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Endoscopic Database (endoscopic + database)

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Medical Sciences	100%

Selected Abstracts

Endoscopic factors in the diagnosis of colorectal dysplasia in chronic inflammatory bowel disease

INFLAMMATORY BOWEL DISEASES, Issue 5 2005
Murat Toruner MD
Abstract Background: Surveillance colonoscopy in inflammatory bowel diseases (IBDs) is advocated for early diagnosis of neoplasia but is imperfect because some patients develop cancer despite surveillance. We sought to determine if any endoscopic factors during surveillance colonoscopy were associated with the diagnosis of colorectal dysplasia before the development of cancer. Methods: We reviewed the Mayo Clinic endoscopic database and medical records of patients with IBD who underwent surveillance colonoscopy between January 2002 and November 2003. Associations were sought between endoscopic factors and the diagnosis of dysplasia. Among 635 IBD patients, 24 (3.8%) had flat dysplasia and 12 (1.9%) had IBD-related polypoid dysplasia. In 28 patients (4.4%), sporadic tubular adenoma was identified. Colonoscopies in which flat dysplasia was identified varied in duration from 7 to 81 minutes (median, 24.5 min) compared with 3 to 70 minutes (median, 22 min) for those in which dysplasia was not found. Results: Using logistic regression analysis, we found that every additional minute in total colonoscopy time increased the flat dysplasia diagnosis rate by 3.5% (P = 0.0157). There was a significant correlation between median surveillance colonoscopy duration per endoscopist and flat dysplasia diagnosis rate (P = 0.0066). The number of biopsies taken during the procedures with flat dysplasia ranged from 6 to 36 (median, 28) compared with 2 to 54 (median, 25) in those without flat dysplasia. There was no significant effect of biopsy number of dysplasia diagnosis. Conclusions: Our results show that the practice of surveillance colonoscopy varies greatly among endoscopists, and longer procedure duration is significantly associated with the likelihood of dysplasia diagnosis. [source]

Variation in practice of ileal intubation among diverse endoscopy settings: results from a national endoscopic database

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 6 2005
G. C. HAREWOOD
Summary Background:, Terminal ileum intubation rates at colonoscopy are variable. One of the major indications for terminal ileum intubation is to identify Crohn's disease. Signs and symptoms which raise a suspicion of Crohn's include abdominal pain/bloating, anaemia and diarrhoea. Aim:, To determine the proportion of terminal ileal intubation in patients undergoing evaluation of abdominal pain/bloating, anaemia or diarrhoea with normal endoscopic findings at colonoscopy. Methods:, The Clinical Outcomes Research Initiative national endoscopic database was analysed to determine the proportion of terminal ileum intubation in patients undergoing evaluation of either abdominal pain/bloating, anaemia or diarrhoea with normal endoscopic findings at colonoscopy and to characterize this population of patients. Patients with known or suspected inflammatory bowel disease were excluded from the analysis. Results:, Between January 2000 and December 2003, 21 638 patients underwent complete colonoscopy for evaluation of either abdominal pain/bloating, anaemia or diarrhoea with normal colon findings. Overall, 3858 patients (18%) underwent terminal ileum evaluation. Intubation rates differed according to procedure indication: abdominal pain (13%), anaemia (13%), diarrhoea (28%). Terminal ileum assessment declined with advancing patient age and was least frequent in Black patients (12% vs. 18% in non-Blacks, P < 0.0001). Ileal intubation rates also varied among endoscopy site types: community (17%), academic (21%), Veterans Affairs Medical Centres (17%), P < 0.0001. Multiple logistic regression identified patients with the indication of diarrhoea (OR: 2.58) as more likely to undergo terminal ileum intubation when compared with those with abdominal pain/bloating. Patients in Veterans Affairs (OR: 1.26) and academic (OR: 1.29) sites were more likely to undergo terminal ileum intubation compared with community sites. Conclusion:, Less than one-fifth of patients with either abdominal pain/bloating, anaemia or diarrhoea underwent ileal intubation in the setting of a normal colonoscopy. Significant practice variation was observed in rates of terminal ileum evaluation. Further study is required to determine whether terminal ileum examination impacts patient management or outcome. [source]

MINOR PAPILLA SPHINCTEROTOMY FOR PANCREATITIS DUE TO PANCREAS DIVISUM

ANZ JOURNAL OF SURGERY, Issue 4 2008
Vu Kwan
Background: Pancreas divisum (PD) is the commonest congenital pancreatic abnormality and is implicated as a cause of acute recurrent pancreatitis (ARP). We report our experience in minor papilla sphincterotomy (MPS) for this condition. Studies published at present have not examined MPS as the primary treatment method in a homogenous (i.e. only those with ARP) patient group. Methods: Patients with PD and ARP were identified from an endoscopic database. Treatment protocol consisted of minor papilla guidewire cannulation and sphincterotomy with either sphincterotome over the wire or needle knife over pancreatic stent. A 5-Fr stent was placed for 1 week. Adjunctive therapy was carried out as required. Follow-up data was collected by interview with the patient and referring doctors and review of the medical record. Results: Twenty-one patients underwent MPS for PD and ARP (median age = 33 years, range 9,77 years, men = 14). Median number of procedures to achieve cannulation and MPS was 1 (range 1,3). Complications encountered were pancreatitis (n = 2) and pain (n = 3). MPS restenosis occurred in 2. Adjuvant therapy was required in 14: stricture dilatation (n = 9), stone extraction (n = 7) and extracorporeal shock-wave lithotripsy (n = 6). Complete stone clearance was achieved in 7/7. Median follow up was 38 months (range 4,67 months). Median total number of pancreatitis episodes and hospitalizations pre-MPS were 4 and 2, respectively (range 1,20 and 0,5, respectively). Post-MPS these were reduced to 0 and 0, respectively (range 0,8 and 0,4; P = 0.0007 and P = 0.0003), with complete abolition of episodes in 13 patients. Conclusion: MPS in association with other endoscopic therapies imparts a significant clinical benefit to patients with ARP and PD. Complete clinical resolution occurs in the majority. Treatment is safe, and the response is durable. [source]