Validation of the St. Paul's Endoscopy Comfort Scale (SPECS) for Colonoscopy.

Aims: Patient comfort during colonoscopy is an important measure of quality, which can improve patient satisfaction and compliance with future procedures. Our aim was to develop and validate a pain assessment tool based on objective behavioural cues tailored to outpatients undergoing colonoscopy: St. Paul's endoscopy comfort score (SPECS).

Improvement of Endoscopic Reports with Implementation of a Dictation Template.

Aims: Completeness of procedure reports is an important quality indicator in endoscopy. A dictation template was developed to ensure key elements were included in colonoscopy and esophagogastroduodenoscopy (EGD) reports. Endoscopy reports were reviewed prior to and following implementation of the dictation templates to determine whether report completeness improved.

Internet-Based Patient Education Prior to Colonoscopy: Prospective, Observational Study of a Single Center's Implementation, with Objective Assessment of Bowel Preparation Quality and Patient Satisfaction.

Background: Nonpharmacologic factors, including patient education, affect bowel preparation for colonoscopy. Optimal cleansing increases quality and reduces repeat procedures. This study prospectively analyzes use of an individualized online patient education module in place of traditional patient education.

A randomized trial comparing winged versus conventional plastic stents for malignant bile duct strictures.

Background And Study Aims: Stent insertion at endoscopic retrograde cholangiopancreatography (ERCP) is an established therapy for managing malignant biliary obstruction. Conventional plastic stents with a tubular design are most commonly used despite limited patency. Plastic stents with a winged design may theoretically increase the duration of stent patency.

A randomized controlled trial assessing the effect of prescribed patient position changes during colonoscope withdrawal on adenoma detection.

Background: High-quality colonoscope withdrawal technique is associated with a higher adenoma detection rate. Position change is routinely used in barium enema and CT colonography to facilitate adequate distension of the colon and promote movement of fluid from the segment of the colon being assessed.

Objective: To determine whether prescribed position changes during colonoscope withdrawal affect the adenoma detection rate compared with the usual care per endoscopist.

Safety and efficacy of Hemospray® in upper gastrointestinal bleeding.

Background: Hemospray (Cook Medical, USA) has recently been approved in Canada for the management of nonvariceal upper gastrointestional bleeding (UGIB).

Objective: To review the authors' experience with the safety and efficacy of Hemospray for treating UGIB.

Methods: A retrospective chart review was performed on patients who required endoscopic evaluation for suspected UGIB and were treated with Hemospray.

Retrospective analysis of radiation exposure during endoscopic retrograde cholagiopancreatography: critical determinants.

Background: Fluoroscopy during endoscopic retrograde cholangiopancreatography (ERCP) has a logarithmic relationship with radiation exposure, and carries a known risk of radiation exposure to patients and staff. Factors associated with prolonged fluoroscopy duration have not been well delineated.

Objectives: To determine the specific patient, physician and procedural factors that affect fluoroscopy duration.

Prospective analysis of fluoroscopy duration during ERCP: critical determinants.

Background: Fluoroscopy during ERCP has a linear relationship with radiation, carrying risk of exposure.

Objective: To determine patient, physician, and procedural factors affecting fluoroscopy duration.

Design: Prospective analysis of ERCPs with evaluation of patient, physician, and procedural variables.

Biliary brush cytology: factors associated with positive yields on biliary brush cytology.

Aim: To evaluate the yield of brushing biliary strictures and the factors associated with a positive result in biliary strictures.

Methods: Data on all consecutive patients (01/02-10/05) who were identified to have a biliary stricture and who underwent biliary brush cytology were collected. The yield of positive biliary brush cytology was evaluated and compared to results with the gold standard for diagnosis (defined as either definitive surgical histology or clinical course).

Prospective evaluation of screening colonoscopy: who is being screened?

Background: Universal access to medical procedures is deemed an advantage of the Canadian health care system. The purposes of this prospective study were to determine the degree to which the practice of colon cancer screening by colonoscopy differed among socioeconomic classes and to assess adherence to screening guidelines.

Methods: Consecutive patients scheduled to undergo colonoscopy at a single center between August 2000 and August 2002 completed a questionnaire that determined patient characteristics and indications for the procedure.

Systemic amyloidosis: a rare presentation of mesenteric angina.

A 64-year-old man presented with an eight-month history of increasing postprandial epigastric pain and a 15 kg weight loss. Computed tomography of the abdomen, panendoscopy and mesenteric angiography failed to explain the cause of the patient's mesenteric angina. Systemic amyloidosis involving intestinal small vasculature without larger arterial involvement was diagnosed at autopsy after the patient died of an asystolic cardiac arrest.