Effect of music on colonoscopy performance: A propensity scorematched analysis

BACKGROUND Music has been used to reduce stress and improve task performance during medical therapy.AIM To assess the effects of music on colonoscopy performance outcomes.METHODS We retrospectively reviewed patients who underwent colonoscopy performed by four endoscopists with popular music.Colonoscopy performance outcomes,such as insertion time,adenoma detection rate(ADR),and polyp detection rate(PDR),were compared between the music and non-music groups.To reduce selection bias,propensity score matching was used.RESULTS After one-to-one propensity score matching,169 colonoscopies were selected from each group.No significant differences in insertion time(4.97 vs 5.17 min,P=0.795)and ADR(39.1%vs 46.2%,P=0.226)were found between the two groups.Subgroup analysis showed that the insertion time(3.6 vs 3.8 min,P=0.852)and ADR(51.1%vs 44.7%,P=0.488)did not significantly differ between the two groups in experts.However,in trainees,PDR(46.9%vs 66.7%,P=0.016)and ADR(25.9%vs 47.6%,P=0.006)were significantly lower in the music than in the nonmusic group.CONCLUSION The current study found that listening to music during colonoscopy did not affect procedure performance.Moreover,it suggested that music may distract trainees from appropriately detecting adenomas and polyps.

Long-term follow up of endoscopic resection for type 3 gastric NET

AIM:To clarify the short and long-term results and to prove the usefulness of endoscopic resection in type 3gastric neuroendocrine tumors(NETs).METHODS:Of the 119 type 3 gastric NETs diagnosed from January 1996 to September 2011,50 patients treated with endoscopic resection were enrolled in this study.For endoscopic resection,endoscopic mucosal resection(EMR)or endoscopic submucosal dissection(ESD)was used.Therapeutic efficacy,complications,and follow-up results were evaluated retrospectively.RESULTS:EMR was performed in 41 cases and ESD in 9 cases.Pathologically complete resection was performed in 40 cases(80.0%)and incomplete resection specimens were observed in 10 cases(7 vs 3 patients in the EMR vs ESD group,P=0.249).Upon analysis of the incomplete resection group,lateral or vertical margin invasion was found in six cases(14.6%)in the EMR group and in one case in the ESD group(11.1%).Lymphovascular invasions were observed in two cases(22.2%)in the ESD group and in one case(2.4%)in the EMR group(P=0.080).During the follow-up period(43.73;13-60 mo),there was no evidence of tumor recurrence in either the pathologically complete resection group or the incomplete resection group.No recurrence was reported during follow-up.In addition,no mortality was reported in either the complete resection group or the incomplete resection group for the duration of the follow-up period.CONCLUSION:Less than 2 cm sized confined submucosal layer type 3 gastric NET with no evidence of lymphovascular invasion,endoscopic treatment could be considered at initial treatment.

Significant risk and associated factors of active tuberculosis infection in Korean patients with inflammatory bowel disease using anti-TNF agents

AIM:To evaluate the incidence and risk factors of Korean tuberculosis(TB) infection in patients with inflammatory bowel disease(IBD) undergoing anti-TNF treatment.METHODS:The data of IBD patients treated with anti-TNFs in 13 tertiary referral hospitals located in the southeastern region of Korea were collected retrospectively.They failed to show response or were intolerant to conventional treatments,including steroids or immunomodulators.Screening measures for latent TB infection(LTBI)and the incidence and risk factors ofactive TB infection after treatment with anti-TNFs were identified.RESULTS:Overall,376 IBD patients treated with antiTNF agents were recruited(male 255,mean age of anti-TNF therapy 32.5±13.0 years);277 had Crohn’s disease,99 had ulcerative colitis,294 used infliximab,and 82 used adalimumab.Before anti-TNF treatment,screening tests for LTBI including an interferon gamma release assay or a tuberculin skin test were performed in 82.2%of patients.Thirty patients(8%)had LTBI.Sixteen cases of active TB infection including one TB-related mortality occurred during 801 personyears(PY)follow-up(1997.4 cases per 100000 PY)after anti-TNF treatment.LTBI(OR=5.76,95%CI:1.57-21.20,P=0.008)and WBC count<5000 mm3(OR=4.5,95%CI:1.51-13.44,P=0.007)during follow-up were identified as independently associated risk factors.CONCLUSION:Anti-TNFs significantly increase the risk of TB infection in Korean patients with IBD.The considerable burden of TB and marked immunosuppression might be attributed to this risk.