Capsule endoscopy in the detection of small-intestinal bleeding in patients supported by a nonpulsatile axial-flow Jarvik 2000 left ventricular assist device.
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Comorbidity↗
Biomedical subjects
Cynthia H Seow
Publications and source records attributed to Cynthia H Seow.
Repeat colonoscopy has a low yield even in symptomatic patients.
BACKGROUND: In many regions, the demand for colonoscopy exceeds its availability. Patients undergoing repeat examinations comprise a significant proportion of those on waiting lists. OBJECTIVE: To assess the yield of repeat colonoscopy in varied clinical settings. DESIGN: Cohort study. SETTING: Endoscopic database of an Australian tertiary referral hospital. PATIENTS: Adults who had >/=2 colonoscopies between 1992 and 2004. Patients were excluded if the repeat procedure was for completion or for high-risk surveillance. MAIN OUTCOME MEASUREMENTS: Yield for neoplasia by indication, interval to repeat examination, and appropriateness for surveillance (determined by National Australian guidelines). RESULTS: A total of 4974 colonoscopies in 2075 patients were studied. The mean age was 63.1 years (range, 19.2-92.4 years). The mean number of examinations was 2.4 (range, 2-8), with a mean interval between examinations of 2.9 years. Colorectal cancer (CRC) was significantly more prevalent at initial colonoscopy compared with subsequent colonoscopies (7.9% vs 0.6%; prevalence ratio 14.2, 95% confidence interval [CI] 8.5-23.7, P < .001), as were advanced adenomas (15.3% vs 4.8%; prevalence ratio 3.2, 95% CI 2.6-3.9, P < .001). No CRCs were detected in symptomatic patients undergoing polyp surveillance examinations performed before the recommended interval. LIMITATIONS: Retrospective design. CONCLUSIONS: Yield of repeat colonoscopy is significantly lower than for initial colonoscopy, irrespective of indication. In symptomatic patients within a polyp surveillance program, the yield is negligible when a colonoscopy is performed before the recommended surveillance interval. The need for a repeat colonoscopy should be carefully considered, and patients who have never had a colonoscopy must take priority on waiting lists over those awaiting repeat examinations.
Adult↗
Survey of consent practices for inpatient colonoscopy and endoscopic retrograde cholangiopancreatography at a tertiary referral center.
BACKGROUND: The purpose of the present paper was to determine informed consent practices for inpatient, open-access colonoscopy and endoscopic retrograde cholangiopancreatography (ERCP) at a tertiary referral center. METHODS: A two-part prospective study incorporating (i) an audit of consent practices for colonoscopy and ERCP; and (ii) a questionnaire directed at gastroenterologists and interns regarding information imparted to patients in the process of acquiring informed consent, was undertaken at Sir Charles Gairdner Hospital, Western Australia. Study subjects consisted of inpatients undergoing open-access colonoscopy and/or ERCP at the study center commencing May 2003; and gastroenterologists and interns at the study center. RESULTS: Written consent was obtained by junior medical staff in 89% of cases. Response rates for the questionnaire was 100% from interns, and 91% from gastroenterologists. Of interns surveyed, 93% had witnessed a colonoscopy, and 59% had witnessed an ERCP. For 12% of interns, colonoscopic bleeding or perforation were not always mentioned. Colonoscopy failure rate and perforation were overestimated by 51% and 63% of interns, respectively. Only 56% of interns always mentioned pancreatitis as a complication of ERCP. The rate of post-ERCP pancreatitis was overestimated by 25% of interns. Only 40% of gastroenterologists always provided additional information to patients whose consent was obtained by someone else. Written material was not routinely provided for patients. Consent was usually obtained on the day of the procedure. CONCLUSIONS: Written consent for inpatients undergoing open-access colonoscopy and ERCP is rarely obtained by the proceduralist. There is substantial variability in the information provided to patients. Guidelines are required to ensure best practice in this area.
Adolescent↗