Impact of an Endoscopic Quality Improvement Program Focused on Adenoma Detection on Sessile Serrated Adenoma/Polyp Detection.

Background: Sessile serrated adenomas/polyps (SSA/P) are an under-recognized disease with a unique malignant pathway. Improved endoscopic recognition and pathological interpretation is needed.

Aims: To determine whether an educational intervention that improved adenoma detection rate (ADR) could improve SSA/P detection rate after reclassification of previously termed "hyperplastic" polyps.

Stability of increased adenoma detection at colonoscopy. Follow-up of an endoscopic quality improvement program-EQUIP-II.

Objectives: We recently completed a randomized controlled trial of an endoscopic quality improvement program (EQUIP) that demonstrated an improved adenoma detection rate (ADR) through simple educational interventions. The aim of this study (phase III) is to examine whether the improvement in ADR in the trained endoscopists remained stable with further follow-up.

Methods: We prospectively followed up 15 staff endoscopists who had previously been randomized to a quality improvement intervention.

Accuracy of in vivo colorectal polyp discrimination by using dual-focus high-definition narrow-band imaging colonoscopy.

Background: Discriminating neoplastic from non-neoplastic polyps can significantly reduce the cost of colonoscopy. The American Society for Gastrointestinal Endoscopy (ASGE) recently set threshold levels for optical diagnostic accuracy to be acceptable for clinical use.

Objective: In this study, we compare a novel colonoscope capable of dual-focus imaging with standard colonoscopy with respect to the ASGE guidelines.

Assessment of adenoma detection rate benchmarks in women versus men.

Background: Current guidelines suggest screening adenoma detection rates (ADRs) of 15% for average-risk women and 25% for average-risk men.

Objective: Determine average-risk screening ADRs and the prevalence of adenomas by location, size, shape, and degree of dysplasia in each sex.

Design: Post hoc analysis of prospectively collected data.

An endoscopic quality improvement program improves detection of colorectal adenomas.

Objectives: Adenoma detection rate (ADR) is a key measure of quality in colonoscopy. Low ADRs are associated with development of interval cancer after "negative" colonoscopy. Uncontrolled studies mandating longer withdrawal time, and other incentives, have not significantly improved ADR.

The effect of polyp location and patient gender on the presence of dysplasia in colonic polyps.

Objective: There is increasing evidence of significant clinical and biological differences between proximal and distal colorectal polyps, as well as possible differences based on patient gender. There is a need to optimize and individualize screening strategies. We studied the potential influence of gender and of polyp location on the presence of dysplasia in colon polyps.

Colorectal surveillance interval assignment based on in vivo prediction of polyp histology: impact of endoscopic quality improvement program.

Background: Validated training methods are needed before in vivo optical diagnosis can be used to guide colorectal cancer surveillance interval assignments.

Objectives: To assess the impact of endoscopist training on accuracy of surveillance intervals based on in vivo optical diagnosis.

Design: Prospective, randomized study.

Quality in colonoscopy reporting: an assessment of compliance and performance improvement.

Background: An ASGE-ACG task force developed quality indicators (QI) for documenting quality endoscopic procedures. Acceptable compliance rates have not been determined.

Aims: To determine our degree of compliance to the intra-procedure colonoscopy QI prior to intervention, design an educational intervention to improve those with low compliance, and to compare the degree of compliance after intervention.

Colonoscopy: new approaches to better outcomes.

Purpose Of Review: Prevention of colorectal cancer relies on the detection and removal of colorectal neoplasia. Recent advances in mucosal imaging and inspection techniques have increased the detection of small and diminutive colorectal polyps with unknown clinical impact. The ability to accurately predict whether a polyp is neoplastic may allow for an optical triage approach to polyp management, improving efficiency while reducing the cost and risk of polypectomy.

An evaluation of risk factors for inadequate cytology in EUS-guided FNA of pancreatic tumors and lymph nodes.

Background: The factors associated with maximizing the cytological adequacy of EUS-guided FNA (EUS-FNA) in pancreatic tumor evaluation are not well-known.

Objective: To examine associations of physician and procedural factors with the endpoint: the presence of an adequate cytological specimen found by using EUS-FNA in patients with pancreatic tumors and lymph nodes.

Design: Retrospective cohort study.

Quality in EUS: an assessment of baseline compliance and performance improvement by using the American Society for Gastrointestinal Endoscopy-American College of Gastroenterology quality indicators.

Background: An American Society for Gastrointestinal Endoscopy-American College of Gastroenterology (ASGE-ACG) task force recently developed quality indicators for the preprocedure, intraprocedure, and postprocedure phases of each endoscopic procedure. Benchmark rates and clinical significance of compliance have not been determined.

Objectives: To establish baseline compliance rates to the preprocedure and intraprocedure quality indicators in our EUS cases, identify indicators with the lowest compliance rates, and establish change in compliance rates with a targeted performance improvement plan.

Cushing's syndrome due to ectopic adrenocorticotropic hormone production secondary to hepatic carcinoid: diagnosis, treatment, and improved quality of life.

Introduction: We describe a previously healthy 40-year-old woman with Cushing's syndrome caused by adrenocorticotropic hormone (ACTH) secretion from metastatic carcinoid.

Case Report: Over a 2-year period, the patient had multiple hospitalizations for uncontrolled hypertension, hyperglycemia, and hypokalemia. She had transient flushing, rashes, and a rapid weight gain.