A Closer Look At Same-Day Bidirectional Endoscopy

Oregon Health and Science University, Department of Gastroenterology, Portland, Oregon 97239, USA.
Gastrointestinal endoscopy (Impact Factor: 4.9). 09/2008; 69(2):271-7. DOI: 10.1016/j.gie.2008.04.063
Source: PubMed

ABSTRACT Same-day bidirectional endoscopy (BDE) is commonly used in clinical practice.
Our purpose was to determine the frequency, patient demographics, indications, and significant endoscopic findings for patients undergoing BDE.
Retrospective study with a national endoscopic database.
Diverse clinical practice settings in the United States, including 75% from private practice.
A total of 591,074 adult patients had upper or lower endoscopy; 66,265 patients (11.2%) with same-day BDE and a subgroup (n = 9067) with a common indication for both upper and lower examinations are the subjects of this analysis.
Age, sex, and procedure indication were analyzed in all subjects. Significant endoscopic findings were measured in patients with a single indication of anemia, a positive fecal occult blood test (FOBT), or abdominal pain/dyspepsia (pain) for both upper and lower endoscopy.
The Clinical Outcomes Research Initiative (CORI) national endoscopic database was analyzed to determine the number of patients who underwent same-day BDE between 2000 and 2004. Patients with a single indication of anemia, positive fecal occult blood test (FOBT), or abdominal pain/dyspepsia (pain) on both EGD and colonoscopy were included for the analysis of endoscopic findings. Significant upper GI findings were defined as suspected malignancy, arteriovenous malformation (AVM), ulcer, Barrett's esophagus, and stricture. Significant lower GI findings included suspected malignancy, polyp >9 mm, and AVM.
A total of 591,074 patients had upper and/or lower endoscopy; 66,265 patients (11.2%) had same-day BDE. The majority of patients were female (52.1%), and the mean age of patients with BDE was 60.8 years. A total of 6538 patients (9.9%) had anemia, 1169 (1.8%) had a positive FOBT, and 1360 (2.1%) had pain as the sole indication for both examinations. After adjustment for age and sex, significant findings were higher in patients with anemia than in those with pain (odds ratio 1.89; 95% CI, 1.59-2.26) and for patients with positive FOBT versus pain (odds ratio 1.83; 95% CI, 1.48-2.26).
Retrospective analysis with possible bias. Fewer patients with pain had significant findings compared to the other two groups (P value <.0001).
More than 10% of patients undergoing upper or lower endoscopy receive same-day BDE. BDE commonly revealed important conditions in patients with anemia or positive FOBT. Bidirectional endoscopy commonly revealed important pathology in patients with anemia or positive FOBT. Patients with pain had a lower prevalence of serious findings compared to the other groups studied. The benefits of BDE in patients with pain are uncertain and require additional investigation.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Bowel preparation before colonoscopy is usually considered worse than the actual procedure. The regimen usually consists of the intake of a large amount of fluid (2–4 L) with an unpalatable taste and smell, which might lead to nausea, vomiting, bloating, and abdominal pain in addition to the required diarrhea. In a meta-analysis comparing the effectiveness of different bowel preparation agents, about 29 % of the subjects were unable to ingest the full volume of polyethylene glycol (PEG) solution [1]. Incomplete consumption of the solution usually affects the quality of bowel cleansing, increasing the probability that the procedure will be aborted and then repeated.One of the conventional ways to overcome the barrier of ingesting a large amount of an unpalatable solution is to instill it directly into the stomach with the use of a nasogastric (NG) tube. Nevertheless, shortcomings including subjects’ discomfort, nasopharyngeal trauma, tube misplacement, and pulmonary aspiration have prec ...
    Digestive Diseases and Sciences 12/2014; 60(1). DOI:10.1007/s10620-014-3441-7 · 2.55 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: A sequential bidirectional endoscopy is commonly performed. However, the optimal sequence of procedures for same-day bidirectional endoscopy using moderate sedation has not been established. The aim of this study was to characterize the optimal sequence of endoscopies for sequential bidirectional endoscopy. This was a single-center, prospective, randomized study. A total of 163 patients aged 18 to 80 years, who were referred for bidirectional endoscopy for any indication, were randomized to start with upper or lower endoscopy. Initially, all patients received intravenously 50 mg of meperidine and 2.5 mg of midazolam. Patient's discomfort and satisfaction, as expressed by the amount of analgesia added to sustain conscious sedation, and the postprocedure satisfaction reported by the patients were set as primary outcomes. There was no significant difference in the total dose of midazolam added, patient's pain assessment and satisfaction from the anesthesia and the procedure, duration of endoscopies, or the time to cecal intubation between the esophagogastroduodenoscopy first and colonoscopy first groups. The rate of diagnosis of significant pathologies and the rate of procedures performed during the examinations were similar in both the study groups. Evaluation of patient's postprocedural recovery did not reveal significant differences. There was no significant variance between the performing physicians regarding anesthetic dosing, duration of examination, pain scoring, and the related patient's pain postprocedural assessment. There were no significant differences in the patient's discomfort and satisfaction, regardless of the procedural sequence.
    Journal of clinical gastroenterology 10/2013; 48(3). DOI:10.1097/MCG.0b013e3182a87e5f · 3.19 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: GOALS:: To evaluate gastroenterologists' use of esophagogastroduodenoscopy (EGD) for positive fecal occult blood test (FOBT). BACKGROUND:: Colonoscopy is recommended when an FOBT performed for colorectal cancer screening is positive. Guidelines suggest no further evaluation if anemia and gastrointestinal (GI) symptoms are absent. METHODS:: Online surveys included 4 vignettes: positive FOBT in average-risk adults 50 years of age or older with/without iron-deficiency anemia and with/without upper GI symptoms. For each scenario, respondents were asked if they would perform colonoscopy only, EGD only, colonoscopy+EGD on same day, or colonoscopy followed by EGD on different day if colonoscopy was negative. RESULTS:: Surveys were returned by 778 (11%) of 7094 potential responders. In patients without anemia or upper GI symptoms, 65% performed colonoscopy only; 35% added EGD (9% same day, 25% different day). EGD was added in 91% with anemia, 96% with symptoms, and 100% with anemia+symptoms. In patients with positive FOBT alone (no symptoms or anemia), multivariate analysis revealed fear of litigation as the primary factor associated with adding EGD to colonoscopy (odds ratio=4.1; 95% confidence interval, 2.3-7.3). When EGD+colonoscopy were planned for positive FOBT, private practice was associated with performing EGD on a different day (odds ratio=6.3; 95% confidence interval, 2.9-13.5 for private versus academic setting). CONCLUSIONS:: One third of gastroenterologists perform EGD in addition to colonoscopy for a positive FOBT alone. Fear of litigation is the most important factor in deciding whether to add EGD to colonoscopy. When both procedures are planned, they are more likely to be performed on different days in a private practice setting than in an academic setting.
    Journal of clinical gastroenterology 04/2013; 48(2). DOI:10.1097/MCG.0b013e31828f1c8d · 3.19 Impact Factor