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Bernth JE, Zhang G, Malas D, Abrahams G, Hayee B, Liu H. MorphGI: A Self-Propelling Soft Robotic Endoscope Through Morphing Shape. Soft Robot 2024. [PMID: 38484296 DOI: 10.1089/soro.2023.0096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
Colonoscopy is currently the best method for detecting bowel cancer, but fundamental design and construction have not changed significantly in decades. Conventional colonoscope (CC) is difficult to maneuver and can lead to pain with a risk of damaging the bowel due to its rigidity. We present the MorphGI, a robotic endoscope system that is self-propelling and made of soft material, thus easy to operate and inherently safe to patient. After verifying kinematic control of the distal bending segment, the system was evaluated in: a benchtop colon simulator, using multiple colon configurations; a colon simulator with force sensors; and surgically removed pig colon tissue. In the colon simulator, the MorphGI completed a colonoscopy in an average of 10.84 min. The MorphGI showed an average of 77% and 62% reduction in peak forces compared to a CC in high- and low-stiffness modes, respectively. Self-propulsion was demonstrated in the excised tissue test but not in the live pig test, due to anatomical differences between pig and human colons. This work demonstrates the core features of MorphGI.
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Affiliation(s)
- Julius E Bernth
- Department of Surgical and Interventional Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Guokai Zhang
- Department of Surgical and Interventional Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Dionysios Malas
- Department of Surgical and Interventional Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - George Abrahams
- Department of Surgical and Interventional Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Bu Hayee
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Hongbin Liu
- Department of Surgical and Interventional Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- Institute of Automation, Chinese Academy of Sciences (CAS), Beijing, China
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Asgari M, Magerand L, Manfredi L. A review on model-based and model-free approaches to control soft actuators and their potentials in colonoscopy. Front Robot AI 2023; 10:1236706. [PMID: 38023589 PMCID: PMC10665478 DOI: 10.3389/frobt.2023.1236706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 09/22/2023] [Indexed: 12/01/2023] Open
Abstract
Colorectal cancer (CRC) is the third most common cancer worldwide and responsible for approximately 1 million deaths annually. Early screening is essential to increase the chances of survival, and it can also reduce the cost of treatments for healthcare centres. Colonoscopy is the gold standard for CRC screening and treatment, but it has several drawbacks, including difficulty in manoeuvring the device, patient discomfort, and high cost. Soft endorobots, small and compliant devices thatcan reduce the force exerted on the colonic wall, offer a potential solution to these issues. However, controlling these soft robots is challenging due to their deformable materials and the limitations of mathematical models. In this Review, we discuss model-free and model-based approaches for controlling soft robots that can potentially be applied to endorobots for colonoscopy. We highlight the importance of selecting appropriate control methods based on various parameters, such as sensor and actuator solutions. This review aims to contribute to the development of smart control strategies for soft endorobots that can enhance the effectiveness and safety of robotics in colonoscopy. These strategies can be defined based on the available information about the robot and surrounding environment, control demands, mechanical design impact and characterization data based on calibration.
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Affiliation(s)
- Motahareh Asgari
- Division of Imaging Science and Technology, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Ludovic Magerand
- Division of Computing, School of Science and Engineering, University of Dundee, Dundee, United Kingdom
| | - Luigi Manfredi
- Division of Imaging Science and Technology, School of Medicine, University of Dundee, Dundee, United Kingdom
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Othman MF, Zakaria AD, Yahya MM, Md Hashim MN, Wan Mokhter WM, Wan Zain WZ, Mohamad IS, Mohd Shah MS, Syed Abd Aziz SH, Nik Ab Kadir MN, Zakaria Z, Wong MPK. Comparing Low Volume Versus Conventional Volume of Polyethylene Glycol for Bowel Preparation during Colonoscopy: A Randomised Controlled Trial. Malays J Med Sci 2023; 30:106-115. [PMID: 37928791 PMCID: PMC10624433 DOI: 10.21315/mjms2023.30.5.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 01/28/2023] [Indexed: 11/07/2023] Open
Abstract
Background Polyethylene glycol (PEG) solution is widely used as a colonoscopic bowel cleaning agent, although some patients are intolerant due to the need for ingesting large solution volumes and unpleasant taste. A low-volume solution may enhance patient tolerability and compliance in bowel preparation. Accordingly, this study compared the effectiveness of two difference PEG volumes for bowel preparation before colonoscopy in terms of bowel cleanliness, completeness of colonoscopy, patient tolerability and colonoscopy duration. Methods Using a prospective randomised controlled single-blinded study design, 164 patients scheduled for colonoscopy were allocated to two groups (n = 82 patients in each) to receive either the conventional PEG volume (3 L, control group) or the low volume (2 L, intervention group). The Boston Bowel Preparation Scale (BBPS), a validated scale for assessing bowel cleanliness during colonoscopy, was used to score bowel cleanliness in three colon segments. Secondarily, colonoscopy completeness, tolerability to drinking PEG and the duration of colonoscopy were compared between the groups. Results There were no statistically significant differences between the two intervention groups in terms of bowel cleanliness (P = 0.119), colonoscopy completion (P = 0.535), tolerability (P = 0.190) or the amount of sedation/analgesia required (midazolam, P = 0.162; pethidine, P = 0.708). Only the duration of colonoscopy differed between the two groups (longer duration in the control group, P = 0.039). Conclusion Low-volume (2 L) PEG is as effective as the standard 3 L solution in bowel cleaning before colonoscopy; however, the superiority of either solution could not be established.
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Affiliation(s)
- Muhammad Faeid Othman
- Department of Surgery, School of Medical Science, Universiti Sains Malaysia, Kelantan, Malaysia
- Department of Surgery, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
- Endoscopy Unit, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
| | - Andee Dzulkarnaen Zakaria
- Department of Surgery, School of Medical Science, Universiti Sains Malaysia, Kelantan, Malaysia
- Department of Surgery, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
- Endoscopy Unit, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
| | - Maya Mazuwin Yahya
- Department of Surgery, School of Medical Science, Universiti Sains Malaysia, Kelantan, Malaysia
- Department of Surgery, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
- Endoscopy Unit, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
| | - Mohd Nizam Md Hashim
- Department of Surgery, School of Medical Science, Universiti Sains Malaysia, Kelantan, Malaysia
- Department of Surgery, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
- Endoscopy Unit, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
| | - Wan Mokhzani Wan Mokhter
- Department of Surgery, School of Medical Science, Universiti Sains Malaysia, Kelantan, Malaysia
- Department of Surgery, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
- Endoscopy Unit, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
| | - Wan Zainira Wan Zain
- Department of Surgery, School of Medical Science, Universiti Sains Malaysia, Kelantan, Malaysia
- Department of Surgery, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
- Endoscopy Unit, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
| | - Ikhwan Sani Mohamad
- Department of Surgery, School of Medical Science, Universiti Sains Malaysia, Kelantan, Malaysia
- Department of Surgery, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
- Endoscopy Unit, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
| | - Mohd Shahrulsalam Mohd Shah
- Department of Surgery, School of Medical Science, Universiti Sains Malaysia, Kelantan, Malaysia
- Department of Surgery, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
| | - Syed Hassan Syed Abd Aziz
- Department of Surgery, School of Medical Science, Universiti Sains Malaysia, Kelantan, Malaysia
- Department of Surgery, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
- Endoscopy Unit, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
| | | | - Zaidi Zakaria
- Department of Surgery, School of Medical Science, Universiti Sains Malaysia, Kelantan, Malaysia
- Department of Surgery, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
- Endoscopy Unit, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
| | - Michael Pak-Kai Wong
- Department of Surgery, School of Medical Science, Universiti Sains Malaysia, Kelantan, Malaysia
- Department of Surgery, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
- Endoscopy Unit, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
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Ganta N, Aknouk M, Alnabwani D, Nikiforov I, Bommu VJL, Patel V, Cheriyath P, Hollenbeak CS, Hamza A. Disparities in colonoscopy utilization for lower gastrointestinal bleeding in rural vs urban settings in the United States. World J Gastrointest Endosc 2022; 14:474-486. [PMID: 36158630 PMCID: PMC9453311 DOI: 10.4253/wjge.v14.i8.474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/14/2022] [Accepted: 07/22/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Lower gastrointestinal bleeds (LGIB) is a very common inpatient condition in the United States. Gastrointestinal bleeds have a variety of presentations, from minor bleeding to severe hemorrhage and shock. Although previous studies investigated the efficacy of colonoscopy in hospitalized patients with LGIB, there is limited research that discusses disparities in colonoscopy utilization in patients with LGIB in urban and rural settings.
AIM To investigate the difference in utilization of colonoscopy in lower gastrointestinal bleeding between patients hospitalized in urban and rural hospitals.
METHODS This is a retrospective cohort study of 157748 patients using National Inpatient Sample data and the Healthcare Cost and Utilization Project provided by the Agency for Healthcare Research and Quality. It includes patients 18 years and older hospitalized with LGIB admitted between 2010 and 2016. This study does not differentiate between acute and chronic LGIB and both are included in this study. The primary outcome measure of this study was the utilization of colonoscopy among patients in rural and urban hospitals admitted for lower gastrointestinal bleeds; the secondary outcome measures were in-hospital mortality, length of stay, and costs involved in those receiving colonoscopy for LGIB. Statistical analyses were all performed using STATA software. Logistic regression was used to analyze the utilization of colonoscopy and mortality, and a generalized linear model was used to analyze the length of stay and cost.
RESULTS Our study found that 37.9% of LGIB patients at rural hospitals compared to approximately 45.1% at urban hospitals received colonoscopy, (OR = 0.730, 95%CI: 0.705-0.7, P > 0.0001). After controlling for covariates, colonoscopies were found to have a protective association with lower in-hospital mortality (OR = 0.498, 95%CI: 0.446-0.557, P < 0.0001), but a longer length of stay by 0.72 d (95%CI: 0.677-0.759 d, P < 0.0001) and approximately $2199 in increased costs.
CONCLUSION Although there was a lower percentage of LGIB patients that received colonoscopies in rural hospitals compared to urban hospitals, patients in both urban and rural hospitals with LGIB undergoing colonoscopy had decreased in-hospital mortality. In both settings, benefit came at a cost of extended stay, and higher total costs.
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Affiliation(s)
- Nagapratap Ganta
- Department of Internal Medicine, Hackensack Meridian Health Ocean Medical Center, Brick, NJ 08724, United States
| | - Mina Aknouk
- Department of Internal Medicine, Hackensack Meridian Health Ocean Medical Center, Brick, NJ 08724, United States
| | - Dina Alnabwani
- Department of Internal Medicine, Hackensack Meridian Health Ocean Medical Center, Brick, NJ 08724, United States
| | - Ivan Nikiforov
- Department of Internal Medicine, Hackensack Meridian Health Ocean Medical Center, Brick, NJ 08724, United States
| | - Veera Jayasree Latha Bommu
- Department of Internal Medicine, Hackensack Meridian Health Ocean Medical Center, Brick, NJ 08724, United States
| | - Vraj Patel
- Department of Internal Medicine, Hackensack Meridian Health Ocean Medical Center, Brick, NJ 08724, United States
| | - Pramil Cheriyath
- Department of Internal Medicine, Hackensack Meridian Health Ocean Medical Center, Brick, NJ 08724, United States
| | - Christopher S Hollenbeak
- Penn State Milton S. Hershey Medical Center, 500 University Drive, University Park, PA 16802, United States
| | - Alan Hamza
- Department of Internal Medicine, Ocala Health, Ocala, FL 34471, United States
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5
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Manfredi L. Endorobots for Colonoscopy: Design Challenges and Available Technologies. Front Robot AI 2021; 8:705454. [PMID: 34336938 PMCID: PMC8317132 DOI: 10.3389/frobt.2021.705454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 06/22/2021] [Indexed: 12/12/2022] Open
Abstract
Colorectal cancer (CRC) is the second most common cause of cancer death worldwide, after lung cancer (Sung et al., 2021). Early stage detection is key to increase the survival rate. Colonoscopy remains to be the gold standard procedure due to its dual capability to optically inspect the entire colonic mucosa and to perform interventional procedures at the same time. However, this causes pain and discomfort, whereby it requires sedation or anaesthesia of the patient. It is a difficult procedure to perform that can cause damage to the colonic wall in some cases. Development of new technologies aims to overcome the current limitations on colonoscopy by using advancements in endorobotics research. The design of these advanced medical devices is challenging because of the limited space of the lumen, the contorted shape, and the long tract of the large bowel. The force applied to the colonic wall needs to be controlled to avoid collateral effects such as injuries to the colonic mucosa and pain during the procedure. This article discusses the current challenges in the colonoscopy procedure, the available locomotion technologies for endorobots used in colonoscopy at a prototype level and the commercial products available.
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Affiliation(s)
- Luigi Manfredi
- Division of Imaging Science and Technology, School of Medicine, University of Dundee, Dundee, United Kingdom
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6
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Beg S, Wronska E, Araujo I, González Suárez B, Ivanova E, Fedorov E, Aabakken L, Seitz U, Rey JF, Saurin JC, Tari R, Card T, Ragunath K. Use of rapid reading software to reduce capsule endoscopy reading times while maintaining accuracy. Gastrointest Endosc 2020; 91:1322-1327. [PMID: 31981645 DOI: 10.1016/j.gie.2020.01.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 01/14/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUNDS AND AIMS A typical capsule endoscopy (CE) case generates tens of thousands of images, with abnormalities often confined to a just few frames. Omni Mode is a novel EndoCapsule software algorithm (Olympus, Tokyo, Japan) that proposes to intelligently remove duplicate images while maintaining accuracy in lesion detection. METHODS This prospective multicenter study took place across 9 European centers. Consecutive, unselected CE cases were read conventionally in normal mode, with every captured frame reviewed. Cases were subsequently anonymized and randomly allocated to another center where they were read using Omni Mode. Detected lesions and reading times were recorded, with findings compared between both viewing modes. The clinical significance of lesions was described according to the P classification (P0, P1, and P2). Where a discrepancy in lesion detection in either mode was found, expert blinded review at a consensus meeting was undertaken. RESULTS The patient population undergoing CE had a mean age of 49.5 years (range, 18-91), with the investigation of anemia or GI bleeding accounting for 71.8% of cases. The average small-bowel transit time was 4 hours, 26 minutes. The mean reading time in normal mode was 42.5 minutes. The use of Omni Mode was significantly faster (P < .0001), with an average time saving of 24.6 minutes (95% confidence interval, 22.8-26.9). The 2127 lesions were identified and classified according to the P classification as P0 (1234), P1 (656), and P2 (237). Lesions were identified using both reading modes in 40% (n = 936), and 1186 lesions were identified by either normal or Omni Mode alone. Normal mode interpretation was associated with 647 lesions being missed, giving an accuracy of .70. Omni Mode interpretation led to 539 lesions being missed, with an accuracy of .75. There was no significant difference in clinical conclusions made between either reading mode. CONCLUSIONS This study shows that CE reading times can be reduced by an average of 40%, without any reduction in clinical accuracy.
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Affiliation(s)
- Sabina Beg
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, United Kingdom; Nottingham Digestive Diseases Centre, The University of Nottingham, Nottingham, United Kingdom
| | - Ewa Wronska
- Department of Gastroenterology, Hepatology and Oncology, Center of Postgraduate Medical Education, Warsaw, Poland; Department of Gastroenterological Oncology, Maria Sklodowska-Curie Institute - Oncology Center, Warsaw, Poland
| | - Isis Araujo
- Gastroenterology Department, ICMDiM, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Begona González Suárez
- Gastroenterology Department, ICMDiM, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Ekaterina Ivanova
- Department of Gastroenterology, Moscow University Hospital N31, Pirogov Russia National Research Medical University, Moscow, Russia
| | - Evgeny Fedorov
- Department of Gastroenterology, Moscow University Hospital N31, Pirogov Russia National Research Medical University, Moscow, Russia
| | - Lars Aabakken
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Uwe Seitz
- Department of Gastroenterology, University Hospital Heidelberg, Heppenheim, Germany
| | - Jean-Francois Rey
- Hepato-Gastroenterology Department, Institut Arnault Tzanck, St. Laurent du Var, France
| | - Jean-Christophe Saurin
- Department of Endoscopy and Gastroenterology, Pavillon L, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Roberto Tari
- Gastroenterology Division, Azienda Ospedaliero Universitaria "Maggiore della Carità", Novara, Italy
| | - Tim Card
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, United Kingdom; Division of Epidemiology and Public Health, School of Medicine The University of Nottingham, Nottingham, United Kingdom
| | - Krish Ragunath
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, United Kingdom; Nottingham Digestive Diseases Centre, The University of Nottingham, Nottingham, United Kingdom
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7
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Maida M, Morreale G, Sinagra E, Ianiro G, Margherita V, Cirrone Cipolla A, Camilleri S. Quality measures improving endoscopic screening of colorectal cancer: a review of the literature. Expert Rev Anticancer Ther 2019; 19:223-235. [PMID: 30614284 DOI: 10.1080/14737140.2019.1565999] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Colorectal cancer (CRC) is a major health-care problem all over the world and CRC screening is effective in reducing mortality and increasing the 5-year survival. Colonoscopy has a central role in CRC screening. It can be performed as a primary test, as a recall policy after a positive result of another screening test, and for surveillance. Since effectiveness of endoscopic screening depends on adequate detection and removal of colonic polyps, consistent quality measures, which are useful in enhancing the diagnostic yield of examination, are essential. Areas covered: The aim of this review is to analyze current evidence from literature supporting quality measures able to refine endoscopic screening of colorectal cancer. Expert commentary: Quality measures namely a) time slot allotted to colonoscopy, b) assessment of indication, c) bowel preparation, d) Cecal intubation, e) withdrawal time, f) adenoma detection rate, g) proper management of lesions (polypectomy technique, polyps retrieval rate and tattooing of resection sites), and h) adequate follow-up intervals play a key role in identifying malignant and at-risk lesions and improving the outcome of screening. Adherence to these quality measures is critical to maximize the effectiveness of CRC screening, as well as, a proper technique of colonoscopy and a quality report of the procedure. Among all recommended measures, adenoma detection rate is the most important and must be kept above the recommended quality threshold by all physicians practicing in the setting of screening.
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Affiliation(s)
- Marcello Maida
- a Section of Gastroenterology , S.Elia - Raimondi Hospital , Caltanissetta , Italy
| | - Gaetano Morreale
- a Section of Gastroenterology , S.Elia - Raimondi Hospital , Caltanissetta , Italy
| | - Emanuele Sinagra
- b Gastroenterology and Endoscopy Unit , Fondazione Istituto San Raffaele Giglio , Cefalù , Italy
| | - Gianluca Ianiro
- c Internal Medicine, Gastroenterology & Liver Unit , Università Cattolica Sacro Cuore , Rome , Italy
| | - Vito Margherita
- d Section of Public Health Epidemiology and Preventive Medicine , S.Elia-Raimondi Hospital , Caltanissetta , Italy
| | - Alfonso Cirrone Cipolla
- d Section of Public Health Epidemiology and Preventive Medicine , S.Elia-Raimondi Hospital , Caltanissetta , Italy
| | - Salvatore Camilleri
- a Section of Gastroenterology , S.Elia - Raimondi Hospital , Caltanissetta , Italy
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8
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Sharma N. Colonoscopy Procedure Time: Does the Learning Environment Matter? Clin Endosc 2017; 50:308. [PMID: 28609822 PMCID: PMC5475523 DOI: 10.5946/ce.2016.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 11/02/2016] [Indexed: 11/28/2022] Open
Affiliation(s)
- Neel Sharma
- Department of Gastroenterology, National University Health System, Singapore.,Harvard Macy Institute, Boston, MA, USA
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9
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Kaminski MF, Thomas-Gibson S, Bugajski M, Bretthauer M, Rees CJ, Dekker E, Hoff G, Jover R, Suchanek S, Ferlitsch M, Anderson J, Roesch T, Hultcranz R, Racz I, Kuipers EJ, Garborg K, East JE, Rupinski M, Seip B, Bennett C, Senore C, Minozzi S, Bisschops R, Domagk D, Valori R, Spada C, Hassan C, Dinis-Ribeiro M, Rutter MD. Performance measures for lower gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) quality improvement initiative. United European Gastroenterol J 2017; 5:309-334. [PMID: 28507745 PMCID: PMC5415221 DOI: 10.1177/2050640617700014] [Citation(s) in RCA: 140] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 02/27/2017] [Indexed: 12/13/2022] Open
Abstract
The European Society of Gastrointestinal Endoscopy and United European Gastroenterology present a short list of key performance measures for lower gastrointestinal endoscopy. We recommend that endoscopy services across Europe adopt the following seven key performance measures for lower gastrointestinal endoscopy for measurement and evaluation in daily practice at a center and endoscopist level: 1 rate of adequate bowel preparation (minimum standard 90%); 2 cecal intubation rate (minimum standard 90%); 3 adenoma detection rate (minimum standard 25%); 4 appropriate polypectomy technique (minimum standard 80%); 5 complication rate (minimum standard not set); 6 patient experience (minimum standard not set); 7 appropriate post-polypectomy surveillance recommendations (minimum standard not set). Other identified performance measures have been listed as less relevant based on an assessment of their importance, scientific acceptability, feasibility, usability, and comparison to competing measures.
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Affiliation(s)
- Michal F Kaminski
- Department of Gastroenterology, Hepatology and Oncology, Medical Center for Postgraduate Education, Warsaw, Poland
- Departments of Gastroenterological Oncology and Cancer Prevention, The Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Siwan Thomas-Gibson
- Wolfson Unit for Endoscopy, St. Mark’s Hospital, Harrow, and Imperial College, London, UK
| | - Marek Bugajski
- Department of Gastroenterology, Hepatology and Oncology, Medical Center for Postgraduate Education, Warsaw, Poland
- Departments of Gastroenterological Oncology and Cancer Prevention, The Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - Michael Bretthauer
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Colin J Rees
- South Tyneside NHS Foundation Trust, South Tyneside, UK
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, University of Amsterdam, Amsterdam, The Netherlands
| | - Geir Hoff
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
- Department of Research and Development, Telemark Hospital, Skien, Norway
- Cancer Registry of Norway, Oslo, Norway
| | - Rodrigo Jover
- Unidad de Gastroenterologia, Hospital General Universitario de Alicante, Alicante, Spain
| | - Stepan Suchanek
- Department of Internal Medicine, Military University Hospital, Prague, Czech Republic
| | - Monika Ferlitsch
- Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - John Anderson
- Gloucestershire Hospitals NHS Foundation Trust, Cheltenham General Hospital, Cheltenham, UK
| | - Thomas Roesch
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Rolf Hultcranz
- Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Istvan Racz
- Department of Internal Medicine and Gastroenterology, Petz Aladar County and Teaching Hospital, Györ, Hungary
| | - Ernst J Kuipers
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Kjetil Garborg
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - James E East
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK
| | - Maciej Rupinski
- Department of Gastroenterology, Hepatology and Oncology, Medical Center for Postgraduate Education, Warsaw, Poland
- Departments of Gastroenterological Oncology and Cancer Prevention, The Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - Birgitte Seip
- Department of Gastroenterology, Vestfold Hospital Trust, Tønsberg, Norway
| | - Cathy Bennett
- Centre for Technology Enabled Research, Coventry University, Coventry, UK
| | - Carlo Senore
- CPO Piemonte, AOU Città della Salute e della Scienza, Turin, Italy
| | - Silvia Minozzi
- CPO Piemonte, AOU Città della Salute e della Scienza, Turin, Italy
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, University Hospital Leuven and KU Leuven, Leuven, Belgium
| | - Dirk Domagk
- Department of Internal Medicine, Joseph’s Hospital, Warendorf, Germany
| | - Roland Valori
- Department of Gastroenterology, Gloucestershire Hospitals NHS Foundation Trust, Gloucestershire, UK
| | - Cristiano Spada
- Digestive Endoscopy Unit, Agostino Gemelli University Hospital, Rome, Italy
| | | | - Mario Dinis-Ribeiro
- Center for Health Technology and Services Research (CINTESIS), University of Porto, Porto, Portugal
- Servicio de Gastroenterologia, Instituto Portugues de Oncologia Francisco Gentil, Porto, Portugal
| | - Matthew D Rutter
- Department of Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, UK
- School of Medicine, Durham University, Durham, UK
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10
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Kim T, Lee BJ. What Is the Mean Procedure Time to Optimize Colonoscopy? Clin Endosc 2016; 49:500-501. [PMID: 27894186 PMCID: PMC5152777 DOI: 10.5946/ce.2016.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 11/07/2016] [Accepted: 11/10/2016] [Indexed: 11/14/2022] Open
Affiliation(s)
- Taehyun Kim
- Division of Gastroenterology, Department of Internal Medicine, Korea University Medical Center, Guro Hospital, Seoul, Korea
| | - Beom Jae Lee
- Division of Gastroenterology, Department of Internal Medicine, Korea University Medical Center, Guro Hospital, Seoul, Korea
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