscopy alone was only 37.5% accurate, increasing to 62.5% when information from the CT scan was added. Conclusion: pre-operative localisation of right-sided colon cancers using colonoscopy and CT scanning is unreliable in at least 29% of cases. Inaccurate localisation of transverse colon tumours risks inadequate lymphadenectomy with an adverse cancer outcome. Pre-operative abdominal CT scan improves accuracy but endoscopic tattoo localisation should be employed routinely especially in patients undergoing laparoscopic resection.

Colonoscopy surveillance for dysplasia and colorectal cancer in patients with inflammatory bowel disease

DEFF Research Database (Denmark)

Aalykke, Claus; Jensen, Michael Dam; Fallingborg, Jan

2015-01-01

The risk of colorectal cancer (CRC) and dysplasia in patients with inflammatory bowel disease (IBD) has been highly debated as risk estimates from different studies vary greatly. The present national Danish guideline on colonoscopy surveillance for dysplasia and colorectal cancer in patients......, in some subgroups of patients the risk is increased. These subgroups of patients, who should be offered colonoscopy surveillance, include patients with ulcerative colitis having extensive disease and a long disease duration (10-13 years); early age at onset (less than 19 years of age) of ulcerative...... colitis; and patients with ulcerative colitis as well as Crohn´s disease with a concomitant diagnosis of primary sclerosing cholangitis. A colonoscopy surveillance program is recommended in these subgroups with intervals ranging from every 3-6 months to every 5 years, using chromoendoscopy with targeted...

Prospective comparison of air-contrast barium enema and colonoscopy in patients with fecal occult blood: a pilot study.

Science.gov (United States)

Rockey, Don C; Koch, Johannes; Yee, Judy; McQuaid, Kenneth R; Halvorsen, Robert A

2004-12-01

The utility of air-contrast barium enema and colonoscopy for evaluation of the colon has been debated. Air-contrast barium enema is less expensive and invasive than colonoscopy, but it also is less sensitive and specific. Further, although air-contrast barium enema may be less painful than colonoscopy, it often is poorly tolerated by patients. Thus, this study compared the sensitivity and the specificity of air-contrast barium enema and colonoscopy for detection of colonic lesions in patients with fecal occult blood. Over a 30-month period, patients with fecal occult blood were recruited. Patients underwent standard air-contrast barium enema, followed by colonoscopy 7 to 14 days later. Colonoscopists were blinded to the results of air-contrast barium enema until the colonoscopy was completed, after which the results were disclosed. If the findings were discrepant, colonoscopy was repeated. A total of 100 patients were evaluated. Nine air-contrast barium enemas were reported to be inadequate, and the cecum was not intubated at colonoscopy in two patients. In the remaining patients, 5 cancers were identified (1 each cecum, transverse colon, descending colon, sigmoid colon, and rectum) by both studies. Sixty-six polypoid lesions were identified in 30 patients. Diverticula were identified in 42 patients by air-contrast barium enema and in 18 patients by colonoscopy. Air-contrast barium enema detected 3 of 36 polypoid lesions 5 mm or less in diameter, 5 of 15 adenomas 6 to 9 mm in size, and 4 of 15 adenomas 10 mm or greater in diameter (sensitivity 8%, 33%, and 27%, respectively). After excluding patients with diverticula, air-contrast barium enema detected 3 of 7 adenomas 10 mm or greater in size. Overall, 12 polypoid lesions or filling defects were identified by air-contrast barium enema that could not be verified by colonoscopy. The specificity of air-contrast barium enema for lesions 1.0 cm or greater in size was 100%; for those 6 mm or greater, it was 97%. Air

Colonoscopy screening among US adults aged 40 or older with a family history of colorectal cancer.

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Tsai, Meng-Han; Xirasagar, Sudha; Li, Yi-Jhen; de Groen, Piet C

2015-05-21

Colonoscopy screening reduces colorectal cancer (CRC) incidence and mortality. CRC screening is recommended at age 50 for average-risk people. Screening of first-degree relatives of CRC patients is recommended to begin at age 40 or 10 years before the age at diagnosis of the youngest relative diagnosed with CRC. CRC incidence has increased recently among younger Americans while it has declined among older Americans. The objective of this study was to determine whether first-degree relatives of CRC patients are being screened according to recommended guidelines. We studied colonoscopy screening rates among the US population reporting a CRC family history using 2005 and 2010 National Health Interview Survey data. Of 26,064 study-eligible respondents, 2,470 reported a CRC family history; of those with a family history, 45.6% had a colonoscopy (25.2% in 2005 and 65.8% 2010). The colonoscopy rate among first-degree relatives aged 40 to 49 in 2010 (38.3%) was about half that of first-degree relatives aged 50 or older (69.7%). First-degree relatives were nearly twice as likely as nonfirst-degree relatives to have a colonoscopy (adjusted odds ratio [AOR], 1.7; 95% confidence interval, 1.5-1.9), but those aged 40 to 49 were less likely to have a colonoscopy than those in older age groups (AOR, 2.6 for age 50-64; AOR, 3.6 for age ≥65). Interactions with age, insurance, and race/ethnicity were not significant. Having health insurance tripled the likelihood of screening. Despite a 5-fold increase in colonoscopy screening rates since 2005, rates among first-degree relatives younger than the conventional screening age have lagged. Screening promotion targeted to this group may halt the recent rising trend of CRC among younger Americans.

Simulation-based training for colonoscopy

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Preisler, Louise; Svendsen, Morten Bo Søndergaard; Nerup, Nikolaj

2015-01-01

in colonoscopy before practicing on patients. Twenty-five physicians (10 consultants with endoscopic experience and 15 fellows with very little endoscopic experience) were tested on 2 different simulator models: a virtual-reality simulator and a physical model. Tests were repeated twice on each simulator model...... on both the models (P virtual-reality and the physical model, respectively. The established pass/fail standards failed one of the consultants (virtual-reality simulator) and allowed one fellow to pass (physical model). The 2 tested...

Sending family history questionnaires to patients before a colonoscopy improves genetic counseling for hereditary colorectal cancer.

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Kessels, Koen; Eisinger, Joey D; Letteboer, Tom G; Offerhaus, G Johan A; Siersema, Peter D; Moons, Leon M G

2017-06-01

To investigate whether sending a family history questionnaire to patients prior to undergoing colonoscopy results in an increased availability of family history and better genetic counseling. A questionnaire was mailed to patients before they underwent outpatient colonoscopy at a university hospital in 2013. These patients' additional characteristics and referral for genetic evaluation were retrieved from the electronic medical records. Patients undergoing inpatient coloboscopy, with confirmed hereditary colorectal cancer (CRC) or inflammatory bowel disease were excluded. All study patients from 2010 to 2013 were matched with the database of the genetics department to determine who consulted a geneticist. A total of 6163 patients underwent colonoscopy from 2010 to 2013. Of 1421 who underwent colonoscopy in 2013, 53 (3.7%) consulted a geneticist, while 75 (1.6%) of 4742 patients undergoing colonoscopy between 2010 and 2012 did so (P history was not recorded in the electronic medical records of 393 (40.3%). In 129 (32.8%), family history was obtained from the completed questionnaire. In 2013, 49 (60.5%) out of 81 patients referred for genetic counseling were referred based on their family history. Eight (9.9%) patients were referred based on the completed questionnaire. Screening for hereditary CRC in a population undergoing outpatient colonoscopy with a questionnaire sent by mail resulted in an increased availability of family histories and genetic counseling. © 2017 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.

Image-based path planning for automated virtual colonoscopy navigation

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Hong, Wei

2008-03-01

Virtual colonoscopy (VC) is a noninvasive method for colonic polyp screening, by reconstructing three-dimensional models of the colon using computerized tomography (CT). In virtual colonoscopy fly-through navigation, it is crucial to generate an optimal camera path for efficient clinical examination. In conventional methods, the centerline of the colon lumen is usually used as the camera path. In order to extract colon centerline, some time consuming pre-processing algorithms must be performed before the fly-through navigation, such as colon segmentation, distance transformation, or topological thinning. In this paper, we present an efficient image-based path planning algorithm for automated virtual colonoscopy fly-through navigation without the requirement of any pre-processing. Our algorithm only needs the physician to provide a seed point as the starting camera position using 2D axial CT images. A wide angle fisheye camera model is used to generate a depth image from the current camera position. Two types of navigational landmarks, safe regions and target regions are extracted from the depth images. Camera position and its corresponding view direction are then determined using these landmarks. The experimental results show that the generated paths are accurate and increase the user comfort during the fly-through navigation. Moreover, because of the efficiency of our path planning algorithm and rendering algorithm, our VC fly-through navigation system can still guarantee 30 FPS.

Focal Colonic FDG Activity with PET/CT: Guidelines for Recommendation of Colonoscopy

OpenAIRE

Liu, Tianye; Behr, Spencer; Khan, Sana; Osterhoff, Robert; Aparici, Carina Mari

2015-01-01

Focal 18F-fluorodeoxyglucose (FDG) colonic activity can be incidentally seen in positron emission tomography/computed tomography (PET/CT) scans. Its clinical significance is still unclear. The purpose of this study was to assess the significance of focal FDG activity in PET/CT scans by correlating the imaging findings to colonoscopy results, and come up with some guidelines for recommendation of follow-up colonoscopy. A total of 133 patients who underwent both 18F-FDG PET/CT for different onc...

Magnetic resonance colonography with a limited bowel preparation and automated carbon dioxide insufflation in comparison to conventional colonoscopy: Patient burden and preferences

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Paardt, M.P. van der, E-mail: m.p.vanderpaardt@amc.uva.nl [Department of Radiology, Academic Medical Center Amsterdam, Amsterdam (Netherlands); Boellaard, T.N., E-mail: t.n.boellaard@amc.uva.nl [Department of Radiology, Academic Medical Center Amsterdam, Amsterdam (Netherlands); Zijta, F.M., E-mail: fmzijta@yahoo.com [Department of Radiology, Medisch Centrum Haaglanden, Den Haag (Netherlands); Baak, L.C., E-mail: l.c.baak@olvg.nl [Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis, Amsterdam (Netherlands); Depla, A.C.T.M., E-mail: actm.depla@slz.nl [Department of Gastroenterology and Hepatology, Slotervaartziekenhuis, Amsterdam (Netherlands); Dekker, E., E-mail: e.dekker@amc.uva.nl [Department of Gastroenterology and Hepatology, Academic Medical Center Amsterdam, Amsterdam (Netherlands); Nederveen, A.J., E-mail: a.j.nederveen@amc.uva.nl [Department of Radiology, Academic Medical Center Amsterdam, Amsterdam (Netherlands); Bipat, S., E-mail: s.bipat@amc.uva.nl [Department of Radiology, Academic Medical Center Amsterdam, Amsterdam (Netherlands); Stoker, J., E-mail: j.stoker@amc.uva.nl [Department of Radiology, Academic Medical Center Amsterdam, Amsterdam (Netherlands)

2015-01-15

Highlights: • MR colonography with a limited bowel preparation and automated carbon dioxide insufflation demonstrated less burden compared to colonoscopy. • When discarding the bowel preparation, the examinations were rated equally burdensome. • The majority of patients preferred MR colonography over colonoscopy for their future examination of the bowel. - Abstract: Objectives: To evaluate patient burden and preferences for MR colonography with a limited bowel preparation and automated carbon dioxide insufflation in comparison to conventional colonoscopy. Methods: Symptomatic patients were consecutively recruited to undergo MR colonography with automated carbon dioxide insufflation and a limited bowel preparation followed within four weeks by colonoscopy with a standard bowel cleansing preparation. Four questionnaires regarding burden (on a five-point scale) and preferences (on a seven-point scale) were addressed after MR colonography and colonoscopy and five weeks after colonoscopy. Results: Ninety-nine patients (47 men, 52 women; mean age 62.3, SD 8.7) were included. None of the patients experienced severe or extreme burden from the MR colonography bowel preparation compared to 31.5% of the patients for the colonoscopy bowel preparation. Colonoscopy was rated more burdensome (25.6% severe or extreme burden) compared to MR colonography (5.2% severe or extreme burden) (P < 0.0001). When discarding the bowel preparations, the examinations were rated equally burdensome (P = 0.35). The majority of patients (61.4%) preferred MR colonography compared to colonoscopy (29.5%) immediately after the examinations and five weeks later (57.0% versus 39.5%). Conclusion: MR colonography with a limited bowel preparation and automated carbon dioxide insufflation demonstrated less burden compared to colonoscopy. The majority of patients preferred MR colonography over colonoscopy.

Prospective multicenter randomized controlled trial comparing adenoma detection rate in colonoscopy using water exchange, water immersion, and air insufflation.

Science.gov (United States)

Hsieh, Yu-Hsi; Tseng, Chih-Wei; Hu, Chi-Tan; Koo, Malcolm; Leung, Felix W

2017-07-01

Adenoma detection rate (ADR), defined as the proportion of patients with at least one adenoma of any size, is a quality indicator. We tested the hypothesis that water exchange (WE) improves ADR but water immersion (WI) has no adverse effect on ADR compared with air insufflation (AI). A prospective study was conducted at the Dalin Tzu Chi Hospital in southern Taiwan and the Hualien Tzu Chi Hospital in eastern Taiwan on patients randomly assigned to WE, WI, or AI with stratification by the 3 study colonoscopists. The primary outcome was ADR. From July 2013 to December 2015, 651 patients were recruited and randomized into 3 groups with a 1:1:1 ratio (217 patients per group). Overall, ADR met quality standards: WE 49.8% (95% CI, 43.2%-56.4%), AI 37.8% (95% CI, 31.6%-44.4%), and WI 40.6% (95% CI, 34.2%-47.2%). Compared with AI, WE significantly increased ADR (P = .016). There was no difference between WI and WE. ADRs of WI and AI were comparable. Compared with AI, WE confirmed a longer insertion time, higher cleanliness score, but similar adenoma per positive colonoscopy (APPC) and withdrawal time with polypectomy. Subgroup analysis found WE significantly increased ADR in propofol-sedated patients. Multivariate generalized linear mixed model analysis revealed that age ≥50 years, WE (vs AI), colonoscopy indication, no previous history of colonoscopy, and withdrawal time >8 minutes were significant predictors of increased ADR. Confirmation of prior reports showing WE, but not WI, increased ADR further strengthened the validity of our observations. WE significantly increased ADR in propofol-sedated patients. The outcome differences justify assessment of the role of WE in colorectal cancer prevention. Similar APPC and withdrawal times suggest that adequate inspection was performed on colonoscope withdrawal in each of the study arms. (Clinical trial registration number: NCT01894191.). Copyright © 2017 American Society for Gastrointestinal Endoscopy. All rights reserved.

Assessing the realism of colonoscopy simulation: the development of an instrument and systematic comparison of 4 simulators.

Science.gov (United States)

Hill, Andrew; Horswill, Mark S; Plooy, Annaliese M; Watson, Marcus O; Karamatic, Rozemary; Basit, Tabinda A; Wallis, Guy M; Riek, Stephan; Burgess-Limerick, Robin; Hewett, David G

2012-03-01

No useful comparative data exist on the relative realism of commercially available devices for simulating colonoscopy. To develop an instrument for quantifying realism and provide the first wide-ranging empiric comparison. Repeated measures, observational study. Nineteen experienced colonoscopists completed cases on 4 colonoscopy simulators (AccuTouch, GI Mentor II, Koken, and Kyoto Kagaku) and evaluated each device. A medical simulation center in a large tertiary hospital. For each device, colonoscopists completed the newly developed Colonoscopy Simulator Realism Questionnaire (CSRQ), which contains 58 items grouped into 10 subscales measuring the realism of different aspects of the simulation. Subscale scores are weighted and combined into an aggregated score, and there is also a single overall realism item. Overall, current colonoscopy simulators were rated as only moderately realistic compared with real human colonoscopy (mean aggregated score, 56.28/100; range, 48.39-60.45, where 0 = "extremely unrealistic" and 100 = "extremely realistic"). On both overall realism measures, the GI Mentor II was rated significantly less realistic than the AccuTouch, Kyoto Kagaku, and Koken (P realism. There is no clear "first choice" simulator among those assessed. Each has unique strengths and weaknesses, reflected in the differing results observed across 9 subscales. These findings may facilitate the targeted selection of simulators for various aspects of colonoscopy training. Copyright © 2012 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

The median effective concentration (EC50) of propofol with different doses of fentanyl during colonoscopy in elderly patients.

Science.gov (United States)

Li, Shiyang; Yu, Fang; Zhu, Huichen; Yang, Yuting; Yang, Liqun; Lian, Jianfeng

2016-04-21

Propofol and fentanyl are the most widely administered anesthesia maintaining drugs during colonoscopy. In this study, we determined the median effective concentration (EC50) of propofol required for colonoscopy in elderly patients, and the purpose of this study was to describe the pharmacodynamic interaction between fentanyl and propofol when used in combination for colonoscopy in elderly patients. Ninety elderly patients scheduled for colonoscopy were allocated into three groups in a randomized, double-blinded manner as below, F0.5 group (0.5 μg.kg(-1) fentanyl), F1.0 group (1.0 μg.kg(-1) fentanyl) and saline control group. Anaesthesia was achieved by target-controlled infusion of propofol (Marsh model, with an initial plasma concentration of 2.0 μg.ml(-1)) and fentanyl. Colonoscopy was started 3 min after the injection of fentanyl. The EC50 of propofol for colonoscopy with different doses of fentanyl was measured by using an up-and-down sequential method with an adjacent concentration gradient at 0.5 μg.ml(-1) to inhibit purposeful movements. Anaesthesia associated adverse events and recovery characters were also recorded. The EC50 of propofol for colonoscopy in elderly patients were 2.75 μg.ml(-1) (95% CI, 2.50-3.02 μg.ml(-1)) in F0.5 group, 2.05 μg.ml(-1) (95% CI, 1.98-2.13 μg.ml(-1)) in F1.0 group and 3.08 μg.ml(-1) (95% CI, 2.78-3.42 μg.ml(-1)) in control group respectively (P fentanyl up to 1.0 μg.kg(-1) reduces the propofol EC50 required for elderly patients undergoing colonoscopy, and there was no significant difference in anaesthesia associated adverse events but prolonged awake and discharge time. Chinese Clinical Trial Registry ChiCTR15006368. Date of registration: May 3, 2015.

Colonoscopic Diagnostic Findings in Patients Undergoing Colonoscopy In Qom Hazrat-e-Masoome Hospital During 2007-2008

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M.R Ghadir

2012-05-01

Full Text Available

Background and Objectives: In recent years there have been noticeable changes in diagnosis and treatment of colon disorders by colonoscopy and direct vision. Along with its international development, this useful equipment is being used in Iran to treat various disorders. It should be mentioned that there are no exact statistics of these disorders to date. This study was done with aim of evaluating the diagnostic findings in patients undergoing colonoscopy in Qom during 2007-2008.

Methods: This descriptive-cross sectional study was done on 500 patients having referred to colonoscopy ward of Hazrate-e-Masoome Hospital in Qom. After colonoscopy, patient data were entered into a special questionnaire and then pathologic findings were added to it. The data were taken for statistical analysis.

Results: Out of 500 patients undergoing colonoscopy 279 were male (55.8% and 221 female (44.2%. In all groups and both sexes the most common reason for carrying out colonoscopy was abdominal pain (46.6% rectorrhagia (41%. As regards diagnosis, a total of 199 cases (39.8% of all 500 colonoscopies had normal colonoscopy,124 cases (24.8% had hemorrhoid, 64 cases (12.8% had polyp, 55 cases (11% had inflammatory bowel diseases (IBD, 30 cases (6% had tumor, 17 cases(3.2% had diverticulosis and 12 cases (2.4% had solitary rectal ulcer. There was a significant relationship between abdominal pain and tumor, polyp and diverticulosis. (p<0.001 There was also a significant relationship between age and the aforementioned disorders. (p<0.001

Conclusion: Based on the findings of this study, the prevalence of cancer and IBD is higher in men

Expert opinions and scientific evidence for colonoscopy key performance indicators.

Science.gov (United States)

Rees, Colin J; Bevan, Roisin; Zimmermann-Fraedrich, Katharina; Rutter, Matthew D; Rex, Douglas; Dekker, Evelien; Ponchon, Thierry; Bretthauer, Michael; Regula, Jaroslaw; Saunders, Brian; Hassan, Cesare; Bourke, Michael J; Rösch, Thomas

2016-12-01

Colonoscopy is a widely performed procedure with procedural volumes increasing annually throughout the world. Many procedures are now performed as part of colorectal cancer screening programmes. Colonoscopy should be of high quality and measures of this quality should be evidence based. New UK key performance indicators and quality assurance standards have been developed by a working group with consensus agreement on each standard reached. This paper reviews the scientific basis for each of the quality measures published in the UK standards. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Multicenter, randomized, controlled trial of virtual-reality simulator training in acquisition of competency in colonoscopy.

Science.gov (United States)

Cohen, Jonathan; Cohen, Seth A; Vora, Kinjal C; Xue, Xiaonan; Burdick, J Steven; Bank, Simmy; Bini, Edmund J; Bodenheimer, Henry; Cerulli, Maurice; Gerdes, Hans; Greenwald, David; Gress, Frank; Grosman, Irwin; Hawes, Robert; Mullin, Gerard; Mullen, Gerard; Schnoll-Sussman, Felice; Starpoli, Anthony; Stevens, Peter; Tenner, Scott; Villanueva, Gerald

2006-09-01

The GI Mentor is a virtual reality simulator that uses force feedback technology to create a realistic training experience. To define the benefit of training on the GI Mentor on competency acquisition in colonoscopy. Randomized, controlled, blinded, multicenter trial. Academic medical centers with accredited gastroenterology training programs. First-year GI fellows. Subjects were randomized to receive 10 hours of unsupervised training on the GI Mentor or no simulator experience during the first 8 weeks of fellowship. After this period, both groups began performing real colonoscopies. The first 200 colonoscopies performed by each fellow were graded by proctors to measure technical and cognitive success, and patient comfort level during the procedure. A mixed-effects model comparison between the 2 groups of objective and subjective competency scores and patient discomfort in the performance of real colonoscopies over time. Forty-five fellows were randomized from 16 hospitals over 2 years. Fellows in the simulator group had significantly higher objective competency rates during the first 100 cases. A mixed-effects model demonstrated a higher objective competence overall in the simulator group (P < .0001), with the difference between groups being significantly greater during the first 80 cases performed. The median number of cases needed to reach 90% competency was 160 in both groups. The patient comfort level was similar. Fellows who underwent GI Mentor training performed significantly better during the early phase of real colonoscopy training.

Time of day variation in polyp detection rate for colonoscopies performed on a 3-hour shift schedule.

LENUS (Irish Health Repository)

Munson, Gregory W

2011-03-01

Recent research suggests that the colonoscopy polyp detection rate (PDR) varies by time of day, possibly because of endoscopist fatigue. Mayo Clinic Rochester (MCR) schedules colonoscopies on 3-hour shifts, which should minimize fatigue.

CT colonography with limited bowel preparation: prospective assessment of patient experience and preference in comparison to optical colonoscopy with cathartic bowel preparation

International Nuclear Information System (INIS)

Jensch, Sebastiaan; Bipat, Shandra; Vries, Ayso H. de; Heutinck, Anneke; Stoker, Jaap; Peringa, Jan; Montauban van Swijndregt, Alexander D.; Dekker, Evelien; Baak, Lubbertus C.

2010-01-01

The purpose of this study was to prospectively compare participant experience and preference of limited preparation computed tomography colonography (CTC) with full-preparation colonoscopy in a consecutive series of patients at increased risk of colorectal cancer. CTC preparation comprised 180 ml diatrizoate meglumine, 80 ml barium and 30 mg bisacodyl. For the colonoscopy preparation 4 l of polyethylene glycol solution was used. Participants' experience and preference were compared using the Wilcoxon signed rank test and the chi-squared test, respectively. Associations between preference and experience parameters for the 173 participants were determined by logistic regression. Diarrhoea occurred in 94% of participants during CTC preparation. This side effect was perceived as severely or extremely burdensome by 29%. Nonetheless, the total burden was significantly lower for the CTC preparation than for colonoscopy (9% rated the CTC preparation as severely or extremely burdensome compared with 59% for colonoscopy; p<0.001). Participants experienced significantly more pain, discomfort and total burden with the colonoscopy procedure than with CTC (p<0.001). After 5 weeks, 69% preferred CTC, 8% were indifferent and 23% preferred colonoscopy (p<0.001). A burdensome colonoscopy preparation and pain at colonoscopy were associated with CTC preference (p<0.04). In conclusion, participants' experience and preference were rated in favour of CTC with limited bowel preparation compared with full-preparation colonoscopy. (orig.)

Dreaming and recall during sedation for colonoscopy.

Science.gov (United States)

Stait, M L; Leslie, K; Bailey, R

2008-09-01

Dreaming is reported by one in five patients who are interviewed on emergence from general anaesthesia, but the incidence, predictors and consequences of dreaming during procedural sedation are not known. In this prospective observational study, 200 patients presenting for elective colonoscopy under intravenous sedation were interviewed on emergence to determine the incidences of dreaming and recall. Sedation technique was left to the discretion of the anaesthetist. The incidence of dreaming was 25.5%. Patients reporting dreaming were younger than those who did not report dreaming. Doses of midazolam and fentanyl were similar between dreamers and non-dreamers, however propofol doses were higher in patients who reported dreams than those who did not. Patients reported short, simple dreams about everyday life--no dream suggested near-miss recall of the procedure. Frank recall of the procedure was reported by 4% of the patients, which was consistent with propofol doses commensurate with light general anaesthesia. The only significant predictor of recall was lower propofol dose. Satisfaction with care was generally high, however dreamers were more satisfied with their care than non-dreamers.

Natural history of diminutive colorectal polyps: long-term prospective observation by colonoscopy.

Science.gov (United States)

Mizuno, Ken-Ichi; Suzuki, Yutaka; Takeuchi, Manabu; Kobayashi, Masaaki; Aoyagi, Yutaka

2014-04-01

Endoscopic removal of colorectal adenomatous polyps effectively prevents cancer. However, the treatment strategy for diminutive polyps (diameter ≤ 5 mm) remains controversial. Understanding the natural history of diminutive polyps is a prerequisite to their effective management. We prospectively examined the natural history of diminutive polyps by long-term surveillance colonoscopy. A total of 207 polyps detected in 112 patients from December 1991 through March 2002 were studied. To avoid potential effects on size and morphological characteristics, all polyps were selected randomly and were followed without biopsy. Polyp size was estimated by comparing the lesion with the diameter of a biopsy forceps. Mean follow up was 7.8 years (SD, 4.8; range, 1.0-18.6; median, 7.5; interquartile range 3.4-11.2). Twenty-four polyps were resected endoscopically, and the histopathological diagnosis was mucosal high-grade neoplasia (Category 4) for one polyp, and mucosal low-grade neoplasia (Category 3) for 23 polyps. Mean linear size of the polyps was 3.2 mm (SD, 1.0; range, 1.3-5.0) at initial colonoscopy and 3.8 mm (SD 1.6; range 1.3-10.0) at final colonoscopy (Ppit pattern was associated with a lower growth rate than a type IIIL1 pattern. We clarified the natural history of diminutive polyps by long-term follow-up colonoscopy. The benign course of diminutive polyps should be considered in the design of treatment strategies. © 2014 The Authors. Digestive Endoscopy © 2014 Japan Gastroenterological Endoscopy Society.

Virtual colonoscopy (CT colonography) in the identification of colorectal cancer. A prospective study in symptomatic patients

International Nuclear Information System (INIS)

Regge, D.; Martincich, L.; Gallo, T.; Pollone, M.; Galatola, G.; Secreto, P.; Pera, A.; Rivolta, A.

2000-01-01

Aim of this study was to evaluate the sensitivity of virtual colonoscopy (CT colonography) in the identification of colorectal cancer and to define the limitations and the advantages of this imaging modality, as well as indications to the examination. It was examined prospectively 62 symptomatic patients aged 36 to 82 years (28 women and 34 men). All patients underwent both conventional and virtual colonoscopy on the same day; the conventional examination allowed exploration of the entire colon. Conventional colonoscopy identified 89 lesions 3-50 mm in diameter, namely 84 benign and 5 malignant lesions. No lesions were identified in 12 patients. CT colonography identified 52 of the 89 lesions, with 57.1% diagnostic accuracy. They were 11 false positives (82.5% positive predictive value and 52.2% specificity) and 37 false negatives (24.5% negative predictive value and 58.4% sensitivity). Sensitivity was significantly higher (85.7%) for polyps ≥ 1 cm. Virtual colonoscopy is an imaging modality with good diagnostic yield, well tolerated by patients and with great potentials for further development. It was suggested that the examination be performed in symptomatic patients who cannot undergo total colonoscopy or refuse the other imaging modalities. Further studies are waranted in larger series of patients, possibly introducing it in screening programs [it

Barriers and facilitators associated with colonoscopy completion in individuals with multiple chronic conditions: a qualitative study

Directory of Open Access Journals (Sweden)

Sultan S

2017-05-01

Full Text Available Shahnaz Sultan,1–4 Melissa R Partin,1,2 Phalgoon Shah,5 Jennifer LeLaurin,4 Ivette Magaly Freytes,4 Chandylen L Nightingale,6 Susan F Fesperman,4 Barbara A Curbow,7 Rebecca J Beyth3,4,8 1Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System, 2Department of Medicine, University of Minnesota, Minneapolis, MN, 3Department of Medicine, University of Florida College of Medicine, Gainesville, FL, 4Center of Innovation on Disability and Rehabilitation Research, North Florida/South Georgia Veterans Health System, Gainesville, FL, 5Department of Medicine, Tripler Army Medical Center, Honolulu, HI, 6Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem NC, 7Department of Community and Behavioral Health, University of Maryland, College Park, MD, 8Geriatric Research, Education and Clinical Center, North Florida/South Georgia Veterans Health System, Gainesville, FL, USA Background: A recommendation to undergo a colonoscopy, an invasive procedure that requires commitment and motivation, planning (scheduling and finding a driver and preparation (diet restriction and laxative consumption, may be uniquely challenging for individuals with multiple chronic conditions (MCCs. This qualitative study aimed to describe the barriers and facilitators to colonoscopy experienced by such patients.Materials and methods: Semistructured focus groups were conducted with male Veterans who were scheduled for outpatient colonoscopy and either failed to complete the procedure or completed the examination. Focus group recordings were transcribed and analyzed by an inductive grounded approach using constant comparative analysis.Results: Forty-four individuals aged 51–83 years participated in this study (23 adherent and 21 nonadherent. Participants had an average of 7.4 chronic conditions (range 2–14. The five most common chronic conditions were hypertension (75%, hyperlipidemia (75

Reiki as a pain management adjunct in screening colonoscopy.

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Bourque, Alda L; Sullivan, Mary E; Winter, Michael R

2012-09-01

The purpose of this study was to determine whether the use of Reiki decreases the amount of meperidine administered to patients undergoing screening colonoscopy. The literature review reveals limited studies to show whether Reiki has been able to decrease the amount of opioid the patient receives during screening colonoscopy. A chart review of 300 patients was conducted to obtain baseline average doses of meperidine patients received as the control. Following the chart review, 30 patients were recruited to the Reiki study. Twenty-five of the study arm patients received Reiki in conjunction with meperidine. Five randomly chosen study arm patients received placebo Reiki in conjunction with meperidine in an attempt to blind the clinicians to the treatment received by the patients. Results showed that there were no significant differences in meperidine administration between the patients in the chart review group (control) and the Reiki group. The study revealed that 16% who received Reiki, together with intravenous administration of conscious sedation, received less than 50 mg of meperidine. All the patients in the chart review group received more than 50 mg of meperidine. Results from this pilot study suggest that there may be a decrease in meperidine needed during screening colonoscopy when patients receive Reiki treatments before the procedure. A larger study powered to detect smaller medication differences is the next step in more accurately determining the effect of Reiki on pain management.

Current state of micro-robots/devices as substitutes for screening colonoscopy: assessment based on technology readiness levels.

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Tapia-Siles, Silvia C; Coleman, Stuart; Cuschieri, Alfred

2016-02-01

Previous reports have described several candidates, which have the potential to replace colonoscopy, but to date, there is still no device capable of fully replacing flexible colonoscopy in the management of colonic disorders and for mass adult population screening for asymptomatic colorectal cancer. NASA developed the TRL methodology to describe and define the stages of development before use and marketing of any device. The definitions of the TRLS used in the present review are those formulated by "The US Department of Defense Technology Readiness Assessment Guidance" but adapted to micro-robots for colonoscopy. All the devices included are reported in scientific literature. They were identified by a systematic search in Web of Science, PubMed and IEEE Xplore amongst other sources. Devices that clearly lack the potential for full replacement of flexible colonoscopy were excluded. The technological salient features of all the devices included for assessment are described briefly, with particular focus on device propulsion. The devices are classified according to the TRL criteria based on the reported information. An analysis is next undertaken of the characteristics and salient features of the devices included in the review: wireless/tethered devices, data storage-transmission and navigation, additional functionality, residual technology challenges and clinical and socio-economical needs. Few devices currently possess the required functionality and performance to replace the conventional colonoscopy. The requirements, including functionalities which favour the development of a micro-robot platform to replace colonoscopy, are highlighted.

Measuring cognitive load during procedural skills training with colonoscopy as an exemplar.

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Sewell, Justin L; Boscardin, Christy K; Young, John Q; Ten Cate, Olle; O'Sullivan, Patricia S

2016-06-01

Few studies have investigated cognitive factors affecting learning of procedural skills in medical education. Cognitive load theory, which focuses on working memory, is highly relevant, but methods for measuring cognitive load during procedural training are not well understood. Using colonoscopy as an exemplar, we used cognitive load theory to develop a self-report instrument to measure three types of cognitive load (intrinsic, extraneous and germane load) and to provide evidence for instrument validity. We developed the instrument (the Cognitive Load Inventory for Colonoscopy [CLIC]) using a multi-step process. It included 19 items measuring three types of cognitive load, three global rating items and demographics. We then conducted a cross-sectional survey that was administered electronically to 1061 gastroenterology trainees in the USA. Participants completed the CLIC following a colonoscopy. The two study phases (exploratory and confirmatory) each lasted for 10 weeks during the 2014-2015 academic year. Exploratory factor analysis determined the most parsimonious factor structure; confirmatory factor analysis assessed model fit. Composite measures of intrinsic, extraneous and germane load were compared across years of training and with global rating items. A total of 477 (45.0%) invitees participated (116 in the exploratory study and 361 in the confirmatory study) in 154 (95.1%) training programmes. Demographics were similar to national data from the USA. The most parsimonious factor structure included three factors reflecting the three types of cognitive load. Confirmatory factor analysis verified that a three-factor model was the best fit. Intrinsic, extraneous and germane load items had high internal consistency (Cronbach's alpha 0.90, 0.87 and 0.96, respectively) and correlated as expected with year in training and global assessment of cognitive load. The CLIC measures three types of cognitive load during colonoscopy training. Evidence of validity is

App-assisted external ventricular drain insertion.

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Eftekhar, Behzad

2016-09-01

The freehand technique for insertion of an external ventricular drain (EVD) is based on fixed anatomical landmarks and does not take individual variations into consideration. A patient-tailored approach based on augmented-reality techniques using devices such as smartphones can address this shortcoming. The Sina neurosurgical assist (Sina) is an Android mobile device application (app) that was designed and developed to be used as a simple intraoperative neurosurgical planning aid. It overlaps the patient's images from previously performed CT or MRI studies on the image seen through the device camera. The device is held by an assistant who aligns the images and provides information about the relative position of the target and EVD to the surgeon who is performing EVD insertion. This app can be used to provide guidance and continuous monitoring during EVD placement. The author describes the technique of Sina-assisted EVD insertion into the frontal horn of the lateral ventricle and reports on its clinical application in 5 cases as well as the results of ex vivo studies of ease of use and precision. The technique has potential for further development and use with other augmented-reality devices.

Quality of Colonoscopy Performed in Rural Practice: Experience From the Clinical Outcomes Research Initiative and the Oregon Rural Practice-Based Research Network.

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Holub, Jennifer L; Morris, Cynthia; Fagnan, Lyle J; Logan, Judith R; Michaels, LeAnn C; Lieberman, David A

2018-02-01

Colon cancer screening is effective. To complete screening in 80% of individuals over age 50 years by 2018 will require adequate colonoscopy capacity throughout the country, including rural areas, where colonoscopy providers may have less specialized training. Our aim was to study the quality of colonoscopy in rural settings. The Clinical Outcomes Research Initiative (CORI) and the Oregon Rural Practice-based Research Network (ORPRN) collaborated to recruit Oregon rural practices to submit colonoscopy reports to CORI's National Endoscopic Database (NED). Ten ORPRN sites were compared to non-ORPRN rural (n = 11) and nonrural (n = 43) sites between January 2009 and October 2011. Established colonoscopy quality measures were calculated for all sites. No ORPRN physicians were gastroenterologists compared with 82% of nonrural physicians. ORPRN practices reached the cecum in 87.4% of exams compared with 89.3% of rural sites (P = .0002) and 90.9% of nonrural sites (P 9mm 16.6% vs 18.7% (P = .106). ORPRN sites performed well on most colonoscopy quality measures, suggesting that high-quality colonoscopy can be performed in rural settings. © 2016 National Rural Health Association.

Midazolam versus diazepam for combined esophogastroduodenoscopy and colonoscopy.

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Brouillette, D E; Leventhal, R; Kumar, S; Berman, D; Kajani, M; Yoo, Y K; Carra, J; Tarter, R; Van Thiel, D H

1989-08-01

This study compares the effects of two different benzodiazepines used for conscious sedation during combined upper gastrointestinal endoscopy (EGD) and colonoscopy. Subjects were assessed for their degree of analgesia and amnesia for the procedure, prior experience with endoscopy, and willingness to undergo another similar procedure should such be necessary. The patients were randomized single blind to receive either midazolam or diazepam for their preprocedure sedation. The amount of preprocedure sedation utilized was determined by titration of the dose to achieve slurring of speech. Prior to receiving either agent, the subjects were shown a standard card containing pictures of 10 common objects, were asked to name and remember them, and were told they would be "quizzed" (at 30 min and 24 hr) after being sedated for their recollection as to the objects pictured on the card. Each subject filled out a questionnaire addressing their perceived discomfort during the endoscopic procedure and their memory of the procedure 24 hr after the procedure. Sixty-three percent of the midazolam-sedated subjects reported total amnesia for their colonoscopy vs 20% of diazepam-sedated patients (P less than 0.001). Fifty-three percent of midazolam-sedated patients reported total amnesia of their upper gastrointestinal endoscopy vs only 23% of diazepam-sedated subjects (P less than 0.05). The midazolam-sedated subjects reported experiencing less pain with both upper gastrointestinal endoscopy (P less than 0.05) and colonoscopy (P less than 0.001) than did the diazepam-sedated group. Most importantly, the midazolam group was more willing to undergo another similar endoscopic procedure should they be asked to do so by their physician (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Optimal preparation-to-colonoscopy interval in split-dose PEG bowel preparation determines satisfactory bowel preparation quality: an observational prospective study.

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Seo, Eun Hee; Kim, Tae Oh; Park, Min Jae; Joo, Hee Rin; Heo, Nae Yun; Park, Jongha; Park, Seung Ha; Yang, Sung Yeon; Moon, Young Soo

2012-03-01

Several factors influence bowel preparation quality. Recent studies have indicated that the time interval between bowel preparation and the start of colonoscopy is also important in determining bowel preparation quality. To evaluate the influence of the preparation-to-colonoscopy (PC) interval (the interval of time between the last polyethylene glycol dose ingestion and the start of the colonoscopy) on bowel preparation quality in the split-dose method for colonoscopy. Prospective observational study. University medical center. A total of 366 consecutive outpatients undergoing colonoscopy. Split-dose bowel preparation and colonoscopy. The quality of bowel preparation was assessed by using the Ottawa Bowel Preparation Scale according to the PC interval, and other factors that might influence bowel preparation quality were analyzed. Colonoscopies with a PC interval of 3 to 5 hours had the best bowel preparation quality score in the whole, right, mid, and rectosigmoid colon according to the Ottawa Bowel Preparation Scale. In multivariate analysis, the PC interval (odds ratio [OR] 1.85; 95% CI, 1.18-2.86), the amount of PEG ingested (OR 4.34; 95% CI, 1.08-16.66), and compliance with diet instructions (OR 2.22l 95% CI, 1.33-3.70) were significant contributors to satisfactory bowel preparation. Nonrandomized controlled, single-center trial. The optimal time interval between the last dose of the agent and the start of colonoscopy is one of the important factors to determine satisfactory bowel preparation quality in split-dose polyethylene glycol bowel preparation. Copyright © 2012 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

Comparison of a 4-Day versus 2-Day Low Fiber Diet Regimen in Barium Tagging CT Colonography in Incomplete Colonoscopy Patients

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Kaan Meric

2015-01-01

Full Text Available Our aim was to compare the amount of residual feces, residual fluid, the tagging quality, and patient compliance using 4-day versus 2-day low fiber diet regimen in barium tagging CT colonography in incomplete colonoscopy patients. Methods. A total of 101 patients who underwent CT colonography were assigned to 2-day diet group (n=56 and 4-day diet group (n=45. Fecal tagging was achieved with barium sulphate while bisacodyl and sennoside B were used for bowel preparation. Residual solid stool was divided into two groups measuring 0.05. The prevalence of moderate discomfort was significantly higher in 4-day group (P<0.001. Conclusion. Our study shows that 2-day limited bowel preparation regimen for fecal tag CT colonography is a safe and reasonable technique to evaluate the entire colon, particularly in incomplete conventional colonoscopy patients.

Development of a Robotic Colonoscopic Manipulation System, Using Haptic Feedback Algorithm.

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Woo, Jaehong; Choi, Jae Hyuk; Seo, Jong Tae; Kim, Tae Il; Yi, Byung Ju

2017-01-01

Colonoscopy is one of the most effective diagnostic and therapeutic tools for colorectal diseases. We aim to propose a master-slave robotic colonoscopy that is controllable in remote site using conventional colonoscopy. The master and slave robot were developed to use conventional flexible colonoscopy. The robotic colonoscopic procedure was performed using a colonoscope training model by one expert endoscopist and two unexperienced engineers. To provide the haptic sensation, the insertion force and the rotating torque were measured and sent to the master robot. A slave robot was developed to hold the colonoscopy and its knob, and perform insertion, rotation, and two tilting motions of colonoscope. A master robot was designed to teach motions of the slave robot. These measured force and torque were scaled down by one tenth to provide the operator with some reflection force and torque at the haptic device. The haptic sensation and feedback system was successful and helpful to feel the constrained force or torque in colon. The insertion time using robotic system decreased with repeated procedures. This work proposed a robotic approach for colonoscopy using haptic feedback algorithm, and this robotic device would effectively perform colonoscopy with reduced burden and comparable safety for patients in remote site.

Development of a Robotic Colonoscopic Manipulation System, Using Haptic Feedback Algorithm

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Woo, Jaehong; Choi, Jae Hyuk; Seo, Jong Tae

2017-01-01

Purpose Colonoscopy is one of the most effective diagnostic and therapeutic tools for colorectal diseases. We aim to propose a master-slave robotic colonoscopy that is controllable in remote site using conventional colonoscopy. Materials and Methods The master and slave robot were developed to use conventional flexible colonoscopy. The robotic colonoscopic procedure was performed using a colonoscope training model by one expert endoscopist and two unexperienced engineers. To provide the haptic sensation, the insertion force and the rotating torque were measured and sent to the master robot. Results A slave robot was developed to hold the colonoscopy and its knob, and perform insertion, rotation, and two tilting motions of colonoscope. A master robot was designed to teach motions of the slave robot. These measured force and torque were scaled down by one tenth to provide the operator with some reflection force and torque at the haptic device. The haptic sensation and feedback system was successful and helpful to feel the constrained force or torque in colon. The insertion time using robotic system decreased with repeated procedures. Conclusion This work proposed a robotic approach for colonoscopy using haptic feedback algorithm, and this robotic device would effectively perform colonoscopy with reduced burden and comparable safety for patients in remote site. PMID:27873506

E2LEMI:Energy-Efficient Logic Encryption Using Multiplexer Insertion

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Qutaiba Alasad

2017-02-01

Full Text Available Due to the outsourcing of chip manufacturing, countermeasures against Integrated Circuit (IC piracy, reverse engineering, IC overbuilding and hardware Trojans (HTs become a hot research topic. To protect an IC from these attacks, logic encryption techniques have been considered as a low-cost defense mechanism. In this paper, our proposal is to insert the multiplexer (MUX with two cases: (i we randomly insert MUXs equal to half of the output bit number (half MUX insertions; and (ii we insert MUXs equal to the number of output bits (full MUX insertions. Hamming distance is adopted as a security evaluation. We also measure the delay, power and area overheads with the proposed technique.

Findings in young adults at colonoscopy from a hospital service database audit.

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Wong, Stephanie; Lidums, Ilmars; Rosty, Christophe; Ruszkiewicz, Andrew; Parry, Susan; Win, Aung Ko; Tomita, Yoko; Vatandoust, Sina; Townsend, Amanda; Patel, Dainik; Hardingham, Jennifer E; Roder, David; Smith, Eric; Drew, Paul; Marker, Julie; Uylaki, Wendy; Hewett, Peter; Worthley, Daniel L; Symonds, Erin; Young, Graeme P; Price, Timothy J; Young, Joanne P

2017-04-19

Colorectal cancer (CRC) diagnosed at young adults. The aim of this work was to document the prevalence and histological subtype of lesions seen in patients aged <50 years, and any associated clinical features. An audit of the colonoscopy database at The Queen Elizabeth Hospital in Adelaide, South Australia over a 12-month period was undertaken. Findings were recorded from both colonoscopy reports and corresponding histological examination of excised lesions. Data were extracted from colonoscopies in 2064 patients. Those aged <50 comprised 485 (24%) of the total. CRC precursor lesions (including sessile serrated adenoma/polyps (SSA/P), traditional serrated adenomas, tubular adenomas ≥10 mm or with high-grade dysplasia, and conventional adenomas with villous histology) were seen in 4.3% of patients aged <50 and 12.9% of patients aged ≥50 (P <0.001). Among colonoscopies yielding CRC precursor lesions in patients under 50 years, SSA/P occurred in 52% of procedures (11/21), compared with 27% (55/204) of procedures in patients aged 50 and older (P = 0.02). SSA/P were proximally located in (10/11) 90% of patients aged under 50, and 80% (43/54) of those aged 50 and older (P = 0.46). SSA/P were the most frequently observed CRC precursor lesions in patients aged <50. Most CRCs in this age group are known to arise in the distal colon and rectum suggesting that lesions other than SSA/P may serve as the precursor for the majority of early-onset CRC.

Evidence-based recommendations for bowel cleansing before colonoscopy in children: a report from a national working group.

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Turner, D; Levine, A; Weiss, B; Hirsh, A; Shamir, R; Shaoul, R; Berkowitz, D; Bujanover, Y; Cohen, S; Eshach-Adiv, O; Jamal, Gera; Kori, M; Lerner, A; On, A; Rachman, L; Rosenbach, Y; Shamaly, H; Shteyer, E; Silbermintz, A; Yerushalmi, B

2010-12-01

There are no current recommendations for bowel cleansing before colonoscopy in children. The Israeli Society of Pediatric Gastroenterology and Nutrition (ISPGAN) established an iterative working group to formulate evidence-based guidelines for bowel cleansing in children prior to colonoscopy. Data were collected by systematic review of the literature and via a national-based survey of all endoscopy units in Israel. Based on the strength of evidence, the Committee reached consensus on six recommended protocols in children. Guidelines were finalized after an open audit of ISPGAN members. Data on 900 colonoscopies per year were accrued, which represents all annual pediatric colonoscopies performed in Israel. Based on the literature review, the national survey, and the open audit, several age-stratified pediatric cleansing protocols were proposed: two PEG-ELS protocols (polyethylene-glycol with electrolyte solution); Picolax-based protocol (sodium picosulphate with magnesium citrate); sodium phosphate protocol (only in children over the age of 12 years who are at low risk for renal damage); stimulant laxative-based protocol (e. g. bisacodyl); and a PEG 3350-based protocol. A population-based analysis estimated that the acute toxicity rate of oral sodium phosphate is at most 3/7320 colonoscopies (0.041 %). Recommendations on diet and enema use are provided in relation to each proposed protocol. There is no ideal bowel cleansing regimen and, thus, various protocols are in use. We propose several evidence-based protocols to optimize bowel cleansing in children prior to colonoscopy and minimize adverse events. © Georg Thieme Verlag KG Stuttgart · New York.

A retrospective study on the use of post-operative colonoscopy following potentially curative surgery for colorectal cancer in a Canadian province

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Bryant Heather E

2004-04-01

Full Text Available Abstract Background Surveillance colonoscopy is commonly recommended following potentially curative surgery for colorectal cancer. We determined factors associated with patients undergoing a least one colonoscopy within five years of surgery. Methods In this historical cohort study, data on 3918 patients age 30 years or older residing in Alberta, Canada, who had undergone a potentially curative surgical resection for local or regional stage colorectal cancer between 1983 and 1995 were obtained from the provincial cancer registry, ministry of health and cancer clinic charts. Kaplan-Meier estimates of the probability of undergoing a post-operative colonoscopy were calculated for patient, tumor and treatment-related variables of interest. Results A colonoscopy was performed within five years of surgery in 1979 patients. The probability of undergoing a colonoscopy for those diagnosed in the 1990s was greater than for those diagnosed earlier (0.65 vs 0.55, P Conclusions The majority of patients undergo colonoscopy following colorectal cancer surgery. However, there are important variations in surveillance practices across different patient and treatment characteristics.

The Conversion of Planned Colonoscopy to Sigmoidoscopy and the Effect of this Practice on the Measurement of Quality Indicators.

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Beg, Sabina; Sansone, Stefano; Manguso, Francesco; Schembri, John; Patel, Jay; Thoufeeq, Mo; Corbett, Gareth; Ragunath, Krish

2017-10-01

A cecal intubation rate (CIR) of >90% is a well-accepted quality indicator of colonoscopy and is consequently monitored within endoscopy units. Endoscopists' desire to meet this target may mean that incomplete colonoscopies are recorded as flexible sigmoidoscopies. The aim of this study was to examine whether the conversion of requested colonoscopies is a clinically significant phenomenon and whether this impacts upon the measurement of quality indicators. A retrospective review of all flexible sigmoidoscopies performed between 1 January 2015 and 31 December 2015 at Nottingham University Hospitals, Sheffield Teaching Hospitals, and Cambridge University Hospitals was performed. Where a colonoscopy was requested but a flexible sigmoidoscopy performed, the patient's records and endoscopy reports were reviewed to determine whether this conversion was decided before the start of the procedure and documented. During the 12-month period, 6,839 flexible sigmoidoscopies were performed by 125 endoscopists. The original requests of 149 sigmoidoscopies could not be retrieved and were therefore excluded from this analysis. Of the 6,690 sigmoidoscopy requests reviewed, 2.8% (n=190) procedures were originally requested as a colonoscopy. On review of patient records, 85 conversions were appropriate according to pre-defined criteria. However, 105 conversions were deemed inappropriate, occurring in patients who had a valid documented indication for colonoscopy and had undergone full bowel preparation. The most common reasons cited included poor bowel preparation (n=37), technically challenging procedure (n=24), at the endoscopist's discretion based on clinical factors (n=21), and obstructing patology (n=8). A clear reason for conversion was not apparent in 11 cases. During the study period, 21,271 colonoscopies were performed and so conversions represent 0.45% of the total requests. When inappropriate conversions were included in individuals' performance data, 15 endoscopists fell

Development of a colonoscopy add-on device for improvement of the intubation process

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Litten JD

2011-12-01

Full Text Available Jonathan D Litten1, JungHun Choi2, David Drozek31Department of Mechanical Engineering; 2Department of Mechanical Engineering and Biomedical Engineering Program; 3College of Osteopathic Medicine, Department of Specialty Medicine, Ohio University, Athens, OH, USAAbstract: A colonoscopy add-on device has been developed to reduce intubation time without modification of the current colonoscope and peripheral devices. One of the main purposes of the system is to minimize trauma caused by the distal tip of the colonoscope. The detachable sensory fixture at the end of the distal tip measures the distance between the distal tip and the colon wall in three directions, and the actuation system attached at the base of the colonoscope controls the distal tip by rotating two dial knobs. The device controls the distal tip to minimize contact between the distal tip and the colon wall, and the distal tip ideally points out the next possible lumen. A compatibility test of the infrared sensory system was carried out, and the design of the actuation system was accomplished. The system is integrated and controlled by a microprocessor. The device was tested in a silicon colon and porcine intestine. The results showed that a colonoscopist successfully reached the cecum with the aid of the colonoscopy add-on device without significant contact between the colon wall and the distal tip. The colonoscopy aid device was very helpful for the novice colonoscopist.Keywords: colonoscope, infrared sensors, intubation, trauma, colonoscopy training model

Risk of metachronous neoplasia on surveillance colonoscopy in young patients with colorectal neoplasia.

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Kim, Hyun Gun; Cho, Young-Seok; Cha, Jae Myung; Shin, Jeong Eun; Kim, Kyeong Ok; Yang, Hyo-Joon; Koo, Hoon Sup; Joo, Young-Eun; Boo, Sun-Jin

2018-03-01

Few prior reports exist that address the appropriate colonoscopy surveillance interval for individuals  .1). In the baseline low-risk adenoma group (n = 1869), the 5-year risk of metachronous advanced neoplasia was 4.9% in the younger patients on screening colonoscopy and 5.1% in the older patients (P > .1). Similarly, in the baseline no neoplasia group (n = 7013), the 5-year risk of metachronous advanced neoplasia was 4.1% in the younger patients on screening colonoscopy and 5.6% in the older patients (P > .1). Considering the similar risk of metachronous advanced neoplasia in younger and older individuals, we suggest a 3-year surveillance interval for high-risk adenoma and a 5-year surveillance interval for low-risk adenoma in young individuals without a strong family history. Copyright © 2018 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Differences between husbands and wives in colonoscopy use: Results from a national sample of married couples.

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Kotwal, Ashwin A; Lauderdale, Diane S; Waite, Linda J; Dale, William

2016-07-01

Marriage is linked to improved colorectal cancer-related health, likely in part through preventive health behaviors, but it is unclear what role spouses play in colorectal cancer screening. We therefore determine whether self-reported colonoscopy rates are correlated within married couples and the characteristics of spouses associated with colonoscopy use in each partner. We use US nationally-representative 2010 data which includes 804 male-female married couples drawn from a total sample of 3137 community-dwelling adults aged 55-90years old. Using a logistic regression model in the full sample (N=3137), we first find married men have higher adjusted colonoscopy rates than unmarried men (61% versus 52%, p=0.023), but women's rates do not differ by marital status. In the couples' sample (N=804 couples), we use a bivariate probit regression model to estimate multiple regression equations for the two spouses simultaneously as a function of individual and spousal covariates, as well as the adjusted correlation within couples. We find that individuals are nearly twice as likely to receive a colonoscopy if their spouse recently has had one (OR=1.94, 95% CI: 1.39, 2.67, pvs 51%, p=0.020); 2) more highly educated (72% vs 51%, p=0.020), and 3) viewed as more supportive (65% vs 52%, p=0.020). Recognizing the role of marital status, relationship quality, and spousal characteristics on colonoscopy uptake, particularly in men, could help physicians increase guideline adherence. Copyright © 2016. Published by Elsevier Inc.

Rural Disparities in Treatment-Related Financial Hardship and Adherence to Surveillance Colonoscopy in Diverse Colorectal Cancer Survivors.

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McDougall, Jean A; Banegas, Matthew P; Wiggins, Charles L; Chiu, Vi K; Rajput, Ashwani; Kinney, Anita Y

2018-03-28

Cancer survivors increasingly report financial hardship as a consequence of the high cost of cancer care, yet the financial experience of rural cancer survivors remains largely unstudied. The purpose of this study was to investigate potential rural disparities in the likelihood of financial hardship and nonadherence to surveillance colonoscopy. Individuals diagnosed with localized or regional colorectal cancer (CRC) between 2004-2012 were ascertained by the population-based New Mexico Tumor Registry. Participants completed a mailed questionnaire or telephone survey about their CRC survivorship experience, including treatment-related financial hardship and receipt of surveillance colonoscopy. Multivariable logistic regression was used to estimate adjusted odds ratios (OR) and 95% confidence intervals (CI). Compared to urban CRC survivors (n=168), rural CRC survivors (n=109) were slightly older, more likely to be married (65% v. 59%) and have an annual income financial hardship (OR 1.86, 95% CI 1.06-3.28) and nonadherence to surveillance colonoscopy guidelines (OR 2.28, 95% CI 1.07-4.85). In addition, financial hardship was independently associated with nonadherence to surveillance colonoscopy (OR 2.17, 95% CI 1.01-4.85). Substantial rural disparities in the likelihood of financial hardship and nonadherence to surveillance colonoscopy exist. Treatment-related financial hardship among rural CRC survivors may negatively impact adherence to guideline recommended follow-up care. Copyright ©2018, American Association for Cancer Research.

An Automated Inpatient Split-dose Bowel Preparation System Improves Colonoscopy Quality and Reduces Repeat Procedures.

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Yadlapati, Rena; Johnston, Elyse R; Gluskin, Adam B; Gregory, Dyanna L; Cyrus, Rachel; Werth, Lindsay; Ciolino, Jody D; Grande, David P; Keswani, Rajesh N

2017-07-19

Inpatient colonoscopy preparations are often inadequate, compromising patient safety and procedure quality, while resulting in greater hospital costs. The aims of this study were to: (1) design and implement an electronic inpatient split-dose bowel preparation order set; (2) assess the intervention's impact upon preparation adequacy, repeated colonoscopies, hospital days, and costs. We conducted a single center prospective pragmatic quasiexperimental study of hospitalized adults undergoing colonoscopy. The experimental intervention was designed using DMAIC (define, measure, analyze, improve, and control) methodology. Prospective data collected over 12 months were compared with data from a historical preintervention cohort. The primary outcome was bowel preparation quality and secondary outcomes included number of repeated procedures, hospital days, and costs. On the basis of a Delphi method and DMAIC process, we created an electronic inpatient bowel preparation order set inclusive of a split-dose bowel preparation algorithm, automated orders for rescue medications, and nursing bowel preparation checks. The analysis data set included 969 patients, 445 (46%) in the postintervention group. The adequacy of bowel preparation significantly increased following intervention (86% vs. 43%; P<0.01) and proportion of repeated procedures decreased (2.0% vs. 4.6%; P=0.03). Mean hospital days from bowel preparation initiation to discharge decreased from 8.0 to 6.9 days (P=0.02). The intervention resulted in an estimated 1-year cost-savings of $46,076 based on a reduction in excess hospital days associated with repeated and delayed procedures. Our interdisciplinary initiative targeting inpatient colonoscopy preparations significantly improved quality and reduced repeat procedures, and hospital days. Other institutions should consider utilizing this framework to improve inpatient colonoscopy value.

BOWEL PREPARATION BEFORE COLONOSCOPY FOR CHILDREN: comparison of efficacy of three different methods

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Seyed Mohsen DEHGHANI

2015-12-01

Full Text Available Background - Colonoscopy is an important diagnostic and therapeutic procedure. Adequate bowel preparation is mandatory. Several regimens were discussed in the literature. Among the drugs which has recently used, polyethylene glycol is one of the most popular agents. Objectives - The aim of this study was to compare efficacy of three different methods for 1 day preparation before colonoscopy. Methods - This study included children with the range of ages (2-21 who had an indication of colonoscopy. Exclusion criteria were based on the history of previous surgery, parental disagreement, and patients who did not use preparation protocol. Three methods for bowel preparation were studied: 1- Polyethylene glycol only; 2- Polyethylene glycol and bisacodyl suppositories; 3- Polyethylene glycol plus normal saline enema. Boston Bowel Preparation Score was used for evaluation of preparation. SPSS version 16.0 (Chicago, IL, USA were used for data analysis. Results - In this study 83 cases completed the bowel preparation completely. Acceptable bowel preparation was seen in 24 (85.71%, 36 (94.73%, and 14 (82.35% of cases in PEG, PEG + bisacodyl, and PEG + normal saline enema groups respectively. PEG + bisacodyl suppositories was more effective than PEG + normal saline for the preparation of the first segment ( P=0.05. For second and third segment of colon, BPPS score was higher in PEG + bisacodyl suppositories compared to other regimens, but this difference was not statistically significant. Conclusion - There was no significant difference between 1 day colonoscopy regimens in terms of bowel preparation score. Lowest score was seen in PEG + enema group compared to other group.

BOWEL PREPARATION BEFORE COLONOSCOPY FOR CHILDREN: comparison of efficacy of three different methods.

Science.gov (United States)

Dehghani, Seyed Mohsen; Javaherizadeh, Hazhir; Haghighat, Mahmood; Imanieh, Mohammad-Hadi; Ghanbari, Saeed

2015-12-01

Colonoscopy is an important diagnostic and therapeutic procedure. Adequate bowel preparation is mandatory. Several regimens were discussed in the literature. Among the drugs which has recently used, polyethylene glycol is one of the most popular agents. The aim of this study was to compare efficacy of three different methods for 1 day preparation before colonoscopy. This study included children with the range of ages (2-21) who had an indication of colonoscopy. Exclusion criteria were based on the history of previous surgery, parental disagreement, and patients who did not use preparation protocol. Three methods for bowel preparation were studied: 1- Polyethylene glycol only; 2- Polyethylene glycol and bisacodyl suppositories; 3- Polyethylene glycol plus normal saline enema. Boston Bowel Preparation Score was used for evaluation of preparation. SPSS version 16.0 (Chicago, IL, USA) were used for data analysis. In this study 83 cases completed the bowel preparation completely. Acceptable bowel preparation was seen in 24 (85.71%), 36 (94.73%), and 14 (82.35%) of cases in PEG, PEG + bisacodyl, and PEG + normal saline enema groups respectively. PEG + bisacodyl suppositories was more effective than PEG + normal saline for the preparation of the first segment ( P=0.05). For second and third segment of colon, BPPS score was higher in PEG + bisacodyl suppositories compared to other regimens, but this difference was not statistically significant. There was no significant difference between 1 day colonoscopy regimens in terms of bowel preparation score. Lowest score was seen in PEG + enema group compared to other group.

Understanding intention to undergo colonoscopy among intermediate-risk siblings of colorectal cancer patients: a test of a mediational model.

Science.gov (United States)

Manne, Sharon; Markowitz, Arnold; Winawer, Sidney; Guillem, Jose; Meropol, Neal J; Haller, Daniel; Jandorf, Lina; Rakowski, William; Babb, James; Duncan, Terry

2003-01-01

There is a need for research to identify factors influencing intentions to undergo colorectal cancer (CRC) screening among family members at risk for CRC. This study tested a mediational model primarily guided by Ronis' elaboration of the Health Belief Model in predicting intention to have colorectal cancer screening among siblings of individuals diagnosed with colorectal cancer prior to age 56 years. Data were collected from 534 siblings of individuals diagnosed with CRC. A baseline survey was administered by telephone. Measures included perceived susceptibility, CRC severity, physician and family support for CRC screening, cancer-specific distress, the closeness of the relationship with the affected sibling, and future intention to have a colonoscopy. Participant age, gender, and number of prior colonoscopies, as well as the stage of the affected patient's cancer and time from the patient's diagnosis to the interview, were controlled for in the analyses. The proposed model was not a good fit to the data. A respecified model was fit to the data. In this model, physician support, family support, and sibling closeness were significantly associated with both perceived benefits and barriers. Perceived severity was associated with barriers. Benefits and barriers, as well as cancer-specific distress, were directly associated with colonoscopy intentions. Results were consistent with a mediational role for benefits and barriers in the associations of sibling closeness and with a mediational role for barriers in the association between perceived severity and colonoscopy intentions. Family and physician support impacted intentions both directly and indirectly through effects on benefits and barriers. Perceived risk was not associated with benefits, barriers, or colonoscopy intentions. Intervention efforts to increase colonoscopy intentions may benefit from targeting family influences, particularly the affected proband in the family, as well as physician influence, cancer

Factors influencing change in clinical practice: A qualitative evaluation of the implementation of the quality improvement in colonoscopy study.

Science.gov (United States)

Rajasekhar, Praveen T; Rees, Colin J; Nixon, Catherine; East, James E; Brown, Sally

2016-01-01

The quality improvement in colonoscopy study was a region wide service improvement study to improve adenoma detection rate at colonoscopy by implementing evidence into routine colonoscopy practice. Implementing evidence into clinical practice can be challenging. The purpose of this paper is to perform a qualitative interview study to evaluate factors that influenced implementation within the study. Semi-structured interviews were conducted with staff in endoscopy units taking part in the quality improvement in colonoscopy study, after study completion. Units and interviewees were purposefully sampled to ensure a range of experiences was represented. Interviews were conducted with 11 participants. Key themes influencing uptake of the quality improvement in colonoscopy evidence bundle included time, study promotion, training, engagement, positive outcomes and modifications. Areas within themes were increased awareness of quality in colonoscopy (QIC), emphasis on withdrawal time and empowerment of endoscopy nurses to encourage the use of quality measures were positive outcomes of the study. The simple, visible study posters were reported as useful in aiding study promotion. Feedback sessions improved engagement. Challenges included difficulty arranging set-up meetings and engaging certain speciality groups. This evaluation suggests that methods to implement evidence into clinical practice should include identification and empowerment of team members who can positively influence engagement, simple, visible reminders and feedback. Emphasis on timing of meetings and strategies to engage speciality groups should also be given consideration. Qualitative evaluations can provide important insights into why quality improvement initiatives are successful or not, across different sites.

A randomized controlled trial of an educational video to improve quality of bowel preparation for colonoscopy.

Science.gov (United States)

Park, Jin-Seok; Kim, Min Su; Kim, HyungKil; Kim, Shin Il; Shin, Chun Ho; Lee, Hyun Jung; Lee, Won Seop; Moon, Soyoung

2016-06-17

High-quality bowel preparation is necessary for colonoscopy. A few studies have been conducted to investigate improvement in bowel preparation quality through patient education. However, the effect of patient education on bowel preparation has not been well studied. A randomized and prospective study was conducted. All patients received regular instruction for bowel preparation during a pre-colonoscopy visit. Those scheduled for colonoscopy were randomly assigned to view an educational video instruction (video group) on the day before the colonoscopy, or to a non-video (control) group. Qualities of bowel preparation using the Ottawa Bowel Preparation Quality scale (Ottawa score) were compared between the video and non-video groups. In addition, factors associated with poor bowel preparation were investigated. A total of 502 patients were randomized, 250 to the video group and 252 to the non-video group. The video group exhibited better bowel preparation (mean Ottawa total score: 3.03 ± 1.9) than the non-video group (4.21 ± 1.9; P educational video could improve the quality of bowel preparation in comparison with standard preparation method. Clinical Research Information Service KCT0001836 . The date of registration: March, 08(th), 2016, Retrospectively registered.

Effectiveness of a multimedia-based educational intervention for improving colon cancer literacy in screening colonoscopy patients.

Science.gov (United States)

Hassinger, James P; Holubar, Stefan D; Pendlimari, Rajesh; Dozois, Eric J; Larson, David W; Cima, Robert R

2010-09-01

Limited data exist regarding colon cancer literacy in screening colonoscopy patients. We aimed to prospectively assess baseline colon cancer literacy and to determine whether a multimedia educational intervention was associated with improved colon cancer literacy. Colon cancer literacy was assessed in a convenience sample of colonoscopy patients before and after educational intervention. Statistically significant associations with colon cancer literacy scores were assessed by use of multivariate logistic regression analysis. Results are frequency (proportion), mean +/- SD, and odds ratio (OR (95% CI)). Seventy-three subjects participated: mean age, 57 +/- 12 years, 35 (48%) were women, 41 (57%) had a college degree, 43 (59%) had prior colonoscopy, 21 (29%) were accompanying family, and 16 (22%) were health care employees. Multivariate factors associated with a higher baseline colon cancer literacy score included health care employee status (7.9 (95% CI, 1.6-63); P = .02) and family colon cancer history (5.3 (95% CI, 1.3-25); P = .02). After multimedia education, mean scores improved from 53% +/- 23% to 88% +/- 12% (Delta = 35%; P screening colonoscopy. Multimedia-based educational intervention was an effective, satisfying strategy for addressing cancer-specific knowledge deficit in laypersons.

Acceptance of Colonoscopy Requires more than Test Tolerance

Directory of Open Access Journals (Sweden)

Amanda Condon

2008-01-01

Full Text Available BACKGROUND: Colon cancer screening, including colonoscopy, lags behind other forms of cancer screening for participation rates. The intrinsic nature of the endoscopic procedure may be an important barrier that limits patients from finding this test acceptable and affects willingness to undergo screening. With colon cancer screening programs emerging in Canada, test characteristics and their impact on acceptance warrant consideration.

Laparoscopic insertion of the Moss feeding tube.

Science.gov (United States)

Albrink, M H; Hagan, K; Rosemurgy, A S

1993-12-01

Placement of enteral feeding tubes is an important part of a surgeon's skill base. Surgical insertion of feeding tubes has been performed safely for many years with very few modifications. With the recent surge in interest and applicability of other laparoscopic procedures, it is well within the skills of the average laparoscopic surgeon to insert feeding tubes. We describe herein a simple technique for the insertion of the Moss feeding tube. The procedure described has a minimum of invasion, along with simplicity, safety, and accuracy.

Colonoscopy

Science.gov (United States)

... passed up to the colon. Small amounts of air are inserted to open the colon and allow viewing of the surrounding area. The tube has a light and camera at the end and sends a picture to a TV screen. Your heart rate, breathing, and oxygen level will ...

Temporal trends and variability of colonoscopy performance in a gastroenterology practice.

Science.gov (United States)

le Clercq, Chantal M C; Mooi, Rick J; Winkens, Bjorn; Salden, Bouke N H; Bakker, C Minke; van Nunen, Annick B; Keulen, Eric P T; de Ridder, Rogier J; Masclee, Ad A M; Sanduleanu, Silvia

2016-03-01

Quality measures for colonoscopy are operator dependent and vary. It is unclear whether quality measures change over time. In this study, time-dependent variation in colonoscopy performance was examined in a gastroenterology practice. Colonoscopy and histopathology records that were collected at three hospitals (one university and two non-university hospitals) over three time periods (2007, 2010, and 2013) were reviewed. Data from colonoscopists performing at least 100 procedures per year were analyzed. Inter-colonoscopist variation in performance (i. e. adjusted cecal intubation rate [aCIR], adenoma detection rate [ADR], advanced ADR, mean adenomas per procedure [MAP], proximal ADR, nonpolypoid ADR, and serrated polyp detection rate) were examined using coefficients of variation. Logistic regression analyses were also performed, adjusting for covariates. A total of 23 colonoscopists performing 6400 procedures were included. Overall, the mean aCIR, ADR, MAP, and proximal ADR improved significantly over time, from 91.9 %, 22.5 %, 0.37, and 10.2 % in 2007 to 95.3 %, 25.8 %, 0.45, and 13.4 %, respectively, in 2013 (P gastroenterology clinical practice. Core quality measures improved over time, mainly through improvement of the lower performers. Measurement of inter-colonoscopist variation in performance helps to identify factors that stimulate or hinder performance, and forms the basis for interventions. http://www.trialregister.nl. © Georg Thieme Verlag KG Stuttgart · New York.

Insertion device calculations with mathematica

Energy Technology Data Exchange (ETDEWEB)

Carr, R. [Stanford Synchrotron Radiation Lab., CA (United States); Lidia, S. [Univ. of California, Davis, CA (United States)

1995-02-01

The design of accelerator insertion devices such as wigglers and undulators has usually been aided by numerical modeling on digital computers, using code in high level languages like Fortran. In the present era, there are higher level programming environments like IDL{reg_sign}, MatLab{reg_sign}, and Mathematica{reg_sign} in which these calculations may be performed by writing much less code, and in which standard mathematical techniques are very easily used. The authors present a suite of standard insertion device modeling routines in Mathematica to illustrate the new techniques. These routines include a simple way to generate magnetic fields using blocks of CSEM materials, trajectory solutions from the Lorentz force equations for given magnetic fields, Bessel function calculations of radiation for wigglers and undulators and general radiation calculations for undulators.

Two-day bowel preparation with polyethylene glycol 3350 and bisacodyl: a new, safe, and effective regimen for colonoscopy in children.

Science.gov (United States)

Phatak, Uma P; Johnson, Susanne; Husain, Sohail Z; Pashankar, Dinesh S

2011-07-01

To assess the safety, efficacy, and acceptance of a 2-day bowel preparation with polyethylene glycol (PEG) 3350 without electrolytes and bisacodyl for colonoscopy in children. In a prospective study, 111 children of mean age 11.9 years were given 2 g/kg of PEG and a 5-mg tablet of bisacodyl daily for 2 days before colonoscopy. Stool frequency, consistency, and adverse effects were monitored for the duration of the bowel preparation. Compliance and quality of colonic preparation were assessed on the day of the colonoscopy. The average daily stool frequency increased from a baseline of 2, to 4* on day 1, and 6.5* on day 2 of the bowel preparation (*P PEG and bisacodyl is safe, effective, and well accepted for colonoscopy in children without any major adverse effects.

Development of a rapid and efficient microinjection technique for gene insertion into fertilized salmonid eggs

Energy Technology Data Exchange (ETDEWEB)

Chandler, D.P.; Welt, M.; Leung, F.C.

1990-10-01

An efficient one-step injection technique for gene insertion into fertilized rainbow trout (Oncorhynchus mykiss) eggs is described, and basic parameters affecting egg survival are reported. Freshly fertilized rainbow trout eggs were injected in the perivitelline space with a recombinant mouse metallothionein-genomic bovine growth hormone (bGH) DNA construct using a 30-gauge hypodermic needle and a standard microinjection system. Relative to control, site of injection and DNA concentration did not affect the egg survival, but injections later than 3--4 hours post fertilization were detrimental. The injection technique permitted treatment of 100 eggs/hr with survivals up to 100%, resulting in a 4% DNA uptake rate as indicated by DNA dot blot analysis. Positive dot blot results also indicated that the injected DNA is able to cross the vitelline membrane and persist for 50--60 days post hatching, obviating the need for direct injection into the germinal disk. Results are consistent with previous transgenic fish work, underscoring the usefulness of the technique for generating transgenic trout and salmonids. 24 refs., 6 figs., 3 tabs.

Endovascular Treatment of Active Splenic Bleeding After Colonoscopy: A Systematic Review of the Literature

International Nuclear Information System (INIS)

Corcillo, Antonella; Aellen, Steve; Zingg, Tobias; Bize, Pierre; Demartines, Nicolas; Denys, Alban

2013-01-01

Purpose: Colonoscopy is reported to be a safe procedure that is routinely performed for the diagnosis and treatment of colorectal diseases. Splenic rupture is considered to be a rare complication with high mortality and morbidity that requires immediate diagnosis and management. Nonoperative management (NOM), surgical treatment (ST), and, more recently, proximal splenic artery embolization (PSAE) have been proposed as treatment options. The goal of this study was to assess whether PSAE is safe even in high-grade ruptures. Methods: We report two rare cases of post colonoscopy splenic rupture. A systematic review of the literature from 2002 to 2010 (first reported case of PSAE) was performed and the three types of treatment compared. Results: All patients reviewed (77 of 77) presented with intraperitoneal hemorrhage due to isolated splenic trauma. Splenic rupture was high-grade in most patients when grading was possible. Six of 77 patients (7.8 %) were treated with PSAE, including the 2 cases reported herein. Fifty-seven patients (74 %) underwent ST. NOM was attempted first in 25 patients with a high failure rate (11 of 25 [44 %]) and requiring a salvage procedure, such as PSAE or ST. Previous surgery (31 of 59 patients), adhesions (10 of 13), diagnostic colonoscopies (49 of 71), previous biopsies or polypectomies (31 of 57) and female sex (56 of 77) were identified as risk factors. In contrast, splenomegaly (0 of 77 patients), medications that increase the risk of bleeding (13 of 30) and difficult colonoscopies (16 of 51) were not identified as risk factors. PSAE was safe and effective even in elderly patients with comorbidities and those taking medications that increase the risk of bleeding, and the length of the hospital stay was similar to that after ST. Conclusion: We propose a treatment algorithm based on clinical and radiological criteria. Because of the high failure rate after NOM, PSAE should be the treatment of choice to manage grade I through IV splenic

Risks and benefits of colonoscopy in patients aged 80 and older: A prospective study

Directory of Open Access Journals (Sweden)

Edson Jurado da Silva

2013-04-01

Full Text Available Objective: this study aims to compare colonoscopy results in patients aged 50-79 and those aged 80 and older. Patients and Methods: a total of 533 diagnostic colonoscopies performed from August 2011 to January 2012 were evaluated in a prospective study analyzing age, ASA classification, co- morbidities, endoscopic findings, time to reach the cecum, number of complete examina- tions, difficulties and complications. Chi-square test was used to compare categorical data whereas Student's t test to compare means. A p value 0.05, ASA > 2 difficult examination: 41 (20% versus 6 (60% p 0.05. Complete colonoscopy in 450 (94% versus 45 (83%, p 0.05 Time to reach the cecum was 39 ± 10 minutes for difficult procedures and 13 ± 9 for the easy ones. Conclusion: age 80 and older is associated with more adverse events during colonoscopy. Resumo: Objetivo: avaliar riscos em colonoscopia após 80 anos de idade. Pacientes e métodos: entre agosto de 2011 e janeiro de 2012 realizamos colonoscopias em 533 pacientes. Grupo A: idade entre 50 e 79 e Grupo B > de 80 anos. Parâmetros analisados: ASA, comorbidades, achados endoscópicos, tempo de chegada ao ceco, número de exames com- pletos, dificuldade e complicações. Usamos teste Qui-quadrado para comparar proporção e teste t de Student para média e desvio padrão. p 0,05 > ASA 2 difícil 41 (20% e 6 (60% p 0.05. Exame completo 450 (94% e 45 (83% p 0,05. Tempo em minutos 39 ± 10 para os difíceis e 13 ± 9 para os fáceis. Conclusão: a idade de 80 anos constitui um risco para a realização de colonoscopia. Keywords: Colonoscopy, Risks, Complications, Older age, Elderly, Palavras-chave: Colonoscopia, Riscos, Complicações, Idade avançada, Terceira idade

Endovascular Treatment of Active Splenic Bleeding After Colonoscopy: A Systematic Review of the Literature

Energy Technology Data Exchange (ETDEWEB)

Corcillo, Antonella, E-mail: antonella.corcillo@chuv.ch [Centre Hospitalier Universitaire Vaudois (CHUV), Departement de Medecine Interne (Switzerland); Aellen, Steve, E-mail: steve.aellen@hopitalvs.ch; Zingg, Tobias [Centre Hospitalier Universitaire Vaudois (CHUV), Service de Chirurgie Viscerale (Switzerland); Bize, Pierre [Centre Hospitalier Universitaire Vaudois (CHUV), Departement de Radiologie Interventionnelle (Switzerland); Demartines, Nicolas [Centre Hospitalier Universitaire Vaudois (CHUV), Service de Chirurgie Viscerale (Switzerland); Denys, Alban [Centre Hospitalier Universitaire Vaudois (CHUV), Departement de Radiologie Interventionnelle (Switzerland)

2013-10-15

Purpose: Colonoscopy is reported to be a safe procedure that is routinely performed for the diagnosis and treatment of colorectal diseases. Splenic rupture is considered to be a rare complication with high mortality and morbidity that requires immediate diagnosis and management. Nonoperative management (NOM), surgical treatment (ST), and, more recently, proximal splenic artery embolization (PSAE) have been proposed as treatment options. The goal of this study was to assess whether PSAE is safe even in high-grade ruptures. Methods: We report two rare cases of post colonoscopy splenic rupture. A systematic review of the literature from 2002 to 2010 (first reported case of PSAE) was performed and the three types of treatment compared. Results: All patients reviewed (77 of 77) presented with intraperitoneal hemorrhage due to isolated splenic trauma. Splenic rupture was high-grade in most patients when grading was possible. Six of 77 patients (7.8 %) were treated with PSAE, including the 2 cases reported herein. Fifty-seven patients (74 %) underwent ST. NOM was attempted first in 25 patients with a high failure rate (11 of 25 [44 %]) and requiring a salvage procedure, such as PSAE or ST. Previous surgery (31 of 59 patients), adhesions (10 of 13), diagnostic colonoscopies (49 of 71), previous biopsies or polypectomies (31 of 57) and female sex (56 of 77) were identified as risk factors. In contrast, splenomegaly (0 of 77 patients), medications that increase the risk of bleeding (13 of 30) and difficult colonoscopies (16 of 51) were not identified as risk factors. PSAE was safe and effective even in elderly patients with comorbidities and those taking medications that increase the risk of bleeding, and the length of the hospital stay was similar to that after ST. Conclusion: We propose a treatment algorithm based on clinical and radiological criteria. Because of the high failure rate after NOM, PSAE should be the treatment of choice to manage grade I through IV splenic

A note on the insertion of rumen cannulae in pregnant ewes

African Journals Online (AJOL)

Modifications to a simple and rapid technique for the insertion of rumen cannulae in sheep are described. The modified technique, executed in three phases, was developed to facilitate the fistula- tion and insertion of rumen cannulae in pregnant ewes, especially during late pregnancy. Wysigings van 'n eenvoudige en ...

The Effect of Insertion Technique on Temperatures for Standard and Self-Drilling External Fixation Pins.

Science.gov (United States)

Manoogian, Sarah; Lee, Adam K; Widmaier, James C

2017-08-01

No studies have assessed the effects of parameters associated with insertion temperature in modern self-drilling external fixation pins. The current study assessed how varying the presence of irrigation, insertion speed, and force impacted the insertion temperatures of 2 types of standard and self-drilling external fixation half pins. Seventy tests were conducted with 10 trials for 4 conditions on self-drilling pins, and 3 conditions for standard pins. Each test used a thermocouple inside the pin to measure temperature rise during insertion. Adding irrigation to the standard pin insertion significantly lowered the maximum temperature (P drilling pin tests dropped average rise in temperature from 151.3 ± 21.6°C to 124.1 ± 15.3°C (P = 0.005). When the self-drilling pin insertion was decreased considerably from 360 to 60 rpm, the temperature decreased significantly from 151.3 ± 21.6°C to 109.6 ± 14.0°C (P drilling pin temperature increase was not significant. The standard pin had lower peak temperatures than the self-drilling pin for all conditions. Moreover, slowing down the insertion speed and adding irrigation helped mitigate the temperature increase of both pin types during insertion.

Diagnostic accuracy and tolerability of contrast enhanced CT colonoscopy in symptomatic patients with increased risk for colorectal cancer

International Nuclear Information System (INIS)

Ozsunar, Yelda; Coskun, Guelten; Delibas, Naciye; Uz, Burcin; Yuekselen, Vahit

2009-01-01

Objective: We compared the accuracy and tolerability of intravenous contrast enhanced spiral computed tomography colonography (CTC) and optical colonoscopy (OC) for the detection of colorectal neoplasia in symptomatic patients for colorectal neoplasia. Methods: A prospective study was performed in 48 patients with symptomatic patients with increased risk for colorectal cancer. Spiral CTC was performed in supine and prone positions after colonic cleansing. The axial, 2D MPR and virtual endoluminal views were analyzed. Results of spiral CTC were compared with OC which was done within 15 days. The psychometric tolerance test was asked to be performed for both CTC and colonoscopy after the procedure. Results: Ten lesions in 9 of 48 patients were found in CTC and confirmed with OC. Two masses and eight polyps, consisted of 1 tubulovillous, 1 tubular, 2 villous adenoma, 4 adenomatous polyp, 4 adenocarcinoma, were identified. Lesion prevalence was 21%. Sensitivity, specificity, accuracy, positive and negative predictive values were found 100%, 87%, 89%, 67% and 100%, respectively. Psychometric tolerance test showed that CTC significantly more comfortable comparing with OC (p = 0.00). CTC was the preferred method in 37% while OC was preferred in 6% of patients. In both techniques, the most unpleasant part was bowel cleansing. Conclusion: Contrast enhanced CTC is a highly accurate method in detecting colorectal lesions. Since the technique was found to be more comfortable and less time consuming compare to OE, it may be preferable in management of symptomatic patients with increased risk for colorectal cancer.

A feasibility study of optical flow-based navigation during colonoscopy

NARCIS (Netherlands)

van der Stap, N.; Reilink, Rob; Misra, Sarthak; Broeders, Ivo Adriaan Maria Johannes; van der Heijden, Ferdinand

In this study, it was shown that using the optical flow and the focus of expansion, obtained from the monocular camera at the beginning of a colonoscope, (semi-)automated steering of flexible endoscopes might become possible. This automation might help to increase colonoscopy efficiency, but is also

Factors associated with adenoma detection rate and diagnosis of polyps and colorectal cancer during colonoscopy in France: results of a prospective, nationwide survey.

Directory of Open Access Journals (Sweden)

Maximilien Barret

Full Text Available INTRODUCTION: Colonoscopy can prevent deaths due to colorectal cancer (CRC through early diagnosis or resection of colonic adenomas. We conducted a prospective, nationwide study on colonoscopy practice in France. METHODS: An online questionnaire was administered to 2,600 French gastroenterologists. Data from all consecutive colonoscopies performed during one week were collected. A statistical extrapolation of the results to a whole year was performed, and factors potentially associated with the adenoma detection rate (ADR or the diagnosis of polyps or cancer were assessed. RESULTS: A total of 342 gastroenterologists, representative of the overall population of French gastroenterologists, provided data on 3,266 colonoscopies, corresponding to 1,200,529 (95% CI: 1,125,936-1,275,122 procedures for the year 2011. The indication for colonoscopy was CRC screening and digestive symptoms in 49.6% and 38.9% of cases, respectively. Polypectomy was performed in 35.5% of cases. The ADR and prevalence of CRC were 17.7% and 2.9%, respectively. The main factors associated with a high ADR were male gender (p=0.0001, age over 50 (p=0.0001, personal or family history of CRC or colorectal polyps (p<0.0001 and p<0.0001, respectively, and positive fecal occult blood test (p=0.0005. The prevalence of CRC was three times higher in patients with their first colonoscopy (4.2% vs. 1.4%; p<0.0001. CONCLUSIONS: For the first time in France, we report nationwide prospective data on colonoscopy practice, including histological results. We found an average ADR of 17.7%, and observed reduced CRC incidence in patients with previous colonoscopy.

Safety of a 1-Day Polyethylene Glycol 3350 Bowel Preparation for Colonoscopy in Children.

Science.gov (United States)

Sahn, Benjamin; Chen-Lim, Mei Lin; Ciavardone, Denise; Farace, Lisa; Jannelli, Frances; Nieberle, Megan; Ely, Elizabeth; Zhang, Xuemei; Kelsen, Judith; Puma, Anita; Mamula, Petar

2016-07-01

Electrolyte-free polyethylene glycol powder (PEG-3350) has been widely used for colonoscopy preparation (prep); however, limited safety data on electrolyte changes exists with 1-day prep regimens. The primary aim of this study was to determine the proportion of patients with significant serum chemistry abnormalities before and at the time of colonoscopy. Secondary aims included evaluation of prep tolerance and bowel cleansing efficacy. We performed a prospective descriptive observational study of pediatric patients scheduled for outpatient colonoscopy who received our standard 1-day, weight-based 4 g/kg PEG-3350 prep with a single stimulant laxative dose and had serum chemistry testing within 60 days before and at the time of colonoscopy. A standardized bowel cleanliness tool (Aronchick scale) was completed by the endoscopist. One hundred fifty-five patients had serum electrolytes data pre- and postprep. Comparison of each patient's chemistries demonstrated statistical equivalence with the 1 exception of blood urea nitrogen levels (P = 0.56). Hypokalemia was detected postprep in 37 subjects (24%), but none had a serum level <3.3 mmol/L, which was deemed to be of no clinical significance. Five patients were hypoglycemic post prep; 3 were 7 years or younger (P = 0.02). The colon cleanliness rating was excellent or good in 77% and suboptimal in 23% of patients. A 1-day, weight-based PEG-3350 bowel prep in children appears safe. Changes in electrolyte levels and renal function were not clinically significant. Children of 7 years or younger seem to be at a higher risk of hypoglycemia compared with older children.

Intraoperative radionuclide study and colonoscopy in gastrointestinal hemorrhage

International Nuclear Information System (INIS)

Navab, F.; Westbrook, K.C.; Slaton, G.; Boyd, C.M.

1985-01-01

Tc-99m labeled red cell imaging is used in the diagnosis and localization of gastrointestinal hemorrhage. A patient in whom a preoperative scan was positive in the right paraumbilical region is discussed. Intraoperative Tc-99m labeled red cell imaging was used in conjunction with colonoscopy, and the site of active bleeding was found in the proximal transverse colon, which had been displaced downward because of adhesions

Back-to-back colon capsule endoscopy and optical colonoscopy in colorectal cancer screening individuals

DEFF Research Database (Denmark)

Kobaek-Larsen, Morten; Kroijer, Rasmus; Dyrvig, Anne-Kirstine

2018-01-01

mm polyps in colon capsule endoscopy (97%; 95% CI: 94-100) was superior to colonoscopy (89%; 95% CI: 84-94). A complete capsule endoscopy examination (N=134) could detect patients with intermediate or greater risk (according to the European guidelines) with an accuracy, sensitivity, specificity...... and positivity rate of 79%, 93%, 69% and 58% respectively, using a cut-off of at least one polyp >10 mm or more than two polyps. CONCLUSION: Colon capsule endoscopy is superior to colonoscopy in polyp detection rate and per-patient sensitivity to >9 mm polyps, but only in complete CCE examinations. The rate...

Effectiveness of Sodium Picosulfate/Magnesium Citrate (PICO) for Colonoscopy Preparation

Science.gov (United States)

Suh, Wu Seok; Jeong, Jin Sik; Kim, Dong Sik; Kim, Sang Woo; Kwak, Dong Min; Hwang, Jong Seong; Kim, Hyun Jin; Park, Man Woo; Shim, Min Chul; Koo, Ja-Il; Kim, Jae Hwang; Shon, Dae Ho

2014-01-01

Purpose Bowel preparation with sodium phosphate was recently prohibited by the U.S. Food and Drug Administration. Polyethylene glycol (PEG) is safe and effective; however, it is difficult to drink. To identify an easy bowel preparation method for colonoscopy, we evaluated three different bowel preparation regimens regarding their efficacy and patient satisfaction. Methods In this randomized, comparative study, 892 patients who visited a secondary referral hospital for a colonoscopy between November 2012 and February 2013 were enrolled. Three regimens were evaluated: three packets of sodium picosulfate/magnesium citrate (PICO, group A), two packets of PICO with 1 L of PEG (PICO + PEG 1 L, group B), and two packets of PICO with 2 L of PEG (PICO + PEG 2 L, group C). A questionnaire survey regarding the patients' preference for the bowel preparation regimen and satisfaction was conducted before the colonoscopies. The quality of bowel cleansing was scored by the colonoscopists who used the Aronchick scoring scale and the Ottawa scale. Results The patients' satisfaction rate regarding the regimens were 72% in group A, 64% in group B, and 45.9% in group C. Nausea and abdominal bloating caused by the regimens were more frequent in group C than in group A or group B (P < 0.01). Group C showed the lowest preference rate compared to the other groups (P < 0.01). Group C showed better right colon cleansing efficacy than group A or group B. Conclusion Group A exhibited a better result than group B or group C in patient satisfaction and preference. In the cleansing quality, no difference was noted between groups A and C. PMID:25360429

Patient anxiety before invasive diagnostic examinations: coronarography, arteriography, and colonoscopy

International Nuclear Information System (INIS)

Gryz, J.; Izdebski, P.

2005-01-01

The aim of this study was to answer such questions as: 1) Do patients show higher levels of anxiety (cognitive and/or physiological rates) before invasive examinations? 2) Does the type of invasive diagnostic examinations influence the patients' anxiety level? 3) Does the level of the patients' knowledge about coronarography, arteriography, or colonoscopy cause differences in their anxiety levels? The study was conducted at the Military Clinical Hospital in Bydgoszcz in the Departments of Gastroenteriology, Radiology, and Cardiology and in the Clinic of General Surgery, Chest and Vessels, and lasted seven months, from August 2002 to February 2003. 93 patients (29 women and 64 men) qualifying for different invasive examinations participated in the study. The participants were divided in three groups. The first consisted of patients awaiting coronarography, the second arteriography of the lower limbs, and the third colonoscopy. The participants were chosen on the basis of medical criteria. A structured interview was used to assess their levels of knowledge about the invasive examination they were to undergo. Anxiety was assessed with the Inventory of State and Trait Anxiety and by blood pressure measurement. On the basis of the obtained data we conclude that patients awaiting invasive examinations have higher physiological anxiety rates and that the type of invasive examination significantly influences patient anxiety levels. The type of examination did not differentiate patients according to their cognitive rates of anxiety: the level was average. The levels of patient knowledge about coronarography, colonoscopy, and arteriography did not cause any differences in physiological and cognitive rates of anxiety. The authors conclude that the cognitive aspects of anxiety do not influence the way patients experience physiological anxiety before invasive examinations. (author)

Closed loop control of sedation for colonoscopy using the Bispectral Index

NARCIS (Netherlands)

Leslie, K.; Absalom, A.; Kenny, G. N. C.

Sixteen patients undergoing colonoscopy were sedated with propofol using a closed-loop control system guided by the Bispectral Index (BIS). Propofol administration, via a target-controlled infusion, was controlled by a proportional-integral-differential control algorithm. The median (range) propofol

Towards continuous improvement of endoscopy standards: Validation of a colonoscopy assessment form.

LENUS (Irish Health Repository)

2012-02-01

Aim: Assessment of procedural colonoscopy skills is an important and topical. The aim of this study was to develop and validate a competency-based colonoscopy assessment form that would be easy to use, suitable for the assessment of junior and senior endoscopists and potentially be a useful instrument to detect differences in performance standards following different training interventions. Method: A standardised assessment form was developed incorporating a checklist with dichotomous yes\\/no responses and a global assessment section incorporating several different elements. This form was used prospectively to evaluate colonoscopy cases during the period of the study in several university teaching hospitals. Results were analysed using ANOVA with Bonferroni corrections for post-hoc analysis. Results: 81 procedures were assessed, performed by eight consultant and 19 trainee endoscopists. There were no serious errors. When divided into three groups based on previous experience (novice, intermediate and expert) the assessment form demonstrated statistically significant differences between all three groups (p<0.05). When separate elements were taken into account, the global assessment section was a better discriminator of skill level than the checklist. Conclusion: This form is a valid, easy to use assessment method. We intend to use it to assess the value of simulator training in trainee endoscopists. It also has the potential to be a useful training tool when feedback is given to the trainee.

Polyethylene glycol powder solution versus senna for bowel preparation for colonoscopy in children.

Science.gov (United States)

Terry, Natalie A; Chen-Lim, Mei Lin; Ely, Elizabeth; Jatla, Muralidhar; Ciavardone, Denise; Esch, Salina; Farace, Lisa; Jannelli, Frances; Puma, Anita; Carlow, Dean; Mamula, Petar

2013-02-01

Safety and effectiveness of large-volume polyethylene glycol-based solution (PEG-ES) have been documented, but the taste and volume can be barriers to successful colonoscopy preparation. Efficacy and safety of small-volume electrolyte-free (PEG-P) preparation (Miralax) for colonoscopy preparation have been rarely studied, although presently used at many pediatric centers. The primary objective of the present study was to determine whether PEG-P results in a more efficacious and safe colonoscopy preparation as compared with senna. The study design was prospective, randomized, and single-blinded. Patients ages 6 to 21 years were randomized to a 2-day clean-out regimen of PEG-P at a dose of 1.5 g/kg divided twice per day for 2 days versus senna 15 mL daily (ages 6-12) or 30 mL daily (ages 12-21) for 2 days. Both preparations required 1 day of clear liquids whereas senna preparation required an additional day of full liquid diet. A blinded endoscopist graded the quality of preparation with a standardized cleanliness tool (Aronchick scale). Serum chemistry panels were obtained. Patients or parents rated symptoms and ease of preparation. The anticipated number of subjects was 166; however, the interim analysis demonstrated inferiority of senna preparation. Thirty patients were evaluated in the present study. Of the patients in the PEG-P arm, 88% (14/16) received an excellent/good score compared with 29% (4/14), with the senna preparation (P = 0.0022). Both preparations were well-tolerated by patient-graded ease of preparation. Demographics and laboratory values did not differ significantly across the 2 groups. No serious adverse events were noted. PEG-P is an effective colonoscopy preparation whereas senna preparation was insufficient. Both were well-tolerated and appear safe in a pediatric population.

Patient experience of CT colonography and colonoscopy after fecal occult blood test in a national screening programme

OpenAIRE

Plumb, Andrew A.; Ghanouni, Alex; Rees, Colin J.; Hewitson, Paul; Nickerson, Claire; Wright, Suzanne; Taylor, Stuart A.; Halligan, Steve; von Wagner, Christian

2016-01-01

Objective To investigate patient experience of CT colonography (CTC) and colonoscopy in a national screening programme. Methods Retrospective analysis of patient experience postal questionnaires. We included screenees from a fecal occult blood test (FOBt) based screening programme, where CTC was performed when colonoscopy was incomplete or deemed unsuitable. We analyzed questionnaire responses concerning communication of test risks, test-related discomfort and post-test pain, as well as compl...

Patient experience of CT colonography and colonoscopy after fecal occult blood test in a national screening programme

OpenAIRE

Plumb, A. A.; Ghanouni, A.; Rees, C. J.; Hewitson, P.; Nickerson, C.; Wright, S.; Taylor, S. A.; Halligan, S.; von Wagner, C.

2017-01-01

OBJECTIVE: To investigate patient experience of CT colonography (CTC) and colonoscopy in a national screening programme. METHODS: Retrospective analysis of patient experience postal questionnaires. We included screenees from a fecal occult blood test (FOBt) based screening programme, where CTC was performed when colonoscopy was incomplete or deemed unsuitable. We analyzed questionnaire responses concerning communication of test risks, test-related discomfort and post-test pain, as well as com...

Ultrasonic Guided Insertion of Central Venous Catheter in Infants ...

African Journals Online (AJOL)

Background/Purpose: ultrasound is licensed for application of regional blocks and insertion of vascular access. We aimed to compare ultrasonic guided (USG) and anatomical landmark technique (ALT) for insertion of central venous catheter (CVC) as regard success rate and rate of complications in infants and children.

Characteristics of right-sided colonic neoplasia and colonoscopy barriers limiting their early detection and prognosis: a review of the literature.

Science.gov (United States)

Fischbach, Wolfgang; Elsome, Rory; Amlani, Bharat

2018-06-05

Colonoscopy provides less protection from colorectal cancer in the right colon than the left. Areas covered: This review examines patient outcomes and colonoscopy success rates to identify factors that limit the protective effect of colonoscopy in the right colon. The MEDLINE and Embase databases were searched for literature from 2000 onwards, on the long-term outcomes and differences in screening practice between the right and left colon. In total, 12 systematic reviews (including nine meta-analyses) and 44 primary data records were included. Differences in patient outcomes and colonoscopy practice were identified between the right and left colon, suggesting that several factors, many of which disproportionally affect the right colon, impact lesion detection rates. Shorter withdrawal times reduce detection rates, while longer times significantly increase detection; mostly of adenomas in the right colon. Colonoscope attachments often only show a significant improvement in detection rates in the right colon, suggesting detection is more challenging due to visibility of the right colonic mucosa. Higher bowel cleansing grades significantly improve detection rates in the right colon compared to the left. Expert commentary: These findings confirm the need for continued improvement of colonoscopy effectiveness, and obligatory quality assessment, overall and especially in the right colon.

Quality of colonoscopy performance among gastroenterology and surgical trainees: a need for common training standards for all trainees?

Science.gov (United States)

Leyden, J E; Doherty, G A; Hanley, A; McNamara, D A; Shields, C; Leader, M; Murray, F E; Patchett, S E; Harewood, G C

2011-11-01

Cecal intubation and polyp detection rates are objective measures of colonoscopy performance. Minimum cecal intubation rates greater than 90% have been endorsed by the American Society for Gastrointestinal Endoscopy (ASGE) and the Joint Advisory Group (JAG) UK. Performance data for medical and surgical trainee endoscopists are limited, and we used endoscopy quality parameters to compare these two groups. Retrospective review of all single-endoscopist colonoscopies done by gastroenterology and surgical trainees ("registrars," equivalent to fellows, postgraduate year 5) with more than two years' endoscopy experience, in 2006 and 2007 at a single academic medical center. Completion rates and polyp detection rates for endoscopists performing more than 50 colonoscopies during the study period were audited. Colonoscopy withdrawal time was prospectively observed in a representative subset of 140 patients. Among 3079 audited single-endoscopist colonoscopies, seven gastroenterology trainees performed 1998 procedures and six surgery trainees performed 1081. The crude completion rate was 82%, 84% for gastroenterology trainees and 78% for surgery trainees (P gastroenterology trainees, and 84% for surgical trainees (P gastroenterology and surgical trainees, respectively (P gastroenterology trainees 14% and surgical trainees 9% (P = 0.0065). In the prospectively audited procedures, median withdrawal time was greater in the gastroenterology trainee group and polyp detection rates correlated closely with withdrawal time (r = 0.99). The observed disparity in endoscopic performance between surgical and gastroenterology trainees suggests the need for a combined or unitary approach to endoscopy training for specialist medical and surgical trainees. © Georg Thieme Verlag KG Stuttgart · New York.

The impact of diet liberalization on bowel preparation for colonoscopy.

Science.gov (United States)

Walter, James; Francis, Gloria; Matro, Rebecca; Kedika, Ramalinga; Grosso, Rachael; Keith, Scott W; Kastenberg, David

2017-04-01

Background and study aims  Dietary restrictions are integral to colonoscopy preparation and impact patient satisfaction. Utilizing split-dose, lower-volume polyethylene glycol 3350-electrolyte solution (PEG-ELS), this study compared colon preparation adequacy of a low-residue diet to clear liquids using a validated grading scale. Patients and methods  This was a prospective, randomized, single-blinded, single-center non-inferiority study evaluating diet the day prior to outpatient colonoscopy. Subjects were randomized to a Low-Residue diet for breakfast and lunch, or Clears only. All subjects received split dose PEG-ELS. The primary endpoint was preparation adequacy using the Boston Bowel Preparation Scale (BBPS), with adequate defined as a score > 5. Secondary endpoints included mean BBPS scores for the entire colon and individual segments, satisfaction, adverse events, polyp and adenoma detection rates, and impact on sleep and daily activities. Results  Final analysis included 140 subjects, 72 assigned to Clears and 68 to Low-Residue. The Low-Residue diet was non-inferior to Clears (risk difference = - 5.08 %, P  = 0.04) after adjusting for age. Mean colon cleansing scores were not significantly different overall and for individual colonic segments. Satisfaction with the Low-Residue diet was significantly greater ( P  = 0.01). The adenoma detection rate was not statistically significantly different between study groups, but the number of adenomas detected was significantly greater with Clears ( P  = 0.01). Adverse events and impact on sleep and activities did not differ significantly between diet arms. Conclusions  A low-residue diet for breakfast and lunch the day prior to colonoscopy was non-inferior to clear liquids alone for achieving adequate colon cleansing when using split dose PEG-ELS.

Virtual colonoscopy: a new alternative for colorectal neoplasm screening?; Colonoscopia virtual: una nueva alternativa en el screening del cancer colorrectal?

Energy Technology Data Exchange (ETDEWEB)

Carrascosa, P; Castiglioni, R; Sanchez, F; Capunay, C; Mazzuco, J; Carrascosa, J [Diagnostico Maipu, Vicente Lopez, Buenos Aires (Argentina)

2000-07-01

The authors presents 46 patients-series with virtual colonoscopy. The findings obtained through virtual colonoscopy were divided into 7 groups: 1) Single polypoid lesion (9 patients); 2) Associated polypoid lesions (11 patients); 3) Tumoral stenosis without synchronic lesion (3 patients); 4) Tumoral stenosis with synchronic lesion (6 patients); 5) Non-tumoral stenosis (4 patients); 6) Normal studies (2 patients); 7) Patients excluded due to wrong preparation (11 patients). We concluded that the virtual colonoscopy is a valid alternative in the screening of the colorectal pathology, showing some advantages when compared to the usual studies, since it is non-invasive, does not require sedation, and allows the staging of the neoplasm. (author)

The FADE mass-stat: A technique for inserting or deleting particles in molecular dynamics simulations

Energy Technology Data Exchange (ETDEWEB)

Borg, Matthew K., E-mail: matthew.borg@strath.ac.uk [Department of Mechanical and Aerospace Engineering, University of Strathclyde, Glasgow G1 1XJ (United Kingdom); Lockerby, Duncan A., E-mail: duncan.lockerby@warwick.ac.uk [School of Engineering, University of Warwick, Coventry CV4 7AL (United Kingdom); Reese, Jason M., E-mail: jason.reese@ed.ac.uk [School of Engineering, University of Edinburgh, Edinburgh EH9 3JL (United Kingdom)

2014-02-21

The emergence of new applications of molecular dynamics (MD) simulation calls for the development of mass-statting procedures that insert or delete particles on-the-fly. In this paper we present a new mass-stat which we term FADE, because it gradually “fades-in” (inserts) or “fades-out” (deletes) molecules over a short relaxation period within a MD simulation. FADE applies a time-weighted relaxation to the intermolecular pair forces between the inserting/deleting molecule and any neighbouring molecules. The weighting function we propose in this paper is a piece-wise polynomial that can be described entirely by two parameters: the relaxation time scale and the order of the polynomial. FADE inherently conserves overall system momentum independent of the form of the weighting function. We demonstrate various simulations of insertions of atomic argon, polyatomic TIP4P water, polymer strands, and C{sub 60} Buckminsterfullerene molecules. We propose FADE parameters and a maximum density variation per insertion-instance that restricts spurious potential energy changes entering the system within desired tolerances. We also demonstrate in this paper that FADE compares very well to an existing insertion algorithm called USHER, in terms of accuracy, insertion rate (in dense fluids), and computational efficiency. The USHER algorithm is applicable to monatomic and water molecules only, but we demonstrate that FADE can be generally applied to various forms and sizes of molecules, such as polymeric molecules of long aspect ratio, and spherical carbon fullerenes with hollow interiors.

The FADE mass-stat: A technique for inserting or deleting particles in molecular dynamics simulations

International Nuclear Information System (INIS)

Borg, Matthew K.; Lockerby, Duncan A.; Reese, Jason M.

2014-01-01

The emergence of new applications of molecular dynamics (MD) simulation calls for the development of mass-statting procedures that insert or delete particles on-the-fly. In this paper we present a new mass-stat which we term FADE, because it gradually “fades-in” (inserts) or “fades-out” (deletes) molecules over a short relaxation period within a MD simulation. FADE applies a time-weighted relaxation to the intermolecular pair forces between the inserting/deleting molecule and any neighbouring molecules. The weighting function we propose in this paper is a piece-wise polynomial that can be described entirely by two parameters: the relaxation time scale and the order of the polynomial. FADE inherently conserves overall system momentum independent of the form of the weighting function. We demonstrate various simulations of insertions of atomic argon, polyatomic TIP4P water, polymer strands, and C 60 Buckminsterfullerene molecules. We propose FADE parameters and a maximum density variation per insertion-instance that restricts spurious potential energy changes entering the system within desired tolerances. We also demonstrate in this paper that FADE compares very well to an existing insertion algorithm called USHER, in terms of accuracy, insertion rate (in dense fluids), and computational efficiency. The USHER algorithm is applicable to monatomic and water molecules only, but we demonstrate that FADE can be generally applied to various forms and sizes of molecules, such as polymeric molecules of long aspect ratio, and spherical carbon fullerenes with hollow interiors

Identification of factors associated with sedation tolerance in 5000 patients undergoing outpatient colonoscopy: Canadian tertiary center experience.

Science.gov (United States)

Shingina, Alexandra; Ou, George; Takach, Oliver; Svarta, Sigrid; Kwok, Ricky; Tong, Jessica; Donaldson, Kieran; Lam, Eric; Enns, Robert

2016-12-16

To develop a prediction model aimed at identifying patients that may require higher than usual sedation doses during colonoscopy. A retrospective chart review on 5000 patients who underwent an outpatient colonoscopy at St. Paul's Hospital from 2009 to 2010 was conducted in order to develop a model for identifying patients who will require increased doses of sedatives. Potential predictor variables including age, gender, endoscopy indication, high sedation requirements during previous endoscopies, difficulty of the procedure, bowel preparation quality, interventions, findings as well as current use of benzodiazepines, opioids and alcohol were analyzed. The outcome of study was the use of high dose of sedation agents for the procedure. In particular, the high dose of sedation was defined as fentanyl greater than 50 mcg and midazolam greater than 3 mg. Analysis of 5282 patients (mean age 57 ± 12, 49% female) was performed. Most common indication for the procedure was screening colonoscopy (57%). Almost half of our patients received doses exceeding Fentanyl 50 mcg and Midazolam 3 mg. Logistic regression models identified the following variables associated with high sedation: Younger age (OR = 0.95 95%CI: 0.94-0.95; P value of high sedation requirements. Our prediction model using the following pre-procedural variables including age, gender, indication for the procedure, medication/substance use, previous surgeries, previous high sedation requirements for colonoscopy yielded an area under the curve of 0.76 for Fentanyl ≥ 100 mcg and Midazolam ≥ 3 mg. Pre-procedural planning is the key in conducting successful, efficient colonoscopy. Logistic regression analysis of 5000 patients who underwent out-patient colonoscopy revealed the following factors associated with increased sedation requirement: Younger age, female gender, difficult endoscopy, specific indications as well as cardiopulmonary complications and current use of opioids/benzodiazepines. Age and gender

Appointment waiting times and education level influence the quality of bowel preparation in adult patients undergoing colonoscopy

Directory of Open Access Journals (Sweden)

Goh Khean-Lee

2011-07-01

Full Text Available Abstract Background Risk factors for poor bowel preparation are recognized to be independent of the type of bowel preparation method used. Patient and administrative factors influencing bowel preparation are known to vary in different healthcare systems. Methods A prospective, cross-sectional study of patients undergoing colonoscopy in an Asian tertiary centre was conducted to identify risk factors associated with poor bowel preparation, and to evaluate the impact of poor bowel preparation on technical performance and patient comfort. Results Data on 501 patients (mean age 60.1 ± 14.0 years old, 51.2% males, 60.9% with secondary education or higher was available for analysis. Poor bowel preparation was present in 151 patients (30.1%. Lower education level (OR = 2.35, 95% CI = 1.54 - 3.60, colonoscopy appointment waiting time beyond 16 weeks (OR = 1.86, 95% CI = 1.04 - 3.37 and non-adherence to bowel preparation instructions (OR = 4.76, 95% CI = 3.00 - 7.55 were identified as independent risk factors for poor bowel preparation. Poor bowel preparation was associated with a lower cecal intubation rate (78.1% versus 98.3%, p Conclusions Education levels and appointment waiting times, in addition to non-adherence to bowel preparation instructions, increase the risk of poor bowel preparation in adult patients undergoing colonoscopy. The latter has a significant impact on colonoscopy performance and patient comfort.

Effect of music on level of anxiety in patients undergoing colonoscopy without sedation.

Science.gov (United States)

Ko, Chia-Hui; Chen, Yi-Yu; Wu, Kuan-Ta; Wang, Shu-Chi; Yang, Jeng-Fu; Lin, Yu-Yin; Lin, Chia-I; Kuo, Hsiang-Ju; Dai, Chia-Yen; Hsieh, Meng-Hsuan

2017-03-01

Listening to music can be a noninvasive method for reducing the anxiety level without any adverse effects. The aim of this study was to explore whether music can reduce anxiety and to compare two different styles of music, informal classical music and light music, to ascertain the more effective style of music in reducing anxiety in patients undergoing colonoscopy without sedation. This study enrolled 138 patients who underwent colonoscopy without sedation during a general health examination from February 2009 to January 2015. The patients were randomly assigned to a group that did not listen to music, a group that listened to music by David Tolley, or a group that listened to music by Kevin Kern. The State-Trait Anxiety Inventory was used to evaluate the status of anxiety. A trend test for mild anxiety was performed on the patients in the three groups, and a significant trend was noted (p=0.017 for all patients; p=0.014 for analysis by sex). Multivariate analysis for mild anxiety on the patients in each group was also performed in this study, and music by Kevin Kern was found to have the lowest odds ratio (Odds ratio=0.34, p=0.045). Listening to music, especially music by Kevin Kern, reduced the level of anxiety in patients undergoing colonoscopy examination without sedation. Copyright © 2016. Published by Elsevier Taiwan LLC.

The Impact of Patient Education with a Smartphone Application on the Quality of Bowel Preparation for Screening Colonoscopy.

Science.gov (United States)

Cho, JeongHyeon; Lee, SeungHee; Shin, Jung A; Kim, Jeong Ho; Lee, Hong Sub

2017-09-01

Few studies have evaluated the use of a smartphone application (app) for educating people undergoing colonoscopy and optimizing bowel preparation. Therefore, this study was designed to develop a smartphone app for people to use as a preparation guide and to evaluate the efficacy of this app when used prior to colonoscopy. In total, 142 patients (male:female=84:58, mean age=43.5±9.3 years), who were scheduled to undergo a colonoscopy at Myongji Hospital, were enrolled in this study. Seventy-one patients were asked to use a smartphone app that we had recently developed to prepare for the colonoscopy, while the 71 patients of the sex and age-matched control group were educated via written and verbal instructions. The quality of bowel cleansing, evaluated using the Boston Bowel Preparation Scale, was significantly higher in the smartphone app group than in the control group (7.70±1.1 vs. 7.24±0.8, respectively, p =0.007 by t -test). No significant differences were found between the two groups regarding work-up time and the number of patients with polyps. In this study, targeting young adults (≤50 years), the bowel preparation achieved by patients using the smartphone app showed significantly better quality than that of the control group.

Causes of lower gastrointestinal bleeding on colonoscopy

International Nuclear Information System (INIS)

Rehman, A.U.; Gul, R.; Khursheed, L.; Hadayat, R.

2017-01-01

Background: Bleeding from anus is usually referred as rectal bleeding but actually rectal bleeding is defined as bleeding from lower colon or rectum, which means bleeding from a place distal to ligament of Treitz. This study was conducted to determine the frequency of different causes of rectal bleeding in patients at Ayub Teaching Hospital, Abbottabad. Methods: One hundred and seventy-five patients with evidence of rectal bleed, without gender discrimination were selected by non-probability convenient sampling from the out-patient department and general medical wards. Patients with suspected upper GI source of bleeding; acute infectious bloody diarrhoea and any coagulopathy were excluded from the study. All patients were subjected to fibre optic colonoscopy after preparation of the gut and findings were recorded. Where necessary, biopsy samples were also taken. Diagnosis was based on colonoscopic findings. Results: A total of 175 patients (92 males and 83 females) with mean age 35.81±9.18 years were part of the study. Colonoscopy showed abnormal findings in 150 (85.7%) patients. The commonest diagnosis was haemorrhoids, which was found in 39 (22.3%) patients. It was followed by inflammatory bowel disease (IBD) in 30 (17.1%) patients, solitary rectal ulcer in 13 (7.4%) patients and polyps in 25 (14.3%) patients. Other less frequent findings were non-specific inflammation and fungating growths in rectum. Conclusion: Haemorrhoids was the leading cause of bleeding per rectum in this study, followed by evidence of IBD while infrequent findings of polyps and diverticuli indicate that these are uncommon in this region. (author)

A Risk Prediction Index for Advanced Colorectal Neoplasia at Screening Colonoscopy.

Science.gov (United States)

Schroy, Paul C; Wong, John B; O'Brien, Michael J; Chen, Clara A; Griffith, John L

2015-07-01

Eliciting patient preferences within the context of shared decision making has been advocated for colorectal cancer screening. Risk stratification for advanced colorectal neoplasia (ACN) might facilitate more effective shared decision making when selecting an appropriate screening option. Our objective was to develop and validate a clinical index for estimating the probability of ACN at screening colonoscopy. We conducted a cross-sectional analysis of 3,543 asymptomatic, mostly average-risk patients 50-79 years of age undergoing screening colonoscopy at two urban safety net hospitals. Predictors of ACN were identified using multiple logistic regression. Model performance was internally validated using bootstrapping methods. The final index consisted of five independent predictors of risk (age, smoking, alcohol intake, height, and a combined sex/race/ethnicity variable). Smoking was the strongest predictor (net reclassification improvement (NRI), 8.4%) and height the weakest (NRI, 1.5%). Using a simplified weighted scoring system based on 0.5 increments of the adjusted odds ratio, the risk of ACN ranged from 3.2% (95% confidence interval (CI), 2.6-3.9) for the low-risk group (score ≤2) to 8.6% (95% CI, 7.4-9.7) for the intermediate/high-risk group (score 3-11). The model had moderate to good overall discrimination (C-statistic, 0.69; 95% CI, 0.66-0.72) and good calibration (P=0.73-0.93). A simple 5-item risk index based on readily available clinical data accurately stratifies average-risk patients into low- and intermediate/high-risk categories for ACN at screening colonoscopy. Uptake into clinical practice could facilitate more effective shared decision-making for CRC screening, particularly in situations where patient and provider test preferences differ.

Treatment of hilar cholangiocarcinoma with inserting biliary double stents

International Nuclear Information System (INIS)

Jia Guangzhi; Zhang Zidong; Wang Xuejing; Yin Hua; Li Jianming

2004-01-01

Objective: To investigate the inserting technique of biliary double stents in treating hilar cholangiocarcinoma. Methods: 6 patients with hilar cholangiocarcinoma (Bismuth IV) were treated by percutaneous transhepatic insertion of biliary stents. Double stents were inserted in each patient. Different inserting methods were adopted according to the branch angles formed by left and right hepatic ducts. Results: The jaundice of all patients alleviated or disappeared obviously after stent implantation. The average difference between post-and pre-operation in the serum total bilirubin level was (104 ± 29) μmol/L (P<0.01). Stent obstruction was found in 2 cases after 4 and 6 months respectively. Conclusion: Double stents implantation is effective for the treatment of hilar cholangiocarcinoma. Beware of the angulation between main hepatic duct and adopting different inserting methods. (authors)

Simulation-Based Training of Non-Technical Skills in Colonoscopy: Protocol for a Randomized Controlled Trial.

Science.gov (United States)

Khan, Rishad; Scaffidi, Michael A; Walsh, Catharine M; Lin, Peter; Al-Mazroui, Ahmed; Chana, Barinder; Kalaichandran, Ruben; Lee, Woojin; Grantcharov, Teodor P; Grover, Samir C

2017-08-04

Non-technical skills (NTS), such as communication and professionalism, contribute to the safe and effective completion of procedures. NTS training has previously been shown to improve surgical performance. Moreover, increases in NTS have been associated with improved clinical endoscopic performance. Despite this evidence, NTS training has not been tested as an intervention in endoscopy. The aim of this study is to evaluate the effectiveness of a simulation-based training (SBT) curriculum of NTS on novice endoscopists' performance of clinical colonoscopy. Novice endoscopists were randomized to 2 groups. The control group received 4 hours of interactive didactic sessions on colonoscopy theory and 6 hours of SBT. Hours 5 and 6 of the SBT were integrated scenarios, wherein participants interacted with a standardized patient and nurse, while performing a colonoscopy on the virtual reality (VR) simulator. The NTS (intervention) group received the same teaching sessions but the last hour was focused on NTS teaching. The NTS group also reviewed a checklist of tasks relevant to NTS concepts prior to each integrated scenario case and was provided with dedicated feedback on their NTS performance during the integrated scenario practice. All participants were assessed at baseline, immediately after training, and 4 to 6 weeks post-training. The primary outcome measure is colonoscopy-specific performance in the clinical setting. In total, 42 novice endoscopists completed the study. Data collection and analysis is ongoing. We anticipate completion of all assessments by August 2017. Data analysis, manuscript writing, and subsequent submission for publication is expected to be completed by December 2017. Results from this study may inform the implementation of NTS training into postgraduate gastrointestinal curricula. NTS curricula may improve attitudes towards patient safety and self-reflection among trainees. Moreover, enhanced NTS may lead to superior clinical performance and

Improving the quality of colonoscopy bowel preparation using a smart phone application: a randomized trial.

Science.gov (United States)

Lorenzo-Zúñiga, Vicente; Moreno de Vega, Vicente; Marín, Ingrid; Barberá, Marta; Boix, Jaume

2015-07-01

Getting ready for a colonoscopy is difficult and involves many steps. Information given to patients is very important for adherence to treatment. We created a novel smart phone application (SPA) aimed to increase bowel preparation quality and patient satisfaction. We carried out a prospective, endoscopist-blinded, randomized, controlled trial. We enrolled 260 outpatient (58% female, age range 21-75 years) owners of a smartphone. Patients were allocated to two different protocols: instructions provided by SPA (SPA group; n = 108) or written instructions with visual aids (control group; n = 152). All procedures were carried out in the afternoon and patients received the same purgative regimen (2 L polyethylene glycol (PEG) solution plus ascorbic acid), in a full-dose same-day regimen. The study was designed to detect an improvement in quality of bowel preparation using the Harefield Cleansing Scale (HCS) scale. Effect of protocol on patient satisfaction was assessed with a specific questionnaire at the time of colonoscopy. Proportion of patients who obtained successful bowel preparation for colonoscopy (HCS A or B) was significantly higher in the SPA group than in the control group (100% vs 96.1%, respectively; P = 0.037). Mean global HCS scores were similar in both groups. Patient-reported tolerability and overall experience with the prescribed bowel preparation were significantly higher for the SPA group than for the control group. Successful cleansing and patient acceptability with the use of SPA were superior to written instructions in outpatients submitted for colonoscopy using 2 L PEG solution plus ascorbic acid. © 2015 The Authors. Digestive Endoscopy © 2015 Japan Gastroenterological Endoscopy Society.

Medicare Under Age 65 and Medicaid Patients Have Poorer Bowel Preparations: Implications for Recommendations for an Early Repeat Colonoscopy.

Directory of Open Access Journals (Sweden)

Bryan B Brimhall

Full Text Available Colonoscopy is performed on patients across a broad spectrum of demographic characteristics. These characteristics may aggregate by patient insurance provider and influence bowel preparation quality and the prevalence of adenomas. The purpose of this study was to evaluate the association of insurance status and suboptimal bowel preparation, recommendation for an early repeat colonoscopy due to suboptimal bowel preparation, adenoma detection rate (ADR, and advanced ADR (AADR.This is a cohort study of outpatient colonoscopies (n = 3113 at a single academic medical center. Patient insurance status was categorized into five groups: 1 Medicare < 65y; 2 Medicare ≥ 65y; 3 Tricare/VA; 4 Medicaid/Colorado Indigent Care Program (CICP; and 5 commercial insurance. We used multivariable logistic or linear regression modeling to estimate the risks for the association between patient insurance and suboptimal bowel preparation, recommendation for an early repeat colonoscopy due to suboptimal bowel preparation, ADR, and AADR. Models were adjusted for appropriate covariates.Medicare patients < 65y (OR 4.91; 95% CI: 3.25-7.43 and Medicaid/CICP patients (OR 4.23; 95% CI: 2.65-7.65 were more likely to have a suboptimal preparation compared to commercial insurance patients. Medicare patients < 65y (OR 5.58; 95% CI: 2.85-10.92 and Medicaid/CICP patients (OR 3.64; CI: 1.60-8.28 were more likely to receive a recommendation for an early repeat colonoscopy compared to commercial insurance patients. Medicare patients < 65y had a significantly higher adjusted ADR (OR 1.50; 95% CI: 1.03-2.18 and adjusted AADR (OR 1.99; 95% CI: 1.15-3.44 compared to commercial insurance patients.Understanding the reasons for the higher rate of a suboptimal bowel preparation in Medicare < 65y and Medicaid/CICP patients and reducing this rate is critical to improving colonoscopy outcomes and reducing healthcare costs in these populations.

Splenic rupture after colonoscopy: Report of a case and review of literature

Directory of Open Access Journals (Sweden)

Piccolo Gaetano

2008-02-01

Full Text Available Abstract Splenic rupture is a rare complication of colonoscopy. For this reason the diagnosis could be delayed and the outcome dismal. Fifty-four cases of splenic rupture after colonoscopy have been described in the literature. The majority of the cases required emergent or delayed splenectomy, 13 of these cases were treated conservatively. The main feature that stands out from the review of the literature is the "surprise" of this unexpected complication. This factor explains the elevated mortality (2 out of 54 cases, likely due to the delay in diagnosis. The case here described is probably among the most complex published in the literature; in fact the presence of dense intra-abdominal adhesions not only contributed to the complication itself, but also explain the confinement of the hemoperitoneum to the left supra-mesocolic space and the delayed presentation (13 days from the time of the trauma.

A centrally generated primary care physician audit report does not improve colonoscopy uptake after a positive result on a fecal occult blood test in Ontario's ColonCancerCheck program.

Science.gov (United States)

Stock, D; Rabeneck, L; Baxter, N N; Paszat, L F; Sutradhar, R; Yun, L; Tinmouth, J

2017-02-01

Timely follow-up of fecal occult blood screening with colonoscopy is essential for achieving colorectal cancer mortality reduction. In the present study, we evaluated the effectiveness of centrally generated, physician-targeted audit and feedback to improve colonoscopy uptake after a positive fecal occult blood test (fobt) result within Ontario's population-wide ColonCancerCheck Program. This prospective cohort study used data sets from Ontario's ColonCancerCheck Program (2008-2011) that were linked to provincial administrative health databases. Cox proportional hazards regression was used to estimate the effect of centralized, physician-targeted audit and feedback on colonoscopy uptake in an Ontario-wide fobt-positive cohort. A mailed physician audit and feedback report identifying individuals outstanding for colonoscopy for 3 or more months after a positive fobt result did not increase the likelihood of colonoscopy uptake (hazard ratio: 0.95; 95% confidence interval: 0.79 to 1.13). Duration of positive fobt status was strongly inversely associated with the hazard of follow-up colonoscopy ( p for linear trend: audit and feedback reports does not improve colonoscopy uptake for screening participants with a positive fobt result outstanding for 3 or more months. Mailed physician-targeted screening audit and feedback reports alone are unlikely to improve compliance with follow-up colonoscopy in Ontario. Other interventions such as physician audits or automatic referrals, demonstrated to be effective in other jurisdictions, might be warranted.

Colonoscopy and Colorectal Cancer Screening in Adults with Intellectual and Developmental Disabilities: Review of a Series of Cases and Recommendations for Examination

Science.gov (United States)

Fischer, Leonard S.; Becker, Andrew; Paraguya, Maria; Chukwu, Cecilia

2012-01-01

Adults with intellectual and developmental disabilities (IDD) frequently have comorbidities that might interfere with colonoscopy preparation and examination. In this article, the authors review their experience with colonoscopies performed from 2002 through 2010 on adults with IDD at a state institution to evaluate quality and safety of…

[THE FAILURE MODES AND EFFECTS ANALYSIS FACILITATES A SAFE, TIME AND MONEY SAVING OPEN ACCESS COLONOSCOPY SERVICE].

Science.gov (United States)

Gingold-Belfer, Rachel; Niv, Yaron; Horev, Nehama; Gross, Shuli; Sahar, Nadav; Dickman, Ram

2017-04-01

Failure modes and effects analysis (FMEA) is used for the identification of potential risks in health care processes. We used a specific FMEA - based form for direct referral for colonoscopy and assessed it for procedurerelated perforations. Ten experts in endoscopy evaluated and computed the entire referral process, modes of preparation for the endoscopic procedure, the endoscopic procedure itself and the discharge process. We used FMEA assessing for likelihood of occurrence, detection and severity and calculated the risk profile number (RPN) for each of the above points. According to the highest RPN results we designed a specific open access referral form and then compared the occurrence of colonic perforations (between 2010 and 2013) in patients who were referred through the open access arm (Group 1) to those who had a prior clinical consultation (non-open access, Group 2). Our experts in endoscopy (5 physicians and 5 nurses) identified 3 categories of failure modes that, on average, reached the highest RPNs. We identified 9,558 colonoscopies in group 1, and 12,567 in group 2. Perforations were identified in three patients from the open access group (1:3186, 0.03%) and in 10 from group 2 (1:1256, 0.07%) (p = 0.024). Direct referral for colonoscopy saved 9,558 pre-procedure consultations and the sum of $850,000. The FMEA tool-based specific referral form facilitates a safe, time and money saving open access colonoscopy service. Our form may be adopted by other gastroenterological clinics in Israel.

Verification of Triple Modular Redundancy Insertion for Reliable and Trusted Systems

Science.gov (United States)

Berg, Melanie; LaBel, Kenneth

2016-01-01

If a system is required to be protected using triple modular redundancy (TMR), improper insertion can jeopardize the reliability and security of the system. Due to the complexity of the verification process and the complexity of digital designs, there are currently no available techniques that can provide complete and reliable confirmation of TMR insertion. We propose a method for TMR insertion verification that satisfies the process for reliable and trusted systems.

Training Distal Locking Screw Insertion Skills to Novice Trainees: A Comparison Between Fluoroscopic- and Electromagnetic-Guided Techniques.

Science.gov (United States)

Leroux, Timothy; Khoshbin, Amir; Nousiainen, Markku T

2015-10-01

To compare the effect fluoroscopy or electromagnetic (EM) guidance has on the learning of locking screw insertion in tibial nails in surgical novices. A randomized, prospective, controlled trial was conducted involving 18 surgical trainees with no prior experience inserting locking screws in intramedullary nails. After a training session using fluoroscopy, participants underwent a pretest using fluoroscopic guidance. Participants were then randomized into either the fluoroscopy or EM group and were further trained using their respective technique. Post, retention, and transfer tests were conducted. Outcomes included task completion, drill attempts, screw changes, and radiation time. Intragroup comparisons revealed that the EM group used significantly less drill attempts during the post and retention tests compared with the pretest (P = 0.016 and P = 0.016, respectively). Intergroup comparisons revealed that the EM group was (1) more likely to complete the task during the retention test (P = 0.043) and (2) had significantly less radiation time during the post and retention tests (P = 0.002 and P = 0.003, respectively). Radiation time in the EM group during the transfer test increased to a level equal to what the fluoroscopy group used during the post and retention tests (P = 0.71 and P = 0.92, respectively). No other significant between-group differences occurred. EM guidance may be safely used to assist in the training of surgical novices in the skill of distal locking screw insertion. Not only does this technology significantly improve the ability to complete the task and decrease radiation use but also it does so without compromising skill acquisition. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Screening colonoscopy for the detection of neoplastic lesions in asymptomatic HIV-infected subjects.

Science.gov (United States)

Bini, E J; Green, B; Poles, M A

2009-08-01

Although non-AIDS defining malignancies are rapidly increasing as HIV-infected subjects live longer, little is know about the results of screening for colonic neoplasms (adenomatous polyps and adenocarcinomas) in this population. We conducted a screening colonoscopy study to determine the prevalence of colonic neoplasms in 136 asymptomatic HIV-infected subjects >or=50 years of age and 272 asymptomatic uninfected control subjects matched for age, sex, and family history of colorectal cancer. Advanced neoplasms were defined as adenomas >or=10 mm or any adenoma, regardless of size, with villous histology, high-grade dysplasia, or adenocarcinoma. The prevalence of neoplastic lesions was significantly higher in HIV-infected subjects than in control subjects (62.5% vs 41.2%, pscreening colonoscopy should be offered to HIV-infected subjects, but the age of initiation and the optimal frequency of screening require further study.

Risk Factors for Hemorrhoids on Screening Colonoscopy.

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Anne F Peery

Full Text Available Constipation, a low fiber diet, sedentary lifestyle and gravidity are commonly assumed to increase the risk of hemorrhoids. However, evidence regarding these factors is limited. We examined the association between commonly cited risk factors and the prevalence of hemorrhoids.We performed a cross sectional study of participants who underwent a colonoscopy in a colorectal adenoma prevention trial and who had a detailed assessment of bowel habits, diet and activity. The presence of hemorrhoids was extracted from the subjects' colonoscopy reports. We used logistic regression to estimate odds ratios and 95% confidence intervals while adjusting for age and sex.The study included 2,813 participants. Of these, 1,074 had hemorrhoids recorded. Constipation was associated with an increased prevalence of hemorrhoids (OR 1.43, 95% CI 1.11, 1.86. Of the fiber subtypes, high grain fiber intake was associated with a reduced risk (OR for quartile 4 versus quartile 1 = 0.78, 95% CI 0.62, 0.98. We found no association when comparing gravid and nulligravida women (OR 0.93, 95% CI 0.62-1.40. Sedentary behavior was associated with a reduced risk (OR 0.80, 95% CI 0.65-0.98, but not physical activity (OR 0.83, 95% CI 0.66-1.03. Neither being overweight nor obese was associated with the presence of hemorrhoids (OR 0.89, 95% CI 0.72-1.09 and OR 0.86, 95% CI 0.70-1.06.Constipation is associated with an increased risk of hemorrhoids. Gravidity and physical activity do not appear to be associated. High grain fiber intake and sedentary behavior are associated with a decreased risk of hemorrhoids.

Risk Factors for Hemorrhoids on Screening Colonoscopy.

Science.gov (United States)

Peery, Anne F; Sandler, Robert S; Galanko, Joseph A; Bresalier, Robert S; Figueiredo, Jane C; Ahnen, Dennis J; Barry, Elizabeth L; Baron, John A

2015-01-01

Constipation, a low fiber diet, sedentary lifestyle and gravidity are commonly assumed to increase the risk of hemorrhoids. However, evidence regarding these factors is limited. We examined the association between commonly cited risk factors and the prevalence of hemorrhoids. We performed a cross sectional study of participants who underwent a colonoscopy in a colorectal adenoma prevention trial and who had a detailed assessment of bowel habits, diet and activity. The presence of hemorrhoids was extracted from the subjects' colonoscopy reports. We used logistic regression to estimate odds ratios and 95% confidence intervals while adjusting for age and sex. The study included 2,813 participants. Of these, 1,074 had hemorrhoids recorded. Constipation was associated with an increased prevalence of hemorrhoids (OR 1.43, 95% CI 1.11, 1.86). Of the fiber subtypes, high grain fiber intake was associated with a reduced risk (OR for quartile 4 versus quartile 1 = 0.78, 95% CI 0.62, 0.98). We found no association when comparing gravid and nulligravida women (OR 0.93, 95% CI 0.62-1.40). Sedentary behavior was associated with a reduced risk (OR 0.80, 95% CI 0.65-0.98), but not physical activity (OR 0.83, 95% CI 0.66-1.03). Neither being overweight nor obese was associated with the presence of hemorrhoids (OR 0.89, 95% CI 0.72-1.09 and OR 0.86, 95% CI 0.70-1.06). Constipation is associated with an increased risk of hemorrhoids. Gravidity and physical activity do not appear to be associated. High grain fiber intake and sedentary behavior are associated with a decreased risk of hemorrhoids.

Tension Pneumothorax and Subcutaneous Emphysema Complicating Insertion of Nasogastric Tube

Directory of Open Access Journals (Sweden)

Narjis AL Saif

2015-01-01

Full Text Available Nasogastric tube has a key role in the management of substantial number of hospitalized patients particularly the critically ill. In spite of the apparent simple insertion technique, nasogastric tube placement has its serious perhaps fatal complications which need to be carefully assessed. Pulmonary misplacement and associated complications are commonplace during nasogastric tube procedure. We present a case of tension pneumothorax and massive surgical emphysema in critically ill ventilated patient due to inadvertent nasogastric tube insertion and also discussed the risk factors, complication list, and arrays of techniques for safer tube placement.

Tumor‐associated DNA mutation detection in individuals undergoing colonoscopy

OpenAIRE

Fleshner, Phillip; Braunstein, Glenn D.; Ovsepyan, Gayane; Tonozzi, Theresa R.; Kammesheidt, Anja

2017-01-01

Abstract The majority of colorectal cancers (CRC) harbor somatic mutations and epigenetic modifications in the tumor tissue, and some of these mutations can be detected in plasma as circulating tumor DNA (ctDNA). Precancerous colorectal lesions also contain many of these same mutations. This study examined plasma for ctDNA from patients undergoing a screening or diagnostic colonoscopy to determine the sensitivity and specificity of the ctDNA panel for detecting CRC and precancerous lesions. T...

Prevalence of colon polyps detected by colonoscopy screening in asymptomatic black and white patients

Science.gov (United States)

Lieberman, David; Holub, Jennifer; Moravec, Matthew; Eisen, Glenn; Peters, Dawn; Morris, Cynthia

2013-01-01

Context Compared to whites, Black men and women have a higher incidence and mortality from colorectal cancer and may develop cancer at a younger age. Colorectal cancer screening might be less effective in Blacks, if there are racial differences in the age-adjusted prevalence and location of cancer precursor lesions. Objectives To determine and compare the prevalence rates and location of polyp(s) >9mm in asymptomatic Blacks and whites who receive colonoscopy screening. Design, Setting, and Patients Colonoscopy data were prospectively collected from 67 practice sites in the United States using a computerized endoscopic report generator from 2004–2005. Data were transmitted to a central data repository, where all asymptomatic whites (n = 80,061) and Blacks (n = 5464) who received screening colonoscopy were identified. Main outcome measures Prevalence and location of polyp(s) >9mm, adjusted for age, gender, and family history of colorectal cancer in a multivariate analysis. Results Both Black men and women had a higher prevalence of polyp(s) >9mm (7.7 versus 6.2%; p 9mm (OR 1.133; 95% CI 0.93,1.38). However, in a sub-analysis of patients over age 60 years, proximal polyps >9mm were more likely in Black men (p = 0.026) and women (p9mm, and Black over age 60 years are more likely to proximal polyps >9mm. PMID:18812532

Revaluation on detection of metastatic cancer of the colorectum with barium enema. Comparison with computed tomography and colonoscopy

International Nuclear Information System (INIS)

Watari, Jiro; Mizukami, Yusuke; Tanabe, Hirotaka

1996-01-01

The findings with barium enema were analyzed and compared to those with computed tomography and colonoscopy in 15 patients with metastatic cancer of the colorectum, which were from 8 gastric, 2 colonic, 2 ovarian, 1 pancreatic, 1 prostatic carcinomas and 1 unknown origin. Primary cancers of intra-abdominal cavity origin tended to make multiple colorectal metastases (91.7%). With barium enema colonic and rectal involvement was mostly expressed as the tethered type and the diffuse type by Ishikawa's classification, respectively. Computed tomography detected direct tumor invasion to the colorectum in 4 cases. Of the other 11 cases, 8 patients (72.3%) showed abnormally thickened colorectal wall. Colonoscopy detected only 3 (37.5%) out of 8 lesions seen in 4 patients who had undergone colonoscopy before barium enema. Many of the lesions missed were the tethered type involvement. Barium enema is the most sensitive method to detect metastatic cancer of the colorectum. (author)

A new specifically designed forceps for chest drain insertion.

LENUS (Irish Health Repository)

Andrews, Emmet

2012-02-03

Insertion of a chest drain can be associated with serious complications. It is recommended that the drain is inserted with blunt dissection through the chest wall but there is no specific instrument to aid this task. We describe a new reusable forceps that has been designed specifically to facilitate the insertion of chest drains.A feasibility study of its use in patients who required a chest drain as part of elective cardiothoracic operations was undertaken. The primary end-point was successful and accurate placement of the drain. The operators also completed a questionnaire rating defined aspects of the procedure. The new instrument was used to insert the chest drain in 30 patients (19 male, 11 female; median age 61.5 years (range 16-81 years)). The drain was inserted successfully without the trocar in all cases and there were no complications. Use of the instrument rated as significantly easier relative to experience of previous techniques in all specified aspects. The new device can be used to insert intercostal chest drains safely and efficiently without using the trocar or any other instrument.

Can we ease the financial burden of colonoscopy? Using real-time endoscopic assessment of polyp histology to predict surveillance intervals.

Science.gov (United States)

Chandran, S; Parker, F; Lontos, S; Vaughan, R; Efthymiou, M

2015-12-01

Polyps identified at colonoscopy are predominantly diminutive (1%) of high-grade dysplasia or carcinoma; however, the cost of histological assessment is substantial. The aim of this study was to determine whether prediction of colonoscopy surveillance intervals based on real-time endoscopic assessment of polyp histology is accurate and cost effective. A prospective cohort study was conducted across a tertiary care and private community hospital. Ninety-four patients underwent colonoscopy and polypectomy of diminutive (≤5 mm) polyps from October 2012 to July 2013, yielding a total of 159 polyps. Polyps were examined and classified according to the Sano-Emura classification system. The endoscopic assessment (optical diagnosis) of polyp histology was used to predict appropriate colonoscopy surveillance intervals. The main outcome measure was the accuracy of optical diagnosis of diminutive colonic polyps against the gold standard of histological assessment. Optical diagnosis was correct in 105/108 (97.2%) adenomas. This yielded a sensitivity, specificity and positive and negative predictive values (with 95%CI) of 97.2% (92.1-99.4%), 78.4% (64.7-88.7%), 90.5% (83.7-95.2%) and 93% (80.9-98.5%) respectively. Ninety-two (98%) patients were correctly triaged to their repeat surveillance colonoscopy. Based on these findings, a cut and discard approach would have resulted in a saving of $319.77 per patient. Endoscopists within a tertiary care setting can accurately predict diminutive polyp histology and confer an appropriate surveillance interval with an associated financial benefit to the healthcare system. However, limitations to its application in the community setting exist, which may improve with further training and high-definition colonoscopes. © 2015 Royal Australasian College of Physicians.

Use, appropriateness, and diagnostic yield of screening colonoscopy: an international observational study (EPAGE)

DEFF Research Database (Denmark)

Burnand, B; JK, Harris; Wietlisbach, V

2006-01-01

was asked of all centers, it is possible that not all consecutive patients were included. Participating centers were a convenience sample and thus may not be representative. CONCLUSIONS: About 1 of 10 colonoscopies were performed for screening, preferentially in middle-aged individuals. A higher diagnostic...

Identifying transposon insertions and their effects from RNA-sequencing data.

Science.gov (United States)

de Ruiter, Julian R; Kas, Sjors M; Schut, Eva; Adams, David J; Koudijs, Marco J; Wessels, Lodewyk F A; Jonkers, Jos

2017-07-07

Insertional mutagenesis using engineered transposons is a potent forward genetic screening technique used to identify cancer genes in mouse model systems. In the analysis of these screens, transposon insertion sites are typically identified by targeted DNA-sequencing and subsequently assigned to predicted target genes using heuristics. As such, these approaches provide no direct evidence that insertions actually affect their predicted targets or how transcripts of these genes are affected. To address this, we developed IM-Fusion, an approach that identifies insertion sites from gene-transposon fusions in standard single- and paired-end RNA-sequencing data. We demonstrate IM-Fusion on two separate transposon screens of 123 mammary tumors and 20 B-cell acute lymphoblastic leukemias, respectively. We show that IM-Fusion accurately identifies transposon insertions and their true target genes. Furthermore, by combining the identified insertion sites with expression quantification, we show that we can determine the effect of a transposon insertion on its target gene(s) and prioritize insertions that have a significant effect on expression. We expect that IM-Fusion will significantly enhance the accuracy of cancer gene discovery in forward genetic screens and provide initial insight into the biological effects of insertions on candidate cancer genes. © The Author(s) 2017. Published by Oxford University Press on behalf of Nucleic Acids Research.

Effectiveness of screening colonoscopy in reducing the risk of death from right and left colon cancer: a large community-based study.

Science.gov (United States)

Doubeni, Chyke A; Corley, Douglas A; Quinn, Virginia P; Jensen, Christopher D; Zauber, Ann G; Goodman, Michael; Johnson, Jill R; Mehta, Shivan J; Becerra, Tracy A; Zhao, Wei K; Schottinger, Joanne; Doria-Rose, V Paul; Levin, Theodore R; Weiss, Noel S; Fletcher, Robert H

2018-02-01

Screening colonoscopy's effectiveness in reducing colorectal cancer mortality risk in community populations is unclear, particularly for right-colon cancers, leading to recommendations against its use for screening in some countries. This study aimed to determine whether, among average-risk people, receipt of screening colonoscopy reduces the risk of dying from both right-colon and left-colon/rectal cancers. We conducted a nested case-control study with incidence-density matching in screening-eligible Kaiser Permanente members. Patients who were 55-90 years old on their colorectal cancer death date during 2006-2012 were matched on diagnosis (reference) date to controls on age, sex, health plan enrolment duration and geographical region. We excluded patients at increased colorectal cancer risk, or with prior colorectal cancer diagnosis or colectomy. The association between screening colonoscopy receipt in the 10-year period before the reference date and colorectal cancer death risk was evaluated while accounting for other screening exposures. We analysed 1747 patients who died from colorectal cancer and 3460 colorectal cancer-free controls. Compared with no endoscopic screening, receipt of a screening colonoscopy was associated with a 67% reduction in the risk of death from any colorectal cancer (adjusted OR (aOR)=0.33, 95% CI 0.21 to 0.52). By cancer location, screening colonoscopy was associated with a 65% reduction in risk of death for right-colon cancers (aOR=0.35, CI 0.18 to 0.65) and a 75% reduction for left-colon/rectal cancers (aOR=0.25, CI 0.12 to 0.53). Screening colonoscopy was associated with a substantial and comparably decreased mortality risk for both right-sided and left-sided cancers within a large community-based population. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Direct random insertion mutagenesis of Helicobacter pylori

NARCIS (Netherlands)

de Jonge, Ramon; Bakker, Dennis; van Vliet, Arnoud H. M.; Kuipers, Ernst J.; Vandenbroucke-Grauls, Christina M. J. E.; Kusters, Johannes G.

2003-01-01

Random insertion mutagenesis is a widely used technique for the identification of bacterial virulence genes. Most strategies for random mutagenesis involve cloning in Escherichia coli for passage of plasmids or for phenotypic selection. This can result in biased selection due to restriction or

Direct random insertion mutagenesis of Helicobacter pylori.

NARCIS (Netherlands)

Jonge, de R.; Bakker, D.; Vliet, van AH; Kuipers, E.J.; Vandenbroucke-Grauls, C.M.J.E.; Kusters, J.G.

2003-01-01

Random insertion mutagenesis is a widely used technique for the identification of bacterial virulence genes. Most strategies for random mutagenesis involve cloning in Escherichia coli for passage of plasmids or for phenotypic selection. This can result in biased selection due to restriction or

Bowel Preparation for Colonoscopy with Sodium Phosphate Solution versus Polyethylene Glycol-Based Lavage: A Multicenter Trial

Directory of Open Access Journals (Sweden)

S. Schanz

2008-01-01

Full Text Available Background: Adequate bowel preparation is essential for accurate colonoscopy. Both oral sodium phosphate (NaP and polyethylene glycol-based lavage (PEG-ELS are used predominantly as bowel cleansing modalities. NaP has gained popularity due to low drinking volume and lower costs. The purpose of this randomized multicenter observer blinded study was to compare three groups of cleansing (NaP, NaP + sennosides, PEG-ELS + sennosides in reference to tolerability, acceptance, and cleanliness. Patient and Methods: 355 outpatients between 18 and 75 years were randomized into three groups (A, B, C receiving NaP = A, NaP, and sennosides = B or PEG-ELS and sennosides = C. Gastroenterologists performing colonoscopies were blinded to the type of preparation. All patients documented tolerance and adverse events. Vital signs, premedication, completeness, discomfort, and complications were recorded. A quality score (0–4 of cleanliness was generated. Results: The three groups were similar with regard to age, sex, BMI, indication for colonoscopy, and comorbidity. Drinking volumes (L (A = 4.33 + 1.2, B = 4.56 + 1.18, C = 4.93 + 1.71 were in favor of NaP (P = .005. Discomfort from ingested fluid was recorded in A = 39.8% (versus C: P = .015, B = 46.6% (versus C: P = .147, and C = 54.6%. Differences in tolerability and acceptance between the three groups were statistically not significant. No differences in adverse events and the cleanliness effects occurred in the three groups (P = .113. The cleanliness quality scores 0–2 were calculated in A: 77.7%, B: 86.7%, and C: 85.2%. Conclusions: These data fail to demonstrate significant differences in tolerability, acceptance, and preparation quality between the three types of bowel preparation for colonoscopy. Cleansing with NaP was not superior to PEG-ELS.

Impact of a simulation training curriculum on technical and nontechnical skills in colonoscopy: a randomized trial.

Science.gov (United States)

Grover, Samir C; Garg, Ankit; Scaffidi, Michael A; Yu, Jeffrey J; Plener, Ian S; Yong, Elaine; Cino, Maria; Grantcharov, Teodor P; Walsh, Catharine M

2015-12-01

GI endoscopy simulation-based training augments early clinical performance; however, the optimal manner by which to deliver training is unknown. We aimed to validate a simulation-based structured comprehensive curriculum (SCC) designed to teach technical, cognitive, and integrative competencies in colonoscopy. Single-blinded, randomized, controlled trial. Endoscopic simulation course at an academic hospital. Thirty-three novice endoscopists were allocated to an SCC group or self-regulated learning (SRL) group. The SCC group received a curriculum consisting of 6 hours of didactic lectures and 8 hours of virtual reality simulation-based training with expert feedback. The SRL group was provided a list of desired objectives and was instructed to practice on the simulator for an equivalent time (8 hours). Clinical transfer was assessed during 2 patient colonoscopies using the Joint Advisory Group Direct Observation of Procedural Skills (JAG DOPS) scale. Secondary outcome measures included differences in procedural knowledge, immediate post-training simulation performance, and delayed post-training (4-6 weeks) performance during an integrated scenario test on the JAG DOPS communication and integrated scenario global rating scales. There was no significant difference in baseline or post-training performance on the simulator task. The SCC group performed superiorly during their first and second clinical colonoscopies. Additionally, the SCC group demonstrated significantly better knowledge and colonoscopy-specific performance, communication, and global performance during the integrated scenario. We were unable to measure SRL participants' effort outside of mandatory training. In addition, feedback metrics and number of available simulation cases are limited. These results support integration of endoscopy simulation into a structured curriculum incorporating instructional feedback and complementary didactic knowledge as a means to augment technical, cognitive, and

Benefits of Barium Enema in Patients with Incomplete Colonoscopy. Prospective Study of 45 Cases; Valor del enema de bario en pacientes con colonoscopia incompleta. Estudio prospectivo de 45 casos

Energy Technology Data Exchange (ETDEWEB)

Gispert, S.; Mayolas, N.; Hidalgo, A. [Hospital General Universitario Vall de Hebron. Barcelona (Spain)

2003-07-01

To evaluate the usefulness of barium enema in patients with incomplete colonoscopy. There was carried out a prospective 10-month study of 45 patients with incomplete colonoscopy (27 men and 18 women), who were later examined by means of barium enema (33 conventional, 12 double-contrast) in order to check for additional pathology in portions of the colon not visualized by colonoscopy. Barium enema diagnosed six possible additional lesions (13.3%) in portions of the colon not visualized by incomplete colonoscopy (four neoplasia and two non-neoplasia). Regarding the neoplasia two were true positives and two false positives. Both true positives were adenocarcinomas (one synchronous caecum, and another in splenic angle). The two false positives corresponded to fecal matter stuck to the intestinal wall. Regarding the non-neoplasia, multiple stenosis was detected in a patient with Crohn's disease and an enterocolic fistula was found in a patient with sigmoid colon neoplasia. The diagnostic yield of barium enema in the detection of additional pathology in colon portions not visualized by colonoscopy was of 9%. Barium enema following incomplete colonoscopy permits a complete colon evaluation in most cases, and it offers additional diagnostic information. (Author) 21 refs.

Patient-to-patient transmission of hepatitis C virus (HCV) during colonoscopy diagnosis.

Science.gov (United States)

González-Candelas, Fernando; Guiral, Silvia; Carbó, Rosa; Valero, Ana; Vanaclocha, Hermelinda; González, Francisco; Bracho, Maria Alma

2010-09-08

No recognized risk factors can be identified in 10-40% of hepatitis C virus (HCV)-infected patients suggesting that the modes of transmission involved could be underestimated or unidentified. Invasive diagnostic procedures, such as endoscopy, have been considered as a potential HCV transmission route; although the actual extent of transmission in endoscopy procedures remains controversial. Most reported HCV outbreaks related to nosocomial acquisition have been attributed to unsafe injection practices and use of multi-dose vials. Only a few cases of likely patient-to-patient HCV transmission via a contaminated colonoscope have been reported to date. Nosocomial HCV infection may have important medical and legal implications and, therefore, possible transmission routes should be investigated. In this study, a case of nosocomial transmission of HCV from a common source to two patients who underwent colonoscopy in an endoscopy unit is reported. A retrospective epidemiological search after detection of index cases revealed several potentially infective procedures: sample blood collection, use of a peripheral catheter, anesthesia and colonoscopy procedures. The epidemiological investigation showed breaches in colonoscope reprocessing and deficiencies in the recording of valuable tracing data. Direct sequences from the NS5B region were obtained to determine the extent of the outbreak and cloned sequences from the E1-E2 region were used to establish the relationships among intrapatient viral populations. Phylogenetic analyses of individual sequences from viral populations infecting the three patients involved in the outbreak confirmed the patient pointed out by the epidemiological search as the source of the outbreak. Furthermore, the sequential order in which the patients underwent colonoscopy correlates with viral genetic variability estimates. Patient-to-patient transmission of HCV could be demonstrated although the precise route of transmission remained unclear. Viral

Colonoscopy results are not enhanced by use of magnet endoguide in specialist practice

DEFF Research Database (Denmark)

Bak-Christensen, Anders; Knudsen, Elisabeth; Hendel, Jakob

2013-01-01

screening. UPD has been proposed as a tool for optimization of results and reduction of patient discomfort. In this study, we aimed to qualify the debate by examining the success rate and patient discomfort in an unselected colonoscopy population referred to specialist clinics with experienced investigators...

Pediatric Enteric Feeding Techniques: Insertion, Maintenance, and Management of Problems

International Nuclear Information System (INIS)

Nijs, Els L. F.; Cahill, Anne Marie

2010-01-01

Enteral feeding is considered a widespread, well-accepted means of delivering nutrition to adults and children who are unable to consume food by mouth or who need support in maintaining adequate nutrition for a variety of reasons, including acute and chronic disease states. Delivery of enteral feeding to nutritionally deprived patients may be achieved by several means. In this article, the indications and insertion of enteral access in children will be reviewed. In addition, common complications and management of problems will be discussed.

Correlation of double-contrast high-density barium enema, colonoscopy, and histology in children with special attention to disparities

International Nuclear Information System (INIS)

Stringer, D.A.; Sherman, P.M.; Jakowenko, N.

1986-01-01

Colonscopic and double-contrast high-density barium enema (DCBE) findings were correlated in 68 patients (39 boys and 29 girls) aged 6 months to 18 years (mean 11.6 years) evaluated over a 24-month period. There was excellent correlation in 53 patients (78.0%) and good correlation in another 3 (4.4%) who had identical diagnoses and only slightly differing extent of disease reported. In 2 of these, DCBE showed more extensive disease, confirmed histologically in 1. Distal colitis seen on colonoscopy as reddening and neovascularity was missed on DCBE in 6 patients. Colonoscopy and DEBE failed to show a polyp in 1 patient each. One patient who had a normal DCBE and colonoscopy demonstrated a histological abnormality, and 1 patient with an abnormality on histology and DCBE was normal on colonscopy. A disparity resulted from the time between procedures in 1 patient and observer error in another. This high correlation is far better than any previously reported in children, supporting the use of high-density barium sulfate and double-contrast barium enemas in pediatric patients. (orig.)

Effect of Tension and Curvature of Skin on Insertion Characteristics of Microneedle Array

Science.gov (United States)

Tachikawa, Hiroto; Takano, Naoki; Nishiyabu, Kazuaki; Miki, Norihisa; Ami, Yoshimichi

Recent MEMS (micro electro mechanical system) fabrication techniques have made it possible to produce painless microneedles precisely enough to be inserted into epidermis layer penetrating the stratum corneum of human skin. This paper presents a testing procedure to evaluate the insertion characteristics of microneedle array using cultured human skin considering the tension and the curvature. First, the biaxial strain applied to the cultured human skin was measured by optical technique with image processing. It was found that almost constant strain could be successfully given within a certain area and that error factors in the experiment except the thickness variation of the cultured skin were negligible. Next, using a microneedle square array for brain machine interface (BMI) application, the effects of biaxial tension and the curvature on insertion characteristics were discussed. Within the above mentioned area with high strain, the needles were successfully inserted.

Polyethylene glycol 3350 without electrolytes: a new safe, effective, and palatable bowel preparation for colonoscopy in children.

Science.gov (United States)

Pashankar, Dinesh S; Uc, Aliye; Bishop, Warren P

2004-03-01

To assess safety, efficacy, and acceptance of polyethylene glycol 3350 without electrolytes (PEG) for bowel preparation for colonoscopy in children. Study design In a prospective study, 46 children (mean age, 11.2 years; range, 2.8-17.8) were given PEG at a dose of 1.5 g/kg/day for 4 days before colonoscopy. Patients were allowed to mix PEG in the beverage of their choice. Stool frequency and adverse effects were monitored during PEG therapy. Compliance, tolerance, and quality of colonic preparation were assessed. Serum electrolytes were measured before and after PEG therapy in 29 children. Daily stool frequency increased with PEG therapy from baseline of 2.6+/-0.3 to 3.0+/-0.5 on day 1, 4.6+/-0.4 on day 2, 5.5+/-0.7 on day 3, and 6.0+/-0.6 on day 4 (days 2, 3, and 4, PPEG therapy. Compliance and tolerance were rated as excellent by 89% and 85% of patients, respectively. Electrolyte-free PEG 3350 can be used as an effective and safe bowel preparation that is well accepted by children for colonoscopy.

Development of in vivo impedance spectroscopy techniques for measurement of micropore formation following microneedle insertion.

Science.gov (United States)

Brogden, Nicole K; Ghosh, Priyanka; Hardi, Lucia; Crofford, Leslie J; Stinchcomb, Audra L

2013-06-01

Microneedles (MNs) provide a minimally invasive means to enhance skin permeability by creating micron-scale channels (micropores) that provide a drug delivery pathway. Adequate formation of the micropores is critical to the success of this unique drug delivery technique. The objective of the current work was to develop sensitive and reproducible impedance spectroscopy techniques to monitor micropore formation in animal models and human subjects. Hairless guinea pigs, a Yucatan miniature pig, and human volunteers were treated with 100 MN insertions per site following an overnight prehydration period. Repeated measurements were made pre- and post-MN treatment using dry and gel Ag/AgCl electrodes applied with light verses direct pressure to hold the electrode to the skin surface. Impedance measurements dropped significantly post-MN application at all sites (p micropore formation. In the Yucatan pig and human subjects, gel electrodes with direct pressure yielded the lowest variability (demonstrated by lower %relative standard deviation), whereas dry electrodes with direct pressure were superior in the guinea pigs. These studies confirm that impedance measurements are suitable for use in both clinical and animal research environments to monitor the formation of new micropores that will allow for drug delivery through the impermeable skin layers. Copyright © 2013 Wiley Periodicals, Inc.

Difference in F-18 FDG uptake after esophago gastroduodenoscopy and colonoscopy in healthy sedated subjects

Energy Technology Data Exchange (ETDEWEB)

Oh, Jong Ryool; Chang, Woo Jin; Bae, Seung Il; Song, In Wook; Bong, Jin Gu; Jeong, Hye Yeon; Park, So Young; Bae, Jeong Yup; Yoon, Hyun Dae [Raphael Hospital, Daegu (Korea, Republic of); Seo, Ji Hyoung [Dept. of Nuclear MedicineFatima Hospital, Daegu (Korea, Republic of)

2017-09-15

We aimed to evaluate the difference in fluorodeoxyglucose (FDG) uptake in sedated healthy subjects after they underwent esophagogastroduodenoscopy (EGD) and colonoscopy procedures. The endoscopy group (n = 29) included healthy subjects who underwent screening via F-18 FDG positron emission tomography/computed tomography (PET/CT) after an EGD and/or colonoscopy under sedation on the same day. The control group (n = 35) included healthy subjects who underwent screening via PET/CT only. FDG uptake in the tongue, uvula, epiglottis, vocal cords, esophagus, stomach, duodenum, liver, cecum, colon, anus, and muscle were compared between the two groups. Maximum standardized uptake value (SUVmax) in the tongue, pharynx, larynx, and esophagus did not significantly differ between the endoscopy and control groups. In contrast, mean SUVmax in the whole stomach was 18 % higher in the endoscopy group than in the control group (SUVmax: 2.96 vs. 2.51, P = 0.010). In the lower gastrointestinal track, SUVmax from the cecum to the rectum was not significantly different between the two groups, whereas SUVmax in the anus was 20 % higher in the endoscopy group than in the control group (SUVmax: 4.21 vs. 3.50, P = 0.002). SUVmax in the liver and muscle was not significantly different between the two groups. Mean volume of the stomach and mean cross section of the colon was significantly higher in the endoscopy group than in the control group (stomach: 313.28 cm{sup 3} vs. 209.93 cm{sup 3}, P < 0.001, colon: 8.82 cm{sup 2} vs. 5.98 cm{sup 2}, P = 0.001). EGD and colonoscopy under sedation does not lead to significant differences in SUVmax in most parts of the body. Only gastric FDG uptake in the EGD subjects and anal FDG uptake in the colonoscopy subjects was higher than uptake in those regions in the control subjects.

Can the localization of primary colonic tumors be improved by staging CT without specific bowel preparation compared to optical colonoscopy?

International Nuclear Information System (INIS)

Feuerlein, Sebastian; Grimm, Lars J.; Davenport, Matthew S.; Haystead, Clare M.; Miller, Chad M.; Neville, Amy M.; Jaffe, Tracy A.

2012-01-01

Objectives: To investigate the ability of staging computed tomography (CT) without bowel preparation to accurately localize colonic tumors compared to optical colonoscopy. Methods: The local institutional review board approved this retrospective and HIPAA-compliant study. Forty-six patients with colonic adenocarcinoma, preoperative colonoscopy, and staging CT within 60 days of resection were included. Patients underwent contrast enhanced CT imaging without bowel preparation or oral contrast. The colon was divided into four segments with the operative reports used as the standard. Rectal and cecal cancers were excluded. CT scans were reviewed by 5 readers in a segmental binary fashion using a 5-point confidence scale in two sessions blinded and unblinded to the colonoscopy report. Results: At surgery 49 tumors were found in 46 patients. Readers detected 86.1%, 74.3%, and 66.9% of lesions with 92.0%, 94.1%, and 95.4% accuracy for confidence scores of ≥3, ≥4, and 5. CT interobserver agreement was good (κ = 0.82) for the unblinded and moderate (κ = 0.60) for the blinded read. Colonoscopic localization was only 78.7% accurate with 2 tumors undiscovered. Colonoscopic accuracy was low in the descending colon (57.1%) and the transverse colon (55.6%). Conclusions: Preoperative staging CT is more accurate than colonoscopy in the localization of colonic tumors

A new composite measure of colonoscopy: the Performance Indicator of Colonic Intubation (PICI).

Science.gov (United States)

Valori, Roland M; Damery, Sarah; Gavin, Daniel R; Anderson, John T; Donnelly, Mark T; Williams, J Graham; Swarbrick, Edwin T

2018-01-01

 Cecal intubation rate (CIR) is an established performance indicator of colonoscopy. In some patients, cecal intubation with acceptable tolerance is only achieved with additional sedation. This study proposes a composite Performance Indicator of Colonic Intubation (PICI), which combines CIR, comfort, and sedation. METHODS : Data from 20 085 colonoscopies reported in the 2011 UK national audit were analyzed. PICI was defined as the percentage of procedures achieving cecal intubation with median dose (2 mg) of midazolam or less, and nurse-assessed comfort score of 1 - 3/5. Multivariate logistic regression analysis evaluated possible associations between PICI and patient, unit, colonoscopist, and diagnostic factors. RESULTS : PICI was achieved in 54.1 % of procedures. PICI identified factors affecting performance more frequently than single measures such as CIR and polyp detection, or CIR + comfort alone. Older age, male sex, adequate bowel preparation, and a positive fecal occult blood test as indication were associated with a higher PICI. Unit accreditation, the presence of magnetic imagers in the unit, greater annual volume, fewer years' experience, and higher training/trainer status were associated with higher PICI rates. Procedures in which PICI was achieved were associated with significantly higher polyp detection rates than when PICI was not achieved. CONCLUSIONS : PICI provides a simpler picture of performance of colonoscopic intubation than separate measures of CIR, comfort, and sedation. It is associated with more factors that are amenable to change that might improve performance and with higher likelihood of polyp detection. It is proposed that PICI becomes the key performance indicator for intubation of the colon in colonoscopy quality improvement initiatives. © Georg Thieme Verlag KG Stuttgart · New York.

Hemorrhoids detected at colonoscopy: an infrequent cause of false-positive fecal immunochemical test results.

NARCIS (Netherlands)

Turenhout, S.T. van; Oort, F.A.; Terhaar sive Droste, J.S.; Coupe, V.M.; Hulst, R.W. van der; Loffeld, R.J.; Scholten, P.; Depla, A.C.; Bouman, A.A.; Meijer, G.A.; Mulder, C.J.; Rossum, L.G.M. van

2012-01-01

BACKGROUND: Colorectal cancer screening by fecal immunochemical tests (FITs) is hampered by frequent false-positive (FP) results and thereby the risk of complications and strain on colonoscopy capacity. Hemorrhoids might be a plausible cause of FP results. OBJECTIVE: To determine the contribution of

The blind pushing technique for peripherally inserted central catheter placement through brachial vein puncture.

Science.gov (United States)

Lee, Jae Myeong; Cho, Young Kwon; Kim, Han Myun; Song, Myung Gyu; Song, Soon-Young; Yeon, Jae Woo; Yoon, Dae Young; Lee, Sam Yeol

2018-03-01

The objective of this study was to conduct a prospective clinical trial evaluating the technical feasibility and short-term clinical outcome of the blind pushing technique for placement of pretrimmed peripherally inserted central catheters (PICCs) through brachial vein access. Patients requiring PICC placement at any of the three participating institutions were prospectively enrolled between January and December 2016. The review boards of all participating institutions approved this study, and informed consent was obtained from all patients. PICC placement was performed using the blind pushing technique and primary brachial vein access. The following data were collected from unified case report forms: access vein, obstacles during PICC advancement, procedure time, and postprocedural complications. During the 12-month study period, 1380 PICCs were placed in 1043 patients. Of these, 1092 PICCs placed in 837 patients were enrolled, with 834 PICCs (76%) and 258 PICCs (34%) placed through brachial vein and nonbrachial vein access, respectively. In both arms, obstacles were most commonly noted in the subclavian veins (n = 220) and axillary veins (n = 94). Successful puncture of the access vein was achieved at first try in 1028 PICCs (94%). The technical success rate was 99%, with 1055 PICCs (97%) placed within 120 seconds of procedure time and 1088 PICCs (99%) having the tip located at the ideal position. Follow-up Doppler ultrasound detected catheter-associated upper extremity deep venous thrombosis (UEDVT) for 18 PICCs in 16 patients and late symptomatic UEDVT for 16 PICCs in 16 patients (3.1%). Catheter-associated UEDVT was noted for 28 PICCs (82%) and 6 PICCs (18%) placed through brachial vein and nonbrachial vein access, respectively. The incidence of obstacles and the procedure time (pushing technique and primary brachial vein access is technically feasible and may represent an alternative to the conventional PICC placement technique, having low incidences of

Multicenter surgical experience evaluation on the Mid-Scala electrode and insertion tools.

Science.gov (United States)

Gazibegovic, Dzemal; Bero, Eva M

2017-02-01

The HiFocus Mid-Scala electrode is intended to improve hearing for individuals with severe-to-profound hearing loss by providing extended electrical coverage of the cochlea while minimizing trauma related to insertion. The electrode is appropriate for use with a wide range of surgical techniques, including either a cochleostomy or round window insertion, and the use of either a free-hand or tool-assisted approach. The objective of this survey was to evaluate how the HiFocus Mid-Scala electrode and insertion tools was used across a population of cochlear implant recipients of differing ages, audiologic profiles, and anatomical characteristics. The intent was to understand the type and frequency of surgical techniques applicable with the electrode, and to provide guidelines for clinical practice. Two questionnaires were completed by surgeons at implant centres located in the United States, Europe, and Asia. Before any surgeries were conducted, surgeons completed a questionnaire that assessed their overall cochlear implant surgical practice and preferences. Following each HiFocus Mid-Scala electrode insertion, surgeons completed a questionnaire that summarized their experience during that surgical procedure. Questionnaires were completed by 32 surgeons from 16 centres for a total of 143 surgeries (112 adults, 31 children). Most surgeons (62 %) preferred to insert the electrode via the round window or an extended round window compared with a cochleostomy (16 %), whereas the remaining 22 % indicated that they made an insertion choice based on presenting anatomy. Sixty-nine percent preferred a free-hand approach over using insertion tools. In 32 procedures, surgeons elected to deviate from an intended round window insertion to either an extended round window or cochleostomy approach.

Is "really conscious" sedation with solely an opioid an alternative to every day used sedation regimes for colonoscopies in a teaching hospital? Midazolam/fentanyl, propofol/alfentanil, or alfentanil only for colonoscopy: a randomized trial

NARCIS (Netherlands)

Eberl, S.; Polderman, J. A. W.; Preckel, B.; Kalkman, C. J.; Fockens, P.; Hollmann, M. W.

2014-01-01

We investigated the satisfaction of patients and endoscopists and concurrently safety aspects of an "alfentanil only" and two clinically routinely used sedation regimes in patients undergoing colonoscopy in a teaching hospital. One hundred and eighty patients were prospectively randomized in three

[Acceptance and willingness-to-pay for colorectal colonoscopy screening among high-risk populations for colorectal cancer in urban China].

Science.gov (United States)

Shi, Jufang; Huang, Huiyao; Guo, Lanwei; Ren, Jiansong; Ren, Ying; Lan, Li; Zhou, Qi; Mao, Ayan; Qi, Xiao; Liao, Xianzhen; Liu, Guoxiang; Bai, Yana; Cao, Rong; Liu, Yuqin; Wang, Yuanzheng; Gong, Jiyong; Li, Ni; Zhang, Kai; He, Jie; Dai, Min

2015-05-01

To survey the acceptance and willingness-to-pay for colorectal cancer colonoscopy screening among high risk populations in urban China. From 2012 to 2013, a Cancer Screening Program in Urban China (CanSPUC) was initiated in 9 provinces, the current survey was conducted among those participants who were evaluated as "high risk for colorectal cancer" by a risk-factor-evaluation-model (community-based) and then went through a colonoscopy screening procedure (hospital-based). All the data were obtained through a questionnaire-based interview (face-to-face or self-completed), mainly focusing on the acceptance and willingness-to-pay of the participants for colorectal colonoscopy screening. The current analysis included a total of 1 624 participants, with an median age of 55.0 years (P25 = 49.0, P75 = 61.0 years) and an annual income per capita of 17 thousand (range: 10-25 thousand) Chinese Yuan (CNY), 42.8% (695/1 624) of whom were males. Of all the participants, 87.0% (1 414/1 624) could totally or substantially accept the colonoscopy screening, particularly in those at higher education level (junior high school: OR = 0.34, 95% CI: 0.22-0.52; high school OR = 0.41, 95% CI: 0.26-0.66; college or over OR = 0.35, 95% CI: 0.20-0.59). Of all the participants, 13.0% (210/1 624) could not or hardly accept it, particularly in those with older age (60-69 years) (OR = 1.48, 95% CI: 1.06-2.07), not in marriage (OR = 2.15, 95% CI: 1.25-3.70) or with family member(s) to raise (OR = 1.60, 95% CI: 1.17-2.20). 1 388 (85.5%) of all the participants had willingness-to-pay for a long-term colonoscopy screening service, particularly in those working in public (OR = 0.61, 95% CI: 0.44-0.84) or enterprise sectors (OR = 0.60, 95% CI: 0.38-0.94), but 82.3% (1 141/1 386) of whom would only pay less than 100 CNY; 14.5% (236/1 624) of total had no willingness-to-pay, particularly in those living in areas with moderate (OR = 4.08, 95% CI: 2.75-6.33) or high GDP per capita (OR = 3.26, 95% CI: 2

Active Choice and Financial Incentives to Increase Rates of Screening Colonoscopy-A Randomized Controlled Trial.

Science.gov (United States)

Mehta, Shivan J; Feingold, Jordyn; Vandertuyn, Matthew; Niewood, Tess; Cox, Catherine; Doubeni, Chyke A; Volpp, Kevin G; Asch, David A

2017-11-01

Behavioral economic approaches could increase uptake for colorectal cancer screening. We performed a randomized controlled trial of 2245 employees to determine whether an email containing a phone number for scheduling (control), an email with the active choice to opt in or opt out (active choice), or the active choice email plus a $100 incentive (financial incentive) increased colonoscopy completion within 3 months. Higher proportions of participants in the financial incentive group underwent screening (3.7%) than in the control (1.6%) or active choice groups (1.5%) (P = .01 and P < .01). We found no difference in uptake of screening between the active choice and control groups (P = .88). The $100 conditional incentive modestly but significantly increased colonoscopy use. ClinicalTrials.gov no: NCT02660671. Copyright © 2017 AGA Institute. Published by Elsevier Inc. All rights reserved.

Psychomotor and cognitive effects of 15-minute inhalation of methoxyflurane in healthy volunteers: implication for post-colonoscopy care.

Science.gov (United States)

Nguyen, Nam Q; Burgess, Jenna; Debreceni, Tamara L; Toscano, Leanne

2016-11-01

Background and study aims: Colonoscopy with portal inhaled methoxyflurane (Penthrox) is highly feasible with low sedation risk and allows earlier discharge. It is unclear if subjects can return to highly skilled psychomotor skill task shortly after Penthrox assisted colonoscopy. We evaluated the psychomotor and cognitive effects of 15-minute inhalation of Penthrox in adults. Patients and methods: Sixty healthy volunteers (18 to 80 years) were studied on 2 occasions with either Penthrox or placebo in a randomized, double-blind fashion. On each occasion, the subject's psychomotor function was examined before, immediately, 30, 60, 120, 180 and 240 min after a 15-minute inhalation of studied drug, using validated psychomotor tests (Digit Symbol Substitution Test (DSST), auditory reaction time (ART), eye-hand coordination (EHC) test, trail making test (TMT) and logical reasoning test (LRT). Results: Compared to placebo, a 15-minute Penthrox inhalation led to an immediate but small impairment of DSST ( P  returns to normal within 30 minutes , indicating that subjects who have colonoscopy with Penthrox can return to highly skilled psychomotor skills tasks such as driving and daily work the same day.

Radiation dose measurements of the insertion devices using radiachromic film dosimeters

International Nuclear Information System (INIS)

Alderman, J.; Semones, E.; Job, P. K.

2004-01-01

The Advanced Photon Source (APS) uses Nd-Fe-B permanent magnets in the insertion devices to produce x-rays for scientific research [1,2]. Earlier investigations have exhibited varying degrees of demagnetization of these magnets [3] due to irradiation from electron beams [4,5,6], 60 Co γ-rays [5], and high-energy neutrons [7,8]. Radiation-induced demagnetization has been observed in the APS insertion devices [9] and was first measured in December of 2001. Partial demagnetization has also been observed in insertion devices at the European Synchrotron Radiation Facility (ESRF) [4,6], where Nd-Fe-B permanent magnets are also used. Growing concern for the lifetime of APS insertion devices, as well as the permanent magnets that will be used in next-generation, high-power light sources, like the FEL [10,11], resulted from the partial demagnetization observations made at both facilities. This concern in relation to radiation-induced demagnetization spurred a long-term project to measure and analyze the absorbed doses received by the APS insertion devices. The project required a reliable photon high-dose dosimetry technique capable of measuring absorbed doses greater than 10 6 rad, which was not readily available at the APS. Through a collaboration with the National Institute of Standards and Technology (NIST), one such technique using radiachromic films was considered, tested, and calibrated at the APS. This consequently led to the implementation of radiachromic film dosimetry for measuring the absorbed doses received by the insertion devices for each of the APS runs

Method of inserting fuel rod

International Nuclear Information System (INIS)

Kamimoto, Shuji; Imoo, Makoto; Tsuchida, Kenji.

1991-01-01

The present invention concerns a method of inserting a fuel rod upon automatic assembling, automatic dismantling and reassembling of a fuel assembly in a light water moderated reactor, as well as a device and components used therefor. That is, a fuel rod is inserted reliably to an aimed point of insertion by surrounding the periphery of the fuel rod to be inserted with guide rods, and thereby suppressing the movement of the fuel rod during insertion. Alternatively, a fuel rod is inserted reliably to a point of insertion by inserting guide rods at the periphery of the point of insertion for the fuel rod to be inserted thereby surrounding the point of insertion with the guide rods or fuel rods. By utilizing fuel rods already present in the fuel assembly as the guide rods described above, the fuel rod can be inserted reliably to the point of insertion with no additional devices. Dummy fuel rods are previously inserted in a fuel assembly which are then utilized as the above-mentioned guide rods to accurately insert the fuel rod to the point of insertion. (I.S.)

A randomized, controlled, double-blind trial of the adjunct use of Clebopride in polyethylene glycol electrolyte (PEG) solution for colonoscopy preparation.

Science.gov (United States)

Abdullah, Murdani; Rani, A Aziz; Fauzi, Achmad; Syam, Ari Fahrial; Makmun, Dadang; Simadibrata, Marcellus; Manan, Chudahman; Harjodisastro, Daldiyono

2010-01-01

To study the benefit of Clebopride as an adjuvant in polyethylene glycol electrolyte (PEG) solution for colonoscopy preparation. Eighty one adult patients who underwent colonoscopy examination were recruited in this randomized double blind controlled study. First group received PEG and placebo, whereas second group received PEG and Clebopride. Two litres of PEG was taken at night before colonoscopy. The acceptability and tolerability of bowel preparation were assessed through interview method. The efficacy of bowel preparation was assessed using Aronchick's Criteria. In terms of acceptability, 64 patients (31 patients from placebo group vs 33 patients from Clebopride group) were able to drink two litres of PEG solution. Sixty patients (29 patients from placebo group and 31 patients from Clebopride group) were willing to accept PEG solution for their next bowel preparation. On the term of tolerability, nausea, abdominal distension, and borborygmus were more frequent in the placebo group (34.2% vs 27.9%; 44.7% vs 32.6%; 26.3% vs 4.6% respectively). However, only the difference at the incidence of borborygmus that was statistically significant (pClebopride group and 81.6% of bowel preparation in placebo group were optimal (p = 0.585). The adjunct use of Clebopride in PEG solution for colonoscopy preparations tends to increase the acceptability, tolerability, and efficacy. The presence of borborygmus was significantly lower in the Clebopride group.

Quality audit of colonoscopy reports amongst patients screened or surveilled for colorectal neoplasia.

Science.gov (United States)

Beaulieu, Daphnée; Barkun, Alan; Martel, Myriam

2012-07-21

To complete a quality audit using recently published criteria from the Quality Assurance Task Group of the National Colorectal Cancer Roundtable. Consecutive colonoscopy reports of patients at average/high risk screening, or with a prior colorectal neoplasia (CRN) by endoscopists who perform 11 000 procedures yearly, using a commercial computerized endoscopic report generator. A separate institutional database providing pathological results. Required documentation included patient demographics, history, procedure indications, technical descriptions, colonoscopy findings, interventions, unplanned events, follow-up plans, and pathology results. Reports abstraction employed a standardized glossary with 10% independent data validation. Sample size calculations determined the number of reports needed. Two hundreds and fifty patients (63.2 ± 10.5 years, female: 42.8%, average risk: 38.5%, personal/family history of CRN: 43.3%/20.2%) were scoped in June 2009 by 8 gastroenterologists and 3 surgeons (mean practice: 17.1 ± 8.5 years). Procedural indication and informed consent were always documented. 14% provided a previous colonoscopy date (past polyp removal information in 25%, but insufficient in most to determine surveillance intervals appropriateness). Most procedural indicators were recorded (exam date: 98.4%, medications: 99.2%, difficulty level: 98.8%, prep quality: 99.6%). All reports noted extent of visualization (cecum: 94.4%, with landmarks noted in 78.8% - photodocumentation: 67.2%). No procedural times were recorded. One hundred and eleven had polyps (44.4%) with anatomic location noted in 99.1%, size in 65.8%, morphology in 62.2%; removal was by cold biopsy in 25.2% (cold snare: 18%, snare cautery: 31.5%, unrecorded: 20.7%), 84.7% were retrieved. Adenomas were noted in 24.8% (advanced adenomas: 7.6%, cancer: 0.4%) in this population with varying previous colonic investigations. This audit reveals lacking reported items, justifying additional research to

Three-Year Outcome of Fixed Partial Rehabilitations Supported by Implants Inserted with Flap or Flapless Surgical Techniques.

Science.gov (United States)

Maló, Paulo; de Araújo Nobre, Miguel; Lopes, Armando

2016-07-01

The aim of this prospective clinical study was to evaluate the 3-year outcome of fixed partial prostheses supported by implants with immediate provisionalization without occlusal contacts inserted in predominantly soft bone with flap and flapless protocols. Forty-one patients partially rehabilitated with 72 NobelSpeedy implants (51 maxillary; 21 mandibular) were consecutively included and treated with a flapless surgical protocol (n = 20 patients; 32 implants) and flapped surgical protocol (n = 21 patients; 40 implants). Primary outcome measure was implant survival; secondary outcome measures were marginal bone resorption (comparing the bone levels at 1 and 3 years with baseline) and the incidence of biological, mechanical, and esthetic complications. Survival was computed through life tables; descriptive statistics were applied to the remaining variables of interest. Eight patients with eight implants dropped out of the study. One implant failed in one patient (flapless group) giving an overall cumulative survival rate (CSR) of 98.6%. No failures were noted with the flapped protocol (CSR 100%), while for the implants placed with the flapless surgical technique, a 96.9% CSR was registered. The overall average marginal bone resorption at 3 years was 1.37 mm (SD = 0.94 mm), with 1.14 mm (SD = 0.49 mm) and 1.60 mm (SD = 1.22 mm) for the flap and flapless groups, respectively. Mechanical complications occurred in nine patients (n = 5 patients in the flapless group; n = 4 patients in the flap group). Implant infection was registered in three implants and three patients (flapless group), who exhibited inadequate oral hygiene levels. Partial edentulism rehabilitation through immediate provisionalization fixed prosthesis supported by dental implants inserted through flap or flapless surgical techniques in areas of predominantly soft bone was viable at 3 years of follow-up. The limitations and risks of the "free-hand" method in flapless surgery should be considered when

Laparoscopic versus open peritoneal dialysis catheter insertion, the LOCI-trial: a study protocol

Directory of Open Access Journals (Sweden)

Hagen Sander M

2011-12-01

Full Text Available Abstract Background Peritoneal dialysis (PD is an effective treatment for end-stage renal disease. It allows patients more freedom to perform daily activities compared to haemodialysis. Key to successful PD is the presence of a well-functioning dialysis catheter. Several complications, such as in- and outflow obstruction, peritonitis, exit-site infections, leakage and migration, can lead to catheter removal and loss of peritoneal access. Currently, different surgical techniques are in practice for PD-catheter placement. The type of insertion technique used may greatly influence the occurrence of complications. In the literature, up to 35% catheter failure has been described when using the open technique and only 13% for the laparoscopic technique. However, a well-designed randomized controlled trial is lacking. Methods/Design The LOCI-trial is a multi-center randomized controlled, single-blind trial (pilot. The study compares the laparoscopic with the open technique for PD catheter insertion. The primary objective is to determine the optimum placement technique in order to minimize the incidence of catheter malfunction at 6 weeks postoperatively. Secondary objectives are to determine the best approach to optimize catheter function and to study the quality of life at 6 months postoperatively comparing the two operative techniques. Discussion This study will generate evidence on any benefits of laparoscopic versus open PD catheter insertion. Trial registration Dutch Trial Register NTR2878

Central venous catheter insertion problem solving using intravenous catheter: technical communication

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Alemohammad M

2013-02-01

Full Text Available Insertion of central venous catheter is an accepted method for hemodynamic monitor-ring, drug and fluid administration, intravenous access, hemodialysis and applying cardiac pace-maker in hospitalized patients. This procedure can be associated with severe complications. The aim of this article is to provide a practical approach to prevent catheter malposition in states that the guide wire will not pass freely.During central venous insertion in internal jugular vein using modified seldinger technique, when after venous insertion, the passage of the guide wire shows difficulties and don’t pass freely, insertion of an intravenous cannula over the wire and re-insertion of the wire can help to prevent malposition of the wire and the catheter. Use of an intravenous cannula over the guide, in situations that the guide wire cannot pass freely among the needle inserted in internal jugular vein, and re-insertion of the guide can probably prevent or reduce the tissue or vascular trauma and the associated complica-tions. This simple maneuver can be helpful in difficult cases especially in cardiac surgery patients who receive high dose heparin and it is necessary to avoid traumatize-tion of carotid artery.

Lattice insertions for POPAE

International Nuclear Information System (INIS)

Cho, Y.; Crosbie, E.A.; Diebold, R.; Johnson, D.E.; Ohnuma, S.; Ruggiero, A.G.; Teng, L.C.

1977-01-01

Four types of insertions are described for the six 200-m straight sections of POPAE. All have dispersion matched to zero. (1) Injection-ejection insertion--This has proper high-β values and phase advances for horizontal injection and vertical ejection. (2) Phase-adjust insertion--The phase advance in this insertion is adjustable over a range of approximately 100 0 . (3) General-purpose insertion--The β* is adjustable from 2.5. to 200 m and the crossing angle is adjustable from 0 to 11 mrad. (4) High-luminosity insertion--This gives an even lower β + of meter

Verification of Triple Modular Redundancy (TMR) Insertion for Reliable and Trusted Systems

Science.gov (United States)

Berg, Melanie; LaBel, Kenneth A.

2016-01-01

We propose a method for TMR insertion verification that satisfies the process for reliable and trusted systems. If a system is expected to be protected using TMR, improper insertion can jeopardize the reliability and security of the system. Due to the complexity of the verification process, there are currently no available techniques that can provide complete and reliable confirmation of TMR insertion. This manuscript addresses the challenge of confirming that TMR has been inserted without corruption of functionality and with correct application of the expected TMR topology. The proposed verification method combines the usage of existing formal analysis tools with a novel search-detect-and-verify tool. Field programmable gate array (FPGA),Triple Modular Redundancy (TMR),Verification, Trust, Reliability,

Improved efficiency of nanoneedle insertion by modification with a cell-puncturing protein

Science.gov (United States)

Ryu, Seunghwan; Matsumoto, Yuta; Matsumoto, Takahiro; Ueno, Takafumi; Silberberg, Yaron R.; Nakamura, Chikashi

2018-03-01

An atomic force microscope (AFM) probe etched into an ultra-sharp cylindrical shape (a nanoneedle) can be inserted into a living cell and mechanical responses of the insertion process are represented as force-distance curves using AFM. A probe-molecule-functionalized nanoneedle can be used to detect intracellular molecules of interest in situ. The insertion efficiencies of nanoneedles vary among cell types due to the cortex structures of cells, and some cell types, such as mouse fibroblast Balb/3T3 cells, show extremely low efficacy of insertion. We addressed this issue by using a cell membrane puncturing protein from bacteriophage T4 (gp5), a needle-like protein that spontaneously penetrates through the cell membrane. Gp5 was immobilized onto a nanoneedle surface. The insertion efficiency of the functionalized nanoneedle increased by over 15% compared to the non-functionalized control. Gp5-modification is a versatile approach in cell manipulation techniques for the insertion of other types of nanostructures into cells.

Insertion Modeling and Its Applications

OpenAIRE

Alexander Letichevsky; Oleksandr Letychevskyi; Vladimir Peschanenko

2016-01-01

The paper relates to the theoretical and practical aspects of insertion modeling. Insertion modeling is a theory of agents and environments interaction where an environment is considered as agent with a special insertion function. The main notions of insertion modeling are presented. Insertion Modeling System is described as a tool for development of different kinds of insertion machines. The research and industrial applications of Insertion Modeling System are presented.

Pain from copper intrauterine device insertion: randomized trial of prophylactic ibuprofen.

Science.gov (United States)

Hubacher, David; Reyes, Veronica; Lillo, Sonia; Zepeda, Ana; Chen, Pai-Lien; Croxatto, Horacio

2006-11-01

This study was undertaken to determine whether 400 mg of prophylactic ibuprofen can alleviate pain from insertion of an intrauterine device (IUD) and to measure level of pain with improved techniques. We conducted a randomized, double-blind, placebo-controlled trial of 2019 first-time IUD users: 1008 women received placebo and 1011 women received 400 mg of ibuprofen. Participants took the single tablet at least 45 minutes before IUD insertion. Immediately after insertion, participants recorded level of pain by using a 10-cm visual analog scale, with the value of 10 meaning "worst imaginable pain." Median level of pain was 1.0 for both ibuprofen and placebo participants; rank test statistics confirmed no difference. Some subgroups of women experienced higher pain (eg, nulliparous women), but ibuprofen still had no important impact on level of pain. Even among first-time users, pain from IUD insertion is generally low. Prophylactic ibuprofen as used in this protocol does not reduce IUD insertion pain.

Ameboma: A Colon Carcinoma-Like Lesion in a Colonoscopy Finding

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Chung-Cheng Lin

2013-10-01

Full Text Available Ameboma is a rare complication of amebic colitis presenting as a mass of granulation tissue with peripheral fibrosis and a core of inflammation related to amebic chronic infection. The initial presentations are usually obstruction and low gastrointestinal bleeding. The most common sites are the ascending colon and the cecum. It may mimic colon carcinoma, Crohn's disease, carcinoma of the colon, non-Hodgkin's lymphoma, tuberculosis, fungal infection, AIDS-associated lymphoma and Kaposi's sarcoma in colonoscopy findings. The therapeutic strategy should be combined with antibiotics for invasive dysentery and eradication of luminal cysts.

Validation of a Low Cost, Disposable, and Ultrasound-guided Suprapubic Catheter Insertion Trainer.

Science.gov (United States)

Nonde, James; Adam, Ahmed; Laher, Abdullah Ebrahim

2018-02-27

To validate the newly designed ultrasound-guided suprapubic catheter insertion trainer (US-SCIT) model against the real life experience by enrolling participants with prior confidence in the technique of US-guided suprapubic catheter (SPC) insertion. The US-SCIT was self-constructed from common disposables and equipment found in the emergency department. A validation questionnaire was completed by all participants after SPC insertion on the US-SCIT model. Fifty participants enrolled in the study. Each participant had reported confidence in the SPC insertion technique, prior to participation in this study. There were 13 "super-users" (>65 previous successful real life SPC insertions) in the study. The total material cost per US-SCIT unit was 1.71 USD. The US-SCIT's value in understanding the principals of US-guided SPC insertion had a mean score of 8.86 (standard deviation [SD] 1.03), whereas its value in simulating contextual anatomy had a mean score of 8.26 (SD 1.48). The mean score of the model's ability to provide realistic sensory feedback was 8.12 (SD 1.78), whereas that of realism of initial urine outflow was 9.06 (SD 1.20). Simulation with the model compared well with real life SPC insertion, with a mean score of 8.30 (SD1.48). The US-SCIT model performed well in various spheres developed to assess its ability to simulate real life SPC insertion. We are confident that this low-cost, validated, US compatible SPC trainer, constructed from common material present in the ED, will be a valuable learning asset to trainees across the globe. Copyright © 2018 Elsevier Inc. All rights reserved.

Computer-assisted surgery for screw insertion into the distal sesamoid bone in horses: an in vitro study.

Science.gov (United States)

Gygax, Diego; Lischer, Christoph; Auer, Joerg A

2006-10-01

To compare the precision of computer-assisted surgery with a conventional technique (CV) using a special guiding device for screw insertion into the distal sesamoid bone in horses. In vitro experimental study. Cadaveric forelimb specimens. Insertion of a 3.5 mm cortex screw in lag fashion along the longitudinal axis of intact (non-fractured) distal sesamoid bones was evaluated in 2 groups (8 limbs each): CV and computer-assisted surgery (CAS). For CV, the screw was inserted using a special guiding device and fluoroscopy, whereas for CAS, the screw was inserted using computer-assisted navigation. The accuracy of screw placement was verified by radiography, computed tomography, and specimen dissection. Surgical precision was better in CAS compared with CV. CAS improves the accuracy of lateromedial screw insertion, in lag fashion, into the distal sesamoid bone. The CAS technique should be considered for improved accuracy of screw insertion in fractures of the distal sesamoid bone.

COMPARATIVE STUDY OF EARLY POSTPARTUM IUCD INSERTION TO INTERVAL IUCD INSERTION

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Shibani Devi

2016-07-01

Full Text Available INTRODUCTION According to National Family Health Survey-3, Indian women have 13% unmet need for contraception and according to District Level Household & Facility Survey-3, it is 21.3% in the postpartum period. Postpartum intrauterine contraceptive device insertion - both immediately post-placental delivery and somewhat later, but within 48 hours after delivery are options which merit consideration as the woman is likely to have a high motivation for accepting contraception and the healthcare centre provides a convenient setting for insertion of IUCD. AIM Comparison of efficacy and complications of IUCD insertions in post-placental with interval period: 6-month followup. METHOD This perspective study was conducted among 100 women: - 50 women had IUCD inserted within 10 minutes of placental delivery and 50 had insertion more than 6 weeks after delivery. They were followed till 6 months post insertion and were compared regarding early and late complications, continuation rates and expulsion rates. RESULT At the end of six months, we found higher occurrence of lower abdominal pain, heavy menstrual bleeding in case of interval insertion as compared to post-placental insertion which was statistically significant (p value-0.04 & 0.007 respectively. However, the expulsion rates of post-placental IUCD were somewhat elevated (14% compared to interval insertions (2%. Continuation rates at the end of 6 months in both the groups were 82% and 86% respectively which is comparable. CONCLUSION Post-placental IUCD is thus found to be an ideal method to meet the unmet need of postpartum women as it is easily accessible and convenient for both women and their health care providers, is associated with less discomfort and fewer side effects and allow women to obtain safe, long acting, highly effective contraception while still in the health care system.

Quality assurance as an integrated part of the electronic medical record - a prototype applied for colonoscopy.

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Hoff, Geir; Ottestad, Per Marcus; Skafløtten, Stein Roger; Bretthauer, Michael; Moritz, Volker

2009-01-01

Electronic medical records (EMRs) have not developed much beyond the days of typewritten journals when it comes to facilitating extraction of data for quality assurance (QA) and improvement of health-care performance. Based on 5 years' experience from the Norwegian Gastronet QA programme, we have developed a highly QA-profiled EMR for colonoscopy. We used a three-tier solution (client, server and database) written in the Java programming language using a number of open-source libraries. QA principles from the Norwegian paper-based Gastronet QA programme formed the basis for development of the ColoReg software. ColoReg is developed primarily for colonoscopy reporting in a screening trial, but may be used in routine clinical work. The QA module in ColoReg is well suited for intervention towards suboptimal performance in both settings. We have developed user-friendly software dominated by clickable boxes and curtain menus reducing free text to a minimum. The software gives warnings when illogical registrations are entered and reasons have to be given for divergence from software recommendations for work-up and surveillance. At any time, defined performance quality parameters are readily accessible in tabular form with the named, logged-in endoscopist being compared with all other anonymized endoscopists in the database. The ColoReg software is developed for use in an international, multicentre trial on colonoscopy screening. It is user-friendly and secures continuous QA of the endoscopist's performance. The principles used are applicable to development of EMRs in general.

[Intestinal cleaning for colonoscopy in children: effectiveness, adherence and adverse effects of schemes differentiated by age].

Science.gov (United States)

Miquel, Isabel; Arancibia, María Eugenia; Alliende, Francisco; Ríos, Gloria; Rodríguez, Lorena; Lucero, Yalda; Saelzer, Eric

2017-04-01

Adequate intestinal cleanliness is crucial to achieve optimal colonoscopy performance. Several bowel preparation (BP) schemes have been proposed, but there is still no consensus as regards which is the most suitable in paediatric patients. To describe the effectiveness, adherence, and adverse effects of BP protocols differentiated by age group in paediatric patients subjected to colonoscopy. Prospective, study that included patients PEG 3350 without electrolytes); 4y-9y 11 m (PEG 3350 without electrolytes + bisacodyl); 10 y-18 y (PEG 3350 with electrolytes). Demographic, clinical information, adherence and adverse effects were registered. Effectiveness was determined using a validated scale (Boston modified) during colonoscopy. A total of 159 patients were included, of which 87 (55%) were males, and with a median age of 4 years (range 1 m-17 years). Seventy eight percent of patients achieved successful BP. The higher effectiveness was observed in the groups of < 6 m (96%) and 10-18 y (91%). Constipation was significantly more frequent (29%) in the 4 yo-9 yo 11 m in which lower effectiveness was observed (69%). Good adherence was observed in 87% of patients. Adverse effects were observed in a third of patients, although they were mild and did not lead to the suspension of the BP. Satisfactory results were achieved with the BP schemes used, with a successful BP being obtained in 4 out of 5 patients. Results were different between groups, which is probably related to previous bowel transit and indicated medication.

Virtual Colonoscopy Screening With Ultra Low-Dose CT and Less-Stressful Bowel Preparation: A Computer Simulation Study

Science.gov (United States)

Wang, Jing; Wang, Su; Li, Lihong; Fan, Yi; Lu, Hongbing; Liang, Zhengrong

2008-10-01

Computed tomography colonography (CTC) or CT-based virtual colonoscopy (VC) is an emerging tool for detection of colonic polyps. Compared to the conventional fiber-optic colonoscopy, VC has demonstrated the potential to become a mass screening modality in terms of safety, cost, and patient compliance. However, current CTC delivers excessive X-ray radiation to the patient during data acquisition. The radiation is a major concern for screening application of CTC. In this work, we performed a simulation study to demonstrate a possible ultra low-dose CT technique for VC. The ultra low-dose abdominal CT images were simulated by adding noise to the sinograms of the patient CTC images acquired with normal dose scans at 100 mA s levels. The simulated noisy sinogram or projection data were first processed by a Karhunen-Loeve domain penalized weighted least-squares (KL-PWLS) restoration method and then reconstructed by a filtered backprojection algorithm for the ultra low-dose CT images. The patient-specific virtual colon lumen was constructed and navigated by a VC system after electronic colon cleansing of the orally-tagged residue stool and fluid. By the KL-PWLS noise reduction, the colon lumen can successfully be constructed and the colonic polyp can be detected in an ultra low-dose level below 50 mA s. Polyp detection can be found more easily by the KL-PWLS noise reduction compared to the results using the conventional noise filters, such as Hanning filter. These promising results indicate the feasibility of an ultra low-dose CTC pipeline for colon screening with less-stressful bowel preparation by fecal tagging with oral contrast.

Safety and Effectiveness of Percutaneously Inserted Peritoneal Ports Compared to Surgically Inserted Ports in a Retrospective Study of 87 Patients with Ovarian Carcinoma over a 10-Year Period

International Nuclear Information System (INIS)

Woodley-Cook, Joel; Tarulli, Emidio; Tan, Kong T.; Rajan, Dheeraj K.; Simons, Martin E.

2016-01-01

PurposePlacement of peritoneal ports has become a favorable technique for direct chemotherapy infusion in treating peritoneal metastases from ovarian cancer. We aim to outline an approach to the percutaneous insertion of peritoneal ports and to characterize success and complication rates compared to surgically inserted ports.Materials and MethodsRetrospective analysis was collected from 87 patients who had peritoneal port insertion (28 inserted surgically and 59 percutaneously) for treatment of peritoneal metastases from ovarian cancer from July 2004 to July 2014. Complications were classified according to the SIR Clinical Practice Guidelines as major or minor.ResultsTechnical success rates for surgically and percutaneously inserted ports were 100 and 96.7 %, respectively (p = 0.44), with the two percutaneous failures successful at a later date. There were no major complications in either group. Minor complication rates for surgically versus percutaneously inserted ports were 46.4 versus 22.0 %, respectively (p = 0.02). The infection rate for surgically inserted versus percutaneously inserted ports was 14.3 and 0 %, respectively (p = 0.002). The relative risk of developing a complication from percutaneous peritoneal port insertion without ascites was 3.4 (p = 0.04). For percutaneously inserted ports, the mean in-room procedure time was 81 ± 1.3 min and mean fluoroscopy time was 5.0 ± 4.5 min.ConclusionPercutaneously inserted peritoneal ports are a safe alternative to surgically inserted ports, demonstrating similar technical success and lower complication rates.

Safety and Effectiveness of Percutaneously Inserted Peritoneal Ports Compared to Surgically Inserted Ports in a Retrospective Study of 87 Patients with Ovarian Carcinoma over a 10-Year Period

Energy Technology Data Exchange (ETDEWEB)

Woodley-Cook, Joel, E-mail: jwoodleycook@gmail.com [The Scarborough Hospital, Vascular and Interventional Radiology, Department of Diagnostic Imaging (Canada); Tarulli, Emidio; Tan, Kong T.; Rajan, Dheeraj K.; Simons, Martin E. [University of Toronto, Vascular and Interventional Radiology, Department of Medical Imaging, University Health Network (Canada)

2016-11-15

PurposePlacement of peritoneal ports has become a favorable technique for direct chemotherapy infusion in treating peritoneal metastases from ovarian cancer. We aim to outline an approach to the percutaneous insertion of peritoneal ports and to characterize success and complication rates compared to surgically inserted ports.Materials and MethodsRetrospective analysis was collected from 87 patients who had peritoneal port insertion (28 inserted surgically and 59 percutaneously) for treatment of peritoneal metastases from ovarian cancer from July 2004 to July 2014. Complications were classified according to the SIR Clinical Practice Guidelines as major or minor.ResultsTechnical success rates for surgically and percutaneously inserted ports were 100 and 96.7 %, respectively (p = 0.44), with the two percutaneous failures successful at a later date. There were no major complications in either group. Minor complication rates for surgically versus percutaneously inserted ports were 46.4 versus 22.0 %, respectively (p = 0.02). The infection rate for surgically inserted versus percutaneously inserted ports was 14.3 and 0 %, respectively (p = 0.002). The relative risk of developing a complication from percutaneous peritoneal port insertion without ascites was 3.4 (p = 0.04). For percutaneously inserted ports, the mean in-room procedure time was 81 ± 1.3 min and mean fluoroscopy time was 5.0 ± 4.5 min.ConclusionPercutaneously inserted peritoneal ports are a safe alternative to surgically inserted ports, demonstrating similar technical success and lower complication rates.

The Diagnostic Role of Magnetic Resonance Enterography as a Complementary Test to Colonoscopy in Active Crohn's Disease.

Science.gov (United States)

Aryan, Arvin; Azizi, Zahra; Teimouri, Azam; Ebrahimi Daryani, Nasser; Aletaha, Najme; Jahanbakhsh, Ali; Nouritaromlou, Mohammad Kazem; Alborzi, Forough; Mami, Masoud; Basirat, Vahid; Javid Anbardan, Sanam

2016-04-01

BACKGROUND According to recent studies comparing magnetic resonance enterography (MRE) with ileocolonoscopy for assessing inflammation of small bowel and colonic segments in adults with active Crohn's disease (CD), we aimed to compare the accuracy of these two diagnostic methods in Iranian population. METHODS During 2013-2014 a follow-up study was done on 30 patients with active CD in a gastroenterology clinic affiliated to Tehran University of Medical Sciences. MRE and ileocolonoscopy were performed for all the patients. All statistical analyses were performed using SPSS (version 18) and p-valuewomen with mean age of 37.30±13.66 years (range: 19-67 years). MRE had sensitivity and specificity of 50% and 90% with positive predictive value (PPV) and negative predictive value (NPV) of 71.43 and 78.26, respectively for localizing sigmoid lesions and ileum had sensitivity and specificity of 84.21 and 45.45 with PPV and NPV of 72.73 and 62.50, respectively. CONCLUSION While moderate sensitivity and high specificity of MRE in localizing colonic lesions makes it an appropriate confirmatory test after colonoscopy, the reported high sensitivity and moderate specificity of MRE versus colonoscopy in detecting ileal lesions makes it a suitable screening test for ileal lesions. Finally we can conclude that MRE can be an important complementary test to colonoscopy in detecting active disease.

Development of a virtual reality haptic Veress needle insertion simulator for surgical skills training.

Science.gov (United States)

Okrainec, A; Farcas, M; Henao, O; Choy, I; Green, J; Fotoohi, M; Leslie, R; Wight, D; Karam, P; Gonzalez, N; Apkarian, J

2009-01-01

The Veress needle is the most commonly used technique for creating the pneumoperitoneum at the start of a laparoscopic surgical procedure. Inserting the Veress needle correctly is crucial since errors can cause significant harm to patients. Unfortunately, this technique can be difficult to teach since surgeons rely heavily on tactile feedback while advancing the needle through the various layers of the abdominal wall. This critical step in laparoscopy, therefore, can be challenging for novice trainees to learn without adequate opportunities to practice in a safe environment with no risk of injury to patients. To address this issue, we have successfully developed a prototype of a virtual reality haptic needle insertion simulator using the tactile feedback of 22 surgeons to set realistic haptic parameters. A survey of these surgeons concluded that our device appeared and felt realistic, and could potentially be a useful tool for teaching the proper technique of Veress needle insertion.

Interval colon cancer in a Lynch syndrome patient under annual colonoscopic surveillance: a case for advanced imaging techniques?

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Oxentenko Amy S

2012-05-01

Full Text Available Abstract Background Lynch syndrome confers increased risk for various malignancies, including colorectal cancer. Colonoscopic surveillance programs have led to reduced incidence of colorectal cancer and reduced mortality from colorectal cancer. Colonoscopy every 1–2 years beginning at age 20–25, or 10 years earlier than the first diagnosis of colorectal cancer in a family, with annual colonoscopy after age 40, is the recommended management for mutation carriers. Screening programs have reduced colon cancer mortality, but interval cancers may occur. Case presentation We describe a 48-year-old woman with Lynch syndrome who was found to have an adenoma with invasive colorectal cancer within one year after a normal colonoscopy. Conclusion Our patient illustrates two current concepts about Lynch syndrome: 1 adenomas are the cancer precursor and 2 such adenomas may be “aggressive,” in the sense that the adenoma progresses more readily and more rapidly to carcinoma in this setting compared to usual colorectal adenomas. Our patient’s resected tumor invaded only into submucosa and all lymph nodes were negative; in that sense, she represents a success for annual colonoscopic surveillance. Still, this case does raise the question of whether advanced imaging techniques are advisable for surveillance colonoscopy in these high-risk patients.

Using motion capture to assess colonoscopy experience level

DEFF Research Database (Denmark)

Svendsen, Morten Bo Søndergaard; Preisler, Louise; Hillingsø, Jens Georg

2014-01-01

AIM: To study technical skills of colonoscopists using a Microsoft Kinect™ for motion analysis to develop a tool to guide colonoscopy education. RESULTS: Ten experienced endoscopists (gastroenterologists, n = 2; colorectal surgeons, n = 8) and 11 novices participated in the study. A Microsoft......) vs 12% for novice endoscopists (SD 9)], the level of the right hand below the sighting line (z-axis) (25 cm for experienced endoscopists vs 36 cm for novice endoscopists, P level of the left hand below the z-axis (6 cm for experienced endoscopists vs 15 cm for novice endoscopists, P...... experienced and novice endoscopists and to provide non-biased feedback. Whether it is possible to use this tool to train novices in a clinical setting requires further study....

Surprising finding on colonoscopy.

Science.gov (United States)

Griglione, Nicole; Naik, Jahnavi; Christie, Jennifer

2010-02-01

A 48-year-old man went to his primary care physician for his annual physical. He told his physician that for the past few years, he had intermittent, painless rectal bleeding consisting of small amounts of blood on the toilet paper after defecation. He also mentioned that he often spontaneously awoke, very early in the morning. His past medical history was unremarkable. The patient was born in Cuba but had lived in the United States for more than 30 years. He was divorced, lived alone, and had no children. He had traveled to Latin America-including Mexico, Brazil, and Cuba-off and on over the past 10 years. His last trip was approximately 2 years ago. His physical exam was unremarkable. Rectal examination revealed no masses or external hemorrhoids; stool was brown and Hemoccult negative. Labs were remarkable for eosinophilia ranging from 10% to 24% over the past several years (the white blood cell count ranged from 5200 to 5900/mcL). A subsequent colonoscopy revealed many white, thin, motile organisms dispersed throughout the colon. The organisms were most densely populated in the cecum. Of note, the patient also had nonbleeding internal hemorrhoids. An aspiration of the organisms was obtained and sent to the microbiology lab for further evaluation. What is your diagnosis? How would you manage this condition?

Quality of colonoscopy in an organised colorectal cancer screening programme with immunochemical faecal occult blood test: the EQuIPE study (Evaluating Quality Indicators of the Performance of Endoscopy).

Science.gov (United States)

Zorzi, Manuel; Senore, Carlo; Da Re, Filippo; Barca, Alessandra; Bonelli, Luigina Ada; Cannizzaro, Renato; Fasoli, Renato; Di Furia, Lucia; Di Giulio, Emilio; Mantellini, Paola; Naldoni, Carlo; Sassatelli, Romano; Rex, Douglas; Hassan, Cesare; Zappa, Marco

2015-09-01

To assess variation in the main colonoscopy quality indicators in organised colorectal cancer (CRC) screening programmes based on faecal immunochemical test (FIT). Data from a case-series of colonoscopies of FIT-positive subjects were provided by 44 Italian CRC screening programmes. Data on screening history, endoscopic procedure and histology results, and additional information on the endoscopy centre and the endoscopists were collected. The adenoma detection rate (ADR) and caecal intubation rate (CIR) were assessed for the whole population and the individual endoscopists. To explore variation in the quality indicators, multilevel analyses were performed according to patient/centre/endoscopist characteristics. We analysed 75 569 (mean age: 61.3 years; men: 57%) colonoscopies for positive FIT performed by 479 endoscopists in 79 centres. ADR ranged from 13.5% to 75% among endoscopists (mean: 44.8%). ADR was associated with gastroenterology specialty (OR: 0.87 for others, 95% CI 0.76 to 0.96) and, at the endoscopy centre level, with the routine use of sedation (OR: 0.80 if occasional (600 colonoscopies; 95% CI 1.11 to 2.04) and, at the endoscopy centre level, screening-dedicated sessions (OR: 2.18; 95% CI 1.24 to 3.83) and higher rates of sedation (OR: 0.47 if occasional; 95% CI 0.24 to 0.92). The quality of colonoscopy was affected by patient-related, endoscopist-related and centre-related characteristics. Policies addressing organisational issues should improve the quality of colonoscopy in our programme and similar programmes. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Control and initial operation of the Fermilab BO low β insertion

International Nuclear Information System (INIS)

Finley, D.A.; Johnson, R.P.; Willeke, F.

1985-06-01

The operation of the Fermilab BO low β insertion involves the coordinated control of the 4 strings of quadrupoles of the insertion itself along with several magnetic correction elements (20 dipoles for the closed orbit, 2 quad circuits for betatron tunes, 1 skew quad circuit for coupling, and 2 sextupole circuits for chromaticity). When the beam is stored at high energy, these elements must correct the errors induced by the strong superconducting quadrupoles of the insertion as the optics are smoothly changed from the fixed target configuration to the low β state. The techniques and control programs for these manipulations and initial tests using a single coasting beam are described. 6 refs., 4 figs

One century of Kirschner wires and Kirschner wire insertion techniques : A historical review

NARCIS (Netherlands)

Franssen, Bas B. G. M.; Schuurman, Arnold H.; Van der Molen, Aebele Mink; Kon, Moshe

A century ago, in 1909, Martin Kirschner (1879-942) introduced a smooth pin, presently known as the Kirschner wire (K-wire). The K-wire was initiallly used for skeletal traction and is now currently used for many different goals. The development of the K-wire and its insertion devices were mainly

In patients with extensive subcutaneous emphysema, which technique achieves maximal clinical resolution: infraclavicular incisions, subcutaneous drain insertion or suction on in situ chest drain?

Science.gov (United States)

Johnson, Charles H N; Lang, Sommer A; Bilal, Haris; Rammohan, Kandadai S

2014-06-01

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: 'In patients with extensive subcutaneous emphysema, which technique achieves maximal clinical resolution: infraclavicular incisions, subcutaneous drain insertion or suction on in situ chest drain?'. Altogether more than 200 papers were found using the reported search, of which 14 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Subcutaneous emphysema is usually a benign, self-limiting condition only requiring conservative management. Interventions are useful in the context of severe patient discomfort, respiratory distress or persistent air leak. In the absence of any comparative study, it is not possible to choose definitively between infraclavicular incisions, drain insertion and increasing suction on an in situ drain as the best method for managing severe subcutaneous emphysema. All the three techniques described have been shown to provide effective relief. Increasing suction on a chest tube already in situ provided rapid relief in patients developing SE following pulmonary resection. A retrospective study showed resolution in 66%, increasing to 98% in those who underwent video-assisted thoracic surgery with identification and closure of the leak. Insertion of a drain into the subcutaneous tissue also provided rapid sustained relief. Several studies aided drainage by using regular compressive massage. Infraclavicular incisions were also shown to provide rapid relief, but were noted to be more invasive and carried the potential for cosmetic defect. No major complications were illustrated. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Patterns of transposable element expression and insertion in cancer

Directory of Open Access Journals (Sweden)

Evan A Clayton

2016-11-01

Full Text Available Human transposable element (TE activity in somatic tissues causes mutations that can contribute to tumorigenesis. Indeed, TE insertion mutations have been implicated in the etiology of a number of different cancer types. Nevertheless, the full extent of somatic TE activity, along with its relationship to tumorigenesis, have yet to be fully explored. Recent developments in bioinformatics software make it possible to analyze TE expression levels and TE insertional activity directly from transcriptome (RNA-seq and whole genome (DNA-seq next-generation sequence data. We applied these new sequence analysis techniques to matched normal and primary tumor patient samples from the Cancer Genome Atlas (TCGA in order to analyze the patterns of TE expression and insertion for three cancer types: breast invasive carcinoma, head and neck squamous cell carcinoma, and lung adenocarcinoma. Our analysis focused on the three most abundant families of active human TEs: Alu, SVA and L1. We found evidence for high levels of somatic TE activity for these three families in normal and cancer samples across diverse tissue types. Abundant transcripts for all three TE families were detected in both normal and cancer tissues along with an average of ~80 unique TE insertions per individual patient/tissue. We observed an increase in L1 transcript expression and L1 insertional activity in primary tumor samples for all three cancer types. Tumor-specific TE insertions are enriched for private mutations, consistent with a potentially causal role in tumorigenesis. We used genome feature analysis to investigate two specific cases of putative cancer-causing TE mutations in further detail. An Alu insertion in an upstream enhancer of the CBL tumor suppressor gene is associated with down-regulation of the gene in a single breast cancer patient, and an L1 insertion in the first exon of the BAALC gene also disrupts its expression in head and neck squamous cell carcinoma. Our results are

Commonly Used Preparations for Colonoscopy: Efficacy, Tolerability and Safety – A Canadian Association of Gastroenterology Position Paper

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Alan Barkun

2006-01-01

Full Text Available INTRODUCTION: The increased demand for colonoscopy, coupled with the introduction of new bowel cleansing preparations and recent caution advisories in Canada, has prompted a review of bowel preparations by the Canadian Association of Gastroenterology.

Chest tube insertion

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Chest drainage tube insertion; Insertion of tube into chest; Tube thoracostomy; Pericardial drain ... Be careful there are no kinks in your tube. The drainage system should always sit upright and be placed ...

Applicable observation of butorphanol in painless colonoscopy examination

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Li Xuefeng

2017-01-01

Full Text Available Objective:To summarize the clinical effect of butorphanol compound propofol in painless colonoscopy examination and its feasibility.Methods:100 colonoscopy examination patients (56 males and 44 females aged from 19 to 60 years old registered between August, 2016 and September, 2016 in the endoscopy center of our hospital were randomly selected. ASA classification is I or II level. Their body weight ranged from 55 kg to 75kg. They were randomly divided into two groups and each group included 50 cases. All patients went through conventional ambrosia and liquid fasting for 8 hours before the anesthesia and they drank magnesium sulfate liquid of 2500ml to clean their gastrointestinal tracts.After patients entered the operating room, their veins of upper limb were opened so as to monitor their HR, MAP and SPO2. After that, butorphanol of 20μg/kg was injected to patients of the experimental group while normal saline of the same amount of was injected to patients of the contrast group. After 60 seconds, propofol of 1~2 mg/kg was injected to both groups by the way of intravenous injection. The enteroscopy examination was started after patients had no eyelash reflection. Besides, actual application dose of propofol was adjusted according to clinical indications of patients and the adjusting frequency each time was controlled between 30 milligrams and 50 milligrams until the completion of the examination. SPSS 22.0 statistical software was used to analyze and handle research data of this group. Results:Anesthesia effect: The difference of inter-group comparison showed no statistical significance (P>0.05. The intra-group comparison and the inter-group comparison show that the difference in terms of changes of HR, MAP and SpO2 of patients in two groups before and after the anesthesia had no statistical significance (P>0.05.The awakening time, VAS score, postoperative vomiting times and the occurrence rate of respiratory depression of the observation group

Anterior transarticular C1-C2 fixation with contralateral screw insertion: a report of two cases and technical note.

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Lvov, Ivan; Grin, Andrey; Kaykov, Aleksandr; Smirnov, Vladimir; Krylov, Vladimir

2017-08-08

Anterior transarticular fixation of the C1-C2 vertebrae is a well-known technique that involves screw insertion through the body of the C2 vertebra into the lateral masses of the atlas through an anterior transcervical approach. Meanwhile, contralateral screw insertion has been previously described only in anatomical studies. We describe two case reports of the clinical application of this new technique. In Case 1, the patient was diagnosed with an unstable C1 fracture. The clinical features of the case did not allow for any type of posterior atlantoaxial fusion, Halo immobilization, or routine anterior fixation using the Reindl and Koller techniques. The possible manner of screw insertion into the anterior third of the right lateral mass was via a contralateral trajectory, which was performed in this case. Case 2 involved a patient with neglected posteriorly dislocated dens fracture who could not lie in the prone position due to concomitant cardiac pathology. Reduction of atlantoaxial dislocation was insufficient, even after scar tissue resection at the fracture, while transdental fusion was not possible. Considering the success of the previous case, atlantoaxial fixation was performed through the small approach, using the Reindl technique and contralateral screw insertion. These two cases demonstrate the potential of anterior transarticular fixation of C1-C2 vertebrae in cases where posterior atlantoaxial fusion is not achievable. This type of fixation can be performed through a single approach if one screw is inserted using the Reindl technique and another is inserted via a contralateral trajectory.

The association of colonoscopy quality indicators with the detection of screen-relevant lesions, adverse events, and postcolonoscopy cancers in an asymptomatic Canadian colorectal cancer screening population.

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Hilsden, Robert J; Dube, Catherine; Heitman, Steven J; Bridges, Ronald; McGregor, S Elizabeth; Rostom, Alaa

2015-11-01

Although several quality indicators of colonoscopy have been defined, quality assurance activities should be directed at the measurement of quality indicators that are predictive of key screening colonoscopy outcomes. The goal of this study was to examine the association among established quality indicators and the detection of screen-relevant lesions (SRLs), adverse events, and postcolonoscopy cancers. Historical cohort study. Canadian colorectal cancer screening center. A total of 18,456 asymptomatic men and women ages 40 to 74, at either average risk or increased risk for colorectal cancer because of a family history, who underwent a screening colonoscopy from 2008 to 2010. Using univariate and multivariate analyses, we explored the association among procedural quality indicators and 3 colonoscopy outcomes: detection of SRLs, adverse events, and postcolonoscopy cancers. The crude rates of SRLs, adverse events, and postcolonoscopy cancers were 240, 6.44, and .54 per 1000 colonoscopies, respectively. Several indicators, including endoscopist withdrawal time (OR, 1.3; 95% CI, 1.2-1.4) and cecal intubation rate (OR, 13.9; 95% CI, 1.9-96.9), were associated with the detection of SRLs. No quality indicator was associated with the risk of adverse events. Endoscopist average withdrawal time over 6 minutes (OR, .12; 95% CI, .002-.85) and SRL detection rate over 20% (OR, .17; 95% CI, .03-.74) were associated with a reduced risk of postcolonoscopy cancers. Single-center study. Quality assurance programs should prioritize the measurement of endoscopist average withdrawal time and adenoma (SRL) detection rate. Copyright © 2015 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Experimental insertions

International Nuclear Information System (INIS)

Sandweiss, J.; Kycia, T.F.

1975-01-01

A discussion is given of the eight identical experimental insertions for the planned ISABELLE storage rings. Four sets of quadrupole doublets are used to match the β functions in the insertions to the values in the cells, and the total free space available at the crossing point is 40 meters. An asymmetric beam energy operation is planned, which will be useful in a number of experiments

Nanoneedle insertion into the cell nucleus does not induce double-strand breaks in chromosomal DNA.

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Ryu, Seunghwan; Kawamura, Ryuzo; Naka, Ryohei; Silberberg, Yaron R; Nakamura, Noriyuki; Nakamura, Chikashi

2013-09-01

An atomic force microscope probe can be formed into an ultra-sharp cylindrical shape (a nanoneedle) using micro-fabrication techniques such as focused ion beam etching. This nanoneedle can be effectively inserted through the plasma membrane of a living cell to not only access the cytosol, but also to penetrate through the nuclear membrane. This technique shows great potential as a tool for performing intranuclear measurements and manipulations. Repeated insertions of a nanoneedle into a live cell were previously shown not to affect cell viability. However, the effect of nanoneedle insertion on the nucleus and nuclear components is still unknown. DNA is the most crucial component of the nucleus for proper cell function and may be physically damaged by a nanoneedle. To investigate the integrity of DNA following nanoneedle insertion, the occurrence of DNA double-strand breaks (DSBs) was assessed. The results showed that there was no chromosomal DNA damage due to nanoneedle insertion into the nucleus, as indicated by the expression level of γ-H2AX, a molecular marker of DSBs. Copyright © 2013 The Society for Biotechnology, Japan. Published by Elsevier B.V. All rights reserved.

Unilateral versus bilateral stent insertion for malignant hilar biliary obstruction.

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Chang, Gang; Xia, Feng-Fei; Li, Hong-Fu; Niu, Su; Xu, Yuan-Shun

2017-11-01

To determine the clinical efficiency and long-term outcomes between unilateral and bilateral stent insertion in patients with malignant hilar biliary obstruction. From August 2012 to February 2016, 63 consecutive patients with malignant hilar biliary obstruction were treated with unilateral or bilateral stent insertion at our center. The bilateral stents were inserted using the side-by-side technique. The clinical efficiency and long-term outcomes were compared between the two groups. Unilateral and bilateral stent insertions were successfully performed in 31 of 33 and 27 of 30 patients, respectively (P = 0.912). No procedure-related complication occurred. Clinical success was achieved in 29 of 31 patients in the unilateral stent group and in 26 of 27 patients in the bilateral stent group (P = 0.637). During the follow-up, re-obstruction of stent occurred in five patients in the unilateral stent group and in three patients in the bilateral stent group (P = 0.58). The significant differences were not observed in the stent patency time (368 vs. 387 days, P = 0.685) and survival (200 vs. 198 days, P = 0.751) between two groups. Based on the univariate and multivariate analyses, the independent risk factors for decreasing the survival time included higher Eastern Cooperative Oncology Group performance status (P = 0.018), higher alanine aminotransferase level (P = 0.009), and absence of anticancer treatment after stent insertion (P = 0.002). Compared to bilateral stent insertion for malignant hilar biliary obstruction, unilateral stent insertion can provide comparable clinical efficiency and long-term outcomes.

Projected increased growth rate of anesthesia professional-delivered sedation for colonoscopy and EGD in the United States: 2009 to 2015.

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Inadomi, John M; Gunnarsson, Candace L; Rizzo, John A; Fang, Hai

2010-09-01

Anesthesia professional-delivered sedation has become increasingly common when performing colonoscopy and EGD. To provide an estimate of anesthesia professional-participation rates in colonoscopy and EGD procedures and to examine rate changes over time and geographic variations for both procedures. Retrospective sample design. National survey data from i3 Innovus for the period 2003 to 2007 on the use rate of anesthesia professionals in both procedures. A sample of 3688 observations included 3-digit zip code-level information on anesthesia professional use rates. Data were linked to the Bureau of Health Professions' Area Resource File to control for sociodemographic factors and provider supply characteristics for anesthesia professional use rates. Multivariable regression analyses were performed to identify factors predicting the use rate of anesthesia professionals in these procedures and to forecast use rates for the years 2009 to 2015. For colonoscopy and EGD, anesthesia professional participation is projected to grow from 23.9% and 24.4% in 2007 to 53.4% and 52.9% by 2015, respectively. Average growth rates were highest in the northeast for colonoscopy (145.8%) and EGD (146.6%). Anesthesia professional use rates were significantly greater in areas having a higher percentage of older subjects (45 years and older), higher per capita income and lower unemployment rates, and higher per capita inpatient admissions and were significantly lower in areas having more per capita outpatient visits for both procedures. Nonexperimental retrospective sample study design. Database sample may not be nationally representative. Market area characteristics were used to control for socioeconomic and demographic factors. However, there may remain some important market factors that we were unable to control. Anesthesia professional-delivered sedation is projected to grow substantially for both procedures. Copyright 2010 American Society for Gastrointestinal Endoscopy. Published by

Three-year colonoscopy surveillance after polypectomy in Korea: a Korean Association for the Study of Intestinal Diseases (KASID multicenter prospective study

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Won Seok Choi

2018-01-01

Full Text Available Background/Aims: Colonoscopic surveillance is currently recommended after polypectomy owing to the risk of newly developed colonic neoplasia. However, few studies have investigated colonoscopy surveillance in Asia. This multicenter and prospective study was undertaken to assess the incidence of advanced adenoma based on baseline adenoma findings at 3 years after colonoscopic polypectomy. Methods: A total of 1,323 patients undergoing colonoscopic polypectomy were prospectively assigned to 3-year colonoscopy surveillance at 11 tertiary endoscopic centers. Relative risks for advanced adenoma after 3 years were calculated according to baseline adenoma characteristics. Results: Among 1,323 patients enrolled, 387 patients (29.3% were followed up, and the mean follow-up interval was 31.0±9.8 months. The percentage of patients with advanced adenoma on baseline colonoscopy was higher in the surveillance group compared to the non-surveillance group (34.4% vs. 25.7%. Advanced adenoma recurrence was observed in 17 patients (4.4% at follow-up. The risk of advanced adenoma recurrence was 2 times greater in patients with baseline advanced adenoma than in those with baseline non-advanced adenoma, though the difference was not statistically significant (6.8% [9/133] vs. 3.1% [8/254], P=0.09. Advanced adenoma recurrence was observed only in males and in subjects aged ≥50 years. In contrast, adenoma recurrence was observed in 187 patients (48.3% at follow-up. Male sex, older age (≥50 years, and multiple adenomas (≥3 at baseline were independent risk factors for adenoma recurrence. Conclusions: A colonoscopy surveillance interval of 3 years in patients with baseline advanced adenoma can be considered appropriate.

Folding and membrane insertion of the pore-forming peptide gramicidin occur as a concerted process.

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Hicks, Matthew R; Damianoglou, Angeliki; Rodger, Alison; Dafforn, Timothy R

2008-11-07

Many antibiotic peptides function by binding and inserting into membranes. Understanding this process provides an insight into the fundamentals of both membrane protein folding and antibiotic peptide function. For the first time, in this work, flow-aligned linear dichroism (LD) is used to study the folding of the antibiotic peptide gramicidin. LD provides insight into the combined processes of peptide folding and insertion and has the advantage over other similar techniques of being insensitive to off-membrane aggregation events. By combining LD data with conventional measurements of protein fluorescence and circular dichroism, the mechanism of gramicidin insertion is elucidated. The mechanism consists of five separately assignable steps that include formation of a water-insoluble gramicidin aggregate, dissociation from the aggregate, partitioning of peptide to the membrane surface, oligomerisation on the surface and concerted insertion and folding of the peptide to the double-helical form of gramicidin. Measurement of the rates of each step shows that although changes in the fluorescence signal cease 10 s after the initiation of the process, the insertion of the peptide into the membrane is actually not complete for a further 60 min. This last membrane insertion phase is only apparent by measurement of LD and circular dichroism signal changes. In summary, this study demonstrates the importance of multi-technique approaches, including LD, in studies of membrane protein folding.

A randomized, double-blind, phase 3 study of fospropofol disodium for sedation during colonoscopy.

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Cohen, Lawrence B; Cattau, Edward; Goetsch, Allen; Shah, Atul; Weber, John R; Rex, Douglas K; Kline, Jacqueline M

2010-01-01

This double-blind, multicenter study evaluated the safety and efficacy of intravenous fospropofol (6.5 mg/kg vs. 2 mg/kg) for moderate sedation in patients undergoing colonoscopy. In all, 314 patients >or=18 years (American Society of Anesthesiologists PS1 to PS3) were randomized to receive fospropofol 2 mg/kg, fospropofol 6.5- mg/kg, or midazolam 0.02 mg/kg, after pretreatment with intravenous fentanyl 50 mcg. Supplemental doses of study medication were permitted to achieve a Modified Observer's Assessment of Alertness/Sedation scale score sedation success, recovery, memory retention, physician satisfaction, and safety. Sedation success was higher in the fospropofol 6.5 mg/kg versus 2 mg/kg group (87% vs. 26%; Pmemory retention (70% and 82% for the 6.5 mg/kg and 2 mg/kg groups, respectively) compared with 41% for the midazolam group. Mean physician satisfaction scores were higher in the fospropofol 6.5-mg/kg group (7.7) than the 2-mg/kg group (4.5), Psedation during colonoscopy and was associated with higher rates of sedation success, memory retention, and physician satisfaction than the fospropofol 2-mg/kg dose.

An investigation of diverticular disease among black patients undergoing colonoscopy at Dr George Mukhari Academic Hospital, Pretoria, South Africa.

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Vally, M; Koto, M Z; Govender, M

2017-01-30

Diverticular disease was previously thought to be non-existent in the black African population. Studies over the past four decades, however, have shown a steady increase in the prevalence of the disease. To report on the profile and current prevalence of diverticular disease in the black South African (SA) population at Dr George Mukhari Academic Hospital, Pretoria, SA. A retrospective descriptive study was performed in black SA patients who were diagnosed with diverticular disease by colonoscopy between 1 January and 31 December 2015. Of 348 patients who had undergone colonoscopies and who were eligible for inclusion in this study, 47 were diagnosed with diverticular disease - a prevalence of 13.50% (95% confidence interval 10.30 - 17.50). The greatest number of patients diagnosed were in their 7th and 8th decades, with an age range of 46 - 86 (mean 67) years. There was a female predominance of 57.45%. Lower gastrointestinal bleeding was the most common (65.96%) indication for colonoscopy. The left colon was most commonly involved (72.34%), followed by the right colon (55.31%). A substantial number of patients had pancolonic involvement (27.65%). This retrospective study suggests that there has been a considerable increase in the prevalence of diverticular disease among black South Africans, possibly owing to changes in dietary habits and socioeconomic status.

An investigation of diverticular disease among black patients undergoing colonoscopy at Dr George Mukhari Academic Hospital, Pretoria, South Africa

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M Vally

2017-02-01

Full Text Available Background. Diverticular disease was previously thought to be non-existent in the black African population. Studies over the past four decades, however, have shown a steady increase in the prevalence of the disease. Objective. To report on the profile and current prevalence of diverticular disease in the black South African (SA population at Dr George Mukhari Academic Hospital, Pretoria, SA. Methods. A retrospective descriptive study was performed in black SA patients who were diagnosed with diverticular disease by colonoscopy between 1 January and 31 December 2015. Results. Of 348 patients who had undergone colonoscopies and who were eligible for inclusion in this study, 47 were diagnosed with diverticular disease – a prevalence of 13.50% (95% confidence interval 10.30 - 17.50. The greatest number of patients diagnosed were in their 7th and 8th decades, with an age range of 46 - 86 (mean 67 years. There was a female predominance of 57.45%. Lower gastrointestinal bleeding was the most common (65.96% indication for colonoscopy. The left colon was most commonly involved (72.34%, followed by the right colon (55.31%. A substantial number of patients had pancolonic involvement (27.65%. Conclusion. This retrospective study suggests that there has been a considerable increase in the prevalence of diverticular disease among black South Africans, possibly owing to changes in dietary habits and socioeconomic status.

[Massive trichuriasis in an adult diagnosed by colonoscopy].

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Sapunar, J; Gil, L C; Gil, J G

1999-01-01

A case of massive trichuriasis in a 37-year-old female from a rural locality of the Metropolitan Region of Chile, with antecedents of alcoholism, chronic hepatic damage and portal cavernomatosis, is presented. Since 12 year ago she has had geophagia. In the last six months she has frequently presented liquid diarrhea, colic abdominal pains, tenesmus and sensation of abdominal distention. Clinical and laboratory tests confirmed her hepatic affection associated with a celiac disease with anemia and hypereosinophilia. Within a week diarrhea became worse and dysentery appeared. A colonoscopy revealed an impressive and massive trichuriasis. The patient was successfully treated with two cures of 200 mg tablets of mebendazole twice daily for three days with a week interval. After the first cure she evacuated a big amount of Tricuris trichiura, fecal evacuations became normal, geophagia disappeared and recovered 4 kg of body weight.

Laterally Spreading Tumors of the Colon During High Resolution Colonoscopy with Narrow Band Imaging and Acetic Acid Chromoscopy

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V.A. Yakovenko

2015-02-01

Materials and Methods. 1632 colonoscopy protocols were studied: 735 — by using video colonoscope Olympus CF-HQ190L and 897 — Olympus CF-150. Results and Discussion. In study group, adenoma detection rate was higher than in control one: 0.78 (571/735 vs. 0.47 (422/897, p < 0.00001; c2 = 157.9. Adenoma detection index was 3.6 times higher in study group than in control one: 2.9 (2,104/735 vs. 0.8 (708/897. Laterally spreading tumors were diagnosed 2.2 times more often in study group than in control one: 22 % (187/735 vs. 10 % (85/897, p < 0.00001; c2 = 53.6. Conclusions. High resolution colonoscopy with narrow band imaging and acetic acid chromoscopy has a high diagnostic value for detection of laterally spreading tumors of the colon.

Suction catheter guided insertion of ProSeal laryngeal mask airway: Experience by untrained physicians

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Valter Perilli

2014-01-01

Full Text Available Background: The use of suction catheter (SC has been shown to improve success rate during ProSeal laryngeal mask airway (PLMA insertion in expert users. Aims: The aim of this study was to compare insertion of PLMA performed by untrained physicians using a SC or the digital technique (DT in anaesthetised non-paralysed patients. Methods: In this prospective randomised double-blind study, conducted in the operating setting, 254 patients (American Society of Anaesthesiologists I-II, aged 18-65 years, undergoing minor surgery were enrolled. Exclusion criteria were body mass index >35 kg/m 2 , laryngeal or oesophageal varices, risk of aspiration or difficult face mask ventilation either referred or suspected (Langeron′s criteria ≥2 and modified Mallampati classification score >2. Participants were randomly allocated to one of the two groups in which PLMA was inserted using DT (DT-group or SC (SC-group. Statistical Analysis: Chi-square test with Yates′ correction, Mann-Whitney U-test or Student′s t-test were carried-out as appropriate. Results: The final insertion success rate was greater in SC-groupcompared with DT-group 90.1% (n = 109 versus 74.4% (n = 99 respectively (P = 0.002. Mean airway leak pressure was higher in SC-group compared to DT-group (23.7 ± 3.9 vs. 21.4 ± 3.2 respectively; (P = 0.001. There were no differences in insertion time, post-operative airway morbidity and complications. Conclusion: The findings of this study suggest that SC-technique improves the success rate of PLMA insertion by untrained physicians.

Insertion of an active fixation lead in the inferior interatrial septum via a 9.0 Fr guiding catheter

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Shumpei Mori, MD

2014-04-01

Full Text Available Placing an atrial lead in the inferior interatrial septum (IAS reportedly reduces the incidence of paroxysmal atrial fibrillation (AF and slows the progression to chronic AF; however, in certain cases, inferior IAS pacing is technically difficult. When this procedure is unsuccessful, insertion of the lead in the right atrial appendage can be considered, but it is associated with a risk of cardiac perforation. Here, we describe a technique for lead insertion in the inferior IAS via a 9.0 Fr guiding catheter, which may serve as an alternative technique for inferior IAS pacing when the conventional stylet-guided insertion is not successful.

Insertion device and method for accurate and repeatable target insertion

Science.gov (United States)

Gubeli, III, Joseph F.; Shinn, Michelle D.; Bevins, Michael E.; Dillon-Townes, Lawrence; Neil, George R.

2017-07-04

The present invention discloses a device and a method for inserting and positioning a target within a free electron laser, particle accelerator, or other such device that generates or utilizes a beam of energy or particles. The system includes a three-point registration mechanism that insures angular and translational accuracy and repeatability of positioning upon multiple insertions within the same structure.

Análise retrospectiva de 504 colonoscopias Retrospective analysis of 504 colonoscopies

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Rodrigo Guimarães Oliveira

2010-06-01

, estando dentro dos padrões habituais.The authors retrospectively analyzed 504 outpatient undergoing colonoscopy, performed from June 2008 to May 2009, in the "Center for Medical Specialties" of Santa Casa de Belo Horizonte, by the Group of Coloproctology of Santa Casa de Belo Horizonte and School of Medical Sciences of Minas Gerais (CPG. The study deserve special highlights the analysis of gender, age, specialty of referring physicians, indications of colonoscopy, bowel preparation used, height achieved by colonoscopy and colonoscopic findings. Regarding gender, 67% (337 were women and 33% (167 men, and as to age, stood sixth (130 patients, 26% and seventh (113 patients, 22%. The examination was self-generated by the GCP in 79.56% (401 colonoscopies and the most common indications were low bleeding (76 cases, 13.0% and control patients undergoing surgical approach to colorectal cancer (70 cases; 12.0%. Bowel preparation was done with mannitol, lactulose and sodium picosulphate, according to the clinical status, allowing for 71% (359 cases of excellent results. Colonoscopy reached the cecum in 445 patients (88.0%, having reached the terminal ileum in 293 cases (58.0%. The main findings were polyps (163 cases, 28.0%, followed by normal findings (149 cases, 26.0% and diverticular disease of the colon (141 cases, 24.0%. Of the 151 polyps that had marked its size, 130 polyps were the largest diameter less than 10 mm (86.0%. Of 207 histopathological examinations performed, either in biopsies or in polyp resection, the polyp was the most common finding (163 cases, 78.8%, and among the 163 polyps resected the most common finding was the adenoma with low grade dysplasia (116 cases ; 71.2%. There were no complications. The data were compared with some published reports, all within the usual standards.

Safety and surgical techniques of C1 lateral mass screws

International Nuclear Information System (INIS)

Kubo, Shinichiro; Kuroki, Hiroshi; Hanado, Shoji; Hamanaka, Hideaki; Inomata, Naoki; Kuroki, Shuji; Chosa, Etsuo

2010-01-01

The objectives of this study were to evaluate the proper insertion techniques of C1 lateral mass screws. Eighteen consecutive patients were examined after upper cervical fusion using twenty-nine C1 lateral mass screws. Screws were placed by three different techniques; Goel's technique (4), Tan's technique (20), Notching technique (5). Pre and post-operative CT scans with multiplanar reconstruction were used to detect cortical breaches and direction of screws. No transverse foramen and vertebral groove violation was found in CT scans. Three had breached superior articular facet of the atlas. However, the range of motion (R.O.M) of atlanto-occipital joints had not changed postoperatively. Theses screws were inserted with Tan's technique and two of three were directed medially. It is feasible to safely insert C1 lateral mass screws when correct insertion point and direction are considered preoperatively. However, care should be taken because screws can violate the atlanto-occipital joint especially with Tan's technique. (author)

Informed consent in colonoscopy: A comparative analysis of 2 methods.

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Sanguinetti, J M; Lotero Polesel, J C; Iriarte, S M; Ledesma, C; Canseco Fuentes, S E; Caro, L E

2015-01-01

The manner in which informed consent is obtained varies. The aim of this study is to evaluate the level of knowledge about colonoscopy and comparing 2 methods of obtaining informed consent. A comparative, cross-sectional, observational study was conducted on patients that underwent colonoscopy in a public hospital (Group A) and in a private hospital (Group B). Group A received information verbally from a physician, as well as in the form of printed material, and Group B only received printed material. A telephone survey was carried out one or 2 weeks later. The study included a total of 176 subjects (group A [n=55] and group B [n=121]). As regards education level, 69.88% (n=123) of the patients had completed university education, 23.29% (n= 41) secondary level, 5.68% (n=10) primary level, and the remaining subjects (n=2) had not completed any level of education. All (100%) of the subjects knew the characteristics of the procedure, and 99.43% were aware of its benefits. A total of 97.7% received information about complications, 93.7% named some of them, and 25% (n=44) remembered major complications. All the subjects received, read, and signed the informed consent statement before the study. There were no differences between the groups with respect to knowledge of the characteristics and benefits of the procedure, or the receipt and reading of the consent form. Group B responded better in relation to complications (P=.0027) and group A had a better recollection of the major complications (P<.0001). Group A had a higher number of affirmative answers (P<.0001). The combination of verbal and written information provides the patient with a more comprehensive level of knowledge about the procedure. Copyright © 2014 Asociación Mexicana de Gastroenterología. Published by Masson Doyma México S.A. All rights reserved.

Two stents insertion via single tract for treatment of hepatic hilar cholangiocarcinoma

International Nuclear Information System (INIS)

Xie Zonggui; Jin Peng; Xie Zhiyong; Yi Yuhai; Zhang Xuping

2003-01-01

Objective: To evaluate the feasibility and clinical application of two stents insertion via single tract for treatment of hepatic hilar cholangiocarcinoma. Methods: Eighteen patients with hepatic hilar cholangiocarcinoma who had left and right bile duct obstruction were treated with stents insertion via right bile duct puncturing routeway. These two stents were implanted between right and left bile duct, and between right bile duct and common bile duct. Results: Eighteen patients obtained successful two stents placement by right bile duct puncturing tract and succeeded with internal drainage for all biliary tree jaundice subsided distinctly. Conclusions: The technique of two stents insertion via single tract could predigest interventional drainage procedure of high bile duct obstruction, reduce operation trauma, shorten handling time and possess promising application value

Transdiaphragmatic Approach to Attenuate Porto-Azygos Shunts Inserting in the Thorax.

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Or, Matan; Kitshoff, Adriaan; Devriendt, Nausikaa; De Ridder, Marianne; Quist-Rybachuk, Galena; de Rooster, Hilde

2016-11-01

To describe the surgical technique and document the application of a transdiaphragmatic approach to attenuate porto-azygos shunts inserting in the thoracic section of the azygos vein. Cadaveric study and prospective case series. Canine cadavers (n=6) and client-owned dogs with porto-azygos shunts inserting in the thoracic section of the azygos vein (n=9). In the cadavers, the azygos vein was filled with aqueous latex. Landmarks were established for creating a safe transdiaphragmatic approach to the caudal intrathoracic portion of the azygos vein. In the clinical cases, porto-azygos communication was diagnosed by trans-splenic portal scintigraphy. All shunts were attenuated close to their insertion site via ventral midline celiotomy and a transdiaphragmatic approach to the shunt. Perioperative complications were recorded. A 3-5 cm incision, 0.5-1 cm ventral and lateral to the level of the aortic hiatus, was made in the pars lumbalis part of the diaphragm. Stay sutures at both sides of the diaphragmatic incision were placed to open up the incision and a retractor was used to push the esophagus away from the aorta. Intrathoracic insertion of the shunt was confirmed intraoperative. Exposure of the shunt insertion site at the azygos vein was excellent in all clinical cases. No intraoperative or postoperative complications were encountered. If thoracic attenuation of a porto-azygos shunt is considered, a transdiaphragmatic approach exposes the insertion site for shunt attenuation. This approach is straightforward, without unnecessary abdominal organ manipulation, and since attenuates at the insertion, avoids missing additional contributing branches. © Copyright 2016 by The American College of Veterinary Surgeons.

Surgical insertion of central venous catheters in low-birth-weight ...

African Journals Online (AJOL)

Aim: Neonatal central vascular access (CVA) represents a daily practice in neonatal intensive care unit. Low birth weight (LBW) neonates pose a challenge to anesthetists who try the landmark technique to cannulate central veins. We reported our experience of open surgical cutdown (OSC) to insert catheters through right ...

Potential testing of reprocessing procedures by real-time polymerase chain reaction: A multicenter study of colonoscopy devices.

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Valeriani, Federica; Agodi, Antonella; Casini, Beatrice; Cristina, Maria Luisa; D'Errico, Marcello Mario; Gianfranceschi, Gianluca; Liguori, Giorgio; Liguori, Renato; Mucci, Nicolina; Mura, Ida; Pasquarella, Cesira; Piana, Andrea; Sotgiu, Giovanni; Privitera, Gaetano; Protano, Carmela; Quattrocchi, Annalisa; Ripabelli, Giancarlo; Rossini, Angelo; Spagnolo, Anna Maria; Tamburro, Manuela; Tardivo, Stefano; Veronesi, Licia; Vitali, Matteo; Romano Spica, Vincenzo

2018-02-01

Reprocessing of endoscopes is key to preventing cross-infection after colonoscopy. Culture-based methods are recommended for monitoring, but alternative and rapid approaches are needed to improve surveillance and reduce turnover times. A molecular strategy based on detection of residual traces from gut microbiota was developed and tested using a multicenter survey. A simplified sampling and DNA extraction protocol using nylon-tipped flocked swabs was optimized. A multiplex real-time polymerase chain reaction (PCR) test was developed that targeted 6 bacteria genes that were amplified in 3 mixes. The method was validated by interlaboratory tests involving 5 reference laboratories. Colonoscopy devices (n = 111) were sampled in 10 Italian hospitals. Culture-based microbiology and metagenomic tests were performed to verify PCR data. The sampling method was easily applied in all 10 endoscopy units and the optimized DNA extraction and amplification protocol was successfully performed by all of the involved laboratories. This PCR-based method allowed identification of both contaminated (n = 59) and fully reprocessed endoscopes (n = 52) with high sensibility (98%) and specificity (98%), within 3-4 hours, in contrast to the 24-72 hours needed for a classic microbiology test. Results were confirmed by next-generation sequencing and classic microbiology. A novel approach for monitoring reprocessing of colonoscopy devices was developed and successfully applied in a multicenter survey. The general principle of tracing biological fluids through microflora DNA amplification was successfully applied and may represent a promising approach for hospital hygiene. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Customizable engineered blood vessels using 3D printed inserts.

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Pinnock, Cameron B; Meier, Elizabeth M; Joshi, Neeraj N; Wu, Bin; Lam, Mai T

2016-04-15

Current techniques for tissue engineering blood vessels are not customizable for vascular size variation and vessel wall thickness. These critical parameters vary widely between the different arteries in the human body, and the ability to engineer vessels of varying sizes could increase capabilities for disease modeling and treatment options. We present an innovative method for producing customizable, tissue engineered, self-organizing vascular constructs by replicating a major structural component of blood vessels - the smooth muscle layer, or tunica media. We utilize a unique system combining 3D printed plate inserts to control construct size and shape, and cell sheets supported by a temporary fibrin hydrogel to encourage cellular self-organization into a tubular form resembling a natural artery. To form the vascular construct, 3D printed inserts are adhered to tissue culture plates, fibrin hydrogel is deposited around the inserts, and human aortic smooth muscle cells are then seeded atop the fibrin hydrogel. The gel, aided by the innate contractile properties of the smooth muscle cells, aggregates towards the center post insert, creating a tissue ring of smooth muscle cells. These rings are then stacked into the final tubular construct. Our methodology is robust, easily repeatable and allows for customization of cellular composition, vessel wall thickness, and length of the vessel construct merely by varying the size of the 3D printed inserts. This platform has potential for facilitating more accurate modeling of vascular pathology, serving as a drug discovery tool, or for vessel repair in disease treatment. Copyright © 2015 Elsevier Inc. All rights reserved.

Facility target insert shielding assessment

Energy Technology Data Exchange (ETDEWEB)

Mocko, Michal [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

2015-10-06

Main objective of this report is to assess the basic shielding requirements for the vertical target insert and retrieval port. We used the baseline design for the vertical target insert in our calculations. The insert sits in the 12”-diameter cylindrical shaft extending from the service alley in the top floor of the facility all the way down to the target location. The target retrieval mechanism is a long rod with the target assembly attached and running the entire length of the vertical shaft. The insert also houses the helium cooling supply and return lines each with 2” diameter. In the present study we focused on calculating the neutron and photon dose rate fields on top of the target insert/retrieval mechanism in the service alley. Additionally, we studied a few prototypical configurations of the shielding layers in the vertical insert as well as on the top.

The discriminatory capability of existing scores to predict advanced colorectal neoplasia: a prospective colonoscopy study of 5,899 screening participants.

Science.gov (United States)

Wong, Martin C S; Ching, Jessica Y L; Ng, Simpson; Lam, Thomas Y T; Luk, Arthur K C; Wong, Sunny H; Ng, Siew C; Ng, Simon S M; Wu, Justin C Y; Chan, Francis K L; Sung, Joseph J Y

2016-02-03

We evaluated the performance of seven existing risk scoring systems in predicting advanced colorectal neoplasia in an asymptomatic Chinese cohort. We prospectively recruited 5,899 Chinese subjects aged 50-70 years in a colonoscopy screening programme(2008-2014). Scoring systems under evaluation included two scoring tools from the US; one each from Spain, Germany, and Poland; the Korean Colorectal Screening(KCS) scores; and the modified Asia Pacific Colorectal Screening(APCS) scores. The c-statistics, sensitivity, specificity, positive predictive values(PPVs), and negative predictive values(NPVs) of these systems were evaluated. The resources required were estimated based on the Number Needed to Screen(NNS) and the Number Needed to Refer for colonoscopy(NNR). Advanced neoplasia was detected in 364 (6.2%) subjects. The German system referred the least proportion of subjects (11.2%) for colonoscopy, whilst the KCS scoring system referred the highest (27.4%). The c-statistics of all systems ranged from 0.56-0.65, with sensitivities ranging from 0.04-0.44 and specificities from 0.74-0.99. The modified APCS scoring system had the highest c-statistics (0.65, 95% C.I. 0.58-0.72). The NNS (12-19) and NNR (5-10) were similar among the scoring systems. The existing scoring systems have variable capability to predict advanced neoplasia among asymptomatic Chinese subjects, and further external validation should be performed.

The Diagnostic Role of Magnetic Resonance Enterography as a Complementary Test to Colonoscopy in Active Crohn’s Disease

Science.gov (United States)

Aryan, Arvin; Azizi, Zahra; Teimouri, Azam; Ebrahimi Daryani, Nasser; Aletaha, Najme; Jahanbakhsh, Ali; Nouritaromlou, Mohammad Kazem; Alborzi, Forough; Mami, Masoud; Basirat, Vahid; Javid Anbardan, Sanam

2016-01-01

BACKGROUND According to recent studies comparing magnetic resonance enterography (MRE) with ileocolonoscopy for assessing inflammation of small bowel and colonic segments in adults with active Crohn’s disease (CD), we aimed to compare the accuracy of these two diagnostic methods in Iranian population. METHODS During 2013-2014 a follow-up study was done on 30 patients with active CD in a gastroenterology clinic affiliated to Tehran University of Medical Sciences. MRE and ileocolonoscopy were performed for all the patients. All statistical analyses were performed using SPSS (version 18) and p-value<0.05 was considered as statistically significant. RESULTS Of the 30 patients with active CD, 11(36.7%) were men and 19 (63.3%) were women with mean age of 37.30±13.66 years (range: 19-67 years). MRE had sensitivity and specificity of 50% and 90% with positive predictive value (PPV) and negative predictive value (NPV) of 71.43 and 78.26, respectively for localizing sigmoid lesions and ileum had sensitivity and specificity of 84.21 and 45.45 with PPV and NPV of 72.73 and 62.50, respectively. CONCLUSION While moderate sensitivity and high specificity of MRE in localizing colonic lesions makes it an appropriate confirmatory test after colonoscopy, the reported high sensitivity and moderate specificity of MRE versus colonoscopy in detecting ileal lesions makes it a suitable screening test for ileal lesions. Finally we can conclude that MRE can be an important complementary test to colonoscopy in detecting active disease. PMID:27252815

Urinary excretion of polyethylene glycol 3350 during colonoscopy preparation

DEFF Research Database (Denmark)

Rothfuss, K. S.; Bode, J.C.; Stange, E.F.

2006-01-01

. In patients with inflammatory bowel disease (IBD), intestinal permeability and PEG absorption were previously reported to be higher than in normal subjects. In the current study, we investigated the absorption of PEG 3350 in patients undergoing routine gut lavage. METHODS AND RESULTS: Urine specimens were...... collected for 8 hours in 24 patients undergoing bowel cleansing with PEG 3350 for colonoscopy. The urinary excretion of PEG 3350, measured by size exclusion chromatography, ranged between 0.01 and 0.51 % of the ingested amount, corresponding to 5.8 and 896 mg in absolute amounts, respectively. Mean PEG...... that intestinal absorption of PEG 3350 is higher than previously assumed and underlies a strong inter-individual variation. Inflammatory changes of the intestine do not necessarily lead to a significantly higher permeability of PEG....

CT colonography: Techniques, indications, findings

International Nuclear Information System (INIS)

Mang, Thomas; Graser, Anno; Schima, Wolfgang; Maier, Andrea

2007-01-01

Computed tomographic colonography (CTC) is a minimally invasive technique for imaging the entire colon. Based on a helical thin-section CT of the cleansed and air-distended colon, two-dimensional and three-dimensional projections are used for image interpretation. Several clinical improvements in patient preparation, technical advances in CT, and new developments in evaluation software have allowed CTC to develop into a powerful diagnostic tool. It is already well established as a reliable diagnostic tool in symptomatic patients. Many experts currently consider CTC a comparable alternative to conventional colonoscopy, although there is still debate about its sensitivity for the detection of colonic polyps in a screening population. This article summarizes the main indications, the current techniques in patient preparation, data acquisition and data analysis as well as imaging features for common benign and malignant colorectal lesions

[Findings from Total Colonoscopy in Obstructive Colorectal Cancer Patients Who Underwent Stent Placement as a Bridge to Surgery(BTS)].

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Maruo, Hirotoshi; Tsuyuki, Hajime; Kojima, Tadahiro; Koreyasu, Ryohei; Nakamura, Koichi; Higashi, Yukihiro; Shoji, Tsuyoshi; Yamazaki, Masanori; Nishiyama, Raisuke; Ito, Tatsuhiro; Koike, Kota; Ikeda, Takashi; Takayanagi, Yasuhiro; Kubota, Hiroyuki

2017-11-01

We clinically investigated 34 patients with obstructive colorectal cancer who underwent placement of a colonic stent as a bridge to surgery(BTS), focusing on endoscopic findings after stent placement.Twenty -nine patients(85.3%)underwent colonoscopy after stent placement, and the entire large intestine could be observed in 28(96.6%).Coexisting lesions were observed in 22(78.6%)of these 28 patients.The lesions comprised adenomatous polyps in 17 patients(60.7%), synchronous colon cancers in 5 patients(17.9%), and obstructive colitis in 3 patients(10.7%), with some overlapping cases.All patients with multiple cancers underwent one-stage surgery, and all lesions were excised at the same time.Colonoscopy after colonic stent placement is important for preoperative diagnosis of coexisting lesions and planning the extent of resection. These considerations support the utility of colonic stenting for BTS.

Colonoscopia: morbidade negligenciada Colonoscopy: neglected morbidity

Directory of Open Access Journals (Sweden)

Fernanda Bellotti Formiga

2009-09-01

Full Text Available OBJETIVO: Avaliar fatores de risco que determinam morbidade ao exame de colonoscopia. MÉTODOS: No período de março a junho de 2009 foram analisados prospectivamente 170 pacientes submetidos a exame colonoscópico. Fatores de risco como idade, sexo, indicação, exame ambulatorial/internado, efeitos adversos e qualidade do preparo intestinal, procedimento endoscópico, diagnóstico e intercorrência peri-procedimento foram relacionados. RESULTADOS: A média de idade da amostra foi 60,16 ± 14,69 anos, com predominância do sexo feminino. A indicação mais prevalente do exame foi seguimento pós-operatório. Três exames foram inconclusivos por mau preparo. Do restante, 36,53% foram normais e a maioria dos alterados apresentou pólipos, adenomatosos predominantemente. Quanto as comorbidades, 48,82% dos pacientes possuíam alguma comorbidade, sendo Hipertensão Arterial Sistêmica a mais prevalente. Apenas 22,94% dos pacientes apresentaram algum efeito adverso ao preparo. O preparo foi limpo em 65,88% dos exames, mostrando significância quando comparado a morbidade. Outro fator de significância estatística foi a realização de procedimentos (44,7% dos exames, sendo a maioria polipectomias. A morbidade chegou a 16,47%, sendo a desidratação a mais prevalente. Não houve mortalidade. CONCLUSÃO: A qualidade do preparo intestinal e a realização de procedimento endoscópico são fatores diretamente relacionados a morbidade do exame de colonoscopia.OBJECTIVE: The objective of this study is to analyze risks factors of morbidity on colonoscopy. METHOD: From March to June of 2009, 170 patients were examined and analyzed prospectively. Risks factors as age, sex, indication of exam, ambulatory or hospital exam, adverse events and quality of intestinal preparation, endoscopic procedure, diagnoses and incident before, during or after procedure were analyzed. RESULTS: The average age was 60,16±14,69 years old, with majority of female. The prevalent

Peripherally inserted central catheters in infants and children - indications, techniques, complications and clinical recommendations

DEFF Research Database (Denmark)

Westergaard, B; Classen, V; Walther-Larsen, S

2013-01-01

of perioperative complications. Assisted visualisation, preferably with ultrasound, yields high rates of insertion success. With good catheter care, rates of mechanical, infectious and thrombotic complications are low and compare favourably with those of traditional central venous catheters. Even in the case...... of occlusion or infection, fibrinolytics and antibiotic locks often allow the catheter to be retained....

Increased native T1-values at the interventricular insertion regions in precapillary pulmonary hypertension.

Science.gov (United States)

Spruijt, Onno A; Vissers, Loek; Bogaard, Harm-Jan; Hofman, Mark B M; Vonk-Noordegraaf, Anton; Marcus, J Tim

2016-03-01

Cardiac magnetic resonance imaging of the pressure overloaded right ventricle (RV) of precapillary pulmonary hypertension (PH) patients, exhibits late gadolinium enhancement at the interventricular insertion regions, a phenomenon which has been linked to focal fibrosis. Native T1-mapping is an alternative technique to characterize myocardium and has the advantage of not requiring the use of contrast agents. The aim of this study was to characterize the myocardium of idiopathic pulmonary arterial hypertension (IPAH), systemic scleroderma related PH (PAH-Ssc) and chronic thromboembolic PH (CTEPH) patients using native T1-mapping and to see whether native T1-values were related to disease severity. Furthermore, we compared native T1-values between the different precapillary PH categories. Native T1-mapping was performed in 46 IPAH, 14 PAH-SSc and 10 CTEPH patients and 10 control subjects. Native T1-values were assessed using regions of interest at the RV and LV free wall, interventricular septum and interventricular insertion regions. In PH patients, native T1-values of the interventricular insertion regions were significantly higher than the native T1-values of the RV free wall, LV free wall and interventricular septum. Native T1-values at the insertion regions were significantly related to disease severity. Native T1-values were not different between IPAH, PAH-Ssc and CTEPH patients. Native T1-values of the interventricular insertion regions are significantly increased in precapillary PH and are related to disease severity. Native T1-mapping can be developed as an alternative technique for the characterization of the interventricular insertion regions and has the advantage of not requiring the use of contrast agents.

Budget-impact model for colonoscopy cost calculation and comparison between 2 litre PEG+ASC and sodium picosulphate with magnesium citrate or sodium phosphate oral bowel cleansing agents.

Science.gov (United States)

Gruss, H-J; Cockett, A; Leicester, R J

2012-01-01

With the availability of several bowel cleansing agents, physicians and hospitals performing colonoscopies will often base their choice of cleansing agent purely on acquisition cost. Therefore, an easy to use budget impact model has been developed and established as a tool to compare total colon preparation costs between different established bowel cleansing agents. The model was programmed in Excel and designed as a questionnaire evaluating information on treatment costs for a range of established bowel cleansing products. The sum of costs is based on National Health Service reference costs for bowel cleansing products. Estimations are made for savings achievable when using a 2-litre polyethylene glycol with ascorbate components solution (PEG+ASC) in place of other bowel cleansing solutions. Test data were entered into the model to confirm validity and sensitivity. The model was then applied to a set of audit cost data from a major hospital colonoscopy unit in the UK. Descriptive analysis of the test data showed that the main cost drivers in the colonoscopy process are the procedure costs and costs for bed days rather than drug acquisition costs, irrespective of the cleansing agent. Audit data from a colonoscopy unit in the UK confirmed the finding with a saving of £107,000 per year in favour of PEG+ASC when compared to sodium picosulphate with magnesium citrate solution (NaPic+MgCit). For every patient group the model calculated overall cost savings. This was irrespective of the higher drug expenditure associated with the use of PEG+ASC for bowel preparation. Savings were mainly realized through reduced costs for repeat colonoscopy procedures and associated costs, such as inpatient length of stay. The budget impact model demonstrated that the primary cost driver was the procedure cost for colonoscopy. Savings can be realized through the use of PEG+ASC despite higher drug acquisition costs relative to the comparator products. From a global hospital funding

Do health behaviours change after colonoscopy? A prospective cohort study on diet, alcohol, physical activity and smoking among patients and their partners.

Science.gov (United States)

Hubbard, Gill; Brown, Alistair; Campbell, Anna; Campbell, Neil; Diament, Bob; Fielding, Shona; Forbat, Liz; Masson, Lindsey F; O'Carroll, Ronan; Stein, Kevin; Morrison, David S

2014-01-14

To describe diet, alcohol, physical activity and tobacco use prospectively, that is, before and 10 months after colonoscopy for patients and their partners. Prospective cohort study of health behaviour change in patients and partners. Comparison groups are patients receiving a normal result notification (NRN) versus patients receiving an abnormal result notification (ARN). Patients and partners (controls) are also compared. 5 Scottish hospitals. Of 5798 colonoscopy registrations, 2577 (44%) patients met the eligibility criteria of whom 565 (22%) were recruited; 460 partners were also recruited. International Physical Activity Questionnaire, Scottish Collaborative Group Food Frequency Questionnaire (includes alcohol), smoking status, sociodemographic characteristics, body mass index, medical conditions, colonoscopy result, Multidimensional Health Locus of Control Scale, behaviour-specific self-efficacy scales. 57% of patients were men, with a mean age of 60.8 years (SE 0.5) and 43% were from more affluent areas. 72% (n=387) of patients received an ARN and 28% (n=149) received an NRN. Response rate of the second questionnaire was 68.9%. Overall, 27% of patients consumed <5 measures of fruit and vegetables/day, 20% exceeded alcohol limits, 50% had low levels of physical activity and 21% were obese. At 10-month follow-up, a 5% reduction in excessive alcohol consumption and an 8% increase in low levels of physical activity were observed among patients; no significant changes occurred in partners. Baseline high alcohol consumption and low physical activity were the strongest predictors of these behaviours at follow-up. Low alcohol self-efficacy and increasing age were associated with poorer health-related behaviours at follow-up for alcohol consumption and physical activity, respectively. Colonoscopy is associated with marginal beneficial changes in some behaviours but not others. Further work is needed to explore how services can optimise increases in beneficial

Feeding tube insertion - gastrostomy

Science.gov (United States)

... this page: //medlineplus.gov/ency/article/002937.htm Feeding tube insertion - gastrostomy To use the sharing features on this page, please enable JavaScript. A gastrostomy feeding tube insertion is the placement of a feeding ...

Results of a Community-based, Randomized Study Comparing a Clear Liquid Diet With a Low-residue Diet Using a Magnesium Citrate Preparation for Screening and Surveillance Colonoscopies.

Science.gov (United States)

Thukral, Chandrashekhar; Tewani, Sumeet K; Lake, Adam J; Shiels, Aaron J; Geissler, Kathy; Popejoy, Sara; Stafford, Megan; Vicari, Joseph J

2017-11-03

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. 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. 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 (PCLD group (PCLD 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.

Computerized tests to evaluate recovery of cognitive function after deep sedation with propofol and remifentanil for colonoscopy.

Science.gov (United States)

Borrat, Xavier; Ubre, Marta; Risco, Raquel; Gambús, Pedro L; Pedroso, Angela; Iglesias, Aina; Fernandez-Esparrach, Gloria; Ginés, Àngels; Balust, Jaume; Martínez-Palli, Graciela

2018-03-27

The use of sedation for diagnostic procedures including gastrointestinal endoscopy is rapidly growing. Recovery of cognitive function after sedation is important because it would be important for most patients to resume safe, normal life soon after the procedure. Computerized tests have shown being accurate descriptors of cognitive function. The purpose of the present study was to evaluate the time course of cognitive function recovery after sedation with propofol and remifentanil. A prospective observational double blind clinical study conducted in 34 young healthy adults undergoing elective outpatient colonoscopy under sedation with the combination of propofol and remifentanil using a target controlled infusion system. Cognitive function was measured using a validated battery of computerized cognitive tests (Cogstate™, Melbourne, Australia) at different predefined times: prior to starting sedation (Tbaseline), and then 10 min (T10), 40 min (T40) and 120 min (T120) after the end of colonoscopy. Tests included the assessment of psychomotor function, attention, visual memory and working memory. All colonoscopies were completed (median time: 26 min) without significant adverse events. Patients received a median total dose of propofol and remifentanil of 149 mg and 98 µg, respectively. Psychomotor function and attention declined at T10 but were back to baseline values at T40 for all patients. The magnitude of psychomotor task reduction was large (d = 0.81) however 100% of patients were recovered at T40. Memory related tasks were not affected 10 min after ending sedation. Cognitive impairment in attention and psychomotor function after propofol and remifentanil sedation was significant and large and could be easily detected by computerized cognitive tests. Even though, patients were fully recovered 40 min after ending the procedure. From a cognitive recovery point of view, larger studies should be undertaken to propose adequate criteria for discharge

Diagnosis of Acute Appendicitis by Endoscopic Retrograde Appendicitis Therapy (ERAT): Combination of Colonoscopy and Endoscopic Retrograde Appendicography.

Science.gov (United States)

Li, Yingchao; Mi, Chen; Li, Weizhi; She, Junjun

2016-11-01

Acute appendicitis is the most common abdominal emergency, but the diagnosis of appendicitis remains a challenge. Endoscopic retrograde appendicitis therapy (ERAT) is a new and minimally invasive procedure for the diagnosis and treatment of acute appendicitis. To investigate the diagnostic value of ERAT for acute appendicitis by the combination of colonoscopy and endoscopic retrograde appendicography (ERA). Twenty-one patients with the diagnosis of suspected uncomplicated acute appendicitis who underwent ERAT between November 2014 and January 2015 were included in this study. The main outcomes, imaging findings of acute appendicitis including colonoscopic direct-vision imaging and fluoroscopic ERA imaging, were retrospectively reviewed. Secondary outcomes included mean operative time, mean hospital stay, rate of complication, rate of appendectomy during follow-up period, and other clinical data. The diagnosis of acute appendicitis was established in 20 patients by positive ERA (5 patients) or colonoscopy (1 patient) alone or both (14 patients). The main colonoscopic imaging findings included mucosal inflammation (15/20, 75 %), appendicoliths (14/20, 70 %), and maturation (5/20, 25 %). The key points of ERA for diagnosing acute appendicitis included radiographic changes of appendix (17/20, 85 %), intraluminal appendicoliths (14/20, 70 %), and perforation (1/20, 5 %). Mean operative time of ERAT was 49.7 min, and mean hospital stay was 3.3 days. No patient converted to emergency appendectomy. Perforation occurred in one patient after appendicoliths removal was not severe and did not require invasive procedures. During at least 1-year follow-up period, only one patient underwent laparoscopic appendectomy. ERAT is a valuable procedure of choice providing a precise yield of diagnostic information for patients with suspected acute appendicitis by combination of colonoscopy and ERA.

Relating Stool Microbial Metabolite Levels, Inflammatory Markers and Dietary Behaviors to Screening Colonoscopy Findings in a Racially/Ethnically Diverse Patient Population

Directory of Open Access Journals (Sweden)

Kristina M. Bridges

2018-02-01

Full Text Available Colorectal cancer (CRC is the third leading cause of cancer death for both men and women in the United States, yet it is treatable and preventable. African Americans have higher incidence of CRC than other racial/ethnic groups, however, it is unclear whether this disparity is primarily due to environmental or biological factors. Short chain fatty acids (SCFAs are metabolites produced by bacteria in the colon and are known to be inversely related to CRC progression. The aim of this study is to investigate how stool SCFA levels, markers of inflammation in stool and dietary intake relate to colonoscopy findings in a diverse patient population. Stool samples from forty-eight participants were analyzed for SCFA levels and inflammatory markers (lysozyme, secretory IgA, lactoferrin. Additionally, participants completed the National Cancer Institute’s Diet History Questionnaire II (DHQ II to report dietary intake over the past year. Subsequently, the majority of participants underwent screening colonoscopy. Our results showed that African Americans had higher total levels of SCFAs in stool than other racial/ethnic groups, significantly lower intake of non-starchy vegetables and similar inflammatory marker expression and colonoscopy outcomes, compared to others. This work is an initial exploration into the biological and clinical factors that may ultimately inform personalized screening approaches and clinical decision-making to improve colorectal cancer disparities for African Americans.

Relating Stool Microbial Metabolite Levels, Inflammatory Markers and Dietary Behaviors to Screening Colonoscopy Findings in a Racially/Ethnically Diverse Patient Population

Science.gov (United States)

Bridges, Kristina M.; Diaz, Francisco J.; Wang, Zhiwen; Ahmed, Ishfaq; Sullivan, Debra K.; Umar, Shahid; Buckles, Daniel C.; Greiner, K. Allen; Hester, Christina M.

2018-01-01

Colorectal cancer (CRC) is the third leading cause of cancer death for both men and women in the United States, yet it is treatable and preventable. African Americans have higher incidence of CRC than other racial/ethnic groups, however, it is unclear whether this disparity is primarily due to environmental or biological factors. Short chain fatty acids (SCFAs) are metabolites produced by bacteria in the colon and are known to be inversely related to CRC progression. The aim of this study is to investigate how stool SCFA levels, markers of inflammation in stool and dietary intake relate to colonoscopy findings in a diverse patient population. Stool samples from forty-eight participants were analyzed for SCFA levels and inflammatory markers (lysozyme, secretory IgA, lactoferrin). Additionally, participants completed the National Cancer Institute’s Diet History Questionnaire II (DHQ II) to report dietary intake over the past year. Subsequently, the majority of participants underwent screening colonoscopy. Our results showed that African Americans had higher total levels of SCFAs in stool than other racial/ethnic groups, significantly lower intake of non-starchy vegetables and similar inflammatory marker expression and colonoscopy outcomes, compared to others. This work is an initial exploration into the biological and clinical factors that may ultimately inform personalized screening approaches and clinical decision-making to improve colorectal cancer disparities for African Americans. PMID:29495356

Nasal inserts containing ondansetron hydrochloride based on Chitosan–gellan gum polyelectrolyte complex: In vitro–in vivo studies

Energy Technology Data Exchange (ETDEWEB)

Sonje, Ashish G.; Mahajan, Hitendra S., E-mail: hsmahajan@rediffmail.com

2016-07-01

The aim of this study was the production of ondansetron hydrochloride loaded lyophilized insert for nasal delivery. The nasal insert was prepared by the lyophilisation technique using Chitosan–gellan gum polyelectrolyte complex as the polymer matrix. The ondansetron loaded inserts were evaluated with respect to water uptake, bioadhesion, drug release kinetic study, ex vivo permeation study, and in vivo study. Lyophilised nasal inserts were characterized by differential scanning calorimetry, scanning electron microscopy and X-ray diffraction study. Scanning electron microscopy confirmed the porous sponge like structure of inserts whereas release kinetic model revealed that drug release followed non-fickian case II diffusion. The nasal delivery showed improved bioavailability as compared to oral delivery. In conclusion, the ondansetron containing nasal inserts based on Chitosan–gellan gum complex with potential muco-adhesive potential is suitable for nasal delivery. - Highlights: • Chitosan–gellan gum polyelectrolyte complex based inserts have been prepared. • The synthesized polymer complex demonstrated important insert properties. • No toxicity was observed toward nasal mucosa. • In vivo study demonstrates the enhancement of bioavailability.

Comparison of conventional Injection Mould Inserts to Additively Manufactured Inserts using Life Cycle Assessment

DEFF Research Database (Denmark)

Hofstätter, Thomas; Bey, Niki; Mischkot, Michael

2016-01-01

Polymer Additive Manufacturing can be used to produce soft tooling inserts for injection moulding. Compared to conventional tooling, the energy and time consumption during production are significantly lower. As the life time of such inserts is significantly shorter than the life time of traditional...... of their potential environmental impact and yield throughout the development and pilot phase. Insert geometry is particularly advantageous for pilot production and small production sizes. In this research, Life Cycle Assessment is used to compare the environmental impact of soft tooling by Additive Manufacturing...... (using Digital Light Processing) and three traditional methods for the manufacture of inserts (milling of brass, steel, and aluminium) for injection moulds during the pre-production phase....

Gastric emptying evaluation by ultrasound prior colonoscopy: An easy tool following bowel preparation

Science.gov (United States)

Coriat, Romain; Polin, Vanessa; Oudjit, Ammar; Henri, Franck; Dhooge, Marion; Leblanc, Sarah; Delchambre, Chantal; Esch, Anouk; Tabouret, Tessa; Barret, Maximilien; Prat, Frédéric; Chaussade, Stanislas

2014-01-01

AIM: To investigate the gastric emptying after bowel preparation to allow general anaesthesia. METHODS: A prospective, non-comparative, and non-randomized trial was performed and registered on Eudra CT database (2011-002953-80) and on www.trial.gov (NCT01398098). All patients had a validated indication for colonoscopy and a preparation using sodium phosphate (NaP) tablets. The day of the procedure, patients took 4 tablets with 250 mL of water every 15 min, three times. The gastric volume was estimated every 15 min from computed antral surfaces and weight according to the formula of Perlas et al (Anesthesiology, 2009). Colonoscopy was performed within the 6 h following the last intake. RESULTS: Thirty patients were prospectively included in the study from November 2011 to May 2012. The maximum volume of the antrum was 212 mL, achieved 15 min after the last intake. 24%, 67% and 92% of subjects had an antral volume below 20 mL at 60, 120 and 150 min, respectively. 81% of patients had a Boston score equal to 2 or 3 in each colonic segment. No adverse events leading to treatment discontinuation were reported. CONCLUSION: Gastric volume evaluation appeared to be a simple and reliable method for the assessment of gastric emptying. Data allow considering the NaP tablets bowel preparation in the morning of the procedure and confirming that gastric emptying is achieved after two hours, allowing general anaesthesia. PMID:25309090

Effects of porous insert on flame dynamics in a lean premixed swirl-stabilized combustor

Science.gov (United States)

Brown, Marcus; Agrawal, Ajay; Allen, James; Kornegay, John

2016-11-01

In this study, we investigated different methods of determining the effect a porous insert has on flame dynamics during lean premixed combustion. A metallic porous insert is used to mitigate instabilities in a swirl-stabilized combustor. Thermoacoustic instabilities are seen as negative consequences of lean premixed combustion and eliminating them is the motivation for our research. Three different diagnostics techniques with high-speed Photron SA5 cameras were used to monitor flame characteristics. Particle image velocimetry (PIV) was used to observe vortical structures and recirculation zones within the combustor. Using planar laser induced fluorescence (PLIF), we were able to observe changes in the reaction zones during instabilities. Finally, utilizing a color high-speed camera, visual images depicting a flame's oscillations during the instability were captured. Using these monitoring techniques, we are able to support the claims made in previous studies stating that the porous insert in the combustor significantly reduces the thermoacoustic instability. Funding for this research was provided by the NSF REU site Grant EEC 1358991 and NASA Grant NNX13AN14A.

A Comparative study of early postpartum IUCD insertion to interval IUCD insertion at Tertiary Care Centre

OpenAIRE

Roopal, Dr.; Bisht, Vandana

2018-01-01

Background: A Comparative study of early postpartum IUCD insertion to interval IUCD insertion at Tertiary Care Centre.Methods: This prospective study was conducted among 100 women at tertiary care centre, Haldwani, Nainital. Patients were divided in to two groups. Group A (n=50)-post placental insertion within 10 minutes of delivery of placenta. Group B (n=50)-Interval insertion after 6 weeks of delivery. Both groups were compared in terms of pain abdomen, bleeding, missing thread, expulsion,...

Filter and window assemblies for high power insertion device synchrotron radiation sources

International Nuclear Information System (INIS)

Khounsary, A.M.; Viccaro, P.J.; Kuzay, T.M.

1992-01-01

The powerful beams of x-ray radiation generated by insertion devices at high power synchrotron facilities deposit substantial amounts of localized heat in the front end and optical components that they intercept. X-ray beams from undulator sources, in particular, are confined to very narrow solid angles and therefore impose very high absorbed heat fluxes. This paper is devoted to a detailed study of the design of windows for the Advanced Photon Source undulators and wigglers, emphasizing alternative design concepts, material considerations, and cooling techniques necessary for handling the high heat load of the insertion devices. Various designs are thermally and structurally analyzed by numerically simulating full-power operating conditions. This analysis also has relevance to the design and development of other beam line components which are subjected to the high heat loads of insertion devices

Colonoscopy is mandatory after Streptococcus bovis endocarditis: a lesson still not learned. Case report

Directory of Open Access Journals (Sweden)

Cavazzi Emma

2008-05-01

Full Text Available Abstract Background Even though the relationship between certain bacterial infections and neoplastic lesions of the colon is well-recognized, this knowledge has not been sufficiently translated into routine practice yet. Case presentation We describe the case of a 51-year-old man who was admitted to our Surgical Department due to rectal bleeding and abdominal pain. Preoperative colonoscopy, staging exams and subsequent surgery demonstrated a stenotic adenocarcinoma of the sigmoid colon, invading the left urinary tract and the homolateral bladder wall, with regional lymph nodes involvement and massive bilobar liver metastases (T4N1M1. After Hartmann's rectosigmoidectomy and despite systemic chemotherapy, a rapid progression occurred and the patient survived for only 5 months after diagnosis. Five years before detecting this advanced colonic cancer, the patient underwent aortic valve replacement due to a severe Streptococcus bovis endocarditis. Subsequent to this infection he never underwent a colonoscopy until overt intestinal symptoms appeared. Conclusion As this case illustrates, in the unusual setting of a Streptococcus bovis infection, it is necessary to timely and carefully rule out occult colon cancer and other malignancies during hospitalization and, if a tumor is not found, to schedule endoscopic follow-up. Rigorous application of these recommendations in the case described would have likely led to an earlier diagnosis of cancer and maybe saved the patient's life.

Evaluation of feasibility of tungsten/oxide dispersion strengthened steel bonding with vanadium insert

International Nuclear Information System (INIS)

Noto, Hiroyuki; Kimura, Akihiko; Kurishita, Hiroaki; Matsuo, Satoru; Nogami, Shuhei

2013-01-01

A diffusion bonding (DB) technique to reduce thermal expansion coefficient mismatch between tungsten (W) and oxide dispersion strengthened ferritic steel (ODS-FS) was developed by applying a vanadium (V) alloy as an insert material. In order to suppress σ phase precipitation at the interface, DB of ODS-FS and V-4Cr-4Ti was carried out by introducing a Ti insert as a diffusion barrier between V-4Cr-4Ti and ODS-FS, and examined feasibility of W/V/Ti/ODS-FS joint for application to fusion reactor components by comparing the three-point bending strength and microstructure between the joints with and without a Ti diffusion barrier layer. It is shown that the fracture strength of the joint without a Ti insert was decreased by 25% after aging at 700°C for 100 h, but that with a Ti insert shows no change after the aging treatment up to 1000 h. The result indicates that the introduction of a Ti insert leads to the prevention of the formation of σ phase during aging and resultant control of the degradation of the bonding strength. (author)

Bowel preparation for pediatric colonoscopy: report of the NASPGHAN endoscopy and procedures committee.

Science.gov (United States)

Pall, Harpreet; Zacur, George M; Kramer, Robert E; Lirio, Richard A; Manfredi, Michael; Shah, Manoj; Stephen, Thomas C; Tucker, Neil; Gibbons, Troy E; Sahn, Benjamin; McOmber, Mark; Friedlander, Joel; Quiros, J A; Fishman, Douglas S; Mamula, Petar

2014-09-01

Pediatric bowel preparation protocols used before colonoscopy vary greatly, with no identified standard practice. The present clinical report reviews the evidence for several bowel preparations in children and reports on their use among North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition members. Publications in the pediatric literature for bowel preparation regimens are described, including mechanisms of action, efficacy and ease of use, and pediatric studies. A survey distributed to pediatric gastroenterology programs across the country reviews present national practice, and cleanout recommendations are provided. Finally, further areas for research are identified.

A feasibility study on laxative-free bowel preparation for virtual colonoscopy

Science.gov (United States)

Liang, Zhengrong; Chen, Dongqing; Wax, Mark; Lakare, Sarang; Li, Lihong; Anderson, Joseph; Kaufman, Arie; Harrington, Donald

2005-04-01

Objective: To investigate the feasibility of laxative-free bowel preparation to relieve the patient stress in colon cleansing for virtual colonoscopy. Materials and Methods: Three different bowel-preparation protocols were investigated by 60 study cases from 35 healthy male volunteers. All the protocols utilize low-residue diet for two days and differ in diet for the third day - the day just prior to image acquisition in the fourth day morning. Protocol Diet-1 utilizes fluid or liquid diet in the third day, Diet-2 utilizes a food kit, and Diet-3 remains the low-residue diet. Oral contrast of barium sulfate (2.1%, 250 ml) was added respectively to the dinner in the second day and the three meals in the third day. Two doses of MD-Gastroview (60 ml) were ingested each in the evening of the third day and in the morning before image acquisition. Images were acquired by a single-slice detector spiral CT (computed tomography) scanner with 5 mm collimation, 1 mm reconstruction, 1.5-2.0:1.0 pitch, 100-150 mA, and 120 kVp after the colons were inflated by CO2. The contrasted colonic residue materials were electronically removed from the CT images by specialized computer-segmentation algorithms. Results: By assumptions that the healthy young volunteers have no polyp and the image resolution is approximately 4 mm, a successful electronic cleansing is defined as "no more than five false positives and no removal of a colon fold part greater than 4 mm" for each study case. The successful rate is 100% for protocol Diet-1, 77% for Diet-2 and 57% for Diet-3. Conclusion: A laxative-free bowel preparation is feasible for virtual colonoscopy.

Training of nurses on Foley catheter insertion in intensive care unit patients: limits and possibilities

Directory of Open Access Journals (Sweden)

Magno Conceição Merces

2013-04-01

Full Text Available Backgound and Objectives: Nursing has an important role in urinary tract infection prevention and control. Urinary catheters insertion represents the local topography with the highest rate of hospital infection. Foley catheter placement is performed solely by the nurse and requires aseptic techniques during its performance, thus preventing risks to the patients. The study aimed to evaluate the training of nurses on Foley catheter insertion and point out limits and possibilities of this practice in patients at the Intensive Care Unit (ICU of Hospital Geral do Interior da Bahia (HGIB. Methods: This was a qualitative, exploratory and descriptive study. Data collection was carried out through semi-structured interviews. After data analysis, two categories were evaluated, namely: the training of nurses on Foley catheter insertion in ICU patients and the limits and possibilities of Foley catheter insertion practice by nurses in ICU patients. Bardin analysis was used for data analysis. Results: The study shows that the nurse’s practice on Foley catheter insertion in ICU patients is based on the use of aseptic techniques for urinary tract infection prevention, theoretical and practical knowledge on Foley catheter insertion in ICU patients, knowledge on urinary tract infections and associations with catheter insertion, whereas the limits and possibilities of Foley catheter insertion practice by nurses are understood through measures to minimize the risk of hospital infection caused by long-term catheter use in the ICU. Nurses point out that the risks of hospital infection are inherent to long-term catheter use. This is an important fact, as the knowledge or its absence may constitute a limit or possibility for Foley catheter insertion practice by the nurse in ICU patients. Conclusion: Nurses must seek the systematization of knowledge, which warrants support for the team, as well as information, safety and prompt care, allowing the reduction of urinary

The kinetics of porous insertion electrodes

Energy Technology Data Exchange (ETDEWEB)

Atlung, S; West, K [British Columbia Univ., Vancouver (Canada)

1989-05-01

The principles of porous electrodes are discussed as well as the discharge of the insertion compound, the working potential, transport in the electrolyte, the time dependence of the electrolyte concentration, and modeling of the porous electrode. The simulation of a TiS2 porous electrode and the composite insertion electrode are considered as well. The influence of electrode thickness and porosity in a typical porous TiS2 electrode is revealed. It is shown that the use of insertion compounds as battery electrodes is limited by the requirement that the inserted ion must be distributed in the interior of the insertion compound particle. 15 refs.

ALS insertion devices

International Nuclear Information System (INIS)

Hoyer, E.; Chin, J.; Halbach, K.; Hassenzahl, W.V.; Humphries, D.; Kincaid, B.; Lancaster, H.; Plate, D.

1990-11-01

The Advanced Light Source (ALS), the first US third generation synchrotron radiation source, is currently under construction at the Lawrence Berkeley Laboratory. The low-emittance, 1.5 GeV electron storage ring and the insertion devices are specifically designed to produce high brightness beams in the UV to soft X-Ray range. The planned initial complement of insertion devices includes four 4.6 m long undulators, with period lengths of 3.9 cm, 5.0 cm (2) and 8.0 cm, and a 2.9 m long wiggler of 16 cm period length. Undulator design is well advanced and fabrication has begun on the 5.0 cm and 8.0 cm period length undulators. This paper discusses ALS insertion device requirements; general design philosophy; and design of the magnetic structure, support structure/drive systems, control system and vacuum system. 18 refs., 9 figs., 5 tabs

Revisiting the NEH algorithm- the power of job insertion technique for optimizing the makespan in permutation flow shop scheduling

Directory of Open Access Journals (Sweden)

A. Baskar

2016-04-01

Full Text Available Permutation flow shop scheduling problems have been an interesting area of research for over six decades. Out of the several parameters, minimization of makespan has been studied much over the years. The problems are widely regarded as NP-Complete if the number of machines is more than three. As the computation time grows exponentially with respect to the problem size, heuristics and meta-heuristics have been proposed by many authors that give reasonably accurate and acceptable results. The NEH algorithm proposed in 1983 is still considered as one of the best simple, constructive heuristics for the minimization of makespan. This paper analyses the powerful job insertion technique used by NEH algorithm and proposes seven new variants, the complexity level remains same. 120 numbers of problem instances proposed by Taillard have been used for the purpose of validating the algorithms. Out of the seven, three produce better results than the original NEH algorithm.

Atomistic Galois insertions for flow sensitive integrity

DEFF Research Database (Denmark)

Nielson, Flemming; Nielson, Hanne Riis

2017-01-01

Several program verification techniques assist in showing that software adheres to the required security policies. Such policies may be sensitive to the flow of execution and the verification may be supported by combinations of type systems and Hoare logics. However, this requires user assistance...... and to obtain full automation we shall explore the over-approximating nature of static analysis. We demonstrate that the use of atomistic Galois insertions constitutes a stable framework in which to obtain sound and fully automatic enforcement of flow sensitive integrity. The framework is illustrated...

Percutaneous Ureteral stent insertion

Energy Technology Data Exchange (ETDEWEB)

Yoon, Yup; Sung, Dong Wook; Choi, Woo Suk; Lee, Dong Ho; Ko, Young Tae; Lee, Sun Wha; Lim, Jae Hoon [Kyung Hee University Hospital, Seoul (Korea, Republic of)

1990-10-15

Percutaneous ureteral stent insertion is a treatment of permanent or temporary urinary diversion to maintain continuity and function of the obstructed and injured ureter. We performed 31 cases of percutaneous double pig tall ureteral stent insertion in 21 patients, included 13 patients with malignant ureteral obstruction and eight patients with injured ureter as well as benign inflammatory stricture. Satisfactory resulted was obtained in all patients but one, who need percutaneous nephrostomy on week later for urinary diversion. No significant complication was encountered. The authors concluded that percutaneous ureteral stent insertion, an interventional procedure alternative to urologic retrograde method, is an effective method for urinary diversion.

Cochlear Dummy Electrodes for Insertion Training and Research Purposes: Fabrication, Mechanical Characterization, and Experimental Validation

Directory of Open Access Journals (Sweden)

Jan-Philipp Kobler

2015-01-01

Full Text Available To develop skills sufficient for hearing preservation cochlear implant surgery, surgeons need to perform several electrode insertion trials in ex vivo temporal bones, thereby consuming relatively expensive electrode carriers. The objectives of this study were to evaluate the insertion characteristics of cochlear electrodes in a plastic scala tympani model and to fabricate radio opaque polymer filament dummy electrodes of equivalent mechanical properties. In addition, this study should aid the design and development of new cochlear electrodes. Automated insertion force measurement is a new technique to reproducibly analyze and evaluate the insertion dynamics and mechanical characteristics of an electrode. Mechanical properties of MED-EL’s FLEX28, FLEX24, and FLEX20 electrodes were assessed with the help of an automated insertion tool. Statistical analysis of the overall mechanical behavior of the electrodes and factors influencing the insertion force are discussed. Radio opaque dummy electrodes of comparable characteristics were fabricated based on insertion force measurements. The platinum-iridium wires were replaced by polymer filament to provide sufficient stiffness to the electrodes and to eradicate the metallic artifacts in X-ray and computed tomography (CT images. These low-cost dummy electrodes are cheap alternatives for surgical training and for in vitro, ex vivo, and in vivo research purposes.

Predicting inadequate bowel preparation for colonoscopy in participants receiving split-dose bowel preparation: development and validation of a prediction score

NARCIS (Netherlands)

Dik, V.K.; Moons, L.M.; Huyuk, M.; Schaar, P. van der; Cappel, W.H. de Vos Tot Nede; Borg, P.C. ter; Meijssen, M.A.; Ouwendijk, R.J.; Fevre, D.M. Le; Stouten, M.; Galien, O. van der; Hiemstra, T.J.; Monkelbaan, J.F.; Oijen, M.G. van; Siersema, P.D.

2015-01-01

BACKGROUND: Adequate bowel preparation is important for optimal colonoscopy. It is important to identify patients at risk for inadequate bowel preparation because this allows taking precautions in this specific group. OBJECTIVE: To develop a prediction score to identify patients at risk for

Predicting inadequate bowel preparation for colonoscopy in participants receiving split-dose bowel preparation : Development and validation of a prediction score

NARCIS (Netherlands)

Dik, Vincent K.; Moons, Leon M G; Hüyük, Melek; Van Der Schaar, Peter; De Vos Tot Nederveen Cappel, Wouter H.; Ter Borg, Pieter C J; Meijssen, Maarten A C; Ouwendijk, Rob J T H; Le Fèvre, Doris M.; Stouten, Merijn; Van Der Galiën, Onno; Hiemstra, Theo J.; Monkelbaan, Jan F.; van Oijen, Martijn G. H.; Siersema, Peter D.; Tang, Thjon J.; Ter Borg, Frank; Kuipers, Ernst J.

2015-01-01

Background: Adequate bowel preparation is important for optimal colonoscopy. It is important to identify patients at risk for inadequate bowel preparation because this allows taking precautions in this specific group. Objective: To develop a prediction score to identify patients at risk for

On measurement of the acoustic nonlinearity parameter using the finite amplitude insertion substitution (FAIS) technique

Science.gov (United States)

Zeqiri, Bajram; Cook, Ashley; Rétat, Lise; Civale, John; ter Haar, Gail

2015-04-01

The acoustic nonlinearity parameter, B/A, is an important parameter which defines the way a propagating finite amplitude acoustic wave progressively distorts when travelling through any medium. One measurement technique used to determine its value is the finite amplitude insertion substitution (FAIS) method which has been applied to a range of liquid, tissue and tissue-like media. Importantly, in terms of the achievable measurement uncertainties, it is a relative technique. This paper presents a detailed study of the method, employing a number of novel features. The first of these is the use of a large area membrane hydrophone (30 mm aperture) which is used to record the plane-wave component of the acoustic field. This reduces the influence of diffraction on measurements, enabling studies to be carried out within the transducer near-field, with the interrogating transducer, test cell and detector positioned close to one another, an attribute which assists in controlling errors arising from nonlinear distortion in any intervening water path. The second feature is the development of a model which estimates the influence of finite-amplitude distortion as the acoustic wave travels from the rear surface of the test cell to the detector. It is demonstrated that this can lead to a significant systematic error in B/A measurement whose magnitude and direction depends on the acoustic property contrast between the test material and the water-filled equivalent cell. Good qualitative agreement between the model and experiment is reported. B/A measurements are reported undertaken at (20 ± 0.5) °C for two fluids commonly employed as reference materials within the technical literature: Corn Oil and Ethylene Glycol. Samples of an IEC standardised agar-based tissue-mimicking material were also measured. A systematic assessment of measurement uncertainties is presented giving expanded uncertainties in the range ±7% to ±14%, expressed at a confidence level close to 95

Insertion Testing of Polyethylene Glycol Microneedle Array into Cultured Human Skin with Biaxial Tension

Science.gov (United States)

Takano, Naoki; Tachikawa, Hiroto; Miyano, Takaya; Nishiyabu, Kazuaki

Aiming at the practical use of polyethylene glycol (PEG) microneedles for transdermal drug delivery system (DDS), a testing apparatus for their insertion into cultured human skin has been developed. To simulate the variety of conditions of human skin, biaxial tension can be applied to the cultured human skin. An adopted testing scheme to apply and control the biaxial tension is similar to the deep-draw forming technique. An attention was also paid to the short-time setup of small, thin and wet cultured skin. One dimensional array with four needles was inserted and influence of tension was discussed. It was found that tension, deflection of skin during insertion and original curvature of skin are the important parameters for microneedles array design.

99 mTc antigranulocyte monoclonal antibody imaging for the detection and assessment of inflammatory bowel disease newly diagnosed by colonoscopy in children

International Nuclear Information System (INIS)

Charron, M.; Hickeson, M.P.

2001-01-01

Objective: This prospective study evaluated a 99m Tc antigranulocyte monoclonal antibody Fab' imaging agent (Sulesomab) in children with inflammatory bowel disease (IBD) newly diagnosed by colonoscopy. Materials and methods: Ten children (4 boys, 6 girls; mean age 14 years) with newly diagnosed Crohn's disease (n = 6) or ulcerative colitis (n = 4) were studied. Colonoscopy was performed in all of these patients. Within 24 h after colonoscopy, they underwent scintigraphy with 99 m Tc-Sulesomab. Abdominal/pelvic images were acquired at 30 min (planar) and 2-4 h (planar and SPECT) after injection of Sulesomab. Eighty bowel segments were evaluated semi-quantitatively by the investigators, using these three sets of images. The Pediatric Disease Activity (PDA) was correlated with the erythrocyte sedimentation rate (ESR), white blood cell (WBC) count, albumin, Kirschner's score, the Sulesomab bowel segment with maximum uptake, and the sum of Sulesomab score in each segment. Results: The median PDA score was 26 (range 12.5-40). Three children had normal ESR and six normal WBC counts. All patients had at least one positive mucosal biopsy for IBD. While using the Kirschner's scale, the maximal severity of colonoscopy findings was graded as none (n = 2), mild (n = 4), moderate (n = 3), or severe (n = 1). Of the 59 segments evaluated with endoscopy, 35 were found to be endoscopically abnormal. The planar images identified 17 of these abnormal segments and the SPECT images 20. Nine of these ten children had abnormal bowel uptake by scintigraphy. Thus, the sensitivity of Sulesomab per patient was 90 % and per bowel segment 57 %. The correlation coefficient between the scintigraphic score for the segment with the Sulesomab maximum activity and the PDA was 0.3 (P = 0.41). Conclusion: In pediatric IBD assessment, planar imaging with Sulesomab did not prove very sensitive in detecting inflammation in each bowel segment. However, SPECT detected the presence of inflammation in the

[Appendectomy for appendicitis by colonoscopy after a cecal invagination of the appendix during childhood].

Science.gov (United States)

Blanc, P; Delacoste, F; Chevassus, P; Espin, A; Kadam, A; Atger, J

2007-01-01

Appendiceal intussusception (the inside-out appendix) was often practiced in pediatric surgery when the appendectomy was performed during laparotomy. Complications are exceptional. We report the first case of appendiceal intussusception in an adult appendectomized by this procedure during childhood, reviewing the radiological aspect, pathogenesis, and treatment. This delayed complication of appendiceal intussusception should be known to the surgeon. Treatment during colonoscopy is possible. This inflammation of the vaginated appendix can be prevented by coagulating the appendicular vessels to the serous membrane before turning it inside-out.

Endovascular technique using a snare and suture for retrieving a migrated peripherally inserted central catheter in the left pulmonary artery

Science.gov (United States)

Teragawa, Hiroki; Sueda, Takashi; Fujii, Yuichi; Takemoto, Hiroaki; Toyota, Yasushi; Nomura, Shuichi; Nakagawa, Keigo

2013-01-01

We report a successful endovascular technique using a snare with a suture for retrieving a migrated broken peripherally inserted central catheter (PICC) in a chemotherapy patient. A 62-year-old male received monthly chemotherapy through a central venous port implanted into his right subclavian area. The patient completed chemotherapy without complications 1 mo ago; however, he experienced pain in the right subclavian area during his last chemotherapy session. Computed tomography on that day showed migration of a broken PICC in his left pulmonary artery, for which the patient was admitted to our hospital. We attempted to retrieve the ectopic PICC through the right jugular vein using a gooseneck snare, but were unsuccessful because the catheter was lodged in the pulmonary artery wall. Therefore, a second attempt was made through the right femoral vein using a snare with triple loops, but we could not grasp the migrated PICC. Finally, a string was tied to the top of the snare, allowing us to curve the snare toward the pulmonary artery by pulling the string. Finally, the catheter body was grasped and retrieved. The endovascular suture technique is occasionally extremely useful and should be considered by interventional cardiologists for retrieving migrated catheters. PMID:24109502

Combined colonoscopy and endometrial biopsy cancer screening results in women with Lynch syndrome.

Science.gov (United States)

Nebgen, Denise R; Lu, Karen H; Rimes, Sue; Keeler, Elizabeth; Broaddus, Russell; Munsell, Mark F; Lynch, Patrick M

2014-10-01

Endometrial biopsy (EMBx) and colonoscopy performed under the same sedation is termed combined screening and has been shown to be feasible and to provide a less painful and more satisfactory experience for women with Lynch syndrome (LS). However, clinical results of these screening efforts have not been reported. The purpose of this study was to evaluate the long-term clinical outcomes and patient compliance with serial screenings over the last 10.5 years. We retrospectively analyzed the data for 55 women with LS who underwent combined screening every 1-2 years between 2002 and 2013. Colonoscopy and endometrial biopsy were performed by a gastroenterologist and a gynecologist, with the patient under conscious sedation. Out of 111 screening visits in these 55 patients, endometrial biopsies detected one simple hyperplasia, three complex hyperplasia, and one endometrioid adenocarcinoma (FIGO Stage 1A). Seventy-one colorectal polyps were removed in 29 patients, of which 29 were tubular adenomas. EMBx in our study detected endometrial cancer in 0.9% (1/111) of surveillance visits, and premalignant hyperplasia in 3.6% (4/111) of screening visits. No interval endometrial or colorectal cancers were detected. Combined screening under sedation is feasible and less painful than EMBx alone. Our endometrial pathology detection rates were comparable to yearly screening studies. Our results indicate that screening of asymptomatic LS women with EMBx every 1-2 years, rather than annually, is effective in the early detection of (pre)cancerous lesions, leading to their prompt definitive management, and potential reduction in endometrial cancer. Copyright © 2014 Elsevier Inc. All rights reserved.

Surgical implications of perimodiolar cochlear implant electrode design: avoiding intracochlear damage and scala vestibuli insertion.

Science.gov (United States)

Briggs, R J; Tykocinski, M; Saunders, E; Hellier, W; Dahm, M; Pyman, B; Clark, G M

2001-09-01

To review the mechanisms and nature of intracochlear damage associated with cochlear implant electrode array insertion, in particular, the various perimodiolar electrode designs. Make recommendations regarding surgical techniques for the Nucleus Contour electrode to ensure correct position and minimal insertion trauma. The potential advantages of increased modiolar proximity of intracochlear multichannel electrode arrays are a reduction in stimulation thresholds, an increase in dynamic range and more localized neural excitation. This may improve speech perception and reduce power consumption. These advantages may be negated if increased intracochlear damage results from the method used to position the electrodes close to the modiolus. A review of the University of Melbourne Department of Otolaryngology experience with temporal bone safety studies using the Nucleus standard straight electrode array and a variety of perimodiolar electrode array designs; comparison with temporal bone insertion studies from other centres and postmortem histopathology studies reported in the literature. Review of our initial clinical experience using the Nucleus Contour electrode array. The nature of intracochlear damage resulting from electrode insertion trauma ranges from minor, localized, spiral ligament tear to diffuse organ of Corti disruption and osseous spiral lamina fracture. The type of damage depends on the mechanical characteristics of the electrode array, the stiffness, curvature and size of the electrode in relation to the scala, and the surgical technique. The narrow, flexible, straight arrays are the least traumatic. Pre-curved or stiffer arrays are associated with an incidence of basilar membrane perforation. The cochleostomy must be correctly sited in relation to the round window to ensure scala tympani insertion. A cochleostomy anterior to the round window rather than inferior may lead to scala media or scala vestibuli insertion. Proximity of electrodes to the modiolus

A randomised controlled trial: can acupuncture reduce drug requirement during analgosedation with propofol and alfentanil for colonoscopy? A study protocol

NARCIS (Netherlands)

Eberl, Susanne; Monteiro de Olivera, Nelson; Preckel, Benedikt; Streitberger, Konrad; Fockens, Paul; Hollmann, Markus W.

2015-01-01

The number of colonoscopies tremendously increased in recent years and will further rise in the near future. Because of patients' growing expectation on comfort during medical procedures, it is not surprising that the demand for sedation also expands. Propofol in combination with alfentanil is known

An Assessment of Radiologically Inserted Transoral and Transgastric Gastroduodenal Stents to Treat Malignant Gastric Outlet Obstruction

Energy Technology Data Exchange (ETDEWEB)

Miller, Bethany H. T., E-mail: bmiller@doctors.org.uk [Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Department of Upper Gastrointestinal Surgery (United Kingdom); Griffiths, Ewen A., E-mail: Eagriffiths@doctors.org.uk [The New Queen Elizabeth Hospital, Department of Upper Gastrointestinal Surgery (United Kingdom); Pursnani, Kishore G., E-mail: Kish.Pursnani@lthtr.nhs.uk; Ward, Jeremy B., E-mail: Jeremy.Ward@lthtr.nhs.uk [Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Department of Upper Gastrointestinal Surgery (United Kingdom); Stockwell, Robert C., E-mail: Robert.Stockwell@lthtr.nhs.uk [Lancashire Teaching Hospitals NHS Foundation Trust, Chorley and South Ribble Hospital, Department of Radiology (United Kingdom)

2013-12-15

IntroductionSelf-expanding metallic stents (SEMS) are used to palliate malignant gastric outlet obstruction (GOO) and are useful in patients with limited life expectancy or severe medical comorbidity, which would preclude surgery. Stenting can be performed transorally or by a percutaneous transgastric technique. Our goal was to review the outcome of patients who underwent radiological SEMS insertion performed by a single consultant interventional radiologist. Methods: Patients were identified from a prospectively collected database held by one consultant radiologist. Data were retrieved from radiological reports, multidisciplinary team meetings, and the patients' case notes. Univariate survival analysis was performed. Results: Between December 2000 and January 2011, 100 patients (63 males, 37 females) had 110 gastroduodenal stenting procedures. Median age was 73 (range 39-89) years. SEMS were inserted transorally (n = 66) or transgastrically (n = 44). Site of obstruction was the stomach (n = 37), duodenum (n = 50), gastric pull-up (n = 10), or gastroenterostomy (n = 13). Seven patients required biliary stents. Technical success was 86.4 %: 83.3 % for transoral insertion, 90.9 % for transgastric insertion. Eleven patients developed complications. Median GOO severity score: 1 pre-stenting, 2 post-stenting (p = 0.0001). Median survival was 54 (range 1-624) days. Post-stenting GOO severity score was predictive of survival (p = 0.0001). Conclusions: The technical success rate for insertion of palliative SEMS is high. Insertional technique can be tailored to the individual depending on the location of the tumor and whether it is possible to access the stomach percutaneously. Patients who have successful stenting and return to eating a soft/normal diet have a statistically significant increase in survival.

An Assessment of Radiologically Inserted Transoral and Transgastric Gastroduodenal Stents to Treat Malignant Gastric Outlet Obstruction

International Nuclear Information System (INIS)

Miller, Bethany H. T.; Griffiths, Ewen A.; Pursnani, Kishore G.; Ward, Jeremy B.; Stockwell, Robert C.

2013-01-01

IntroductionSelf-expanding metallic stents (SEMS) are used to palliate malignant gastric outlet obstruction (GOO) and are useful in patients with limited life expectancy or severe medical comorbidity, which would preclude surgery. Stenting can be performed transorally or by a percutaneous transgastric technique. Our goal was to review the outcome of patients who underwent radiological SEMS insertion performed by a single consultant interventional radiologist. Methods: Patients were identified from a prospectively collected database held by one consultant radiologist. Data were retrieved from radiological reports, multidisciplinary team meetings, and the patients’ case notes. Univariate survival analysis was performed. Results: Between December 2000 and January 2011, 100 patients (63 males, 37 females) had 110 gastroduodenal stenting procedures. Median age was 73 (range 39–89) years. SEMS were inserted transorally (n = 66) or transgastrically (n = 44). Site of obstruction was the stomach (n = 37), duodenum (n = 50), gastric pull-up (n = 10), or gastroenterostomy (n = 13). Seven patients required biliary stents. Technical success was 86.4 %: 83.3 % for transoral insertion, 90.9 % for transgastric insertion. Eleven patients developed complications. Median GOO severity score: 1 pre-stenting, 2 post-stenting (p = 0.0001). Median survival was 54 (range 1–624) days. Post-stenting GOO severity score was predictive of survival (p = 0.0001). Conclusions: The technical success rate for insertion of palliative SEMS is high. Insertional technique can be tailored to the individual depending on the location of the tumor and whether it is possible to access the stomach percutaneously. Patients who have successful stenting and return to eating a soft/normal diet have a statistically significant increase in survival

Kirschner Wires : insertion techniques and bone related consequences

NARCIS (Netherlands)

Franssen, B.B.G.M.

2010-01-01

The Kirschner (K-) wire was first introduced in 1909 by Martin Kirschner. This is a thin unthreaded wire of surgical steel with a diameter of up to three millimeters and a selection of different tips. The use of K-wires is often promoted as a simple technique because of its easy placement,

Quality of colonoscopy performance among gastroenterology and surgical trainees: a need for common training standards for all trainees?

LENUS (Irish Health Repository)

Leyden, J E

2011-11-01

Cecal intubation and polyp detection rates are objective measures of colonoscopy performance. Minimum cecal intubation rates greater than 90% have been endorsed by the American Society for Gastrointestinal Endoscopy (ASGE) and the Joint Advisory Group (JAG) UK. Performance data for medical and surgical trainee endoscopists are limited, and we used endoscopy quality parameters to compare these two groups.

Prototype of a computer system for managing data and video colonoscopy exams

Directory of Open Access Journals (Sweden)

Renato Bobsin Machado

2012-03-01

Full Text Available OBJECTIVE: Develop a prototype using computer resources to optimize the management process of clinical information and video colonoscopy exams. MATERIALS AND METHODS: Through meetings with medical and computer experts, the following requirements were defined: management of information about medical professionals, patients and exams; video and image captured by video colonoscopes during the exam, and the availability of these videos and images on the Web for further analysis. The technologies used were Java, Flex, JBoss, Red5, JBoss SEAM, MySQL and Flamingo. RESULTS AND DISCUSSION: The prototype contributed to the area of colonocospy by providing resources to maintain the patients' history, tests and images from video colonoscopies. The web-based application allows greater flexibility to physicians and specialists. The resources for remote analysis of data and tests can help doctors and patients in the examination and diagnosis. CONCLUSION: The implemented prototype has contributed to improve colonoscopy-related processes. Future activities include the prototype deployment in the Service of Coloproctology and the utilization of this model to allow real-time monitoring of these exams and knowledge extraction from such structured database using artificial intelligence.OBJETIVO: Desenvolver um protótipo por meio de recursos computacionais para a otimização de processos de gerenciamento de informações clínicas e de exames de videocolonoscopia. MATERIAIS E MÉTODOS: Por meio de reuniões com especialistas médicos e computacionais, definiram-se os seguintes requisitos: gestão de informações sobre profissionais médicos, pacientes e exames complementares; aquisição dos vídeos e captura de imagens a partir do videocolonoscópio durante a realização desse exame, e a disponibilidade por meio da Web para análise posterior dessas imagens. As tecnologias aplicadas foram: Java, Flex, JBOSS, Red5, JBOSS SEAM, MySQL e Flamingo. RESULTADOS E

CRISPR/Cas9 cleavages in budding yeast reveal templated insertions and strand-specific insertion/deletion profiles.

Science.gov (United States)

Lemos, Brenda R; Kaplan, Adam C; Bae, Ji Eun; Ferrazzoli, Alexander E; Kuo, James; Anand, Ranjith P; Waterman, David P; Haber, James E

2018-02-27

Harnessing CRISPR-Cas9 technology provides an unprecedented ability to modify genomic loci via DNA double-strand break (DSB) induction and repair. We analyzed nonhomologous end-joining (NHEJ) repair induced by Cas9 in budding yeast and found that the orientation of binding of Cas9 and its guide RNA (gRNA) profoundly influences the pattern of insertion/deletions (indels) at the site of cleavage. A common indel created by Cas9 is a 1-bp (+1) insertion that appears to result from Cas9 creating a 1-nt 5' overhang that is filled in by a DNA polymerase and ligated. The origin of +1 insertions was investigated by using two gRNAs with PAM sequences located on opposite DNA strands but designed to cleave the same sequence. These templated +1 insertions are dependent on the X-family DNA polymerase, Pol4. Deleting Pol4 also eliminated +2 and +3 insertions, which are biased toward homonucleotide insertions. Using inverted PAM sequences, we also found significant differences in overall NHEJ efficiency and repair profiles, suggesting that the binding of the Cas9:gRNA complex influences subsequent NHEJ processing. As with events induced by the site-specific HO endonuclease, CRISPR-Cas9-mediated NHEJ repair depends on the Ku heterodimer and DNA ligase 4. Cas9 events are highly dependent on the Mre11-Rad50-Xrs2 complex, independent of Mre11's nuclease activity. Inspection of the outcomes of a large number of Cas9 cleavage events in mammalian cells reveals a similar templated origin of +1 insertions in human cells, but also a significant frequency of similarly templated +2 insertions.

The clinical anatomy of the insertion of the rotator cuff tendons.

Science.gov (United States)

Vosloo, M; Keough, N; De Beer, M A

2017-04-01

The rotator cuff (RC) insertions according to most anatomical texts are described as being separate from one another. However, clear fusion of the RC tendon fibres exists with prior studies showing this interdigitation forming a common, continuous insertion onto and around the lesser and greater tubercles (LT and GT) of the humerus. Current surgical repair methods (especially arthroscopic techniques) rarely mention or consider these connections during repair and suture anchor implantation. The general principles of RC surgery remain a controversial subject, due to various available techniques, surgeon experience and preference, and the contradicting success rates. This results from old-fashioned knowledge of the anatomy of the RC complex and its functional aspects. Therefore, the purpose of this project was to visualise and define the RC footprint and extension insertions with the aim of enhancing and improving knowledge of the basic anatomy in the hopes that this will be considered during orthopaedic repair. Twenty shoulders (16 cadaveric and 4 fresh) were used in the study. The fresh shoulders were received from the National Tissue Bank, and ethical clearance was obtained (239/2015). Reverse dissection was performed to better visualise the RC unit exposing the interdigitated rotator hood (extension insertions), as well as the complete RC unit (tendons + internal capsule) separated from the scapula and humerus. Once the insertions were exposed and documented, the RC muscle footprint (articular surface area) was measured and recorded, using AutoCAD 2016. No statistical significant difference between left and right (p = 0.424) was noted, but a significant difference between males and females (p = 0.000) was. Collectively, these findings indicate and strengthen evidence towards the notion that the RC muscles/tendons and the internal capsule are one complete and inseparable unit/complex. The fact that the RC unit is more complex in its structure and attachment

ISABELLE insertion quadrupoles

International Nuclear Information System (INIS)

Kaugerts, J.; Polk, I.; Sampson, W.; Dahl, P.F.

1979-01-01

Beam focussing and control at the beam intersection regions of ISABELLE is accomplished by a number of superconducting insertion quadrupoles. These magnets differ from the standard ISABELLE quadrupoles in various ways. In particular, the requirements of limited space near the intersections and aperture for beam extraction impose constraints on their configuration. To achieve optimum beam focussing and provide tuning flexibility calls for stronger quadrupole trim windings than those in the standard quadrupoles. The magnetic and mechanical design of the insertion quadrupoles and their associated correction and steering windings to accomplish the above tasks is presented

Medical image of the week: Boerhaave's syndrome during colonoscopy

Directory of Open Access Journals (Sweden)

Meenakshisundaram C

2015-07-01

Full Text Available No abstract available. Article truncated at 150 words. A 76-year-old woman with no significant past medical history underwent outpatient screening colonoscopy. The procedure was difficult due to a tortuous colon and only multiple diverticula were visualized. She vomited once during the procedure. In the immediate postoperative period, she complained of neck swelling. Her vital signs were stable. On examination, right sided neck and facial swelling with palpable crepitations were noticed as well as coarse breath sounds heard on auscultation of both lung fields. Immediate chest X-ray (Figure 1 was obtained which showed bilateral subcutaneous emphysema extending from the supraclavicular area and above to the neck. Subsequent thoracic CT scan showed extensive subcutaneous air within the soft tissues of the neck bilaterally, extending into the mediastinum and along the anterior chest wall (Figure 2. An esophagram (Figure 3 revealed a focus of oral contrast actively extravasating approximately at 2.5 cm above the gastro-esophageal junction consistent with a small perforation ...

Polyethylene Glycol Electrolyte Lavage Solution versus Colonic Hydrotherapy for Bowel Preparation before Colonoscopy: A Single Center, Randomized, and Controlled Study

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Yan Cao

2014-01-01

Full Text Available This single center, randomized, and controlled study aimed to compare the effectiveness and safety of polyethylene glycol electrolyte lavage (PEG-EL solution and colonic hydrotherapy (CHT for bowel preparation before colonoscopy. A total of 196 eligible outpatients scheduled for diagnostic colonoscopy were randomly assigned to the PEG-EL (n=102 or CHT (n=94 groups. Primary outcome measures included colonic cleanliness and adverse effects. Secondary outcome measures were patient satisfaction and preference, colonoscopic findings, ileocecal arrival rate, examiner satisfaction, and cecal intubation time. The results show that PEG-EL group was associated with significantly better colonic cleanliness than CHT group, fewer adverse effects, and increased examiner satisfaction. However, the CHT group had higher patient satisfaction and higher diverticulosis detection rates. Moreover, the results showed the same ileocecal arrival rate and patient preference between the two groups (P>0.05. These findings indicate that PEG-EL is the preferred option in patients who followed the preparation instructions completely.

Two low-dose bowel-cleansing regimens: efficacy and safety of senna and sodium phosphorus solution for colonoscopy

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Poyrazoglu OK

2015-09-01

Full Text Available Orhan Kursat Poyrazoglu, Mehmet Yalniz Department of Gastroenterology, School of Medicine, Firat University, Elazig, Turkey Background: The aim of the present study was to compare the efficacy, adequacy, side effects, and patient compliance of sodium phosphorus (NaP and senna solutions when preparing the colon before colonoscopy.Methods: A total of 137 consecutive patients who were considered for colonoscopy evaluation had randomly received one of two premeditated regimens: 90 mL of oral NaP (NaP group or 500 mL of 1,000 mg of sennosides A and B calcium +66.6 g of sorbitol (senna group. Patients’ compliance with the bowel-cleansing method was determined using a questionnaire prior to the colonoscopic examination. On the other hand, the adequacy of the bowel-cleansing method was evaluated by the colonoscopist who was blind to the bowel-cleansing regimen used prior to the examination of the colon from the rectum to the cecum.Results: Nausea and vomiting complaints were seen more frequently in the NaP group than in the senna group (47 vs 28 and 31 vs 10; P<0.05 and P<0.01, respectively. The response to the question of whether the patients would like to use the same regimen again or not was similar in both groups. The acceptable bowel-cleansing rate was also comparable across both groups. Nevertheless, the number of patients that experienced excellent bowel cleansing in terms of general appraisal of the colonoscopic evaluation was significantly greater in the NaP group than in the senna group (46 vs 25; P<0.001.Conclusion: Although bowel cleansing was better in the NaP group, both cleansing regimens were comparable regarding the admissibility of the preparations for the procedure. The senna regimen is, however, superior to the NaP regimen in terms of application compliance and its side effects, and it may be an effective alternative for cleansing the bowel prior to colonoscopic examination. Keywords: bowel preparation, colonoscopy, side effect

Computed tomography colonography versus colonoscopy for the diagnosis of colorectal cancer: a systematic review and meta-analysis

Directory of Open Access Journals (Sweden)

Duarte RB

2018-02-01

Full Text Available Ralph B Duarte, Wanderley M Bernardo, Christiano M Sakai, Gustavo LR Silva, Hugo G Guedes, Rogerio Kuga, Edson Ide, Robson K Ishida, Paulo Sakai, Eduardo GH de Moura Gastrointestinal Endoscopy Unit of Hospital das Clínicas of São Paulo University Medical School, São Paulo, SP, Brazil Abstract: Colorectal cancer (CRC is a significant cause of morbidity and mortality. Optical colonoscopy (OC is the first choice of investigation for assessing the state of the colon and it is excellent for CRC screening. Newer technologies such as computed tomography colonography (CTC may also be useful in CRC screening. This systematic review compares the benefits of CTC and OC for CRC screening. This review includes all the available randomized clinical trials comparing CTC and OC for CRC screening in asymptomatic patients. Three studies were included in the systematic review and were submitted for meta-analysis. In the analysis of participation rates, only 2,333 of 8,104 (29% patients who were invited for screening underwent the CTC, and only 1,486 of the 7,310 (20% patients who were invited for screening underwent OC. The absolute risk difference in participation rate in the two procedures was 0.1 (95% CI, 0.05–0.14 in favor of CTC. In the analysis of advanced colorectal neoplasia (ACN detection rates, 2,357 patients undergoing CTC and 1,524 patients undergoing OC were included. Of these, 135 patients (5.7% who underwent a CTC and 130 patients (8.5% who underwent an OC were diagnosed with ACN. The absolute risk difference in ACN detection rate in the two procedure types was -0.02 (with a 95% CI between -0.04 and -0.00 in favor of OC. CTC is an option for CRC screening in asymptomatic patients. However, as CTC was inferior in detecting ACN, it should not replace OC, which remains the gold standard. Keywords: computed tomography colonography, colonography, CT colonography, virtual colonoscopy, colonoscopy, colorectal neoplasm, colorectal cancer, colorectal

Assessment of the insertion of reprocessed fuel spiked with thorium in a PWR core

Energy Technology Data Exchange (ETDEWEB)

Castro, Victor F.; Monteiro, Fabiana B.A.; Pereira, Claubia, E-mail: victorfc@fis.grad.ufmg.br, E-mail: claubia@nuclear.ufmg.br [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Departamento de Engenharia Nuclear

2017-07-01

Reprocessed fuel by UREX+ technique and spiked with thorium was inserted in a PWR core and neutronic parameters have been analyzed. Based on the Final Safety Analysis Report (FSAR) of the Angra-2 reactor, the core was modeled and simulated with SCALE6.0 package. The neutronic data evaluation was carried out by the analysis of the effective and infinite multiplication factors, and the fuel evolution during the burnup. The conversion ratio (CR) was also evaluated. The results show that, when inserting reprocessed fuel spiked with thorium, the insertion of burnable poison rods is not necessary, due to the amount of absorber isotopes present in the fuel. Besides, the conversion ratio obtained was greater than the presented by standard UO{sub 2} fuel, indicating the possibility of extending the burnup. (author)

Fixation of the Achilles tendon insertion using suture button technology.

Science.gov (United States)

Fanter, Nathan J; Davis, Edward W; Baker, Champ L

2012-09-01

In the operative treatment of Achilles insertional tendinopathy, no guidelines exist concerning which form of fixation of the Achilles tendon insertion is superior. Transcalcaneal drill pin passage does not place any major plantar structures at risk, and the addition of a Krackow stitch and suture button to the fixation technique provides a significant increase in ultimate load to failure in Achilles tendon insertional repairs. Controlled laboratory study. The Achilles tendon insertions in 6 fresh-frozen cadaveric ankles were detached, and transcalcaneal drill pins were passed. Plantar dissection took place to evaluate the drill pin relationship to the plantar fascia, lateral plantar nerve and artery, flexor digitorum longus tendon, and master knot of Henry. The Achilles tendons were then repaired with a double-row suture anchor construct alone or with a suture button and Krackow stitch added to the double-row suture anchor construct. The repairs were then tested to maximum load to failure at 20 mm/min. The mode of failure was recorded, and the mean maximum load to failure was assessed using the Student t test for distributions with equal variance. Transcalcaneal drill pin passage did not place any selected anatomic structures at risk. The mean maximum load to failure for the suture bridge group was 239.2 N; it was 391.4 N for the group with the suture button (P = .014). The lateral plantar artery was the structure placed at greatest risk from drill pin placement, with a mean distance of 22.7 mm (range, 16.5-29.2 mm) between the pin and artery. In this laboratory study, transcalcaneal drill pin passage appeared to be anatomically safe, and the use of suture button technology with a Krackow stitch for Achilles tendon insertional repair significantly increased repair strength. Achilles tendon insertional repair with suture button fixation and a Krackow stitch may facilitate the earlier institution of postoperative rehabilitation and improve clinical outcomes.

Sequential cooling insert for turbine stator vane

Science.gov (United States)

Jones, Russel B

2017-04-04

A sequential flow cooling insert for a turbine stator vane of a small gas turbine engine, where the impingement cooling insert is formed as a single piece from a metal additive manufacturing process such as 3D metal printing, and where the insert includes a plurality of rows of radial extending impingement cooling air holes alternating with rows of radial extending return air holes on a pressure side wall, and where the insert includes a plurality of rows of chordwise extending second impingement cooling air holes on a suction side wall. The insert includes alternating rows of radial extending cooling air supply channels and return air channels that form a series of impingement cooling on the pressure side followed by the suction side of the insert.

Fuel insert shuffler

International Nuclear Information System (INIS)

Naser, J.; Colley, R.; Gaiser, J.; Brookmire, T.; Engle, S.

1987-01-01

The potential for the use of expert systems in the nuclear power industry is widely recognized. The benefits of such systems include consistency of reasoning during off-normal situations when humans are under great stress, the reduction of time required to perform certain functions and the retention of human expertise in performing specialized functions. As the potential benefits are more and more demonstrated and realized, the development of expert systems becomes a necessary part of the nuclear power industry. The development of the fuel insert shuffle expert system is used as a case study. In fact, it shows that the potential benefits are realizable. Currently, the development of the insert shuffle plan requires three to four man-weeks of effort. Further modifications to this plan are sometimes required dur to either changes in the desired core load pattern or damaged fuel assemblies or inserts. These changes generally require two to four man-days of effort and could be stressful if they are critical path items on the outage schedule

Intravenous contrast enhanced computed tomography colonoscopy in children with suspected colonic polyps

International Nuclear Information System (INIS)

Bhatia, Anmol; Saxena, Akshay K.; Kalra, Naveen; Sodhi, Kushaljit S.; Thapa, Babu R.; Rao, Katragadda L.N.; Khandelwal, Niranjan

2013-01-01

Objective: The purpose of this study was to evaluate the diagnostic performance of intravenous contrast enhanced computed tomographic colonoscopy (IVCTC) in the diagnosis of clinically suspected colorectal polyps in children, using conventional colonoscopy (CC) as the gold standard. Methods: This was a prospective study conducted between July 2008 and June 2010. 30 pediatric patients with history of rectal bleeding and clinically suspected to have colorectal polyps were enrolled. All of the patients underwent IVCTC followed by CC. 30 IVCTC and 31 CC were performed in 30 patients. The findings of IVCTC were compared with those of CC. Statistical analysis was performed to obtain diagnostic performance values of IVCTC on per polyp (sensitivity and positive predictive value) and per patient (sensitivity, specificity, positive predictive value and negative predictive value) basis. Results: By IVCTC, 63 polyps were detected in 28 patients of which 53 polyps were eligible for inclusion in the statistical analysis. 60 polyps were detected by CC in 28 patients of which 50 polyps were eligible for inclusion in the statistical analysis. The per polyp sensitivity and positive predictive values were 94% and 88.6% respectively. The per patient sensitivity, specificity, positive predictive value, and negative predictive values were 96.4, 50, 96.4, and 50% respectively. Twenty polyps, in 10 patients, were visualized only after intravenous contrast administration of which 5 polyps, in 5 patients, were likely to have been missed in the absence of the intravenous contrast injection as these polyps were submerged in fluid. Four patients would have had a false negative CTC examination if the intravenous contrast had not been injected; while in another patient, the number of polyps would have been underestimated. Conclusion: CTC is capable of serving as a safe and efficient non-invasive tool for evaluating children with clinically suspected colorectal polyps. Administration of

Costs of Finding an Advanced Adenoma in Colorectal Screening

Directory of Open Access Journals (Sweden)

Jerome B Simon

2004-01-01

Full Text Available The authors used computerized decision analysis to estimate the costs of finding and removing an advanced colonic adenoma in patients referred because of a positive fecal occult blood test. An advanced adenoma was defined as a villous adenoma, a tubular adenoma 10 mm or more in size, or a lesion that harboured highgrade dysplasia or cancer. Four strategies were compared: flexible sigmoidoscopy, flexible sigmoidoscopy plus air contrast barium enema, virtual colonoscopy (CT colography and colonoscopy. Colonoscopy with polypectomy was undertaken if any of the methods detected a polyp. Probabilities and test characteristics were determined from the literature, and costs were estimated from the provincial fee schedule (Ontario and local hospital sources. With an assumed 17% probability of an advanced adenoma being present, sigmoidoscopy was the most cost effective strategy at $1930 to find and clear an advanced lesion, but the procredure missed between one-third and almost one-half of the lesions, depending on the depth of insertion. At $2290, colonoscopy was slightly more expensive than sigmoidoscopy and more cost effective than either sigmoidoscopy plus barium enema ($2840 or virtual colonoscopy ($3681, neither of which detected as many advanced adenomas. The authors concluded that colonoscopy is the preferred investigative strategy and that improved access to colonoscopy is an important goal for occult blood screening programs.

An evaluation of patient attitudes to colonoscopy and the importance of endoscopist interaction and the endoscopy environment to satisfaction and value.

Science.gov (United States)

McEntire, Jude; Sahota, Jagdeep; Hydes, Theresa; Trebble, Timothy Mark

2013-03-01

Understanding patients' attitudes to their medical experience is essential for identifying value in the patient pathway, optimizing care and use of resources. This service evaluation was undertaken to determine patients' preferences and expectations for day case colonoscopy, a common gastrointestinal procedure for which there is limited such data. Patients attending for elective colonoscopy were invited to complete a composite, validated dedicated endoscopy questionnaire, with Likert-scale questions and a 15-point preference (ranking) scale of domains of endoscopy care that were considered most important (1) to least important (15) as contributing to a satisfactory experience. Two hundred and sixteen out of 224 patients returned questionnaires. Moderate to severe anxiety was recorded in 56% of patients, commonly with respect to anticipation of pain or the results of the procedure. The median values for ranked preference scores consistent with greatest importance for satisfaction were technical skill of the endoscopist (1), discomfort during the procedure (4), and manner of the endoscopist (5). Factors considered of relatively low importance included the single-sex environment (15) (although this was more important to female patients), noise levels (13), and explanation of delay (11). Only 14% of patients responded that they would be prepared to delay an appointment for a single-sex environment. Patients undergoing colonoscopy highly prioritize aspects of care relating to the interaction with the endoscopist and the procedure itself. Environment factors are considered to be less important. These findings may assist in service redesign around patient-identified value within the patient pathway.

[Effects of slow twisting needle insertion and tubing needle insertion at Neiguan (PC 6) on cardiovascular function: a comparative study].

Science.gov (United States)

Ning, Shaoli; Zhao, Lihua; Xu, Lingjun; Huang, Yu; Pang, Yong; Huang, Dingjian

2016-01-01

To compare the effects between slow twisting needle insertion and tubing needle insertion. With cross-over design, 100 healthy young subjects (half male and half female) aged from 19 to 23 years were randomly divided into two groups by random digital table, 50 cases in each one. At the first stage, subjects in the group A were treated with slow twisting needle insertion while, subjects in,the group B were treated with tubing needle insertion. One week later, the procedure of second stage was performed alternately. The needle was inserted into Neiguan (PC 6) with two methods by one acupuncturist. The needle was retained for 5 min before removal. Five min before needle insertion as well as needle withdrawal and 30 min after needle withdrawal, ZXG-E automatic cardiovascular diagnostic apparatus was used to test cardiovascular function. At the tim of needle withdrawal, slow twisting needle insertion could improve effect work of kinetics (EWK), effective blood volume (BV) and reduce elastic expansion coefficient of blood vessel (FEK) and left ventricular spray blood impedance (VER), which was significantly different from tubing needle insertion (all P 0.05). The slow twisting needle insertion is significantly superior to tubing needle insertion on lowering vascular tension and VER, improving EWK and BV.

Motion-Computerized Tomographic Colography is a Better Method for Screening for Polyps: Arguments for the Motion

Directory of Open Access Journals (Sweden)

Benoit C Pineau

2003-01-01

Full Text Available Colorectal cancer is an important public health problem that is amenable to prevention and early treatment. Traditional screening techniques - fecal occult blood testing, flexible sigmoidoscopy, barium enema and colonoscopy - each have limitations in terms of diagnostic accuracy, cost and/or patient acceptability. Compliance with recommendations for screening has been poor, in part, because of negative perceptions about the available modalities. Virtual colonoscopy, or computerized tomographic colography, is a minimally invasive technique that safely evaluates the entire colon and does not require sedation. Thorough cleansing as well as immobilization and air insufflation of the colon is crucial to a successful examination. Sensitivity and specificity rates are reasonable, compared with conventional colonoscopy, and it has been shown that the latter technique can be averted in over two-thirds of cases, with few false-negative examinations. Most patients find virtual colonoscopy more acceptable than the conventional technique, and would prefer it if a repeat procedure were warranted. An economic analysis that found that computerized tomographic colography was less cost effective than conventional colonoscopy did not consider the indirect costs of the latter, which is an important limitation. Virtual colonoscopy is a novel radiological technique that may revolutionize screening for colorectal cancer.

CRISPR/Cas9-induced transgene insertion and telomere-associated truncation of a single human chromosome for chromosome engineering in CHO and A9 cells.

Science.gov (United States)

Uno, Narumi; Hiramatsu, Kei; Uno, Katsuhiro; Komoto, Shinya; Kazuki, Yasuhiro; Oshimura, Mitsuo

2017-10-06

Chromosome engineering techniques including gene insertion, telomere-associated truncation and microcell-mediated chromosome transfer (MMCT) are powerful tools for generation of humanised model animal, containing megabase-sized genomic fragments. However, these techniques require two cell lines: homologous recombination (HR)-proficient DT40 cells for chromosome modification, and CHO cells for transfer to recipient cells. Here we show an improved technique using a combination of CRISPR/Cas9-induced HR in CHO and mouse A9 cells without DT40 cells following MMCT to recipient cells. Transgene insertion was performed in CHO cells with the insertion of enhanced green fluorescence protein (EGFP) using CRISPR/Cas9 and a circular targeting vector containing two 3 kb HR arms. Telomere-associated truncation was performed in CHO cells using CRISPR/Cas9 and a linearised truncation vector containing a single 7 kb HR arm at the 5' end, a 1 kb artificial telomere at the 3' end. At least 11% and 6% of the targeting efficiency were achieved for transgene insertion and telomere-associated truncation, respectively. The transgene insertion was also confirmed in A9 cells (29%). The modified chromosomes were transferrable to other cells. Thus, this CHO and A9 cell-mediated chromosome engineering using the CRISPR/Cas9 for direct transfer of the modified chromosome is a rapid technique that will facilitate chromosome manipulation.

A macaque's-eye view of human insertions and deletions: differences in mechanisms.

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Erika M Kvikstad

2007-09-01

Full Text Available Insertions and deletions (indels cause numerous genetic diseases and lead to pronounced evolutionary differences among genomes. The macaque sequences provide an opportunity to gain insights into the mechanisms generating these mutations on a genome-wide scale by establishing the polarity of indels occurring in the human lineage since its divergence from the chimpanzee. Here we apply novel regression techniques and multiscale analyses to demonstrate an extensive regional indel rate variation stemming from local fluctuations in divergence, GC content, male and female recombination rates, proximity to telomeres, and other genomic factors. We find that both replication and, surprisingly, recombination are significantly associated with the occurrence of small indels. Intriguingly, the relative inputs of replication versus recombination differ between insertions and deletions, thus the two types of mutations are likely guided in part by distinct mechanisms. Namely, insertions are more strongly associated with factors linked to recombination, while deletions are mostly associated with replication-related features. Indel as a term misleadingly groups the two types of mutations together by their effect on a sequence alignment. However, here we establish that the correct identification of a small gap as an insertion or a deletion (by use of an outgroup is crucial to determining its mechanism of origin. In addition to providing novel insights into insertion and deletion mutagenesis, these results will assist in gap penalty modeling and eventually lead to more reliable genomic alignments.

pH-Triggered Conformational Switching along the Membrane Insertion Pathway of the Diphtheria Toxin T-Domain

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Alexey S. Ladokhin

2013-08-01

Full Text Available The translocation (T-domain plays a key role in the action of diphtheria toxin and is responsible for transferring the catalytic domain across the endosomal membrane into the cytosol in response to acidification. Deciphering the molecular mechanism of pH-dependent refolding and membrane insertion of the T-domain, which is considered to be a paradigm for cell entry of other bacterial toxins, reveals general physicochemical principles underlying membrane protein assembly and signaling on membrane interfaces. Structure-function studies along the T-domain insertion pathway have been affected by the presence of multiple conformations at the same time, which hinders the application of high-resolution structural techniques. Here, we review recent progress in structural, functional and thermodynamic studies of the T-domain archived using a combination of site-selective fluorescence labeling with an array of spectroscopic techniques and computer simulations. We also discuss the principles of conformational switching along the insertion pathway revealed by studies of a series of T-domain mutants with substitutions of histidine residues.

Per-operative vibration analysis: a valuable tool for defining correct stem insertion: preliminary report.

Science.gov (United States)

Mulier, Michiel; Pastrav, Cesar; Van der Perre, Georges

2008-01-01

Defining the stem insertion end point during total hip replacement still relies on the surgeon's feeling. When a custom-made stem prosthesis with an optimal fit into the femoral canal is used, the risk of per-operative fractures is even greater than with standard prostheses. Vibration analysis is used in other clinical settings and has been tested as a means to detect optimal stem insertion in the laboratory. The first per-operative use of vibration analysis during non-cemented custom-made stem insertion in 30 patients is reported here. Thirty patients eligible for total hip replacement with uncemented stem prosthesis were included. The neck of the stem was connected with a shaker that emitted white noise as excitation signal and an impedance head that measured the frequency response. The response signal was sent to a computer that analyzed the frequency response function after each insertion phase. A technician present in the operating theatre but outside the laminated airflow provided feed-back to the surgeon. The correlation index between the frequency response function measured during the last two insertion hammering sessions was >0.99 in 86.7% of the cases. In four cases the surgeon stopped the insertion procedure because of a perceived risk of fracture. Two special cases illustrating the potential benefit of per-operative vibration analysis are described. The results of intra-operative vibration analysis indicate that this technique may be a useful tool assisting the orthopaedic surgeon in defining the insertion endpoint of the stem. The development of a more user-friendly device is therefore warranted.

Validation of an improved abnormality insertion method for medical image perception investigations

Science.gov (United States)

Madsen, Mark T.; Durst, Gregory R.; Caldwell, Robert T.; Schartz, Kevin M.; Thompson, Brad H.; Berbaum, Kevin S.

2009-02-01

The ability to insert abnormalities in clinical tomographic images makes image perception studies with medical images practical. We describe a new insertion technique and its experimental validation that uses complementary image masks to select an abnormality from a library and place it at a desired location. The method was validated using a 4-alternative forced-choice experiment. For each case, four quadrants were simultaneously displayed consisting of 5 consecutive frames of a chest CT with a pulmonary nodule. One quadrant was unaltered, while the other 3 had the nodule from the unaltered quadrant artificially inserted. 26 different sets were generated and repeated with order scrambling for a total of 52 cases. The cases were viewed by radiology staff and residents who ranked each quadrant by realistic appearance. On average, the observers were able to correctly identify the unaltered quadrant in 42% of cases, and identify the unaltered quadrant both times it appeared in 25% of cases. Consensus, defined by a majority of readers, correctly identified the unaltered quadrant in only 29% of 52 cases. For repeats, the consensus observer successfully identified the unaltered quadrant only once. We conclude that the insertion method can be used to reliably place abnormalities in perception experiments.

Chest tube insertion - series (image)

Science.gov (United States)

Chest tubes are inserted to drain blood, fluid, or air and allow full expansion of the lungs. The tube is placed in the pleural space. The area where the tube will be inserted is numbed (local anesthesia). The patient may also be sedated. The chest ...

Magnetic resonance urography in duplex kidney with ectopic ureteral insertion

Directory of Open Access Journals (Sweden)

Conjeevaram Rajendrarao Thambidorai

2011-01-01

Full Text Available This is a report on the use of magnetic resonance urography (MRU in a 6-year-old girl who presented with urinary incontinence. She had a left duplex kidney with poorly functioning upper moiety and ectopic insertion of the dilated upper pole ureter. MRU has been shown to be superior to conventional imaging techniques in delineating poorly functioning moieties of duplex kidneys and ectopic ureters.

Training mid-career internists to perform high-quality colonoscopy: a pilot training programme to meet increasing demands for colonoscopy.

Science.gov (United States)

Shah-Ghassemzadeh, Nicole K; Jackson, Christian S; Juma, David; Strong, Richard M

2017-08-01

Colorectal cancer (CRC) is the second leading cause of cancer deaths in the USA. Despite a recent rise in CRC screening there remains an increasing demand for colonoscopy, yet a limited supply of gastroenterologists who can meet this need. To determine if a mid-career general internist (GIN) could be trained to perform high-quality colonoscopes via an intensive training programme. A GIN trained 2-3 days/week, 4-5 hours/day, for 7 months with an experienced gastroenterologist. Their independent performance was then compared with that of a gastroenterology attending (GA), with and without a gastroenterology fellow (GF). The primary outcome was to compare caecal intubation rates, adenoma detection rates (ADRs), interval CRC rates and complications between the three groups. 989 patients were initially included in the study, and 818 were included in the final analysis. Caecal intubation rates were 95%, 94% and 93% for the GIN, GA+GF and GA, respectively (p=0.31). The overall polyp detection rates were 68%, 39% and 44% among the GIN, GA+GF and GA, respectively (pdemand for colonoscopists. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Miniaturized Human Insertable Cardiac Monitoring System with Wireless Power Transmission Technique

Directory of Open Access Journals (Sweden)

Jong-Ha Lee

2016-01-01

Full Text Available Prolonged monitoring is more likely to diagnose atrial fibrillation accurately than intermittent or short-term monitoring. In this study, an implantable electrocardiograph (ECG sensor to monitor atrial fibrillation patients in real time was developed. The implantable sensor is composed of a micro controller unit, an analog-to-digital converter, a signal transmitter, an antenna, and two electrodes. The sensor detects ECG signals from the two electrodes and transmits these to an external receiver carried by the patient. Because the sensor continuously transmits signals, its battery consumption rate is extremely high; therefore, the sensor includes a wireless power transmission module that allows it to charge wirelessly from an external power source. The integrated sensor has the approximate dimensions 3 mm × 4 mm × 14 mm, which is small enough to be inserted into a patient without the need for major surgery. The signal and power transmission data sampling rate and frequency of the unit are 300 samples/s and 430 Hz, respectively. To validate the developed sensor, experiments were conducted on small animals.

Lithium insertion in nanostructured titanates

NARCIS (Netherlands)

Borghols, W.J.H.

2010-01-01

Upon nano-sizing of insertion compounds several significant changes in Li-insertion behavior have been observed for sizes below approximately 50 nm. Although the origins of the phenomena are interrelated, the changes can be divided in three main observations. (1) The formation of new phases, leading

Technical note: Computer-manufactured inserts for prosthetic sockets.

Science.gov (United States)

Sanders, Joan E; McLean, Jake B; Cagle, John C; Gardner, David W; Allyn, Katheryn J

2016-08-01

The objective of this research was to use computer-aided design software and a tabletop 3-D additive manufacturing system to design and fabricate custom plastic inserts for trans-tibial prosthesis users. Shape quality of inserts was tested right after they were inserted into participant's test sockets and again after four weeks of wear. Inserts remained properly positioned and intact throughout testing. Right after insertion the inserts caused the socket to be slightly under-sized, by a mean of 0.11mm, approximately 55% of the thickness of a nylon sheath. After four weeks of wear the under-sizing was less, averaging 0.03mm, approximately 15% of the thickness of a nylon sheath. Thus the inserts settled into the sockets over time. If existing prosthetic design software packages were enhanced to conduct insert design and to automatically generate fabrication files for manufacturing, then computer manufactured inserts may offer advantages over traditional methods in terms of speed of fabrication, ease of design, modification, and record keeping. Copyright © 2016 IPEM. Published by Elsevier Ltd. All rights reserved.

Test manufacture of a canister insert

International Nuclear Information System (INIS)

Raiko, H.

2004-11-01

This report describes the insert-manufacturing test of a disposal canister for spent nuclear fuel that was made by Metso Paper Oy, Jyvaeskylae Foundry, in 2003 on contract for Posiva Oy. The test manufacture was a part of the co-operation development programme of encapsulation technology between SKB AB and Posiva Oy. Insert casting was specified according to the current manufacturing specifications of SKB. The canister insert was of BWR-type with integral bottom. This was the first trial manufacture of this type of insert in Finland and, in total, the second test manufacture of insert by Metso Paper. The result fulfilled all the requirements but the material mechanical properties and metallurgical structure of the cast material. The measured tensile strength, ultimate strength and elongation at rupture were lower than specified. The reason for this was revealed in the metallurgical investigation of the cast material. The nodulizing of the graphite was not occurred during the casting process according to the requirements. (orig.)

Concepts for stereoselective acrylate insertion

KAUST Repository

Neuwald, Boris

2013-01-23

Various phosphinesulfonato ligands and the corresponding palladium complexes [{((PaO)PdMeCl)-μ-M}n] ([{( X1-Cl)-μ-M}n], (PaO) = κ2- P,O-Ar2PC6H4SO2O) with symmetric (Ar = 2-MeOC6H4, 2-CF3C6H4, 2,6-(MeO)2C6H3, 2,6-(iPrO)2C 6H3, 2-(2′,6′-(MeO)2C 6H3)C6H4) and asymmetric substituted phosphorus atoms (Ar1 = 2,6-(MeO)2C6H 3, Ar2 = 2′-(2,6-(MeO)2C 6H3)C6H4; Ar1 = 2,6-(MeO)2C6H3, Ar2 = 2-cHexOC 6H4) were synthesized. Analyses of molecular motions and dynamics by variable temperature NMR studies and line shape analysis were performed for the free ligands and the complexes. The highest barriers of ΔGa = 44-64 kJ/mol were assigned to an aryl rotation process, and the flexibility of the ligand framework was found to be a key obstacle to a more effective stereocontrol. An increase of steric bulk at the aryl substituents raises the motional barriers but diminishes insertion rates and regioselectivity. The stereoselectivity of the first and the second methyl acrylate (MA) insertion into the Pd-Me bond of in situ generated complexes X1 was investigated by NMR and DFT methods. The substitution pattern of the ligand clearly affects the first MA insertion, resulting in a stereoselectivity of up to 6:1 for complexes with an asymmetric substituted phosphorus. In the consecutive insertion, the stereoselectivity is diminished in all cases. DFT analysis of the corresponding insertion transition states revealed that a selectivity for the first insertion with asymmetric (P aO) complexes is diminished in the consecutive insertions due to uncooperatively working enantiomorphic and chain end stereocontrol. From these observations, further concepts are developed. © 2012 American Chemical Society.

A meta-analysis of randomized controlled trials of low-volume polyethylene glycol plus ascorbic acid versus standard-volume polyethylene glycol solution as bowel preparations for colonoscopy.

Directory of Open Access Journals (Sweden)

Qingsong Xie

Full Text Available BACKGROUND: Standard-volume polyethylene glycol (PEG gut lavage solutions are safe and effective, but they require the consumption of large volumes of fluid. A new lower-volume solution of PEG plus ascorbic acid has been used recently as a preparation for colonoscopy. AIM: A meta-analysis was performed to compare the performance of low-volume PEG plus ascorbic acid with standard-volume PEG as bowel preparation for colonoscopy. STUDY: Electronic and manual searches were performed to identify randomized controlled trials (RCTs that compared the performance of low-volume PEG plus ascorbic acid with standard-volume PEG as bowel preparation for colonoscopy. After a methodological quality assessment and data extraction, the pooled estimates of bowel preparation efficacy during bowel cleansing, compliance with preparation, willingness to repeat the same preparation, and the side effects were calculated. We calculated pooled estimates of odds ratios (OR by fixed- and/or random-effects models. We also assessed heterogeneity among studies and the publication bias. RESULTS: Eleven RCTs were identified for analysis. The pooled OR for preparation efficacy during bowel cleansing and for compliance with preparation for low-volume PEG plus ascorbic acid were 1.08 (95% CI = 0.98-1.28, P = 0.34 and 2.23 (95% CI = 1.67-2.98, P<0.00001, respectively, compared with those for standard-volume PEG. The side effects of vomiting and nausea for low-volume PEG plus ascorbic acid were reduced relative to standard-volume PEG. There was no significant publication bias, according to a funnel plot. CONCLUSIONS: Low-volume PEG plus ascorbic acid gut lavage achieved non-inferior efficacy for bowel cleansing, is more acceptable to patients, and has fewer side effects than standard-volume PEG as a bowel preparation method for colonoscopy.

Method Of Wire Insertion For Electric Machine Stators

Science.gov (United States)

Brown, David L; Stabel, Gerald R; Lawrence, Robert Anthony

2005-02-08

A method of inserting coils in slots of a stator is provided. The method includes interleaving a first set of first phase windings and a first set of second phase windings on an insertion tool. The method also includes activating the insertion tool to radially insert the first set of first phase windings and the first set of second phase windings in the slots of the stator. In one embodiment, interleaving the first set of first phase windings and the first set of second phase windings on the insertion tool includes forming the first set of first phase windings in first phase openings defined in the insertion tool, and forming the first set of second phase windings in second phase openings defined in the insertion tool.

Insertion profiles of 4 headless compression screws.

Science.gov (United States)

Hart, Adam; Harvey, Edward J; Lefebvre, Louis-Philippe; Barthelat, Francois; Rabiei, Reza; Martineau, Paul A

2013-09-01

In practice, the surgeon must rely on screw position (insertion depth) and tactile feedback from the screwdriver (insertion torque) to gauge compression. In this study, we identified the relationship between interfragmentary compression and these 2 factors. The Acutrak Standard, Acutrak Mini, Synthes 3.0, and Herbert-Whipple implants were tested using a polyurethane foam scaphoid model. A specialized testing jig simultaneously measured compression force, insertion torque, and insertion depth at half-screw-turn intervals until failure occurred. The peak compression occurs at an insertion depth of -3.1 mm, -2.8 mm, 0.9 mm, and 1.5 mm for the Acutrak Mini, Acutrak Standard, Herbert-Whipple, and Synthes screws respectively (insertion depth is positive when the screw is proud above the bone and negative when buried). The compression and insertion torque at a depth of -2 mm were found to be 113 ± 18 N and 0.348 ± 0.052 Nm for the Acutrak Standard, 104 ± 15 N and 0.175 ± 0.008 Nm for the Acutrak Mini, 78 ± 9 N and 0.245 ± 0.006 Nm for the Herbert-Whipple, and 67 ± 2N, 0.233 ± 0.010 Nm for the Synthes headless compression screws. All 4 screws generated a sizable amount of compression (> 60 N) over a wide range of insertion depths. The compression at the commonly recommended insertion depth of -2 mm was not significantly different between screws; thus, implant selection should not be based on compression profile alone. Conically shaped screws (Acutrak) generated their peak compression when they were fully buried in the foam whereas the shanked screws (Synthes and Herbert-Whipple) reached peak compression before they were fully inserted. Because insertion torque correlated poorly with compression, surgeons should avoid using tactile judgment of torque as a proxy for compression. Knowledge of the insertion profile may improve our understanding of the implants, provide a better basis for comparing screws, and enable the surgeon to optimize compression. Copyright �

A scaled experimental study of control blade insertion dynamics in Pebble-Bed Fluoride-Salt-Cooled High-Temperature Reactors

Energy Technology Data Exchange (ETDEWEB)

Buster, Grant C., E-mail: grant.buster@gmail.com; Laufer, Michael R.; Peterson, Per F.

2016-07-15

Highlights: • A granular dynamics scaling methodology is discussed. • Control blade insertion in a representative pebble-bed core is experimentally studied. • Control blade insertion forces and pebble displacements are experimentally measured. • X-ray tomography techniques are used to observe pebble displacement distributions. - Abstract: Direct control element insertion into a pebble-bed reactor core is proposed as a viable control system in molten-salt-cooled pebble-bed reactors. Unlike helium-cooled pebble-bed reactors, this reactor type uses spherical fuel elements with near-neutral buoyancy in the molten-salt coolant, thus reducing contact forces on the fuel elements. This study uses the X-ray Pebble Bed Recirculation Experiment facility to measure the force required to insert a control element directly into a scaled pebble-bed. The required control element insertion force, and therefore the contact force on fuel elements, is measured to be well below recommended limits. Additionally, X-ray tomography is used to observe how the direct insertion of a control element physically displaces spherical fuel elements. The tomography results further support the viability of direct control element insertion into molten-salt-cooled pebble-bed reactor cores.

Randomised clinical trial: Polyethylene glycol 3350 with sports drink vs. polyethylene glycol with electrolyte solution as purgatives for colonoscopy--the incidence of hyponatraemia.

Science.gov (United States)

Matro, R; Daskalakis, C; Negoianu, D; Katz, L; Henry, C; Share, M; Kastenberg, D

2014-09-01

Polyethylene glycol 3350 plus sports drink (PEG-SD) is a hypo-osmotic purgative commonly used for colonoscopy, though little safety data are available. To evaluate the effect of PEG-SD on serum sodium (Na) and other electrolytes compared with PEG-electrolyte solution (PEG-ELS). We performed a single center, prospective, randomised, investigator-blind comparison of PEG-ELS to PEG-SD in out-patients undergoing colonoscopy. Laboratories were obtained at baseline and immediately before and after colonoscopy. The primary endpoint was development of hyponatraemia (Na PEG-SD, 184 PEG-ELS). The groups were well matched except for a higher fraction of women and Blacks in PEG-ELS. Seven patients (3.9%) in PEG-SD and four patients (2.2%) in PEG-ELS developed hyponatraemia (OR = 1.82, 95% CI: 0.45-8.62, P = 0.376). Changes in electrolytes from baseline were small but significantly worse with PEG-SD for sodium, potassium and chloride (P = 0.001, 0.012, 0.001, respectively). Preparation completion, adverse events, and overall colon cleansing were similar between the groups, but PEG-ELS had more excellent preparations (52% vs. 30%; P = 0.001). Greater, but very modest, electrolyte changes occur with PEG-SD. Hyponatraemia is infrequent with both purgatives. A significant increase in hyponatraemia was not identified for PEG-SD vs. PEG-ELS, but the sample size may have been inadequate to identify a small, but clinically important difference. ClinicalTrials.gov identifier NCT01299779. © 2014 John Wiley & Sons Ltd.

Colonic diverticular bleeding: urgent colonoscopy without purging and endoscopic treatment with epinephrine and hemoclips

Directory of Open Access Journals (Sweden)

Ignacio Couto-Worner

2013-09-01

Full Text Available Diverticular disease is the most frequent cause of lower gastrointestinal bleeding. Most of the times, bleeding stops without any intervention but in 10-20 % of the cases it is necessary to treat the hemorrhage. Several modalities of endoscopic treatment have been described after purging the colon. We present five cases of severe diverticular bleeding treated with injection of epinephrine and hemoclips. All the colonoscopies were performed without purging of the colon in an emergency setting, with correct visualization of the point of bleeding. Patients recovered well avoiding other aggressive procedures such as angiography or surgery.

Colonoscopy quality assessment Valoración de la calidad en la práctica de la colonoscopia

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S. Morán Sánchez

2009-02-01

Full Text Available Aim: colonoscopy has become accepted as the most effective method for colon exploration. Some application problems have been detected in the setting of normal clinical care due to its wide range of uses in recent years, and therefore there is a need to measure colonoscopy quality. For that purpose valid quality indicators are necessary to be defined. The application process of some quality indicators is presented in this study. The proposed indicators in this study are: quality of bowel preparation, cecal intubation rate, withdrawal time, adenoma detection rate, and adenoma removal rate. Material and method: this is a prospective 12-month study where colonoscopies performed in the VI health area of Murcia Region were evaluated. From February 2006 to February 2007 a total of 609 subjects were eligible for colonoscopy after a positive fecal blood test in the setting of a colorectal cancer screening program. A sample of thirty patients (n: 30 was considered representative to assess the reliability of quality indicators and for a preliminary analysis of results. Results: indicators results are: quality of bowel preparation (87%, kappa 0.74 (95% CI: 0.48-0.99; cecal intubation rate (90% 0.74 (95% CI: 0.49-0.99; adenoma detection and removal rate (96%, kappa: 0.78 (95% CI: 0.53-0.99; withdrawal time: 13.36 min (95% CI: 10.48-16.11. Kappa: 0.78 (95% CI: 0.49-0.99. Conclusions: quality indicators definition and application in colonoscopy performance is possible. More studies are necessary to define the role of these indicators in the setting of clinical practice.Objetivo: la colonoscopia constituye la técnica exploratoria del colon más importante en la actualidad. Su uso, cada vez más frecuente conlleva la aparición de problemas en su aplicación. Es necesario medir la calidad en la realización de esta técnica, para ello es preciso definir indicadores válidos que permitan la realización de ciclos de evaluación de la calidad. En este estudio se

Field errors in hybrid insertion devices

International Nuclear Information System (INIS)

Schlueter, R.D.

1995-02-01

Hybrid magnet theory as applied to the error analyses used in the design of Advanced Light Source (ALS) insertion devices is reviewed. Sources of field errors in hybrid insertion devices are discussed

Field errors in hybrid insertion devices

Energy Technology Data Exchange (ETDEWEB)

Schlueter, R.D. [Lawrence Berkeley Lab., CA (United States)

1995-02-01

Hybrid magnet theory as applied to the error analyses used in the design of Advanced Light Source (ALS) insertion devices is reviewed. Sources of field errors in hybrid insertion devices are discussed.

Impact of ultrasonography on central venous catheter insertion in intensive care

International Nuclear Information System (INIS)

Palepu, Gopal B; Deven, Juneja; Subrahmanyam, M; Mohan, S

2009-01-01

The insertion of central venous catheters (CVCs) is an integral part of the management of critically ill patients. We aimed to study the impact of ultrasonography (USG) on CVC insertion in intensive care. A prospective study of 450 patients requiring CVC in the intensive care unit (ICU) of a tertiary care hospital. The patients were randomized into two groups: to have CVC insertion with USG-guidance or with the anatomic landmark technique (ALT). Data were collected on patient demographics; operator experience; and method, site and side of insertion. Outcome measures included successful insertion of CVC, number of attempts needed and complications. Internal jugular vein (IJV) cannulation was successful in 177/194 patients (91.2%) using ALT and in 200/205 patients (97.6%) using USG guidance, a significant difference of 6.4% (P = 0.006). Using ALT, 72.7% of cannulations could be accomplished in the first attempt as compared with 84.4% with USG guidance (P = 0.004). The overall complication rate was 28/399 (7%), with 19 (9.8%) complications in the ALT group and 9 (4.4%) in the USG group (age-, sex-, and operator-adjusted OR = 0.35, 95% CI: 0.13–0.96; P = 0.03). For subclavian vein catheterization, the success rate was 26/28 (92.9%) in the ALT group and 17/17 (100%) in the USG group (P = 0.52). Using ALT, 71.4% cannulation could be accomplished in the first attempt as compared with 82.4% under USG guidance (P = 0.49). The overall complication rate was 6/45 (13.3%), with 4 (14.3%) complications in the ALT group and 2 (11.8%) in the USG group (P > 0.99). Real-time USG guidance improves success rates, reduces the number of attempts and decreases the complications associated with CVC insertion, especially for the IJV, and should become the standard of care in intensive care

Insertion mechanics of bioinspired needles into soft tissues.

Science.gov (United States)

Sahlabadi, Mohammad; Khodaei, Seyedvahid; Jezler, Kyle; Hutapea, Parsaoran

2017-12-22

Most studies to date confirm that any increase in the needle insertion force increases the damage to the tissue. When it comes to brain tissue, even minor damage can cause a long-lasting traumatic brain injury. Thus there is a great demand for innovative minimally invasive needles among the medical community. In our previous studies a novel bioinspired needle design with specially designed barbs was used to perform insertion tests into Polyvinyl chloride (PVC) tissue-mimicking gels, in which it decreased the insertion force by as much as 25%. In this work, bioinspired needles were designed using a CAD software, and were then manufactured using a 3 D printer. The insertion tests into bovine brain and liver were then performed to further investigate the performance of our bioinspired needles in real tissues. Our results show that there was a 10-25% decrease in the insertion force for insertions into bovine brain, and a 35-45% reduction in the insertion force for insertions into bovine liver using the proposed bioinspired needles. The reduction in the insertion force is due to the decrease in the friction force of the bioinspired needle with the bovine tissues, and its results are consistent with our previous results.

Agitation within Mk-42 insert caused by air sparge

International Nuclear Information System (INIS)

Ramsey, C.J.

1991-01-01

Dissolution of Rocky Flats Pu alloys and Pu metal using a ''nested insert'' configuration (One Well Insert (S-3352) inside the Mk-42 Insert) will require a Nuclear Safety Study, a major assumption of which will be that the annular dissolver is well-mixed. The ''well-mixed'' assumption was theoretically and experimentally supported for alloy dissolution using the Three Well Insert, but the present situation differs significantly. In the former case, the insert was directly exposed to the agitation induced by air sparging; in the case under consideration, the One Well Insert would be shielded by the Mk-42 Insert. In an effort to determine if the ''nested insert'' approach should be pursued, the past studies and technical literature have been surveyed and an attempt made to predict the extent of mixing and bulk circulation for a ''nested insert'' configuration in the presence of air sparging