ABSTRACT
Background and Aim: Poor bowel preparation for colonoscopy leads to aborted procedures and reduced polyp and cancer detection rates, leading to increased risk for patients, inconvenience to families, and additional resource use in a burgeoning health care system. The UK's Joint Advisory Group on GI Endoscopy suggests that units have a > 90% rate of adequate preparation for successful accreditation. To improve patient education and poor preparation rates at our institution, the Project GEO - GE Online video platform was introduced in 2019. This consists of five Vimeo-hosted short educational videos to help prepare patients and their carers for their endoscopy and colonoscopy procedures, including diet and bowel preparation. We aimed to examine key performance indicators in colonoscopy, including bowel preparation, before and after the introduction of GEO. Method(s): We performed a retrospective audit in a metropolitan teaching hospital in Queensland that performs more than 6000 colonoscopies per year. A link to GEO, a set of culturally sensitive, patient-centered videos, was sent in a letter, an email, and SMS to patients preparing for endoscopy and colonoscopy. Previously, patients were required to attend the hospital and were given printed handouts for information. This audit obtained Provation MD data for a 6-month period in 2019, before the initiation of GEO, and a 6-month period after, in 2021. Incomplete colonoscopies or those without preparation reporting were excluded from the analysis. Statistics were performed with chi2 analysis, and significance was set as a P value of < 0.05. Result(s): In the 6 months of 2019, before the GEO videos, a total of 2798 colonoscopies were performed. After colonoscopies with missing data and incomplete procedures were removed, there were 2031 colonoscopies for analysis. A total of 2277 colonoscopies were included in the post-GEO dataset. Results for bowel preparation and sessile serrated adenoma (SSA) detection rate before and after GEO are shown in Table 1. Conclusion(s): Project GEO has shown a significant reduction in poor preparation rates in a high-performing center and reduced repeat procedures, while not compromising SSA detection rate. Poor preparation often leads to abandonment of procedures, waste of health resources, and significant risk and inconvenience for patients, carers, and the system provider. Project GEO has had excellent patient feedback that it is improving patient and carer education and understanding, is improving compliance, and is convenient. This has led to a massive reduction in face-to-face outpatient visits (> 10 000). GEO is also COVID-19-friendly, culturally sensitive, and reaches our patients in distant regional and rural Queensland.
ABSTRACT
Background and Aim: The correlation between non-invasive fibrosis scores and histological liver fibrosis is well established. As the availability of FibroScan is limited in geographically isolated settings and those impacted by coronavirus disease 2019 (COVID-19), we aimed to demonstrate a correlation between FibroScan median liver stiffness readings of patients with metabolic-associated fatty liver disease (MAFLD) with aspartate aminotransferase (AST) to platelet ratio index (APRI), Fibrosis-4 (FIB-4) score, and Non-Alcoholic Fatty Liver Disease Fibrosis Score (NFS). Methods:We conducted a retrospective analysis over 2 years of patients referred to the hepatology service by primary care physicians with deranged liver function test results. Data were obtained from routine clinical investigations in electronic medical records at a single Australian tertiary referral center. Data collected included FibroScan liver stiffness measurements, age, body mass index, glycated hemoglobin level, albumin level, platelet count, AST level, and alanine aminotransferase (ALT) level. The APRI, FIB-4, and NFS scores were calculated. Results: We identified 65 patients, all of whom proceeded to FibroScan and exclusion of causes other than MAFLD. Of the 65 patients, we found correlation between FibroScan and all non-invasive scores. However, as expected, there was an indirect relationship only with multiple outliers beyond the commonly used cut-offs for excluding advanced fibrosis (APRI < 0.5, FIB-4 < 1.45, NFS < -1.45). Of the 48 patients with an APRI score < 0.5, 41 (85.4%) had a FibroScan result of <8.0 kPa. Of the 54 patients with a FIB-4 score < 1.45, 47 (87%) had a FibroScan result of <8 kPa. Of the 43 patients with an NFS score < -1.454, 41 (95%) had a FibroScan result of <8 kPa (Fig. 1). Conclusion: Use of non-invasive measures of fibrosis is accurate for excluding advanced fibrosis in the population with MAFLD. Individual previously published cut-off values all correlate well with a FibroScan reading of <8 kPa;so much so that, when used together, they may be relied upon when FibroScan is unavailable. This has obvious indications in the Australian setting with regional and remote communities that have limited access to FibroScan. This is of particular value in helping to avoid hospital attendance amid the COVID-19 pandemic and is also of value in risk stratification in primary care.
ABSTRACT
Background and Aim: In March 2020, the Gastroenterological Society of Australia released recommendations for endoscopic triaging during the coronavirus disease 2019 (COVID-19) pandemic. These unique circumstances resulted in diagnostic delays. In a Brisbane hospital, computed tomography (CT) colonography was used as a minimally invasive method to examine the colon, with the aim of identifying and expediting the diagnosis of patients with high-risk abnormalities. We aimed to explore the findings and outcomes of CT colonography. Methods: In April 2020, an experienced gastroenterologist reviewed and triaged about 645 category one waitlist colonoscopy patients. Of these, 130 patients were selected on clinical grounds and referred to three community radiology providers for CT colonography between April and June 2020. Data were retrospectively collected, including patient demographics, indication from referral source, and radiology reports. Colonoscopy reports were reviewed using ProVation software. Results: Of the 130 patients selected, 92 consented and 39 declined. After CTcolonography, 13 patients were referred for colonoscopy and 79 were referred to a gastroenterology outpatient clinic. The indication for referral addressed “red flag” symptoms of unexplained anemia, rectal bleeding, weight loss, or change in bowel habits in 54/92 patients (58.7%). The median time from referral to CT colonography was 20 days. Of the CT colonographies, 75 (81.5%) were recorded as being “good” or “satisfactory” quality. The significant colonic findings and outcomes of CT colonography are shown in Table 1. One patient had a significant extracolonic finding of a malignancy, consistent with renal cell carcinoma. This patient was reviewed in the urology outpatient clinic 9 days after CT colonography. Conclusion: This cohort of patients faced delays in the time to colonoscopy due to the COVID-19 pandemic. In using CT colonography, three patients were diagnosed with significant conditions that required urgent management and treatment. In 78/130 patients (60%), no high-risk radiological abnormalities were identified, and they were referred to an outpatient clinic. CTcolonography may be an appropriate tool to assist with risk stratification for patients facing long waitlists. This requires further study to assess outcomes after clinic consultation and colonoscopy procedures.