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Bakgrund: Koloskopi utförs i diagnostiskt syfte, vid uppföljningar av olika tarmsjukdomar och i behandlande syfte. I och med ökad livslängd, fler cancerfall och utökad screeningsverksamhet kommer antalet koloskopiundersökningar att öka. Syfte: Syftet med denna litteraturstudie var att belysa faktorer som påverkar patientens situation vid koloskopiundersökning. Metod: I denna litteraturstudie har nio kvantitativa och en två-fas studie granskats och analyserats. Sökningarna av artiklarna genomfördes i databaserna CINAHL och PubMed. Även manuell sökning genomfördes. Resultat: Analysen resulterade i tre kategorier och fyra underliggande subkategorier. Fysiska och psykiska faktorer; Smärta och obehag, Oro. Psykologiska faktorer; Skam och genans. Sociala faktorer; Bemötande och samspel mellan patient och vårdpersonal. Resultatet visade  att ovanstående faktorer påverkar patienten negativt inför och under koloskopiundersökningen. Resultatet visade även att det fanns könsskillnader som påverkar situationen vid koloskopiundersökningen. Konklusion: Behov finns att lyfta fram och belysa de faktorer som påverkar patientens situation vid koloskopiundersökning. För sjuksköterskan är det viktigt att ha kunskap om dessa faktorer för att kunna bemöta och ha ett samspel med patienten och få en djupare förståelse av vad det innebär för patienten att genomgå en koloskopiundersökning. Nyckelord: colonoscopy, experience, anxiety, attitudes, patient

No / Objective The number of colonoscopies required to reach competency is not well established. The primary aim of this study was to determine the number of colonoscopies trainees need to perform to attain competency, defined by a caecal intubation rate (CIR) ≥90%. As competency depends on completion, we also investigated trainee factors that were associated with colonoscopy completion. Design The Joint Advisory Group on GI Endoscopy in the UK has developed a trainee e-portfolio from which colonoscopy data were retrieved. Inclusion criteria were all trainees who had performed a total of ≥20 colonoscopies and had performed ≤50 colonoscopies prior to submission of data to the e-portfolio. The primary outcome measure was colonoscopy completion. The number of colonoscopies required to achieve CIR ≥90% was calculated by the moving average method and learning curve cumulative summation (LC-Cusum) analysis. To determine factors which determine colonoscopy completion, a mixed effect logistic regression model was developed which allowed for nesting of patients within trainees and nesting of patients within hospitals, with various patient, trainee and training factors entered as fixed effects. Results 297 trainees undertook 36 730 colonoscopies. By moving average analysis, the cohort of trainees reached a CIR of 90% at 233 procedures. By LC-Cusum analysis, 41% of trainees were competent after 200 procedures. Of the trainee factors, the number of colonoscopies, intensity of training and previous flexible sigmoidoscopy experience were significant factors associated with colonoscopy completion. Conclusions This is the largest study to date investigating the number of procedures required to achieve competency in colonoscopy. The current training certification benchmark in the UK of 200 procedures does not appear to be an inappropriate minimum requirement. The LC-Cusum chart provides real time feedback on individual learning curves for trainees. The association of training intensity and flexible sigmoidoscopy experience with colonoscopy completion could be exploited in training programmes.

Colorectal cancer is the third most common form of cancer, and is the number two cancer-related death in the United States. Receiving regular colonoscopies can reduce the average person's risk of dying from colon cancer by 90%. However, only 54% if adults over the age of 50 get regular colonoscopies. This low percentage can be attributed to the exam's poor availability, severe discomfort, high cost, and the risk of procedural complications. The Endoscope Propulsion System, or EPS, will assist in the colonoscopy procedure. This device will enable a lesser skilled physician to effectively perform the colonoscopy, thus increasing the procedure's availability. In addition to requiring less skill, the assistive nature of the EPS will also decrease the chance of complications due to colon perforation. The EPS will greatly reduce the discomfort cause by the colonoscope, which will eliminate the need for anesthesia and recovery, therefore greatly reducing the cost of the procedure. The Endoscope Propulsion System design described in this paper is an update to the device outlined in Dr. M. Jonathan Bern's patent application (20060270901). The criteria and requirements of the design are discussed along with the final design and analysis. Finally, a prototype was built to ensure the validity of the proposed invention. / Master of Science

BACKGROUND: Colorectal cancer is usually asymptomatic until later stage and the 5-year survival for stage III or IV are 68% and 10 % because of delayed diagnosis. Worldwide, it is the 4th leading cause of death among cancers which accounted for 694,000 deaths in 2012. While healthy diet and lifestyle helps prevent colorectal cancer, increased surveillance through screening has been suggested to attribute to the decreasing trend of colorectal cancer incidence in the United States in the past decade. Identifying what type of colorectal cancer screening methods is more effective is of public health relevance to Hong Kong where colorectal cancer ranks the top leading cancer. OBJECTIVES: To conduct a systematically review on current literatures to examine whether endoscopy screening by flexible sigmoidoscopy or colonoscopy is more effective for reducing the mortality and incidence of colorectal cancer than no screening as many colorectal cancers arise from adenomatous polyps, which polypectomy is hypothesized to be protective. Meanwhile, different countries adopt different kinds of colorectal cancer screening modalities, but yet, there is no agreement for the types of screening. METHODS: Four databases, Medline (OVIDSP), Pubmed, CINAHL plus (EBSCOhost), Embase (OVIDSP) were used to search for published journals. Reference list of the identified articles were screened for more relevant studies. RESULTS: A total of 8 studies were included in this systematic review. There were only 2 randomized controlled trials (RCTs) on screening for colorectal cancer using flexible sigmoidoscopy in asymptomatic and average-risk people and no RCT was found for colonoscopy. Based on the studies reviewed, findings were inconsistent on whether endoscopy screening is more effective in reducing overall colorectal cancer incidence and mortality than no screening. Endoscopy screening, either sigmoidoscopy or colonoscopy was associated with lower incidence of distal colorectal cancer. CONCLUSION: Screening by flexible sigmoidoscopy or colonoscopy is not clearly associated with lower overall colorectal cancer risks based on current systematic review. Randomized controlled trials or retrospective cohorts are required to clarify the effectiveness of endoscopy screening before considering the implementation of population-wide colorectal cancer screening. / published_or_final_version / Public Health / Master / Master of Public Health

Die Koloskopie ist eine der wichtigsten apparativen Untersuchungsmethoden der heutigen Medizin. Sie dient nicht nur der Diagnostik, sondern kann auch therapeutische Verwendung finden. Bei der vorliegenden Arbeit handelt es sich um eine randomisierte kontrollierte doppelblinde Studie. Das Hauptziel bestand in dem Vergleich der etablierten Methode, bei der Raumluft als Insufflationsgas verwendet wird, mit einer Methode, bei welcher stattdessen Kohlenstoffdioxid benutzt wird. Insgesamt wurden 150 Patienten in die prospektive Studie aufgenommen. Diese wurden gebeten, zu festgelegten Zeitpunkten nach der Untersuchung, Angaben zu Ihrem Beschwerdebild anzufertigen. Zusätzlich wurde nach der Arbeitsfähigkeit und der Zufriedenheit gefragt. Abschließend wurden noch verschiedene Faktoren während der Koloskopie geprüft, die der untersuchende Arzt am Ende der Prozedur notierte. Zu diesen gehörten die Allgemeine Einschätzung, die Untersuchungsdauer, etwaig auftretende Komplikationen und der Sedierungsbedarf.

Colorectal cancer is the second leading cause of cancer-related deaths behind lung cancer in the United States. Colonoscopy is the preferred screening method for detection of diseases like Colorectal Cancer. In the year 2006, American Society for Gastrointestinal Endoscopy (ASGE) and American College of Gastroenterology (ACG) issued guidelines for quality colonoscopy. The guidelines suggest that on average the withdrawal phase during a screening colonoscopy should last a minimum of 6 minutes. My aim is to classify the colonoscopy video into insertion and withdrawal phase. The problem is that currently existing shot detection techniques cannot be applied because colonoscopy is a single camera shot from start to end. An algorithm to detect phase boundary has already been developed by the MIGLAB team. Existing method has acceptable levels of accuracy but the main issue is dependency on MPEG (Moving Pictures Expert Group) 1/2. I implemented exhaustive search for motion estimation to reduce the execution time and improve the accuracy. I took advantages of the C/C++ programming languages with multithreading which helped us get even better performances in terms of execution time. I propose a method for improving the current method of colonoscopy video analysis and also an extension for the same to make it usable for real time videos. The real time version we implemented is capable of handling streams coming directly from the camera in the form of uncompressed bitmap frames. Existing implementation could not be applied to real time scenario because of its dependency on MPEG 1/2. Future direction of this research includes improved motion search and GPU parallel computing techniques.

Inflammatory bowel disease (IBD) affects millions of people in the United States, with the number of diagnoses steadily rising. It has been associated with poor quality of life and a host of comorbidities. Most notably, IBD patients are at an increased risk of developing colorectal cancer (CRC). The American Gastroenterological Association (AGA) recommends that IBD patients with involvement of 1/3 or more of the colon undergo colonoscopy regularly to screen for CRC starting 8 years after initial IBD diagnosis. Colonoscopy techniques for IBD-related CRC screening are highly variable and differ widely between clinical practices. Currently, high-definition white-light colonoscopy (HD-WLC) and dye spraying chromoendoscopy (DCE) are both standard of care. The use of these technologies requires a high level of skill that is typically attained during clinicians’ 3-year gastroenterology (GI) fellowship. This study intends to compare outcomes of screening colonoscopies performed by GI fellows and attending physicians in patients with longstanding IBD (>8 years) and to assess the impact of GI fellow involvement on these procedures. Additionally, the current research intends to draw distinctions between HD-WLC and DCE procedures. The research was performed in the Division of Gastroenterology at Beth Israel Deaconess Medical Center (BIDMC) as part of a large randomized controlled trial (RCT) that aims to evaluate the comparative efficacy of HD-WLC and DCE. Patients were screened for study eligibility using relevant criteria and then randomized to undergo colonoscopy using HD-WLC technique or DCE technique. Data from 128 procedures were included in the study. Of these procedures, 59 (46.1%) were attending-performed procedures while 69 (53.9%) were fellow-performed, attending-supervised procedures. Of the attending-performed procedures, 30 (50.8%) were performed using the DCE technique and 29 (49.2%) were performed using the HD-WLC technique. Of the fellow-performed, attending-supervised procedures, 32 (46.4%) were performed using the DCE technique while 37 (53.6%) were performed using the HD-WLC technique. Fellow-performed, attending-supervised procedures were associated with longer total procedure time (TPT) and increased intra-procedure administration of sedation medications without superior lesion detection. Thus, fellows appear to be on par with attendings in terms of lesion detection but this level of proficiency comes at the cost of increased TPT. Assessing the short-term and long-term impacts of this could be a valuable area of future investigation. Also, DCE procedures took longer for all clinicians to perform, especially fellows, and are not associated with enhanced lesion detection. Further research is needed to understand the usefulness of DCE.

Background: Bowel preparation is essential for quality colonoscopy. Although most bowel preparation regimens recommend dietary restriction for 24 to 48 hours before the procedure, the evidence for this is poor. Objectives: To establish whether dietary restriction during bowel preparation improves the quality of bowel preparation. Methods: A prospective single blind, randomised controlled pilot study. The dietary restriction (DR) group was instructed not to ingest high fibre foods for 48 hours prior to the use of a polyethylene glycol (PEG) bowel preparation. The non-dietary restriction (NDR) group was not given any dietary modification, but received instructions for the use of the PEG-based preparation solution. On the day of colonoscopy, the quality of the bowel effluent was assessed, and additional preparation given as necessary. The primary endpoint was quality of bowel cleansing using the Harefield Cleansing Scale during colonoscopy. The secondary endpoint was the need for additional bowel preparation and quantity of additional bowel preparation given prior to endoscopy. Data were analysed on an intention to treat basis. Results: Twenty-three participants were randomised to the intervention group and thirty-four to the control group. Patient demographics were similar in both groups. Dietary restriction did not influence the success rate of bowel preparation: 97% successful bowel preparation in the DR group, vs 91% successful bowel preparation in the NDR group (p=0.559). Additional bowel preparation requirement were similar in both groups: 35% in DR group vs 39% in NDR group (p=0.768). Mean amount of additional bowel preparation required was similar: 560 ml in the DR group vs 460 ml in the NDR group (p=0.633). Conclusion: The quality of bowel preparation was comparable in patients with and without dietary restrictions prior to colonoscopy. Non-restrictive diets prior to bowel preparation should be considered to increase compliance. The sample size of this pilot study prohibited definite statistical conclusions but demonstrated this to be a reasonable methodology for a larger study.