bluuebunny/crossref_metadata_2025_split huggingface dataset:
539 Gastroenterologists versus Gastroenterologists With Fellows versus Surgeons: A Comparison of the Detection Rates of Adenoma and Sessile Serrated Adenoma/Polyp
Authors: Hassan Seemeen , Ahmed Zaheer , Chhabra Rajiv , Sadeddin Esmat , Yousef Osama 
Published: October 2019

INTRODUCTION:
Screening colonoscopies are performed by gastroenterologists & surgeons, sometimes with trainees. The aim was to compare the adenoma detection rate (ADR) & sessile serrated adenoma/polyp detection rate (SDR) between surgeons, gastroenterologists & gastroenterologists with fellows.

METHODS:
The Clinical Outcomes Research Initiative (CORI) V4 was queried for adult average risk screening colonoscopies from 2009-2014. Data on self-reported specialty of the endoscopists was collected. The number of fellows were counted by the number of procedures signed by fellows. ADR & SDR were compared between 3 groups (gastroenterologists, gastroenterologists with trainees & surgeons). Sites with ≥ 95% polyp pathology submission to CORI were included. 13 sites were included which were community-based sites and/or Veterans Affairs sites (VA). SAS was used.

RESULTS:
31467 screening average risk colonoscopies met the inclusion criteria. Most of them were performed by gastroenterologists without fellows (n=31035, 98.6%). Gastroenterologist with fellows & surgeons performed 355 & 77 procedures respectively. ADR of gastroenterologists was the highest (31.2%) & met the quality benchmark of ≥25% (Table 1). The ADR of gastroenterologists with fellows was lower (23.1%). Surgeons had a low ADR of 7.8%. The SDR of gastroenterologists, gastroenterologists with fellows & surgeons were 4.7%, 0.6% & 0% respectively. Rectal retroflexion, cecal intubation rate & total procedure time were comparable between gastroenterologists & surgeons but they all were much lower when gastroenterologists were with fellows. The complication rates were low. No deaths were reported. The rates of abdominal pain, gastrointestinal bleeding and perforation were 1.6%, 0.04% & 0.01% respectively. The adverse effects were not reported for gastroenterologists with fellows & surgeons in CORI for procedures included in this study.

CONCLUSION:
Community-based and VA gastroenterologists meet the quality benchmark of ADR ≥ 25%. Gastroenterologists had a lower ADR & SDR when they were with fellows. Gastroenterologists with fellows had longer procedure times & lower cecal intubation rates than gastroenterologists alone. There was under-reporting of colonoscopic procedural and outcome data to CORI by surgeons and those gastroenterologists who worked with fellows. University-based gastroenterology fellowship programs that participated in CORI under-reported post polypectomy pathology results to CORI nationwide & hence could not be included in this analysis.
540 Ergonomic and Procedural Metrics Associated With Musculoskeletal Pain Among Endoscopists
Authors: Miller Alexander , Herberts Michelle , Hansel Stephanie , Murray Joseph , League John , Chadrick Hinson , Van Dyke Carol 
Published: October 2019

INTRODUCTION:
Rates of musculoskeletal (MSK) injury among gastroenterologists are estimated to be as high as 75%, exceeding rates of 35% among non-proceduralists. Specific ergonomic/procedural factors influencing these injuries have yet to be defined. We sought to characterize potential risk factors for MSK injury by analyzing the physical traits and technical procedural data of a cohort of endoscopists.

METHODS:
The QuickDASH (Disabilities of Arm, Shoulder, and Hand) survey was sent to all gastroenterologists across a large tertiary care system. Added questions assessed injury characteristics, glove size, and other demographic data. Endpoints defining affected vs. unaffected groups include self-reported function-limiting upper extremity or back pain, injury necessitating limiting/stopping endoscopy, and trends toward higher QuickDash, Work Impairment, or Sport/Instrument Disability scores. A procedural database capturing all endoscopic activities of each respondent from 2011 to 2018 was queried to gather procedural types, volumes, durations, and insertion times; scope types; and polyp detection rates.

RESULTS:
64 surveys were completed (28.1% female, mean age 44.4 ±10.8 yrs). The average time in practice was 18.9 (±10.8) years. 51% (n = 33) of respondents reported significant activity-limiting pain, including hand/wrist (n = 31), arm/elbow (n = 12), shoulder (n = 19), and back (n = 24) pain. Characteristics between affected and non-affected groups are detailed in Table 1 with further exploratory analyses found in Table 2. Those needing to limit/stop endoscopy due to pain more frequently used pediatric scopes (31% vs. 19%, P = 0.037), took longer to perform colonoscopy (25.3 vs. 22.1 minutes, P = 0.035) and had lower yearly procedural volumes (532 vs. 807, P = 0.009). Those with hand/wrist pain had longer colonoscopy insertion times (9.35 vs. 8.21 minutes, P = 0.03) and less colonoscopy hands-on scope hours per year (81.2 vs. 111.7 hours, P = 0.039). Females had more severe shoulder pain (P = 0.04), but there were no other associations with sex or small glove size.

CONCLUSION:
Activity-limiting MSK injuries affect over 50% of endoscopists. MSK symptoms were associated with longer procedure times and higher EGD or push enteroscopy volumes. Symptomatic subjects were more likely to use pediatric colonoscopes. Hand/wrist pain is the most common and (presumably) the most limiting type of injury. Further prospective monitoring is warranted to better elucidate which variables are causative versus compensatory responses to injury.
541 Endoscopic Evaluation of Radiological Distal Esophageal Thickening
Authors: Leung Galen , Mizrahi Joseph , Quintero Samuel , Sosa Daniel , Parkinson Deborah , Desai Deepak , Cheng Edward 
Published: October 2019

INTRODUCTION:
The growth of diagnostic imaging in healthcare has led to an increase in incidental findings of “Distal Esophageal Thickening” (DET). This nonspecific finding frequently prompts a formal Esophagogastroduodenoscopy (EGD) for evaluation – many of which demonstrate benign conditions and less commonly, malignancy. There may be many unnecessary procedures being performed and a misuse of valuable resources. Thus, we aim to determine the incidence of EGDs primarily performed for DET found on imaging, and the actual endoscopic and histologic findings for these EGDs.

METHODS:
We performed a retrospective chart review of 905 EGDs performed from 2016-2018 at a single institution. Patient demographics, comorbidities, symptoms, imaging reports, procedure reports, and pathology reports were collected. Descriptive analysis was performed to determine the incidence of EGDs performed for imaging findings of DET, as well as their endoscopic and histological findings.

RESULTS:
Demographics for the EGDs are in Table 1. Out of 905 total endoscopies, 6.6% (n=60) were done specifically due to findings of DET on imaging within 6 months of the EGD. Table 2 conveys the endoscopic findings, and Table 3 shows the histologic findings for DET and non-DET EGDs. Of all the endoscopic findings for DET patients (n=76), 11 (14.5%) showed either masses or suspicion for Barrett's Esophagus. 15.8% (n=3) of histological specimens were diagnosed with cancer and 21.1% (n=4) with intestinal metaplasia. This is compared to 3.77% (n=6) of histological specimens of patients with non-DET EGDs which had cancer diagnosed, and 28.3% (n=45) with intestinal metaplasia or dysplasia.

CONCLUSION:
There is a remarkable number of upper endoscopies performed specifically for imaging findings of DET. The majority of these endoscopic histological findings are benign. However, there is indeed an increased incidence of cancer for endoscopies performed for DET, compared to endoscopies not performed for DET. Next steps include determining specific risk factors associated with metaplasia, dysplasia, or cancer in patients with DET in order to better understand who would most benefit from an upper endoscopy and who would not.
547 Increasing Endoscopy Unit Efficiency: It's Time to Take Control
Authors: Gladys-Oryhon Jordan , Umar Shifa , Cole Rita , Thakkar Payal , Syed Aslam , Midian Robin , Morrissey Suzanne , Mitre Marcia , Thakkar Shyam , Farah Katie 
Published: October 2019

INTRODUCTION:
Operational flow is an important factor in relation to efficiency in an endoscopy center. There are opportunities for improvement in efficiency while keeping the standards of quality. We performed a time flow analysis in our outpatient endoscopy center to identify workflow improvement opportunities.

METHODS:
We evaluated 616 patients who underwent EGD and colonoscopy. We analyzed preop prep time, procedure time, room turnover, recovery room time, total time in unit, and physician arrival time. These times were compared to efficiency benchmarks identified in the limited literature available. A process map was documented to illustrate patient flow and to assess redundancies and non-value added steps (Figure 1). Post-intervention data was collected on 381 patients.

RESULTS:
Pre-procedure nursing time exceeded benchmark intervals for both EGD and colonoscopy (Table 1). This was due to lack of documentation if the patient could not be reached during precall assessment 5 days prior to procedure requiring the nurse to obtain the information on the day of endoscopy. 2/3 of nurses did not have EMR access to be able to chart the medical history prior to patient arrival. In addition, IV was placed prior to the restroom visit delaying procedure start time while physician was ready to proceed. Doubles were allotted only 30 min block times and progressive delay was noticed increasing pre-procedure wait time. Physician start time was delayed 26% by an average of 12 min (Figure 2). This was due to clerical tasks, staff questions, and operational tasks. Encounter forms were reformatted to be user friendly for nursing documentation. All nurses were given EMR access in the event where patient was not reached prior to procedure. Pre-call assessment changed from 5 to 7 days prior to procedure to increase probability of reaching patients. Patients were offered restroom break prior to IV placement. Block times for doubles were extended from 30 to 45 minute block times . Recovery room delays with EGDs were attributed to oversedation by a single nurse anesthetist who was educated regarding propofol usage. Physician delays remained essentially unchanged (Figure 2).

CONCLUSION:
With our interventions, we reduced pre-procedure time by 8 mins for EGDs and 7 minutes for colonoscopy. We improved recovery room time. Delays related to physician behavior remain unchanged. Our next step is to address physician arrival times will be to post results of physician start times on a weekly basis at our endocenter.
548 Five Minute Intervention for Improved Inpatient Bowel Preparation Quality at a Large, Urban Safety Net Hospital
Authors: Evans Nicole S. , Haghighat Shida , Ramprasad Chethan , Hsieh Eric 
Published: October 2019

INTRODUCTION:
Achieving adequate bowel preparation can often be difficult for hospitalized patients. More than half of the colonoscopies performed at our large, urban safety net hospital are rated as suboptimal. Given the limited availability of resources in this setting, achieving adequate bowel preparation is paramount to cost effectiveness. The objective of this study is to determine the impact of patient education in the form of counseling and written instruction on the quality of bowel cleanliness at colonoscopy.

METHODS:
This was a single-blinded, randomized, prospective study. Forty-six inpatients scheduled for colonoscopy were randomized into two groups: intervention and standard of care (SOC). Patients who speak English or Spanish as their primary language were included in this study. The intervention group received a five-minute educational session as well as a pictorial and verbal brochure in their preferred language regarding the purpose of a colonoscopy and value of adequate bowel preparation. The SOC group did not receive this education session or brochure. Both groups were administered a clear liquid diet and four liters polyethylene glycol. Patient demographics, a brief medical history, and length of hospitalization were documented. Endoscopists blinded to randomization used the Boston Bowel Preparation Scale (BBPS) to grade bowel preparation quality.

RESULTS:
There were 46 colonoscopies in total, 25 in the SOC group (75% male, mean age 52.6), and 21 in the intervention group (81% male, mean age 55.7). Of these patients, 56.5% preferred Spanish as their primary language when discussing their healthcare. There were no statistically significant differences between the intervention and control group with respect to demographics, BMI, primary language, history of diabetes, family history of colorectal cancer, inpatient narcotic use, need for repeat colonoscopy, baseline educational level, or length of hospitalization. The mean BBPS score in the intervention group was greater than the mean BBPS score in the SOC group (8.6 vs. 6.8; P < 0.01). Greater than 75% of the intervention group received a perfect score of 9, compared to 0.08% in the standard of care group (P < 0.01).

CONCLUSION:
Providing both written and verbal education prior to inpatient colonoscopy is a simple and cost-effective way to optimize colonoscopy preparation. In a healthcare setting where resources are scarce, this five-minute intervention significantly improved bowel preparation quality.
555 Disaccharidase Dilemma in Adults: Utility of Routine Assays in Diagnostic Upper Endoscopies
Authors: Vasireddi Neal , Vasireddi Nikhil , Khakoo Nidah S. , Kasi Keerthana , Duggimpudi Arul Ruthwik , Minassian Haig , Vasireddi Srinivas S. 
Published: October 2019

INTRODUCTION:
Disaccharidase assay for evaluating abdominal pain has been well studied in the pediatric population. Deficiency of lactase or sucrase-isomaltase can present with chronic diarrhea, flatulence, abdominal pain, and bloating in such patients. However, the prevalence of disaccharidase deficiencies in adult populations with such symptoms has not been well delineated.

METHODS:
Distal duodenal specimens from 100 patients with above symptoms, who underwent an upper endoscopy (EGD) at an outpatient facility were submitted for disaccharidase assay. Standardized laboratory cut off values were used to determine disaccharidase levels that were outside the normal range. Statistical analysis was done to determine the frequencies of abnormal disaccharidases. Analysis of the group, with normal or low lactase/sucrase and presenting clinical features, was performed.

RESULTS:
Mean age of study patients was 52 years and 46% of the patients were male. The racial distribution was as follows: 45% White, 23% Hispanic, 18% Asian, 6% Black, 8% other. Table 1 shows the frequencies of normal and low values for these patients. 84% of the cohort had low lactase, 21% had low sucrase, and 11% had all 4 values in normal range. Figure 2 shows the distribution of the remaining patients who had at least 1 abnormal disaccharide.

CONCLUSION:
The association between abdominal symptoms and carbohydrate malabsorption in adults is widely recognized, but testing is rarely performed by gastroenterologists in clinical practice. Dietary recommendations are often made empirically. We investigated the prevalence of low disaccharidase levels in the adult population with above symptoms. Besides lactase deficiency, a significant number of patients also had deficiency of sucrase, maltase and palatinase. While this study cannot establish a causal relationship between low levels noted and patient symptoms, this information can be used to recommend appropriate diets or the use of lactase and sucrase enzyme supplements offering a more selective approach in patient care.
556 A Pilot Study on the Recovery Rate in Patients Who Receive Propofol Sedation During Upper Endoscopy (EGD)
Authors: Thirumurthi Selvi , Hagan Katherine B. , Tan Jens , Cata Juan , Hernandez Mike 
Published: October 2019

INTRODUCTION:
Procedural sedation for gastrointestinal endoscopy has shifted towards the use of propofol instead of moderate sedation. While medications used for moderate sedation produce delayed psychomotor recovery, patients receiving propofol often report a subjective return to baseline by the time they leave the recovery area following brief endoscopic procedures. Patients are advised to take the day off of work, abstain from major decisions and have an adult accompany them home. This comes at a societal cost as both the patient and caregiver must miss a full day of work. Willey et al. previously studied the rate of recovery for patients receiving moderate sedation with fentanyl and midazolam for upper endoscopy (EGD) finding that average psychomotor recovery was only 64.4 ± 4.4% of baseline and that the letter cancellation test (LCT) and manual dexterity test (MDT) were the most powerful predictors of recovery. We hypothesize that patients receiving propofol sedation will experience a discrete period of psychomotor depression, followed by rapid improvement.

METHODS:
IRB approval was obtained and 30 outpatients undergoing EGD (divided into three equal age groups) were enrolled (Table 1). To determine normal score variability within each age group the LCT and the MDT were given twice in the pre-procedure period to each patient. Each patient also took the tests upon awakening in recovery and a follow up 30 minutes post-procedure. A patient's recovery status was defined as a 30 minute post-procedure test score within 2 standard deviations of the average score for their age cohort.

RESULTS:
Overall and within each age group, patients experienced a decrease in performance in the immediate post-procedure period on both the LCT and the MDT. Figure 1 All groups showed improvement on the 30 minute post-procedure test, although full recovery was only achieved 40.0 to 90.0% of the time (overall average of 73.3%) with the LCT and 90.0 – 100% of the time (overall average 90%) for the MDT (Table 2).

CONCLUSION:
In comparison to previously published results of moderate sedation, propofol sedation demonstrates an improved psychomotor recovery profile. The two tests utilized for this pilot study cannot be considered to provide a full evaluation of psychomotor recovery. We hope that this prospective data may ultimately be used to develop an easily accessible, inexpensive tool to assess psychomotor recovery at the bedside.
557 Standardized Post-Endoscopy Report Card Improves Inpatient Post-Endoscopy Knowledge Translation
Authors: Taylor Stephen , Rumman Amir , Ma Ann , Saperia James , Bernstein Michael , Mosko Jeff , Al Ghamdi Sarah 
Published: October 2019

INTRODUCTION:
There is limited literature reviewing the utility and validity of a post-endoscopy report card in helping to better facilitate post-endoscopy recall and patient satisfaction. Augmenting verbal instructions with written ones has been shown to improve patient comprehension and compliance. The aim of this QI initiative was to improve recall of endoscopy results post-endoscopy via the use of a written endoscopy report card (WR) for patients, augmented to the current standard of care which involves a standard verbal report (VR). We evaluated the effect of providing a WR to patients before discharge, focusing on recall of endoscopic findings, physician recommendations, follow-up and overall satisfaction. Our goal was to increase patient recall of inpatient endoscopy results and follow up plans by 50% over a 6-month period at a tertiary hospital.

METHODS:
A prospective single-center trial. Between February and May 2019, 9 patients were enrolled in the standard of care arm, consisting of VR post-procedure. 21 patients underwent the intervention receiving the standard VR followed by receipt of a WR. Patients who met inclusion criteria were given the WR prior to discharge. This included patients age3 18 years admitted to hospital for less than 2 weeks who underwent endoscopy in a non-ICU setting during admission. All patients received a standardized telephone survey containing questions about patient recall and satisfaction 5-10 days following discharge. Baseline characteristics of the two study groups were compared by using X2 tests. Results were calculated using the Pearson Chi-Square Test and the Student T-test for patient satisfaction utilizing the Likert Scale.

RESULTS:
81% of patients in intervention group (17/21) retained WR at the time of telephone survey. Receipt of a WR improved recall of findings (P < 0.001), recall of medications (P < 0.001), recall for clinic follow-up (P = 0.006) and for recall for follow-up (P = 0.008). Satisfaction was high for all patients but was significantly improved by the receipt and retention of report (P < 0.001). Study limitations include the small sample size, and exclusion of patients who did not speak English.

CONCLUSION:
A post-endoscopy report card given to patients prior to discharge may improve recall of results, prescribed medications and overall satisfaction with procedures. This inexpensive and safe intervention should be routinely adopted into the standard of care.
562 Triage Surveys Are a Safe and Efficient Method to Streamline Utilization of Direct Access Endoscopy
Authors: Hsu Angela , Haber Erin , Woo Stephanie , Lulevitch Nicole , Kruger Annie , Loughney Thomas , Jiang Tina , Moore Carmen 
Published: October 2019

INTRODUCTION:
Direct Access Endoscopy (DAE) is a process by which Gastroenterology (GI) practices provide patients with access to endoscopic intervention without incurring delays in awaiting GI clinic visits. Medstar Georgetown University Hospital (MGUH) employs the DAE mechanism through a triage system called Discussed with Patient (DWP) survey which is a screening questionnaire administered by central scheduling to determine which patients are low enough risk to safely bypass a pre-procedural clinic visit. This study was designed to evaluate safety and efficacy of our DWP triage system.

METHODS:
We performed a retrospective chart review of outpatient endoscopic procedures using our department's procedure scheduling system and electronic medical record system. Inclusion criteria included colonoscopy and EGD procedures performed by MGUH GI attendings from October 1-31, 2018 (total 23 working days). To focus data analysis, other procedures (i.e.; ERCP, EUS, MRCP, Flex sig) were excluded. We then analyzed patient demographics, indication for procedure, and safety documentation recorded within triage surveys.

RESULTS:
727 total endoscopic procedures were analyzed. Sixty-five percent (479/727) of the study population was screened with a DWP prior to procedure. Of this population, a large majority (355, or 74%) did not require a pre-procedural GI clinic visit. Assuming an average of 30 minutes per pre-procedural visit, we estimated this accounted for a total of 177 hours of clinic time saved. Of the 479 cases scheduled by the direct access pathway, 120 (25%) had clear documentation of the DWP triage survey positively affecting patient care including adjustment of anticoagulation regimen (n = 29, 24%) and guidance on obtaining cardiac, renal, or pulmonary clearance (n = 23, 19%).

CONCLUSION:
The DWP triage survey utilized by our institution is an effective method to provide direct access endoscopy to a large population while eliminating unnecessary pre-procedural GI clinic visits for low-risk patients. The benefit of this intervention is evidenced by the estimated 177 hours saved per month. In addition, the DWP serves as a safety screen that allows for physicians and ancillary staff to make crucial adjustments that optimize patient safety prior to procedure. Strengths of this study include the large number of procedures analyzed and a wide distribution of MGUH endoscopists. Limitations of this study include lack of post-procedural safety outcomes.