10 Recent Findings on GI Quality Issues

Here are 10 recent studies on quality issues affecting gastroenterology/endoscopy.

1. Not enough data supporting deep small-bowel endoscopy modalities. In an article published in Gastrointestinal Endoscopy, Andrew Ross, MD, reflects on studies comparing the use of spiral enteroscopy and single-balloon enteroscopy in gastroenterology. Results from one study comparing the two modalities showed no different in diagnostic yield of examination duration between the two procedures. Spiral enteroscopy demonstrated a greater depth of maximal insertion than single-balloon enteroscopy. The author, however, points out that neither procedure was performed via retrograde approach and that the study was not a prospective, randomized trial. In conclusion, Dr. Ross says the question of which system to purchase for deep small-bowel endoscopy remains a mystery, as there is still not sufficient data to support any one modality.

2. Hydrocolonoscopy a possibility in GI. David Robbins, MD, a gastroenterologist from New York, reflects on the use of hydrocolonoscopy and cites two studies published in Gastrointestinal Endoscopy supporting use of the method. One study Dr. Robbins cites in his column examined whether the use of hydrocolonoscopy eliminated the need for on-demand sedation. Results showed 12.9 percent of test subjects undergoing water method requested sedation, compared to 21.9 percent of test subjects undergoing air insufflation. Overall tolerability was also higher in the water method group.

3. Many modalities can help in evaluation of the small bowel. Jonathan A. Leighton, MD, a gastroenterologist at the Mayo Clinic, details the latest enteroscopic modalities that currently aid gastroenterologists in evaluations of the small bowel. In an article published in The American Journal of Gastroenterology, he says new modalities including capsule endoscopy, double-balloon enteroscopy, single-balloon enteroscopy and spiral-assisted enteroscopy, have allowed physicians to substantially improve the diagnosis, treatment or management of many GI conditions.

4. Use of NSAIDs should be determined before interpreting capsule endoscopy findings. Researchers found that of the patients who underwent capsule endoscopy in their study, 13.6 percent took NSAIDs or aspirin but did not disclose that they were using those medications. Small bowel inflammation was found to be common among these patients and could be mistaken for Crohn's disease, highlighting the importance of clear medication history for accurate image interpretation.

5. Study shows suggestions by U.S. Preventive Services Task Force not always aligned with Medicare for preventive screenings. Results from a study showed USPSTF made recommendations for 15 preventive interventions for adults 65 years and older. Of those recommended preventive services, Medicare fully reimbursed for only 7 percent of those services. Likewise, USPSTF recommended against 16 preventive services, including colorectal cancer screening for individuals 85 years or older. Medicare fully reimbursed for 44 percent of those services, including CRC screening for individuals older than 85 years. USPSTF advises against preventive services on the basis of lack of evidence supporting such services.

6. Remote-controlled capsule endoscopy safe and effective for screening. Researchers from Germany conducted a study showing that magnetic maneuvering of a modified capsule endoscope in the stomach of health volunteers under clinical conditions is safe, well-tolerated and technically feasible. Traditionally, capsule endoscopy was considered a more "patient-friendly" alternative to upper endoscopy for the detection of gastric mucosal alteration. However, capsule endoscopies have high variability in the visualization of the stomach. This recent study by German researchers showed that magnetic maneuvering of the capsule provided detailed visualization of the gastric mucosa while maintaining patient safety and tolerance.

7. Seventy percent of Americans over 50 fear colonoscopies. A survey conducted by the Colon Cancer Alliance suggests a large majority of Americans over the age of 50 avoid undergoing colonoscopies due to fear, according to a news release. Seven out of 10 people age 50 years or older for whom the test was recommended still had not had a colonoscopy primarily due to fear. Seventy-three percent of respondents said bowel prep is the hardest part of the colonoscopy.

8. Fourteen days is appropriate time span for reporting perforations, bleeding. Researchers have conducted a study to determine an appropriate time span for measuring and reporting rates of perforation and bleeding requiring a hospital admission after outpatient colonoscopy. Researchers concluded that use of a 14-day time span for reporting would capture all patients experiencing perforations and the majority of patients experiencing bleeding following colonoscopies.

9. Researchers find greater benefits with water method over sedation during colonoscopies. Researchers studied 100 veterans accepting on-demand sedation for colonoscopies, half of whom were assigned to the water method and the half of whom were assigned to the air method. Results showed 78 percent of patients in the water group could complete colonoscopy without sedation, compared to 54 percent of the air group. A secondary analysis showed that the water method also resulted in reduced medication requirements for fentanyl and midazolam. Patients in the water group also reported a faster recovery time than the air group, and less discomfort was experienced in the water group than the air group.

10. Patients using SEDASYS System reported better outcomes during colonoscopy. Researchers studied the use of SEDASYS on 1,000 patients undergoing routine colonoscopy or EGD. Of these patients, 496 patients were selected for the SEDASYS group, and 504 patients underwent the current standard of care, which is a combination of benzodiazepine and opioid. Results showed patients in the SEDASYS group were significantly more satisfied than patients who underwent the current standard of care. Additionally, SEDASYS patients recovered sooner and experienced a lower incidence of adverse events than the current-standard-of-care group. Clinician satisfaction was also higher with the SEDASYS group than the current-standard-of-care group.

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