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Current Issue August 2015

Comparison of cecal intubation and adenoma detection between hospitals can provide incentives to improve quality of colonoscopy (FREE ACCESS)

Tim D. G. Belderbos, Elisabeth J. Grobbee, Martijn G. H. van Oijen, Maarten A. C. Meijssen, Rob J. T. Ouwendijk, Thjon J. Tang, Frank ter Borg, Peter van der Schaar, Doris M. Le Fèvre, Merijn T. Stouten, Onno van der Galiën, Theo J. Hiemstra, Wouter H. de Vos tot Nederveen Cappel, Pieter C. J. ter Borg, Manon C. W. Spaander, Leon M. G. Moons, Ernst J. Kuipers, Peter D. Siersema

The quality of colonoscopy can be measured by the cecal intubation rate (CIR) and the adenoma detection rate (ADR). The rates in seven hospitals in The Netherlands were analyzed to determine whether modifiable factors, such as institution and bowel preparation, affected the rates and could be targeted for quality improvement. Factors associated with CIR were hospital and a Boston bowel preparation scale (BBPS) ≥6.Overall ADR was 31.8% and varied between hospitals, ranging from 24.8% to 46.8 %. Independent predictors for ADR were hospital, a BBPS ≥6 and CIR. By combining CIR and ADR per hospital the authors developed a colonoscopy quality indicator (CQI). Rates were compared between hospitals using this newly developed CQI to depict differences. The investigators found that differences in quality of colonoscopy between hospitals can be demonstrated. Thus, the newly developed CQI could assist hospitals to stimulate quality improvement in colonoscopy. Read more.

Endoscopic mucosal resection of laterally spreading lesions involving the ileocecal valve: technique, risk factors for failure, and outcomes (FREE ACCESS)

 

Kavinderjit S. Nanda, Nicholas Tutticci, Nicholas G. Burgess, Rebecca Sonson, Stephen J. Williams, Michael J. Bourke

This single-center study from Australia examined the outcome of endoscopic mucosal resection of large (≥20mm) laterally spreading lesions at the ileocecal valve in 53 patients. Resection at this technically challenging location was achieved in 83%. Complications were comparable to the use of this technique elsewhere in the colon; recurrence was slightly more common (17.5% vs. 11.5 %), but could be successfully treated in all patients.  Read more.

Appropriate time for selective biliary cannulation by trainees during ERCP – a randomized trial (FREE ACCESS)

Yanglin Pan, Lina Zhao, Joseph Leung, Rongchun Zhang, Hui Luo, XiangpingWang, Zhiguo Liu, Bingnian Wan, Qin Tao, Shaowei Yao, Na Hui, Daiming Fan, Kaichun Wu, Xuegang Guo

Selective biliary cannulation is one of the most challenging aspects of endoscopic retrograde cholangiopancreatography. In the absence of early success, the ideal time allowed for repeated attempts by trainees is unknown. In an elegant randomized study, Chinese investigators evaluate the appropriate time for trainees to achieve successful cannulation. Cannulation success plateaued at 10 minutes. The question is more complex than time intervals alone, but this is a useful start. Read more.