A Closer Look At Same-Day Bidirectional Endoscopy
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.
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ABSTRACT: Fundic gland polyps (FGPs), the most common type of gastric polyps, have been associated with prolonged proton pump inhibitor therapy and an increased risk of colon cancer. The presence of FGPs has been inversely correlated with Helicobacter pylori infection. We evaluated the prevalence of H pylori-associated gastritis, colonic polyps, and carcinomas in subjects with and without FGPs. We analyzed data collected from community-based endoscopy centers in 36 states (plus Washington DC and Puerto Rico) on patients who underwent esophagogastroduodenoscopy (EGD) and colonoscopy between April 2007 and March 2008. Of the 103,385 patients who underwent EGD during this time period, gastric biopsy samples were collected from 78,801 and colonic biopsies from 26,017. Slides of samples from Helicobacter-infected FGPs and FGPs with dysplasia were reviewed. FGPs were detected in 6081 patients (67.8% women). Helicobacter infection was present in less than 0.5% patients with FGPs and 13.0% of those without FGPs (odds ratio [OR], 29.05; 95% confidence interval [CI], 20.4-41.4; P < .0001). Colonic adenomas were detected in 42.3% of women with FGPs and 33.8% of those without (OR, 1.43; 95% CI, 1.26-1.63; P < .001); there was no significant difference in colonic adenomas between men with and without FGPs. Women had a higher prevalence of FGPs. FGPs were associated with gastroesophageal reflux disease symptoms, gastric heterotopia, hyperplastic colonic polyps (only in men), and colonic adenomas (only in women, especially those over 60 years of age). The presence of FGPs was inversely correlated with H pylori infection, active gastritis, and gastric neoplasia.Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association 05/2009; 7(8):849-54. DOI:10.1016/j.cgh.2009.05.015 · 7.90 Impact Factor
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ABSTRACT: Same-day bidirectional endoscopy including esophagogastroduodenoscopy (EGD) and colonoscopy is routinely performed to evaluate anemia and gastrointestinal bleeding, as well as to conduct cancer surveillance. Numerous questions have been raised regarding the most appropriate procedural sequence and the resulting potential procedure interactions. We compared the quality and feasibility of performing EGD and colonoscopy without sedation in patients subjected to EGD-colonoscopy (Group I) or colonoscopy-EGD (Group II) sequences. A total of 80 patients were prospectively randomized into two groups (40:40). All EGD examinations were recorded on videotape, and the quality of 18 EGD steps was assessed by three endoscopists. In addition, we analyzed the colonoscopic parameters and subjective discomfort scores of patients. Group I displayed significantly superior quality for retroflexion-related steps (P11-13; all median of Group I vs Group II = 2:3; P < 0.01), visualization of the angular fold (P10; Group I vs Group II = 2:3; P = 0.048), and general assessment of the stomach (P17; Group I vs Group II = 2:3; P = 0.008) and upper GI tract (P15; Group I vs Group II = 2:3; P = 0.047). Colonoscopic insertion time, total time, and prolonged insertion ratio did not differ between the two groups. Questionnaire responses indicated that EGD was perceived to be more stressful in Group II sequence. The quality of EGD steps is influenced by the sequence of bidirectional endoscopy. EGD is perceived to be more stressful to patients when preceded by colonoscopy. Therefore, EGD followed by colonoscopy may be the preferable procedural sequence for same-day bidirectional endoscopy.Journal of Gastroenterology and Hepatology 05/2010; 25(5):899-904. DOI:10.1111/j.1440-1746.2009.06157.x · 3.50 Impact Factor
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ABSTRACT: UK guidelines1 suggest investigation with bidirectional endoscopy (BDE) (upper endoscopy and colonoscopy) in the same sedative episode is a reasonable approach for the investigation of iron deficiency anaemia. There are few data regarding such investigation for iron deficiency anaemia (IDA) in young men. To assess the use of synchronous BDE for IDA in men and in women <50; and to compare the effectiveness of synchronous BDE in the investigation of iron deficiency anaemia in patients <50 years with those >50 years. Our endoscopy database was searched for all synchronous bidirectional endoscopies that were undertaken for the indication of iron deficiency anaemia between 2003 and 2009. Age, gender and endoscopic findings were retrieved for each procedure. Significant findings were defined as cancer, grade 3 oesophagitis (Savory Miller classification), oesophageal stricture, Barrett's oesophagus, ulcer, arteriovenous malformation, colitis, and colonic polyps >1 cm. 558 patients underwent synchronous BDE for iron deficiency anaemia between 2003 and 2009. A significant finding in those >50 years was found in 24.6% vs 11.3% of patients <50 years (OR 2.5, 95% CI 1.3 to 5.0). In men under 50 years a significant finding was present in 20.6%. Dual pathology was present in 1.5% of patients over 50 vs 1.3% under 50 years. Our findings suggest that synchronous BDE is an appropriate means of investigation for iron deficiency anaemia in patients >50 and for men <50 years old.Postgraduate medical journal 06/2010; 86(1016):338-40. DOI:10.1136/pgmj.2009.094904 · 1.45 Impact Factor