Longer withdrawal time is not associated with increased patient discomfort in colonoscopy: a retrospective observational study.

PURPOSE: Withdrawal time of sufficient length is a quality indicator for colonoscopies. Nonetheless, whether extending the withdrawal time contributes to patient discomfort remains unknown. This study aimed to clarify the relationship between colonoscopy withdrawal time and patient discomfort. METHODS: A cohort of consecutive patients who underwent colonoscopy at a single institution from October 2018 to January 2020 was retrospectively analyzed. Initially, the relationship between the mean withdrawal time for each colonoscopist in no-finding examinations and polyp detection rate was investigated in 2,043 patients. Subsequently, the primary outcome of association between withdrawal time and patient discomfort, as determined by patient questionnaire, was assessed for each examination in 481 patients from the initial cohort. RESULTS: The mean withdrawal time was strongly correlated with polyp detection rate (correlation coefficient, 0.72; P<0.001). In contrast, longer withdrawal time was not associated with increased discomfort; however, there was a weak inverse correlation between patient discomfort and longer withdrawal time (correlation coefficient, -0.25; P<0.001). Similarly, multiple regression analysis adjusted for confounding variables revealed that longer withdrawal time was not associated with increased patient discomfort (regression coefficient, -0.04 for each 1-minute increase in the length of withdrawal time; P=0.45). CONCLUSION: This study showed for the first time that longer withdrawal times did not result in increased discomfort, indicating that withdrawal time can be extended to sufficient length for optimal patient examination and polyp detection.

Recent trends in the prevalence and distribution of colonic diverticula in Japan evaluated using computed tomography colonography.

BACKGROUND: Computed tomography colonography (CTC) may be superior to colonoscopy and barium enema for detecting diverticula. However, few studies have used CTC to diagnose diverticula. AIM: To evaluate the current prevalence and distribution of colonic diverticula in Japan using CTC. METHODS: This study was conducted as part of the Japanese National Computed Tomographic Colonography Trial, which included 1181 participants from 14 hospitals in Japan. We analyzed the prevalence and distribution of colonic diverticula and their relationships with age and sex. The relationship between the diverticula and the length of the large intestine was also analyzed. RESULTS: Diverticulosis was present in 48.1% of the participants. The prevalence of diverticulosis was higher in the older participants (P < 0.001 for trend). The diverticula seen in younger participants were predominantly located in the right-sided colon. Older participants had a higher frequency of bilateral type (located in the right- and left-sided colon) diverticulosis (P < 0.001 for trend). The length of the large intestine with multiple diverticula in the sigmoid colon was significantly shorter in those without diverticula (P < 0.001). CONCLUSION: The prevalence of colonic diverticulosis in Japan is higher than that previously reported. The prevalence was higher, and the distribution tended to be bilateral in older participants.

Inverse time trends of peptic ulcer and reflux esophagitis show significant association with reduced prevalence of Helicobacter pylori infection.

INTRODUCTION: Recent prevalence and trends of gastric/duodenal ulcer (GU/DU) and reflux esophagitis (RE) are inadequate. METHODS: We reviewed the records of consecutive 211,347 general population subjects from 1991 to 2015. RESULTS: During the 25 years, the prevalence of GU and DU has gradually decreased (from 3.0% to 0.3% and from 2.0% to 0.3%) whereas that of RE has markedly increased (from 2.0% to 22%). The prevalence of Helicobacter pylori (HP) infection has decreased from 49.8% (in 1996) to 31.2% (in 2010). Multivariable logistic regression analyses demonstrated that HP infection was positively associated with GU/DU and negatively associated with RE with statistical significance. The panel data analyses showed that reduced rate of HP infection is proportionally correlated with decrease of GU/DU and inversely correlated with increase of RE. It is further suggested other latent factors should be important for changed prevalence of these three acid-related diseases. Age-period-cohort analysis indicated the significant association of older age, male gender, and absence of HP infection with RE. CONCLUSIONS: The prevalence of GU and DU has gradually decreased whereas that of RE has markedly increased in Japan. Inverse time trends of peptic ulcer and reflux esophagitis are significantly associated with reduced prevalence of HP infection. KEY MESSAGES The prevalence of gastric and duodenal ulcer has gradually decreased whereas that of reflux esophagitis has markedly increased in Japan. The prevalence of Helicobacter pylori infection in Japan has greatly decreased from 49.8% to 31.2% during the 14 years (from 1996 to 2010). Inverse time trends of peptic ulcer and reflux esophagitis are associated with reduced prevalence of Helicobacter pylori infection with statistical significance.

Causative factors of discomfort in esophagogastroduodenoscopy: A large-scale cross-sectional study.

BACKGROUND: It is important to reduce patient discomfort in esophagogastroduodenoscopy. Remedial measures can be taken to alleviate discomfort if the causative factors are determined; however, all the factors have not been elucidated yet. AIM: To clearly determine the factors influencing discomfort in transoral esophagogastroduodenoscopy using a large-size cross-sectional study with readily available data. METHODS: Consecutive patients who underwent screening transoral esophagogastroduodenoscopy consecutively between August 2017 and October 2017 at a health check-up center were included. Discomfort was evaluated using a face scale between 0 and 10 with a 6-level questionnaire. Univariate and multiple regression analyses were performed to investigate the factors related to the discomfort in esophagogastroduodenoscopy. Univariate analysis was performed in both the unsedated and sedated study groups. Age, sex, height, body mass index, smoking status, alcohol intake, hiatal hernia, history of gastrectomy, biopsy during examination, Lugol's solution usage, administration of butylscopolamine with/without a sedative (pethidine, midazolam, or both), endoscope model, history of endoscopy, and endoscopists were considered as possible factors of discomfort. RESULTS: Finally, 1715 patients were enrolled in this study. Overall, the median discomfort score was 2 and the interquartile range was 2-4. High discomfort (score ≥ 6) was recorded in 18% of the participants. According to univariate analysis, in the unsedated group, young age (P < 0.001), female sex (P < 0.001), and no history of endoscopy (P < 0.001) were factors associated with increased discomfort. Significant differences were also noted for height (P = 0.007), smoking status (P = 0.003), and endoscopists (P < 0.001). In the sedation group, young age (P < 0.001), female sex (P < 0.001), and no history of endoscopy (P = 0.004) were associated with increased discomfort; additionally, significant differences were found in smoking status (P < 0.001), type of sedation (P < 0.001), and endoscopists (P = 0.027). There was also a marginal difference due to alcohol intake (P = 0.055). Based on multiple regression analysis, young age, female sex, less height, current smoking status, and presence of hiatal hernia [regression coefficients of 0.08, P < 0.001 (for -1 years); 0.45, P = 0.013; 0.02, P = 0.024 (for -1 cm); 0.35, P = 0.036; and 0.34, P = 0.003, respectively] were factors that significantly increased discomfort in esophagogastroduodenoscopy. Alternatively, sedation significantly reduced discomfort and pethidine (regression coefficient: -1.47, P < 0.001) and midazolam (regression coefficient: -1.63, P = 0.001) significantly reduced the discomfort both individually and in combination (regression coefficient: -2.92, P < 0.001). A difference in the endoscopist performing the procedure was also associated with discomfort. CONCLUSION: Young age, female sex, and smoking are associated with esophagogastroduodenoscopy discomfort. Additionally, heavy alcohol consumption diminished the effects of sedation. These factors are easily obtained and are thus useful.

Multiple White and Flat Elevated Lesions Observed in the Stomach: A Prospective Study of Clinical Characteristics and Risk Factors.

Objective Multiple white and flat elevated lesions (MWFLs) observed in the stomach have only been presented in abstracts at academic conferences over the last decade; therefore, relatively little is known about these lesions. Our aim was to prospectively clarify the clinical characteristics of MWFLs, to identify their risk factors and to retrospectively evaluate the clinical progression of these lesions. Methods A prospective analysis of clinical characteristics and risk factors was conducted in participants who underwent esophagogastroduodenoscopic screening at our hospital. A retrospective analysis of the medical chart of patients identified as having MWFLs was conducted to describe the clinical progression of these lesions. Results The prevalence rate of MWFLs was 10.4% (80/767), with the following risk factors identified on a logistic regression analysis: use of proton pump inhibitors [odds ratio (OR), 3.51; 95% confidence interval (CI), 1.92-6.43], female sex (OR, 1.92; 95% CI, 1.19-3.12) and a 1-year increase in age (OR, 1.05; 95% CI, 1.02-1.08). Among the 70 cases with MWFLs observed over a mean duration of 2.3 years, no progression of MWFLs was detected in 67 cases (96%). Among the 3 remaining cases, progression was mild, with none of the lesions progressing to malignancy. Conclusion The use of proton pump inhibitors (PPIs), female sex, and age are risk factors for MWFLs. We believe that endoscopists should recognize these lesions.

Diagnostic Performance and Patient Acceptance of Reduced-Laxative CT Colonography for the Detection of Polypoid and Non-Polypoid Neoplasms: A Multicenter Prospective Trial.

Purpose To evaluate the diagnostic accuracy and patient acceptance of reduced-laxative computed tomographic (CT) colonography without computer-aided detection (CAD) for the detection of colorectal polypoid and non-polypoid neoplasms in a population with a positive recent fecal immunochemical test (FIT). Materials and Methods Institutional review board approval and written informed consent were obtained. This multicenter prospective trial enrolled patients who had positive FIT results. Reduced-laxative CT colonography and colonoscopy were performed on the same day. Patients received 380 mL polyethylene glycol solution, 20 mL iodinated oral contrast agent, and two doses of 20 mg mosapride the day before CT colonography. The main outcome measures were the accuracy of CT colonography for the detection of neoplasms 6 mm or larger in per-patient and per-lesion analyses and a survey of patient perceptions regarding the preparation and examination. The Clopper-Pearson method was used for assessing the 95% confidence intervals of per-patient and per-lesion accuracy. Survey scores were analyzed by using the Wilcoxon and χ2 tests. Results Three hundred four patients underwent both CT colonography and colonoscopy. Per-patient sensitivity, specificity, positive predictive value, and negative predictive value of CT colonography for detecting neoplasms 10 mm or larger were 0.91 (40 of 44), 0.99 (255 of 258), 0.93 (40 of 43), and 0.98 (255 of 259), respectively; these values for neoplasms 6 mm or larger were 0.90 (71 of 79), 0.93 (207 of 223), 0.82 (71 of 87), and 0.96 (207 of 215), respectively. Per-lesion sensitivities for detection of polypoid and non-polypoid neoplasms 10 mm or larger were 0.95 (40 of 42) and 0.67 (six of nine), respectively; those for neoplasms 6 mm or larger were 0.90 (104 of 115) and 0.38 (eight of 21), respectively (P < .05 for both). Patient acceptance of preparation and examination with CT colonography was significantly higher than that with colonoscopy, and 62% (176 of 282) of patients would choose CT colonography as the first examination if they have a positive FIT result in the future. Conclusion Reduced-laxative CT colonography without CAD is accurate in the detection of polypoid neoplasms 6 mm or larger but is less accurate in the detection of non-polypoid neoplasms. Reduced-laxative CT colonography has high patient acceptance and is an efficient triage examination for patients with a positive FIT. © RSNA, 2016 Online supplemental material is available for this article.

Emergency carotid artery stent placement in patients with acute ischemic stroke.

BACKGROUND AND PURPOSE: An effective intervention has not yet been established for patients with acute ischemic stroke who present with serious neurologic symptoms due to occlusion or a high-grade stenosis of the internal carotid artery (ICA). The aim of our retrospective study was to investigate the feasibility, safety, and efficacy of emergency carotid artery stent placement to improve neurologic symptoms and clinical outcome. METHODS: Of 896 consecutive patients with acute ischemic stroke who were admitted to our institution within 7 days of onset from July 2000 to June 2003, 17 patients (1.9%) with occlusion or a high-grade stenosis of the ICA underwent emergency carotid artery stent placement. We reviewed their records for neurologic outcome, per the National Institutes of Health Stroke Scale (NIHSS) score, before and at 7 days after stent placement; clinical outcome, per the modified Rankin Scale score (mRS), at 90 days; frequency of procedure-related complications within 30 days; and recurrence rate of ipsilateral ischemic stroke within 90 days. RESULTS: Carotid lesions were dilated completely in all patients. Median NIHSS scores before emergency stent placement and at 7 days were 12 and 5, respectively, showing significant improvement (P < .01, Wilcoxon rank sum test). Ten patients (59%) had favorable outcomes (mRS score 0-1) at 90 days. Irreversible complications occurred in two patients (12%): distal embolism in one and intracerebral hemorrhage in the other. No ipsilateral ischemic stroke recurred. CONCLUSION: Emergency carotid artery stent placement can improve the 7-day neurologic outcome and may improve the 90-day clinical outcome in selected patients with ischemic stroke.