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Background & Aims Most fulfillment and benchmarking information for colonoscopy quality indicators has been obtained from studies of primary screening colonoscopies. We analyzed differences in the fulfillment of colonoscopy quality indicators based on the indication for endoscopy. Methods We performed an observational, multicenter, cross-sectional study of 14,867 patients who underwent endoscopy procedures for gastrointestinal symptoms (40.3%), a positive result from a fecal immunochemical test (36.0%), postpolypectomy surveillance (15.3%), or primary screening (8.4%), from February 2016 through December 2017 at 14 centers in Spain. We evaluated rates of adequate colon cleansing, cecal intubation, adenoma detection, and colorectal cancer detection, among others. We used findings from primary screening colonoscopies as the reference standard. Results Fewer than 90% of patients had adequate bowel preparation; 83.1% of patients with gastrointestinal symptoms had adequate bowel preparation (odds ratio [OR] compared with patients with primary screening colonoscopies, 0.62; 95% CI, 0.49–0.78) and 85.3% of patients receiving postpolypectomy surveillance had adequate bowel preparation (OR, 0.71; 95% CI, 0.55–0.91). The cecal intubation rate was also lower in patients with gastrointestinal symptoms (93.1%) (OR, 0.34; 95% CI, 0.22–0.52). The adenoma detection rate was higher in patients with a positive result from a fecal immunochemical test (46.4%) (OR, 2.01; 95% CI, 1.71–2.35) and in patients undergoing postpolypectomy surveillance (48.2%) (OR, 1.41; 95% CI, 1.20–1.67). The highest proportion of patients with colorectal cancer was in the gastrointestinal symptom group (5.1%) (OR, 5.24; 95% CI, 2.30–11.93) and the lowest was in patients undergoing surveillance (0.8%) (OR, 0.83; 95% CI, 0.32–2.14). Conclusions Fulfillment of colonoscopy performance measures varies substantially by indication. Policies addressing performance measures beyond colonoscopy screening procedures should be developed. Benchmarking recommendations could be adjusted according to colonoscopy indication.

Introduccion y objetivos: el impacto de la reseccion quirurgica del tumor primario en la supervivencia del cancer colorrectal metastatico obstructivo es aun controvertido. El objetivo principal de este estudio ha sido analizar la supervivencia de pacientes con cancer colorrectal metastatico obstructivo tras tratamiento con cirugia resectiva o con protesis de colon. Material y metodos: estudio retrospectivo de todos los pacientes con cancer colorrectal estadio IV con clinica obstructiva diagnosticados entre 2005 y 2012 y tratados con cirugia resectiva o protesis de colon. Se han excluido casos con perforacion, absceso, neoplasia en colon derecho o recto distal, neoplasia colorrectal multiple y cirugia derivativa. Resultados: se incluyeron 95 pacientes, 49 tratados con cirugia resectiva y 46 con protesis de colon. El grupo tratado con protesis presento mayor indice de Charlson (9,5 ± 2,1 vs. 8,6 ± 1,5, p = 0,01), menor tiempo para la ingesta oral (0,9 ± 1,1 vs. 16,4 ± 53,5 dias, p = 0,05), menor estancia hospitalaria (4 ± 4,8 vs. 16,7 ± 15,5 dias, p = 0,0001), menor necesidad de estoma (11,1 % vs. 32,7 %, p = 0,01), menos complicaciones precoces (4,3 % vs. 46,9 %, p = 0,0001) y mas complicaciones tardias (33,3 % vs. 6,4 %, p = 0,001). Recibir quimioterapia (p = 0,008) fue el unico factor independiente de mayor supervivencia. En el subgrupo de pacientes tratados con quimioterapia la reseccion quirurgica del tumor primario fue un factor independiente de mayor supervivencia. Conclusion: en los pacientes diagnosticados de cancer colorrectal obstructivo estadio IV, ambos tratamientos son eficaces en la resolucion del cuadro obstructivo. La cirugia resectiva no impacta de forma positiva en la supervivencia y no puede ser recomendada como terapia de eleccion.

espanolIntroduccion: las guias internacionales recomiendan la colonoscopia de rutina tras un episodio de diverticulitis aguda para descartar la presencia de neoplasia avanzada. Sin embargo, tras la incorporacion en los ultimos anos de la tomografia axial computarizada dicha recomendacion ha quedado en entredicho, sobre todo en lo que se refiere a la diverticulitis no complicada. Por otro lado, la colonoscopia es una tecnica que comporta riesgos y costes adicionales. Objetivo: conocer la rentabilidad diagnostica, calidad y seguridad de la colonoscopia en la diverticulitis aguda. Metodos: estudio retrospectivo de todos los pacientes diagnosticados de diverticulitis aguda por tomografia computarizada (TC) entre los anos 2005 y 2013, a los que posteriormente se les realizo una colonoscopia. Resultados: doscientos dieciseis pacientes diagnosticados de diverticulitis aguda por TC (58 diverticulitis complicada [27%] y 158 diverticulitis no complicada [73%]) fueron incluidos. Se detecto neoplasia avanzada en 12 pacientes (5,6% [complicada/no complicada 11,7/3,2%, p = 0,02]). No se observaron complicaciones mayores. La calidad fue baja (completa: 88%; preparacion eficaz: 75%; reseccion de polipos EnglishIntroduction: international guidelines recommend a routine colonoscopy to rule out advanced neoplasm after an acute diverticulitis event. However, in recent years, this recommendation has been called into question following the advent of computerized tomography (CT), particularly with regard to uncomplicated diverticulitis. Furthermore, colonoscopy is associated with a risk and additional costs. Objective: to understand the diagnostic yield, quality and safety of colonoscopy in the setting of acute diverticulitis. Methods: this was a retrospective study of all patients diagnosed with acute diverticulitis via CT between 2005 and 2013, who subsequently underwent a colonoscopy. Results: two hundred and sixteen patients diagnosed with acute diverticulitis via CT were enrolled. These included 58 cases with complicated diverticulitis (27%) and 158 with uncomplicated diverticulitis (73%). An advanced neoplasm was found in 12 patients (5.6%); 11.7% were complicated and 3.2% were uncomplicated (p = 0.02). No major complications were identified. The quality was low but improved over time; the complete procedure rate was 88%, an effective preparation was achieved in 75% and excision of polyps

T1 colorectal polyps with at least 1 risk factor for metastasis to lymph node should be treated surgically and are considered endoscopically unresectable. Optical analysis, based on the Narrow-Band Imaging International Colorectal Endoscopic (NICE) classification system, is used to identify neoplasias with invasion of the submucosa that require endoscopic treatment. We assessed the accuracy of the NICE classification, along with other morphologic characteristics, in identifying invasive polyps that are endoscopically unresectable (have at least 1 risk factor for metastasis to lymph node).We performed a multicenter, prospective study of data collected by 58 endoscopists, from 1634 consecutive patients (examining 2123 lesions) at 17 university and community hospitals in Spain from July 2014 through June 2016. All consecutive lesions10 mm assessed with narrow-band imaging were included. The primary end point was the accuracy of the NICE classification for identifying lesions with deep invasion, using findings from histology analysis as the reference standard. Conditional inference trees were fitted for the analysis of diagnostic accuracy.Of the 2123 lesions analyzed, 89 (4.2%) had features of deep invasion and 91 (4.3%) were endoscopically unresectable. The NICE classification system identified lesions with deep invasion with 58.4% sensitivity (95% CI, 47.5-68.8), 96.4% specificity (95% CI, 95.5-97.2), a positive-predictive value of 41.6% (95% CI, 32.9-50.8), and a negative-predictive value of 98.1% (95% CI, 97.5-98.7). A conditional inference tree that included all variables found the NICE classification to most accurately identify lesions with deep invasion (P.001). However, pedunculated morphology (P.007), ulceration (P = .026), depressed areas (P.001), or nodular mixed type (P.001) affected accuracy of identification. Results were comparable for identifying lesions that were endoscopically unresectable.In an analysis of 2123 colon lesions10 mm, we found the NICE classification and morphologic features identify those with deep lesions with96% specificity-even in non-expert hands and without magnification. ClinicalTrials.gov number NCT02328066.

Background and Aims TC-325 (Hemospray, Cook Medical, Winston-Salem, NC) is an inorganic hemostatic powder recently approved by the U.S. Food and Drug Administration. This study aimed to examine the effectiveness, safety, and predictors of TC-325 failure in a large real-life cohort. Methods This was a retrospective study conducted at 21 Spanish centers. All patients treated with TC-325 until September 2018 were included. The primary outcome was treatment failure, defined as failed intraprocedural hemostasis or recurrent bleeding within the first 30 postprocedural days. Secondary outcomes included safety and survival. Risk and predictors of failure were assessed via competing-risk models. Results The cohort comprised 261 patients, of whom 219 (83.9%) presented with upper gastrointestinal bleeding (GIB). The most common causes were peptic ulcer (28%), malignancy (18.4%), and therapeutic endoscopy-related GIB (17.6%). TC-325 was used as rescue therapy in 191 (73.2%) patients. The rate of intraprocedural hemostasis was 93.5% (95% confidence interval [CI], 90%-96%). Risks of TC-325 failure at postprocedural days 3, 7, and 30 were 21.1%, 24.6%, and 27.4%, respectively. On multivariate analysis, spurting bleeding (P = .004), use of vasoactive drugs (P = .02), and hypotension (P = .008) were independent predictors of failure. Overall 30-day survival was 81.9% (95% CI, 76%-86%) and intraprocedural hemostasis was associated with a better prognosis (adjusted hazard ratio, 0.29; P = .006). Two severe adverse events were noted. Conclusion TC-325 was safe and effective for intraprocedural hemostasis in more than 90% of patients, regardless of the cause or site of bleeding and its use as rescue therapy. In this high-risk cohort treated with TC-325, the 30-day failure rate exceeded 25% and was highest with spurting bleeding or hemodynamic instability.