Retrograde-viewing device improves adenoma detection rate in colonoscopies for surveillance and diagnostic workup

AIM:To determine which patients might benefit most from retrograde viewing during colonoscopy through subset analysis of randomized,controlled trial data.METHODS:The Third Eye Retroscope Randomized Clinical Evaluation(TERRACE) was a randomized,controlled,multicenter trial designed to evaluate the efficacy of a retrograde-viewing auxiliary imaging device that is used during colonoscopy to provide a second video image which allows viewing of areas on the proximal aspect of haustral folds and flexures that are difficult to see with the colonoscope's forward view.We performed a post-hoc analysis of the TERRACE data to determine whether certain subsets of the patient population would gain more benefit than others from use of the device.Subjects were patients scheduled for colonoscopy for screening,surveillance or diagnostic workup,and each underwent same-day tandem examinations with standard colonoscopy(SC) and Third Eye colonoscopy(TEC),randomized to SC followed by TEC or vice versa.RESULTS:Indication for colonoscopy was screening in 176/345 subjects(51.0%),surveillance after previous polypectomy in 87(25.2%) and diagnostic workup in 82(23.8%).In 4 subjects no indication was specified.Previously reported overall results had shown a net additional adenoma detection rate(ADR) with TEC of 23.2% compared to SC.Relative risk(RR) of missing adenomas with SC vs TEC as the initial procedure was 1.92(P = 0.029).Post-hoc subset analysis shows additional ADRs for TEC compared to SC were 4.4% for screening,35.7% for surveillance,55.4% for diagnostic and 40.7% for surveillance and diagnostic combined.The RR of missing adenomas with SC vs TEC was 1.11(P = 0.815) for screening,3.15(P = 0.014) for surveillance,8.64(P = 0.039) for diagnostic and 3.34(P = 0.003) for surveillance and diagnostic combined.Although a multivariate Poisson regression suggested gender as a possibly significant factor,subset analysis showed that the difference between genders was not statistically significant.Age,bowel prep quality and withdrawal time did not significantly affect the RR of missing adenomas with SC vs TEC.Mean sizes of adenomas detected with TEC and SC were similar at 0.59 cm and 0.56 cm,respectively(P = NS).CONCLUSION:TEC allows detection of significantly more adenomas compared to SC in patients undergoing surveillance or diagnostic workup,but not in screening patients(ClinicalTrials.gov Identifier:NCT01044732).

Endoscopic non-technical skills team training:The next step in quality assurance of endoscopy training

AIM:To investigate whether novel,non-technical skills training for Bowel Cancer Screening(BCS)endoscopy teams enhanced patient safety knowledge and attitudes.METHODS:A novel endoscopy team training intervention for BCS teams was developed and evaluated as a pre-post intervention study.Four multi-disciplinary BCS teams constituting BCS endoscopist(s),specialist screening practitioners,endoscopy nurses and administrative staff(A)from English BCS training centres participated.No patients were involved in this study.Expert multidisciplinary faculty delivered a single day’s training utilising real clinical examples.Pre and post-course evaluationcomprised participants’patient safety awareness,attitudes,and knowledge.Global course evaluations were also collected.RESULTS:Twenty-three participants attended and their patient safety knowledge improved significantly from43%-55%(P≤0.001)following the training intervention.12/41(29%)of the safety attitudes items significantly improved in the areas of perceived patient safety knowledge and awareness.The remaining safety attitude items:perceived influence on patient safety,attitudes towards error management,error management actions and personal views following an error were unchanged following training.Both qualitative and quantitative global course evaluations were positive:21/23(91%)participants strongly agreed/agreed that they were satisfied with the course.Qualitative evaluation included mandating such training for endoscopy teams outside BCS and incorporating team training within wider endoscopy training.Limitations of the study include no measure of increased patient safety in clinical practice following training.CONCLUSION:A novel comprehensive training package addressing patient safety,non-technical skills and adverse event analysis was successful in improving multi-disciplinary teams’knowledge and safety attitudes.

How we can measure quality in colonoscopy?

Measuring quality is a current need of medical services either to assess their cost-effectiveness or to identify discrepancies requiring refinement. With the advent of bowel cancer screening and increasing patient awareness of bowel symptoms, there has been an unprecedented increase in demand for colonoscopy.Consequently, there is an expanding open-discussion on missed rates of cancer or precancerous polyps during diagnostic/screening colonoscopy and on the rate of adverse events related to therapeutic colonoscopy.Delivering a quality colonoscopy service is therefore a healthcare priority. Colonoscopy is a multi-step process and therefore assessment of all aspects of the procedure must be addressed. Quality in colonoscopy refers to a combination of many patient-centered technical and non-technical skills and knowledge aiming to patient's safety and satisfaction through a continuous effort for improvement. The benefits of this endless process are hiding behind small details which can eventually make the difference in colonoscopy.Identifying specific quality metrics help to define and shape an optimal service and forms a secure basis of improvement. Τhis paper does not aim to give technical details on how to perform colonoscopy but to summarize what to measure and when, in accordance with the current identified quality indicators and standards for colonoscopy.

单向和双向广角CT结肠成像:对遗漏区、显示面、观察时间和息肉清晰度的影响

研究三维腔内CT结肠成像(CTC)中视野对黏膜面的显示和阅片效率的影响。采用标准90°和广角140°视野对20例CTC数据集行回顾研究。