Predictors of suboptimal bowel preparation in asymptomatic patients undergoing average-risk screening colonoscopy

AIM To identify risk factors for a suboptimal preparation among a population undergoing screening or surveillance colonoscopy.METHODS Retrospective review of the University of Michigan and Veteran's Administration(VA) Hospital records from 2009 to identify patients age 50 and older who underwent screening or surveillance procedure and had resection of polyps less than 1 cm in size and no more than 2 polyps. Patients with inflammatory bowel disease or a family history of colorectal cancer were excluded. Suboptimal procedures were defined as procedure preparations categorized as fair, poor or inadequate by the endoscopist. Multivariable logistic regression was used to identify predictors of suboptimal preparation.RESULTS Of 4427 colonoscopies reviewed, 2401 met our inclusion criteria and were analyzed. Of our population, 16% had a suboptimal preparation. African Americans were 70% more likely to have a suboptimal preparation(95%CI: 1.2-2.4). Univariable analysis revealed that narcotic and tricyclic antidepressants(TCA) use, diabetes, prep type, site(VA vs non-VA), and presence of a gastroenterology(GI) fellow were associated with suboptimal prep quality. In a multivariable model controlling for gender, age, ethnicity, procedure site and presence of a GI fellow, diabetes [odds ratio(OR) = 2.3; 95%CI: 1.6-3.2], TCA use(OR = 2.5; 95%CI: 1.3-4.9), narcotic use(OR = 1.7; 95%CI: 1.2-2.5) and Miralax-Gatorade prep vs 4L polyethylene glycol 3350(OR = 0.6; 95%CI: 0.4-0.9) were associated with a suboptimal prep quality. CONCLUSION Diabetes, narcotics use and TCA use were identified as predictors of poor preparation in screening colonoscopies while Miralax-Gatorade preps were associated with better bowel preparation.

A survey of ampullectomy practices

AIM:To investigate the endoscopic ampullectomy practices of expert biliary endoscopists.METHODS:An anonymous survey was mailed to 79 expert biliary endoscopists to assess ampullectomy practices.RESULTS:Forty six(58%) biliary endoscopists returned the questionnaire.Of these, 63% were in academia and in practice for an average of 16.4 years(± 8.6).Endoscopists performed an average of 1.1(± 0.8) ampullectomies per month.Prior to ampullectomy, endoscopic ultrasound was"always"utilized by 67% of respondents vs"sometimes"in 31% of respondents.Empiric biliary sphincterotomy was not utilized uniformly, only 26%"always"and 37%"sometimes"performed it prior to resection.Fifty three percent reported"never"performing empiric pancreatic sphincterotomy prior to ampullectomy.Practitioners with high endoscopic retrograde cholangiopancreatography volumes were the most likely to perform a pancreatic sphincterotomy(OR = 10.9;P = 0.09).Participants overwhelmingly favored"always"placing a prophylactic pancreatic stent, with 86% placing it after ampullectomy rather than prior to resection(23%).Argon plasma coagulation was the favored adjunct modality(83%) for removal of residual adenomatous tissue.Practitioners uniformly(100%) preferred follow-up examination to be within 6 mo post-ampullectomy.CONCLUSION:Among biliary experts, there is less variation in ampullectomy practices than is reflected in the literature.

CT colonography:Friend or foe of practicing endoscopists

AIM:To investigate the perceived impact of computed tomographic colonography(CTC) on endoscopists' current and future practice.METHODS:A 21-question survey was mailed to 1570 randomly chosen American Society for Gastrointestinal Endoscopy(ASGE) members.Participants reported socio-demographics,colonoscopy volume,percentage of colonoscopies performed for screening,and likelihood of integration of CTC into their practice.RESULTS:A total of 367 ASGE members(23%) returned the questionnaire.Respondents were predominantly male(> 90%) and white(83%) with an average age of 49 years.Most respondents(58%) had no plans to incorporate CTC into daily practice and only 7% had already incorporated CTC into daily practice.Private practice respondents were the least likely to incorporate this modality into their daily practice(P=0.047).Forty-three percent of participants were willing to take courses on CTC reading,particularly those with the highest volume of colonoscopy(P=0.049).Forty percent of participants were unsure of CTC's impact on future colonoscopy volume while 21% and 18% projected a decreased and increased volume,respectively.The estimated impact of CTC volume varied significantly by age(P=0.002).Respondents > 60 years felt that CTC would increase colonoscopy,whereas those < 40 years thought CTC would ultimately decrease colonoscopy.CONCLUSION:Practicing endoscopists are not enthusiastic about the incorporation of CTC into their daily practice and are unsure of its future impact on their practice.