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Reducing the Carbon Footprint of Colorectal Cancer Screening 减少大肠癌筛查的碳足迹
IF 2.4 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-01-01 DOI: 10.1016/j.tige.2024.03.006
Swapna Gayam , Aasma Shaukat

Climate change is the largest public health threat of the 21st century. Gastrointestinal endoscopy is the second overall waste generator and third highest hazardous waste generator in a hospital setting, making it essential for all gastroenterologists to reexamine their practices to reduce this negative impact. Colorectal cancer (CRC) is a major contributor to the gastrointestinal disease burden, and CRC screening is a vital component of age-appropriate cancer screening in the United States. Along the spectrum of colon cancer screening methods, considerations regarding their environmental impact are gaining prominence. Consequently, focusing mitigation strategies on CRC screening is justified. Mitigation strategies focused on CRC screening are likely to have a measurable impact on reducing the environmental impact of endoscopy, given the stark volume of procedures performed in the United States. In this paper, we review the different CRC screening options and strategies to reduce the environmental impact of these processes.

气候变化是 21 世纪最大的公共卫生威胁。在医院环境中,消化道内窥镜检查是第二大废物产生者和第三大有害废物产生者,因此所有消化内科医生都必须重新审视自己的工作,以减少这种负面影响。结肠直肠癌(CRC)是造成胃肠道疾病负担的主要因素,在美国,CRC 筛查是适龄癌症筛查的重要组成部分。在各种结肠癌筛查方法中,对其环境影响的考虑日益突出。因此,将缓解策略的重点放在 CRC 筛查上是合理的。鉴于美国内镜检查的数量巨大,以 CRC 筛查为重点的缓解策略很可能会对减少内镜检查对环境的影响产生可衡量的影响。在本文中,我们回顾了不同的 CRC 筛查方案以及减少这些过程对环境影响的策略。
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引用次数: 0
Semaglutide Is an Independent Predictor of Retained Solid Gastric Contents, but Same-Day Colonoscopy Mitigates Effect 塞马鲁肽是滞留固体胃内容物的独立预测因子,但当日结肠镜检查可减轻影响
IF 1.2 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-01-01 DOI: 10.1016/j.tige.2024.07.001
Haarika Korlipara , Jason Chua , Adam Buckholz , Jacob Jamison , Ariel Gonzalez , Sonal Kumar , Marissa Weber , Sanjay Salgado , Reem Sharaiha , Carolyn Newberry

BACKGROUND AND AIMS

Glucagon-like peptide-1 receptor agonists are commonly prescribed for diabetes and obesity; however, their use may complicate anesthetized procedures due to delayed gastric emptying. This study sought to define rates of retained solid gastric contents, a risk factor for periprocedural complications, in a population taking semaglutide.

METHODS

This is a retrospective cohort study comparing individuals undergoing upper endoscopy over a 5-year period at a tertiary care center who were prescribed semaglutide, a long-acting glucagon-like peptide-1 receptor agonist, for >4 weeks against a matched control cohort not on the medication. Multivariant logistic regression and multivariable propensity-matched association analysis were conducted to compare outcomes of interest, including retained solid gastric contents, endoscopic complications, and endoscopic outcomes.

RESULTS

In total, 1212 patients comprised the study population (602 on semaglutide, 610 not on semaglutide). On multivariant logistic regression analyzing causes of delayed gastric emptying, semaglutide was an independent risk factor for retained solid gastric contents (odds ratio [OR], 4.74; 95% CI, 2.40-9.35; P < 0.0001). On multivariable propensity-matched association analysis utilizing demographic and clinical characteristics, semaglutide use was associated with an absolute increase of 6% of retained solid gastric contents (coefficient, 0.0644; 95% CI, 0.034-0.095; P < 0.0001). Same-day colonoscopy was protective against this finding (OR, 0.41; 95% CI, 0.23-0.73; P = 0.003). Intubation was rare and not associated with semaglutide use (OR, 0.70; 95% CI, 0.30-1.64; P = 0.41). No periprocedural aspiration events occurred.

CONCLUSION

Semaglutide was an independent risk factor for retained solid gastric contents, even when accounting for confounding factors. This was negated in patients undergoing same-day colonoscopy, indicating an opportunity for preprocedural fasting protocols in the absence of medication hold.
背景和目的胰高血糖素样肽-1 受体激动剂是治疗糖尿病和肥胖症的常用处方药;然而,由于胃排空延迟,使用这种药物可能会使麻醉手术复杂化。这是一项回顾性队列研究,比较了在一家三级医疗中心接受上内镜检查的患者与未使用该药物的匹配对照组的情况,前者在5年时间里服用了长效胰高血糖素样肽-1受体激动剂--塞马鲁肽4周,后者在4周时间里服用了塞马鲁肽4周。研究人员进行了多变量逻辑回归和多变量倾向匹配关联分析,以比较相关结果,包括滞留的固态胃内容物、内镜并发症和内镜结果。多变量逻辑回归分析了胃排空延迟的原因,结果显示,塞马鲁肽是固体胃内容物滞留的独立风险因素(几率比 [OR],4.74;95% CI,2.40-9.35;P <;0.0001)。在利用人口统计学和临床特征进行的多变量倾向匹配关联分析中,使用塞马鲁肽与固性胃内容物滞留率绝对值增加6%有关(系数为0.0644;95% CI为0.034-0.095;P <;0.0001)。当天的结肠镜检查对这一结果具有保护作用(OR,0.41;95% CI,0.23-0.73;P = 0.003)。插管很少见,且与使用塞马鲁肽无关(OR,0.70;95% CI,0.30-1.64;P = 0.41)。结论 即使考虑到混杂因素,塞马鲁肽也是固体胃内容物滞留的独立风险因素。接受当天结肠镜检查的患者不会出现这种情况,这表明在没有药物保留的情况下,可以在术前禁食。
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引用次数: 0
Step-Up Strategy for Endoscopic Hemostasis Using PuraStat After Endoscopic Sphincterotomy Bleeding (STOP Trial) 内镜括约肌切开术出血后使用 PuraStat 的内镜止血阶梯策略(STOP 试验)
IF 1.2 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-01-01 DOI: 10.1016/j.tige.2024.03.005

Background and Aims

Recently, a novel self-assembling peptide hemostatic gel (PuraStat) has become available. Although PuraStat for endoscopic sphincterotomy (EST) bleeding has been evaluated and reported mainly in case reports and several retrospective studies, no prospective evaluation has been reported. The aim of the present study was to prospectively evaluate the safety and efficacy of PuraStat for persistent EST bleeding >120 seconds as a first-line endoscopic hemostasis technique.

Methods

This single-arm, prospective study was conducted between November 2022 and August 2023. As the primary technique for endoscopic hemostasis, PuraStat was applied first. If hemostasis failed, other techniques were used. The primary outcome of the present study was to evaluate the technical success rate of the application of PuraStat to the bleeding site. Clinical success was defined as the absence of oozing for 180 seconds after PuraStat application. Adverse events associated with procedures and secondary hemorrhage were secondary outcomes. PuraStat application was performed using the embankment method.

Results

During the study period, 1080 endoscopic retrograde cholangiopancreatography procedures were performed. A total of 108 patients experienced complications with EST bleeding. Among them, endoscopic hemostasis was required in 51 patients. These patients enrolled in this prospective study. All patients successfully underwent PuraStat application without PuraStat dislocation into the third part of the duodenum. The technical success rate of endoscopic hemostasis using PuraStat was 98% (50/51). As possible factors associated with secondary hemorrhage, biliary stents, including plastic or metal stents, were deployed in 60.7% (31/51). Finally, severe adverse events associated with the procedures were not observed in any patients, although mild acute pancreatitis was observed in 2 patients, and conservative treatment was successful.

Conclusion

In conclusion, PuraStat application may be safe for oozing after EST without increasing the frequency of acute pancreatitis.

背景和目的最近,一种新型自组装多肽止血凝胶(PuraStat)问世。虽然 PuraStat 用于内镜括约肌切开术(EST)出血的评估和报告主要见于病例报告和几项回顾性研究,但尚未见前瞻性评估报告。本研究旨在前瞻性地评估 PuraStat 作为一线内镜止血技术在治疗EST持续出血>120 秒的安全性和有效性。作为内镜止血的主要技术,首先应用 PuraStat。如果止血失败,则使用其他技术。本研究的主要结果是评估在出血部位应用 PuraStat 的技术成功率。临床成功的定义是使用 PuraStat 后 180 秒内无渗血。与手术相关的不良事件和继发性出血是次要结果。研究期间共进行了 1080 例内镜逆行胰胆管造影术。共有 108 名患者出现EST出血并发症。其中 51 例患者需要内镜止血。这些患者参加了这项前瞻性研究。所有患者都成功应用了 PuraStat,且 PuraStat 没有移位到十二指肠的第三部分。使用 PuraStat 进行内镜止血的技术成功率为 98%(50/51)。60.7%(31/51)的患者使用了胆道支架,包括塑料或金属支架,这可能是继发性出血的相关因素。最后,尽管有 2 名患者出现了轻微的急性胰腺炎,但没有发现任何与手术相关的严重不良事件,保守治疗也取得了成功。
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引用次数: 0
Sphincterotomy vs Sham Procedure for Pain Relief in Sphincter of Oddi Dysfunction: Systematic Review and Meta-analysis 括约肌切开术与用于缓解奥奇氏括约肌功能障碍患者疼痛的假手术:系统回顾和元分析
IF 2.4 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-01-01 DOI: 10.1016/j.tige.2023.10.003
Dennis Wang, Kayla Dadgar, Mohammad Yaghoobi

Background and Aims

Endoscopic sphincterotomy (ES) used to be part of sphincter of Oddi dysfunction (SOD) management, but recent studies changed attitudes about its utility. We conducted a systematic review and meta-analysis of randomized sham-controlled trials (RCTs) investigating ES for biliary SOD-related pain.

Methods

Articles were retrieved from PubMed, Medline, Embase, and CENTRAL. We included RCTs comparing ES with a sham procedure on post-cholecystectomy patients ≥18 years old with biliary SOD. Standardized data collection sheets were used, as well as the Risk of Bias 2 tool. A random-effects model was used to calculate risk ratios (RRs) with 95% confidence intervals (CIs). Subgroups included normal vs abnormal sphincter of Oddi manometry (SOM) and type II vs III SOD.

Results

From 517 articles retrieved, 4 RCTs were included, encompassing 376 patients. Overall, no difference existed between ES and the sham procedure in improving biliary SOD-related pain overall (RR 1.32, 95% CI 0.77-2.26, P = .31) and for the normal (RR 0.83, 95% CI 0.42-1.65, P = .60) and abnormal SOM subgroups (RR 1.90, 95% CI 0.84-4.29, P = .12). ES was numerically favored over the sham procedure in patients with type II (RR 2.51, 95% CI 1.32-4.81, P = .005) but not type III SOD (RR 1.02, 95% CI 0.32-3.27, P = .98). However, there was no significant subgroup difference between these type-based subgroups (P = .18, I2 = 43.2%).

Conclusion

ES does not improve biliary SOD-related pain overall or for type II vs III SOD or normal vs abnormal SOM subgroups. This meta-analysis confirms that there is no proven role for SOM or ES in managing SOD.

背景和目的内镜下括约肌切开术(ES)曾是奥奇括约肌功能障碍(SOD)治疗的一部分,但最近的研究改变了人们对其效用的看法。我们对研究 ES 治疗胆道 SOD 相关疼痛的随机假对照试验(RCT)进行了系统回顾和荟萃分析。我们纳入了对胆囊切除术后年龄≥18 岁的胆道 SOD 患者进行 ES 与假手术比较的 RCT。我们使用了标准化数据收集表和偏倚风险 2 工具。采用随机效应模型计算风险比 (RR) 和 95% 置信区间 (CI)。亚组包括正常与异常Oddi括约肌测压(SOM)和II型与III型SOD。结果从检索到的517篇文章中,共纳入了4项RCT,涉及376名患者。总体而言,ES 与假手术在改善胆道 SOD 相关疼痛方面没有差异(RR 1.32,95% CI 0.77-2.26,P = .31),正常(RR 0.83,95% CI 0.42-1.65,P = .60)和异常 SOM 亚组(RR 1.90,95% CI 0.84-4.29,P = .12)也没有差异。在 II 型(RR 2.51,95% CI 1.32-4.81,P = .005)而非 III 型 SOD(RR 1.02,95% CI 0.32-3.27,P = .98)患者中,ES 在数字上优于假手术。然而,这些基于类型的亚组之间没有明显的亚组差异(P = .18,I2 = 43.2%)。结论ES不能改善总体胆道SOD相关疼痛,也不能改善II型与III型SOD或正常与异常SOM亚组的疼痛。这项荟萃分析证实,SOM 或 ES 在控制 SOD 方面没有公认的作用。
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引用次数: 0
Preface: Optimizing and Sustaining High-Quality Colorectal Cancer Screening 前言优化和维持高质量的大肠癌筛查
IF 2.4 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-01-01 DOI: 10.1016/j.tige.2024.03.002
Audrey H. Calderwood
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引用次数: 0
Outside the Training Paradigm: Challenges and Solutions for Endoscopy Provision in Resource-Limited Settings 超越培训范式:在资源有限的环境中提供内窥镜检查服务的挑战与解决方案
IF 1.2 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-01-01 DOI: 10.1016/j.tige.2024.06.002
Sandie Thomson , Chris Hair , Ganiyat Kikelomo Oyeleke

Limited-resource settings pose problems for the provision of health services. Experience with the challenges of the provision of endoscopy services and potential solutions are presented by authors who have taught and practiced in such settings in Africa and the Pacific Islands. The concept of limited-resource settings is defined in the context of health services in general. The situation regarding endoscopy provision details and discusses the unique challenges of manpower, endoscopy facilities, endoscope and accessory equipment inventory, and endoscopy reporting. Health services quality is related to wealth and how it is deployed. Simplistically wealth means health, and poverty illness. Low-income and Low middle–income countries have the biggest challenges. One is the health professional workforce. The number of gastroenterologists per 100,000 in South Africa, an upper middle–income country, is 0.33 compared with 3.9 in the United States. Hence, endoscopy provision is by general surgeons and physicians. Upper and lower gastrointestinal endoscopic capacity in East Africa was 106 and 45 procedures per 100,000 persons per year, respectively which is <10% of that reported from high-income countries. Outside major teaching hospitals, most endoscopy is practiced in uncustomized single rooms often in a surgery complex. Endoscope inventory is more expensive than in the United States as is maintenance and repair as they are out of the country resulting in many units being below the minimum requirements to run a sustained service. Electronic reporting systems are few and not standardized. The World Gastroenterology Organisation and the World Endoscopy Organization should be the overarching advocates to support public–private partnerships and develop solutions for sustainable inventory acquisition. Endoscopy must be monitored electronically to assess procedural competency and provide desperately needed information to influence health policy.

资源有限的环境给医疗服务的提供带来了问题。作者曾在非洲和太平洋岛屿的此类环境中执教和实践,他们介绍了提供内窥镜服务所面临挑战的经验和可能的解决方案。在一般医疗服务的背景下定义了资源有限环境的概念。详细介绍了内窥镜检查的提供情况,并讨论了人力、内窥镜检查设施、内窥镜和附件设备库存以及内窥镜检查报告等方面的独特挑战。医疗服务的质量与财富及其使用方式有关。简单地说,富裕意味着健康,贫穷意味着疾病。低收入和中低收入国家面临的挑战最大。其一是卫生专业人员队伍。在中上收入国家南非,每 10 万人中只有 0.33 名肠胃病学专家,而美国则有 3.9 名。因此,内窥镜检查由普通外科医生和内科医生提供。东非的上消化道内窥镜检查能力分别为每年每 10 万人 106 例和 45 例,是高收入国家的 10%。在大型教学医院之外,大多数内窥镜手术都是在非定制的单间里进行的,通常是在外科综合大楼里。内窥镜库存比美国昂贵,维护和修理也比美国昂贵,因为它们都在国外,导致许多单位的内窥镜库存低于持续提供服务所需的最低要求。电子报告系统很少,而且没有标准化。世界胃肠病学组织和世界内镜组织应成为支持公私合作伙伴关系的主要倡导者,并为可持续的库存采购制定解决方案。必须对内镜检查进行电子监控,以评估手术能力,并提供急需的信息来影响卫生政策。
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引用次数: 0
Adenoma-Based Colonoscopy Quality Metrics for the 45–49 Years Old Military Screening Population 基于腺瘤的 45 至 49 岁军人结肠镜检查质量标准
IF 1.2 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-01-01 DOI: 10.1016/j.tige.2024.02.002

BACKGROUND AND AIMS

With the rising incidence of colorectal cancer in younger individuals, guidelines now recommend initiating average-risk screening at age 45 years. We sought to assess the impact of this younger screening population on established and emerging colonoscopy quality metrics.

METHODS

We compared all well-described lesion detection rates by colonic segment removed during initial, average-risk screening colonoscopies in the San Antonio Market military healthcare network from July 2019 to September 2022.

RESULTS

A total of 2165 colonoscopies met the inclusion criteria, with 755 (34.9%) colonoscopies performed on patients aged 45-49 years old. The detection rates for adenomas, proximal adenomas, advanced adenomas, and adenomas per colonoscopy were lower in the 45-49 years old group (33.4%, 18.7%, 3.8%, and 0.58, respectively) compared with the 50-75 years old group (42.7%, 24.2%, 7.7%, and 1.11, respectively; all P < 0.05). There was no difference in serrated polyp detection in the 45-49 years old group (11.5%) compared with the 50-75 years old group (12.5%; P = 0.287). There were no differences in withdrawal times, cecal intubation rates, or bowel preparation adequacy across age groups.

CONCLUSION

In our screening population, we found that adenoma-based colonoscopy quality metrics were significantly lower in the 45-49 years old population compared to the traditional screening age cohort, while there was no difference in serrated polyp detection. Endoscopists should anticipate a small decline in colonoscopy quality benchmarks as the screening population becomes younger, although these results require validation through multicenter, prospective monitoring.

背景和目的随着年轻人结直肠癌发病率的上升,现在的指南建议在 45 岁开始进行平均风险筛查。我们试图评估这一年轻筛查人群对既有和新出现的结肠镜检查质量指标的影响。方法我们比较了 2019 年 7 月至 2022 年 9 月期间圣安东尼奥市场军事医疗保健网络中初始、平均风险筛查结肠镜检查中按切除结肠段划分的所有明确描述的病变检出率。结果共有 2165 例结肠镜检查符合纳入标准,其中 755 例(34.9%)结肠镜检查针对 45-49 岁的患者。与 50-75 岁年龄组(分别为 42.7%、24.2%、7.7% 和 1.11;均为 P < 0.05)相比,45-49 岁年龄组的腺瘤、近端腺瘤、晚期腺瘤和腺瘤每次结肠镜检查的检出率较低(分别为 33.4%、18.7%、3.8% 和 0.58)。45-49 岁组的锯齿状息肉检出率(11.5%)与 50-75 岁组(12.5%;P = 0.287)相比没有差异。结论 在我们的筛查人群中,我们发现与传统筛查年龄组相比,45-49 岁人群基于腺瘤的结肠镜检查质量指标明显较低,而锯齿状息肉的检出率则没有差异。尽管这些结果需要通过多中心、前瞻性监测来验证,但内镜医师应预计随着筛查人群的年轻化,结肠镜检查质量基准会略有下降。
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引用次数: 0
Endoscopy and Its Alternatives in Resource-Limited Countries in Africa 非洲资源有限国家的内窥镜检查及其替代方法
IF 1.2 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-01-01 DOI: 10.1016/j.tige.2024.06.004
Akwi Asombang , Purnima Bhat

Endoscopy service provision in low-income countries is sparse and inadequate to meet patient demands. Although novel endoscopic therapeutics have dramatically changed the way diseases are treated in the developed world, in low-resource countries, even basic services such as upper gastrointestinal (GI) endoscopy and colonoscopy are lacking. The need for endoscopy is apparent with high rates of upper GI bleeding from varices and peptic ulcers, and the rapidly growing rates of inflammatory bowel disease and GI cancers in these regions. There are limited alternatives to endoscopy available and are in general more risky and less efficacious. In Africa, the barriers to endoscopy service provision vary across the continent and serve as a model for challenges to overcome in providing health services in limited-resource environments. Although the clinical need for endoscopy grows, there has not been a parallel growth in the number of trained endoscopists with most regions having only one endoscopist for every 400,000 people. Many countries do not have a formal GI training program. Infrastructure investment remains insufficient, not fit-for-purpose, and endoscopy equipment is not consistently available in many regions. Nevertheless, some units continue to provide endoscopy services in challenging environments, modifying workflow to suit the limited structure, and adapting to local constraints while still trying to maintain endoscopy standards for their patients. The challenges are further amplified in bringing services to remote areas where, in some countries, more than 75% of the population resides, requiring innovative approaches such as mobile endoscopy units. Endoscopy is an essential life-saving medical service that is scarcely available in low-income countries. By examining the challenges to the development of endoscopy services throughout Africa, we hope to understand better the mechanisms by which GI medical services can be optimally delivered in low-and-middle–income countries.

低收入国家提供的内窥镜检查服务稀少,无法满足患者的需求。尽管新型内窥镜疗法极大地改变了发达国家治疗疾病的方式,但在低收入国家,甚至连上消化道(GI)内窥镜和结肠镜检查等基本服务都缺乏。在这些地区,静脉曲张和消化性溃疡导致的上消化道出血率很高,炎症性肠病和消化道癌症的发病率也在迅速增长,因此对内窥镜检查的需求显而易见。目前可替代内镜检查的方法有限,而且一般风险较大,疗效较差。在非洲,提供内窥镜检查服务的障碍在整个非洲大陆各不相同,这也是在资源有限的环境中提供医疗服务所要克服的挑战的典范。虽然内镜检查的临床需求不断增长,但受过培训的内镜医师人数却没有同步增长,大多数地区每 40 万人中只有一名内镜医师。许多国家没有正规的消化内镜培训计划。许多地区的基础设施投资仍然不足,不能满足需要,内镜检查设备也不稳定。尽管如此,一些单位仍继续在充满挑战的环境中提供内镜检查服务,修改工作流程以适应有限的结构,并适应当地的限制因素,同时仍努力为患者维持内镜检查标准。在一些国家,超过 75% 的人口居住在偏远地区,要把服务带到这些地区,挑战就会进一步加大,这就需要采取创新的方法,如流动内镜室。内窥镜检查是一项重要的救生医疗服务,但在低收入国家却很少能提供。我们希望通过研究内镜服务在非洲各地发展所面临的挑战,更好地了解在中低收入国家优化提供消化道医疗服务的机制。
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引用次数: 0
Development and Validation of an Automated, Real-time Adenoma Detection Rate and Colonoscopy Quality Metrics Calculator 腺瘤自动实时检测率和结肠镜检查质量指标计算器的开发与验证
IF 2.4 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-01-01 DOI: 10.1016/j.tige.2023.07.004
Todd A. Brenner , Branislav Bujnak , Matthew Alverson , Alexandra T. Strauss , Anmol Singh , Saowanee Ngamruengphong , Mouen Khashab , Vikesh Singh , Eun Ji Shin , Venkata S. Akshintala

Background and Aims

High-quality colonoscopy reduces the risk of death from colorectal cancer. The adenoma detection rate (ADR) is the principal measure of colonoscopy quality but is onerous to calculate. We report the development of a fully automated platform for calculation of the ADR and other key colonoscopy quality indicators without the need for manual data entry.

Methods

Endoscopy and pathology reports from 6 centers were collected over a 3-month period and collated using a novel data transfer interface. Text-based classification parameters were developed to identify average-risk screening colonoscopies, adenomatous pathology, cecal intubation, and withdrawal time. Automated quality metrics calculators based on these classifications were built into a web-based reporting platform, and the resulting quality metrics were benchmarked against those produced through a manual record review. Confirmation of the calculator's performance was performed in a validation cohort with data collected over a 1-month period, 6 months after the initial study.

Results

The study included 3809 colonoscopies (mean age 56.1 ± 6.40 years, 53.7% female, 38 endoscopists). The automated calculator yielded an ADR of 45.1% compared with 44.3% on manual review. Correct classification of ADR-qualifying screening colonoscopies was achieved with high predictive value, with a sensitivity of 0.918 and specificity of 1.0. The cecal intubation rate was 95.8%, and the average withdrawal time was 10:05 minutes.

Conclusion

We demonstrate the feasibility and performance of a colonoscopy quality reporting platform capable of calculating the ADR and other key metrics using novel, fully automated pathology report integration and a text query-based classification accessible in a wide range of practice settings.

背景和目的高质量的结肠镜检查可降低结肠直肠癌的死亡风险。腺瘤检出率(ADR)是衡量结肠镜检查质量的主要指标,但计算繁琐。我们报告了一个全自动平台的开发情况,该平台用于计算 ADR 和其他关键结肠镜检查质量指标,无需手动输入数据。开发了基于文本的分类参数,用于识别平均风险筛查结肠镜检查、腺瘤病理、盲肠插管和退出时间。基于这些分类的自动质量指标计算器被内置到一个基于网络的报告平台中,由此产生的质量指标与通过人工记录审查产生的质量指标进行比较。结果该研究包括 3809 例结肠镜检查(平均年龄 56.1 ± 6.40 岁,53.7% 为女性,38 名内镜医师)。自动计算器得出的 ADR 为 45.1%,而人工审核的 ADR 为 44.3%。对符合 ADR 筛选结肠镜检查的正确分类具有很高的预测价值,灵敏度为 0.918,特异性为 1.0。结论我们证明了结肠镜检查质量报告平台的可行性和性能,该平台能够利用新颖的全自动病理报告集成和基于文本查询的分类方法计算 ADR 和其他关键指标,适用于各种实践环境。
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引用次数: 0
Gastric Peroral Endoscopic Myotomy (G-POEM) for the Management of Gastroparesis 治疗胃痉挛的胃口周围内窥镜肌切开术(G-POEM)
IF 2.4 Q4 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-01-01 DOI: 10.1016/j.tige.2023.09.002
Ernesto Robalino Gonzaga , Peter V. Draganov , Dennis Yang

Gastroparesis is a chronic debilitation condition characterized by delayed gastric emptying. Medically refractory gastroparesis poses a significant burden on patients and the health care system. Managing these patients can be challenging, partly due to the overlap of symptoms with other functional disorders and the lack of a consistent association between symptoms and the degree of gastric dysmotility. Gastric peroral endoscopic myotomy (G-POEM) has recently emerged as a novel therapeutic option for managing gastroparesis. This review provides an overview of G-POEM for medically refractory gastroparesis, discussing patient selection, technical aspects of the procedure, clinical outcomes, and future directions.

胃瘫是一种以胃排空延迟为特征的慢性衰弱病症。药物难治性胃瘫给患者和医疗系统带来了沉重的负担。对这些患者的管理具有挑战性,部分原因是其症状与其他功能性疾病重叠,而且症状与胃运动障碍程度之间缺乏一致的联系。胃口周围内窥镜肌切开术(G-POEM)是最近出现的一种治疗胃瘫的新疗法。本综述概述了 G-POEM 治疗药物难治性胃瘫的情况,讨论了患者选择、手术技术、临床结果和未来发展方向。
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Techniques and Innovations in Gastrointestinal Endoscopy
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