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Background In 2018, the European Society of Gastrointestinal Endoscopy (ESGE) and United European Gastroenterology (UEG) published quality performance measures for endoscopic retrograde cholangiopancreatography (ERCP). Since January 2016, all endoscopists in the Netherlands have been required to register all ERCP procedures in a nationwide quality registry. This study aimed to evaluate the procedural success rates of ERCP after the implementation of mandatory national registration and to compare these with the ESGE quality performance measures. Methods This study was conducted with data from a multicenter endoscopy database. Data from 2019 and 2020 were analyzed. The primary outcome was ERCP procedural outcome. ESGE performance measures that could be evaluated were the percentage of successful bile duct cannulations in patients with virgin papillary anatomy; successful stent placement for a biliary obstruction located below the liver hilum; and complete removal of bile duct stones ( Result In total, 5295 ERCPs performed in 11 centers were included for analysis. The overall procedural success rate was 89.1 %. Successful biliary cannulation in patients with a virgin papilla was 90.3 % in nonacademic and 92.4 % in academic centers. The rates of successful stent placement in patients with a biliary obstruction located below the liver hilum were 97.0 % in nonacademic and 98.2 % in academic centers, and of successful bile duct stone extraction were 97.9 % in both nonacademic and academic centers. Conclusions The quality of ERCPs performed met five of the six evaluated ESGE performance measures. The 95 % target for successful biliary cannulation in patients with virgin papillary anatomy in academic centers was not met. Mandatory registration provides valuable insight into ERCP performance rates.

Background To optimize colonoscopy quality, several performance measures have been developed. These are usually assessed without distinction between the indications for colonoscopy. This study aimed to assess the feasibility of linking two national registries (one for colonoscopy and one for adverse events of gastrointestinal endoscopies in the Netherlands), and to describe the results of colonoscopy quality per indication. Methods This retrospective study was conducted with prospectively collected data of the Dutch Gastrointestinal Endoscopy Audit (DGEA) and the Dutch Registration of Complications in Endoscopy (DRCE). Data between 01–01–2016 and 01–01–2019 were analyzed. To calculate adverse event rates, data were linked at the level of endoscopy service. Results During the 3-year study period, 266 981 colonoscopies were recorded in DGEA. Of all indications, cecal intubation rate was highest in fecal immunochemical test (FIT)-positive screening colonoscopies (97.1 %), followed by surveillance (93.2 %), diagnostic (90.7 %), and therapeutic colonoscopies (83.1 %). The highest rate of adequate bowel preparation was observed in FIT-positive screening colonoscopies (97.1 %). A total of 1540 colonoscopy-related adverse events occurred (0.58 % of all colonoscopies). Bleeding and perforation and rates were highest for therapeutic (1.56 % and 0.51 %, respectively) and FIT-positive screening (0.72 % and 0.06 %, respectively) colonoscopies. The colonoscopy-related mortality was 0.006 %. Conclusion This study describes the first results of the Dutch national colonoscopy registry, which was successfully linked to data from the national registry for adverse events of gastrointestinal endoscopies. In this large dataset, performance varied between indications. Our results emphasize the importance of defining benchmarks per indication in future guidelines.

Contains fulltext : 235697.pdf (Publisher’s version ) (Open Access) BACKGROUND AND AIMS: Upper gastrointestinal (GI) endoscopy is frequently performed in patients with upper abdominal symptoms. Although guidelines recommend withholding an endoscopy in the absence of alarm symptoms, dyspeptic symptoms remain a predominant indication for endoscopy. We aimed to investigate the yield of upper GI endoscopy in patients with low-risk dyspeptic symptoms. METHODS: We conducted an analysis in a prospectively maintained endoscopy reporting database. We collected the results of all upper GI endoscopy procedures between 2015 and 2019 that was performed in adult patients aged

Background COVID-19 has dramatically affected gastrointestinal endoscopy practice. We aimed to investigate its impact on procedure types, indications, and findings. Methods We retrospectively analyzed endoscopies performed in 15 Dutch hospitals by comparing periods 15 March to 25 June of 2019 and 2020 using the prospective Trans.IT database. Results During lockdown in 2020, 9776 patients underwent endoscopy compared with 19 296 in 2019. Gastroscopies decreased by 57 % (from 7846 to 4467) and colonoscopies by 45 % (from 12219 to 5609), whereas endoscopic retrograde cholangiopancreatography volumes remained comparable (from 578 to 522). Although endoscopy results indicative of cancer decreased (from 524 to 340), the likelihood of detecting cancer during endoscopy increased (2.7 % [95 % confidence interval (CI) 2.5 – 3.0] in 2019 versus 3.5 % [95 %CI 3.1 – 3.9] in 2020; P Conclusions Fewer endoscopies were performed during the COVID-19 lockdown, leading to a significant reduction in the absolute detection of cancer. Endoscopies increased rapidly after lockdown, except for colorectal cancer screening.

Background and Aims: The importance of having quality assessment, assurance, and improvement tools in health care is increasingly recognized. However, the additional associated administration burden progressively interferes with the structural implementation and adoption of such tools, especially when it concerns high-volume procedures such as colonoscopies. The development of the Dutch Gastrointestinal Endoscopy Audit (DGEA), a registry with automated extraction of colonoscopy quality data, and its first results are described. Methods: In close cooperation with commercial endoscopy reporting systems and a national histopathology database, healthcare professionals performing colonoscopies initiated a quality registry that extracts data from its core hospital resource or histology database without manual interference of the healthcare providers. Data extracted consisted of patient age, gender, indication of the colonoscopy, American Society of Anesthesiologists score, Boston Bowel Preparation Score, and cecal intubation; for the colonoscopy after a positive fecal immunochemical test in the colorectal cancer screening program, other data were polyp detection rate, which was available for all 48 hospitals or endoscopy centers, and adenoma detection rate, which was available for 26 hospitals or endoscopy centers. Results: Between January 1, 2016 and March 31, 2019, 48 hospitals or endoscopy centers voluntarily participated in the DGEA, and 275,017 unique patients with 313,511 colonoscopies were registered. Overall missing values were limited to

Background: Anti-tumour necrosis factor [anti-TNF] treatment was demonstrated to have disease-modifying abilities in inflammatory bowel disease [IBD]. In this study, we aimed to determine the effect of anti-TNF treatment timing on IBD disease complications and mucosal healing [MH]. Methods: The following IBD-related complications were tested in relation to timing of anti-TNF therapy start in newly diagnosed IBD patients [n = 413]: fistula formation, abscess formation, extra-intestinal manifestations [EIM], surgery, referral to academic centre, and MH. Results: A total of 85 patients [21%] received anti-TNF (66 Crohn's disease [CD], 16 ulcerative colitis [UC], 3 inflammatory bowel disease unclassified [IBDU]) of whom 57% [48 patients] were treated < 16 months after diagnosis. Patients receiving anti-TNF early [< 16 months] did not differ from patients receiving anti-TNF late [> 16 months] regarding gender, age, smoking status, and familial IBD. More importantly, patients receiving anti-TNF early did not suffer less IBD-related complications during follow-up as compared with patients started on anti-TNF late, nor was more MH observed. Similar results were obtained when anti-TNF treated patient were stratified more stringently, ie 2 4 months [24 patients]. Cox regression analysis showed no beneficial correlations between anti-TNF timing and IBD-related complications. Anti-TNF treated patients achieving MH were 11 times less likely to develop EIMs compared with patients who did not achieved MH while on anti-TNF. Conclusions: This study was unable to confirm a benefit of earlier anti-TNF treatment on IBD disease complications. This could be explained by more aggressive treatment earlier in disease, resulting in fewer IBD complications. However, it seems more likely that inappropriate selection of patients for therapy leads to suboptimal treatment and subsequently suboptimal outcome.

Background B-cell depletion can improve a variety of chronic inflammatory diseases, but does not appear beneficial for patients with Crohn's disease. Objective To elucidate the involvement of B cells in Crohn's disease, we here performed an 'in depth' analysis of intestinal and blood B-cells in this chronic inflammatory disease. Methods Patients with Crohn's disease were recruited to study B-cell infiltrates in intestinal biopsies (n = 5), serum immunoglobulin levels and the phenotype and molecular characteristics of blood B-cell subsets (n = 21). The effects of infliximab treatment were studied in 9 patients. Results Granulomatous tissue showed infiltrates of B lymphocytes rather than Ig-secreting plasma cells. Circulating transitional B cells and CD21(low) B cells were elevated. IgM memory B cells were reduced and natural effector cells showed decreased replication histories and somatic hypermutation (SHM) levels. In contrast, IgG and IgA memory B cells were normally present and their Ig gene transcripts carried increased SHM levels. The numbers of transitional and natural effector cells were normal in patients who responded clinically well to infliximab. Conclusions B cells in patients with Crohn's disease showed signs of chronic stimulation with localization to granulomatous tissue and increased molecular maturation of IgA and IgG. Therapy with TNF-alpha-blockers restored the defect in IgM memory B-cell generation and normalized transitional B-cell levels, making these subsets candidate markers for treatment monitoring. Together, these results suggest a chronic, aberrant B-cell response in patients with Crohn's disease, which could be targeted with new therapeutics that specifically regulate B-cell function.

Patients with colorectal cancer are at risk for developing metachronous colorectal cancer. The purpose of posttreatment surveillance is to detect and remove premalignant lesions to prevent metachronous colorectal cancer.The aim of this study was to investigate the incidence of and predictive factors for metachronous colorectal cancer in patients with newly diagnosed colorectal cancer.The data on all patients with newly diagnosed colorectal cancer between 1995 and 2006 were obtained from the Rotterdam Cancer Registry in The Netherlands and studied for metachronous colorectal cancer.The annual incidence rate and the standardized incidence ratios were calculated.In total, colorectal cancer was diagnosed in 10,283 patients; there were 39,974 person-years of follow-up. The mean annual incidence rate of metachronous colorectal cancer was 314/100,000 person-years at risk during 10 years of follow-up, corresponding with a mean annual incidence of 0.3% and a cumulative incidence of 1.1% at 3 years, 2.0% at 6 years, and 3.1% at 10 years. The incidence of metachronous colorectal cancer after resection of a first colorectal cancer is significantly higher than the incidence of colorectal cancer in an age- and sex-matched general population (standardized incidence ratio 1.3, 95% CI 1.1-1.5). This difference is especially seen during the first 3 years after first colorectal cancer diagnosis (standardized incidence ratio 1.4, 95% CI 1.1-1.8). The presence of synchronous colorectal cancer was the only significant risk factor for developing metachronous colorectal cancer (relative risk 13.9, 95% CI 4.7-41.0).Despite the availability of colonoscopy, metachronous colorectal cancer is still seen during follow-up in patients with colorectal cancer; the highest risk is during the first 3 years after initial diagnosis. For this reason, a follow-up colonoscopy is useful at a short-term interval after colorectal cancer diagnosis. The presence of synchronous colorectal cancer at the time of first colorectal cancer diagnosis is the only predictive risk factor for developing metachronous colorectal cancer. Tailored surveillance programs may be considered in patients with a diagnosis of synchronous tumors.

Background: A noticeable proportion of colorectal cancer (CRC) patients are diagnosed with synchronous CRC. Large population-based studies on the incidence, risk factors and prognosis of synchronous CRC are, however, scarce, and are needed for better determination of risks of synchronous CRC in patients diagnosed with colonic neoplasia. Methods: All newly diagnosed CRC between 1995 and 2006 were obtained from the Rotterdam Cancer Registry in The Netherlands, and studied for synchronous CRC. Results: Of the 13,683 patients diagnosed with CRC, 534 patients (3.9%) were diagnosed with synchronous CRC. The risk of having synchronous CRC was significantly higher in men (OR 1.54, 95% CI 1.29-1.84) and in patients aged >70 years (OR 1.83,95% CI 1.39-2.40). Synchronous CRC patients had a significantly higher risk of distant metastases (OR 1.69, 95% CI 1.27-2.26). In 34% (184/534) the two tumours were located in different surgical segments. Five-year relative survival of synchronous CRC was similar to patients with solitary CRC after multivariate adjustment for the presence of distant metastases. Conclusion: One out of 25 patients diagnosed with CRC presents with synchronous CRC. In the multivariate analysis, survival of patients with synchronous CRC was similar to patients with solitary CRC, when corrected for the presence of distant metastases at first presentation. One third of the synchronous CRC were located in different surgical segments, which stresses the importance of performing total colon examination preferably prior to surgery. (C) 2011 Elsevier Ltd. All rights reserved.

Contains fulltext : 88612.pdf (Publisher’s version ) (Closed access) OBJECTIVES: To assess the prior exposure to colorectal examinations between colorectal cancer (CRC) patients and matched control participants to estimate the effect of these examinations on the development of CRC and to obtain insight into the background incidence of colorectal examinations. METHODS: A population-based case-control study was conducted within the Dutch Integrated Primary Care Information database over the period 1996-2005. All incident CRC cases were matched with up to 18 controls (n=7,790) for age, sex, index date (date of CRC diagnosis) and follow-up before diagnosis. All colorectal examinations performed in symptomatic participants in the period 0.5-5 years before index date were considered in the analyses. RESULTS: Within the source population of 457 024 persons, we identified 594 incident cases of CRC. In the period 0.5-5 years before index date 2.9% (17 of 594) of the CRC cases had undergone colorectal examinations, compared with 4.4% (346 of 7790) in the control population [odds ratio (ORadj): 0.56, 95% confidence interval (CI): 0.33-0.94]. For left-sided CRC, significantly more controls than cases had undergone a colorectal examination (4.7 vs. 2.0%, respectively, ORadj: 0.36, 95% CI: 0.17-0.76), which was not seen for right-sided CRCs (3.3 vs. 3.9%, respectively, ORadj: 0.98, 95% CI: 0.42-2.25). CONCLUSION: Patients diagnosed with CRC were less likely than controls to have had a colorectal examination in previous years, being more pronounced in patients diagnosed with left-sided CRCs. If diagnostic examinations have a similar protective effect as screening examinations, this finding supports the concept that colorectal examination can have a major impact on the reduction of CRC risk. 01 april 2010

Background and study aims Gastrointestinal endoscopy investigations are frequently requested by gastroenterologists, general practitioners and other physicians. In addition to the classic methods of report writing, several electronic endoscopic report systems are currently available. The aim of the study was to evaluate the costs of three different ways of producing reports; by hand, by dictation, or by computer. Methods Three methods of report writing were compared, with special attention to costs. The endoscopy process was analyzed, from arrival of the patient to sending the report to the referring doctor, and including production of endoscopic images or video, logging of used endoscopes and their disinfection, and storage costs for endoscopy data. Results During the first 5 years, the mean costs per procedure were Euro 4.78 for handwritten, Euro 6.39 for dictated and Euro 8.90 for computerized reports. Due to depreciation, after this initial period, the respective costs declined to Euro 4.37, Euro 5.20 and Euro 5.13, respectively. Despite high initial costs, a cost-benefit analysis already revealed a financial benefit from a computerized system after 3 years. Conclusions The electronic production of an endoscopic report turned out to be the most expensive way of report writing during the first 5 years, due to high initial costs. After 5 years the costs of the different systems were comparable with each other. Cost-benefit analysis showed a positive financial benefit for computerized reports after 3 years.

Item does not contain fulltext BACKGROUND: Endoscopic follow-up (FU) in patients treated for colorectal adenomas or cancer (CRC) is intended to reduce the incidence of CRC. In the Dutch postpolypectomy guidelines, the FU interval is solely determined by the number of previous adenomas, whereas in other countries size and histology are also taken into account. Whether this difference in policy is also reflected in clinical practice is unknown. Furthermore, FU guidelines after CRC are not standardized in The Netherlands, even though national recommendations are available. GOAL: To assess the adherence to the current Dutch postpolypectomy guidelines and to evaluate the FU policy after CRC resection. STUDY: A survey was sent to all Gastrointestinal Departments in The Netherlands. The survey consisted of questions on logistic organization of FU, postpolypectomy FU intervals, and FU after CRC. RESULTS: The response rate was 85%. In contrast to the national guidelines, size and histology of the adenomas were often taken into account, leading to shortening of the FU interval. With respect to the CRC cases, 52% of the respondents advised shorter FU intervals than advised by the national recommendations. CONCLUSIONS: Despite recent Dutch postpolypectomy guidelines, clinicians incorporate histology and size into their clinical strategy. Either further education on the guidelines is needed, or the guidelines need to be reconsidered. Furthermore, evidence-based guidelines for FU after CRC should be formulated.

Technological developments have greatly promoted interest in the use of computer systems for recording findings and images at endoscopy and creating databases. The aim of this study was to develop a comprehensive WHO-approved code system for gastrointestinal endoscopic terminology. The International Classification of Diseases, 10th edition (ICD-10), and the ICD-10 clinical modification (ICD-10-CM) were expanded to allow description of every possible gastrointestinal endoscopic term under conditions defined by the WHO. Classifications of specific gastrointestinal disorders and endoscopic locations were added. A new chapter was developed for frequently used terminology that could not be classified in the existing ICD-10, such as descriptions of therapeutic procedures. The new extended code system was named Gastrointestinal Endoscopic Terminology Coding (GET-C). The GET-C is a complete ICD-10-related code system that can be used within every endoscopic database program for all specific endoscopic terms. The GET-C is available for free at http://www.trans-it.org/.

OBJECTIVES: Immunochemical fecal occult blood test (FOBT) and determination of tumor pyruvate kinase isoenzyme type M2 (TuM2-PK) in stool samples may be valuable new screening tools for colorectal cancer (CRC). The aim of this study was to compare the accuracy of fecal TuM2-PK testing with immunochemical FOBT in patients with CRC or adenomas. METHODS: A total of 52 patients with CRC were analyzed, 47 with colorectal adenomas, and 63 matched controls with a normal colonoscopy. Nineteen additional patients with inflammatory bowel disease were tested to determine influence of inflammation. Stool samples were analyzed with two immunochemical FOBTs, Immo-care and OC-Light, and with a commercial enzyme-linked immunosorbent assay for TuM2-PK. RESULTS: In patients with CRC, the sensitivity of TuM2-PK, Immo-care and OC-Light was respectively 85, 92 and 94%. In patients with adenomas, the sensitivity was respectively 28, 40 and 34%. Specificity for these tests was 90% for TuM2-PK and 97% for both immunochemical FOBTs. All tests showed a high positivity rate in patients with inflammatory bowel disease (79% for TuM2-PK and Immo-care, and 89% for OC-Light). CONCLUSION: Both immunochemical FOBTs appear valuable and are sensitive tests for CRC screening. TuM2-PK does not have supplemental value for screening for CRC because of a lower sensitivity and specificity. None of these tests is sensitive enough for detection of advanced adenomas. Patients with inflammatory bowel disease should be excluded from CRC screening when using immunochemical FOBT or TuM2-PK.

Item does not contain fulltext BACKGROUND AND STUDY AIMS: Cecal intubation rate (CIR) and adenoma detection rate (ADR) have been found to be inversely associated with the occurrence of post-colonoscopy colorectal cancer. Depicting differences in CIR and ADR between hospitals could provide incentives for quality improvement. The aim of this study was to compare quality parameters of routine colonoscopies between seven hospitals in The Netherlands in order to determine the extent to which possible differences were attributable to procedural and institutional factors. PATIENTS AND METHODS: Consecutive patients undergoing colonoscopy were prospectively included between November 2012 and January 2013 at two academic and five nonacademic hospitals. Patients with inflammatory bowel disease or hereditary colorectal cancer syndromes were excluded. Main outcome measures were CIR and ADR. RESULTS: A total of 3129 patients were included (mean age 59 +/- 15 years; 45.5 % male). The majority of patients (86.2 %) had a Boston Bowel Preparation Scale (BBPS) score >/= 6. Overall CIR was 94.8 %, ranging from 89.4 % to 99.2 % between hospitals. After adjustment for case mix (age, sex, American Society of Anesthesiologists score, and indication for colonoscopy), factors associated with CIR were hospital and a BBPS score >/= 6. Overall ADR was 31.8 % and varied between hospitals, ranging from 24.8 % to 46.8 %. Independent predictors for ADR were hospital, BBPS score >/= 6, and cecal intubation. By combining CIR and ADR for each hospital, a colonoscopy quality indicator (CQI) was developed, which can be used by hospitals to stimulate quality improvement. CONCLUSION: Differences in the quality of colonoscopy between hospitals can be demonstrated using CIR and ADR. As both indicators are affected by institution and bowel preparation, a comparison between hospitals based on the newly developed CQI could assist in further improving the quality of colonoscopy.

textabstractBackground: To describe the clinical characteristics of inflammatory bowel disease (IBD) at diagnosis in Netherlands at the population level in the era of biologics. Methods: All patients with newly diagnosed IBD (diagnosis made between January 1, 2006 and January 1, 2007) followed in 9 general hospitals in the southwest of the Netherlands were included in this population-based inception cohort study. Results: A total of 413 patients were enrolled, of which 201 Crohn's disease (CD) (48.7%), 188 ulcerative colitis (UC) (45.5%), and 24 IBD unclassified (5.8%), with a median age of 38 years (range, 14-95). Seventy-eight patients with CD (38.8%) had ileocolonic disease and 73 patients (36.3%) had pure colonic disease. In 8 patients (4.0%), the upper gastrointestinal tract was involved. Nineteen patients with CD (9.5%) had perianal disease. Thirty-nine patients with CD (19.4%) had stricturing phenotype. Of the patients with UC and IBDU, 39 (18.4%) suffered from pancolitis and 61 (29%) from proctitis. Severe endoscopic lesions at diagnosis were seen in 119 patients (28.8%, 68 CD, 49 UC, and 2 IBDU), whereas 98 patients (23.7%) had severe histological disease activity. Thirteen patients (3.1%, 10 CD and 3 UC) had extraintestinal manifestations at diagnosis. Twenty-three patients (5.6%, 20 CD and 3 UC) had fistula at diagnosis. Conclusions: In this cohort, 31% of the patients with CD had complicated disease at diagnosis, 39% had ileocolonic disease, 9.5% had perianal disease, and in 4% the upper gastrointestinal tract was involved. Most patients with UC suffered from left-sided colitis (51%). Severe endoscopic lesions were reported in 34% of the patients with CD and 26% of the patients with UC. Three percent of the patients with IBD had extraintestinal manifestations. Copyright

Background & Aims We assessed the course of inflammatory bowel disease (IBD) among pregnant women who stopped taking anti–tumor necrosis factor (TNF) agents. We also analyzed levels of anti-TNF agents in cord blood samples. Methods We followed 31 pregnancies in 28 women with IBD between April 2006 and April 2011 who were treated with anti-TNF agents (18 received infliximab, and 13 received adalimumab) during pregnancy. We used enzyme-linked immunosorbent assays to measure levels of anti-TNF agents in cord blood collected from 18 newborns (12 whose mothers took infliximab, and 6 whose mothers took adalimumab). Results Among the patients taking infliximab, 12 (71%) discontinued treatment before gestational week 30; all patients remained in remission. All the patients taking adalimumab discontinued treatment before gestational week 30; two patients had relapses of IBD. There were 28 live births, 1 miscarriage among patients taking infliximab (at gestational week 6), and 2 miscarriages among patients taking adalimumab (at weeks 6 and 8); there were no congenital malformations. The mean cord blood level of infliximab was 6.4 ± 1.6 μg/mL; it was significantly lower among women who received the drug 10 weeks or less before delivery (2.8 ± 1.1 μg/mL) than those who received infliximab closer to delivery (10 ± 2.3 μg/mL; P = .02). Adalimumab was detected in 5 samples of cord blood (mean concentration, 1.7 ± 0.4 μg/mL); 1 cord blood sample from a woman who discontinued the treatment at gestational week 22 had an undetectable level of the drug. Conclusions Discontinuation of anti-TNF therapy appears to be safe for pregnant women with quiescent IBD. However, these drugs are still detected in cord blood samples.

BACKGROUND/OBJECTIVES: As recently as 40 years ago, a decline in the incidence of peptic ulcers was observed. The discovery of Helicobacter pylori had a further major impact on the incidence of ulcer disease. Our aim was to evaluate the trends in the incidence and bleeding complications of ulcer disease in the Netherlands.METHODS: From a computerized endoscopy database of a district hospital, the data of all patients who underwent upper gastrointestinal endoscopy from 1996 to 2005 were analyzed. The incidence of duodenal and gastric ulcers, with and without complications, were compared over time.RESULTS: Overall, 20,006 upper gastrointestinal endoscopies were performed. Duodenal ulcers were diagnosed in 696 (3.5%) cases, with signs of bleeding in 158 (22.7%). Forty-five (6.5%) of these ulcers were classified as Forrest I and 113 (16.2%) as Forrest II. Gastric ulcers were diagnosed in 487 cases (2.4%), with signs of bleeding in 60 (12.3%). A Forrest 1 designation was diagnosed in 19 patients (3.9%) and Forrest 2 in 41 patients (8.4%). The incidence of gastric ulcers was stable over time, while the incidence of duodenal ulcers declined.CONCLUSIONS: The incidence of duodenal ulcer disease in the Dutch population is steadily decreasing over time. Test and treatment regimens for H pylori have possibly contributed to this decline. With a further decline in the prevalence of H pylori, the incidence of gastric ulcers is likely to exceed the incidence of duodenal ulcers in the very near future, revisiting a similar situation that was present at the beginning of the previous century.

Objective. Although colonoscopy can be effective in the prevention of colorectal cancer (CRC), it requires many endoscopic facilities, has a high patient burden and risk of complications, and it is expensive. The aim of this study was to determine the risk for proximal CRC and to identify subgroups in which screening sigmoidoscopy can be effective. Material and methods. A database search was carried out on all patients who underwent endoscopy of the lower gastrointestinal (GI) tract between 1997 and 2005. All patients diagnosed with CRC were included. Variables including age, gender and the presence of distal colonic neoplasia were used for risk analyses. Results. In total, 783 patients were diagnosed with CRC. Tumour was located in the proximal colon in 68/255 (27%) of the patients 65 years. Of the patients 65 years, 22% (57/255) had proximal CRC without synchronous distal lesions and would thus have been missed by sigmoidoscopy screening. Among patients 65 years, 41% (216/528) were diagnosed with proximal CRC, significantly more often in women than in men (p 0.001). In 35% of patients (185/528) proximal CRC without distal colonic neoplasia was found, significantly more than in those under 65 years of age (p 0.001). Conclusions. Significantly more proximal localized CRC would have been missed by sigmoidoscopy screening in elderly patients, especially in women. In subjects 65 years of age, sigmoidoscopy screening allows detection of almost 80% of CRC cases and might suffice as a screening method.

Background Endoscopists use different methods for reporting their findings after a gastrointestinal endoscopy. These may result in handwritten, dictated, or computerized reports. The time needed to create the report is an important parameter for acceptance of the method used. It is also important to be aware of the possible advantages and disadvantages of these different methods. The aim of this study was to compare time aspects of different methods of report writing. Methods Three different methods of report writing, i.e., handwritten, dictated, and computerized, were compared. In three different endoscopy departments, one investigator recorded the time needed to compose the report and to send it to the referring doctor. The time needed to describe different diagnoses at endoscopy was compared between the systems. Results Handwritten reports were completed in an average time of 113 s, free text dictated reports by the endoscopist in 65 s with an additional 172 s allowed for the typist, and computerized, pre-defined reports were completed in 86 s. The incidences of abnormalities found in the reports of the different hospitals were comparable. Conclusion To a large extent, computerized, pre-defined reports could be composed in almost the same amount of time as handwritten and dictated reports. Free text dictated and computerized, pre-defined reports are both stored in the hospital information system, but only computerized, pre-defined reports including endoscopic pictures are stored in a structured database, which makes statistical analysis possible.

Sa1403 Bowel Preparation and Hospital Are Important Factors Influencing Quality of Colonoscopy As Measured by Cecum Intubation and Adenoma Detection Elisabeth J. Grobbee*, Tim D. Belderbos, Maarten Meijssen, Rob J. Ouwendijk, Thjon J. Tang, Frank Ter Borg, Peter J. Van Der Schaar, Doris M. Le Fevre, Merijn Stouten, Onno Van Der GalieN, Theo J. Hiemstra, Wouter H. De Vos Tot Nederveen Cappel, Pieter Ter Borg, Leon M. Moons, Ernst J. Kuipers, Peter D. Siersema Gastroenterology and Hepatology, Erasmus MC, Rotterdam, Netherlands; Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, Netherlands; Gastroenterology and Hepatology, Isala Hospital, Zwolle, Netherlands; Gastroenterology and Hepatology, Ikazia Hospital, Rotterdam, Netherlands; Gastroenterology and Hepatology, IJsseland Hospital, Capelle aan den IJssel, Netherlands; Gastroenterology and Hepatology, Deventer Hospital, Deventer, Netherlands; Gastroenterology and Hepatology, Antonius Hospital, Nieuwegein, Netherlands; Achmea Health Care, Leiden, Netherlands; Gupta Strategists, Ophemert, Netherlands Background: As more colorectal cancer (CRC) screening programs are implemented worldwide, adequate measurement of the quality of colonoscopy becomes increasingly important. Cecal intubation rate (CIR) and adenoma detection rate (ADR) are used as quality indicators and have been related to the occurrence of post-colonoscopy CRC. The aim of this study was to compare the quality of routine colonoscopy between seven hospitals in the Netherlands to determine to what extent possible differences in CIR and ADR are attributable to casemix versus proceduraland hospital-related factors. Methods: We prospectively registered all colonoscopies performed between November 2012 and January 2013 in two academic and five general hospitals in the Netherlands. Colonoscopies in patients with inflammatory bowel disease (IBD) or hereditary CRC syndromes were excluded. Multivariate analyses were adjusted for age, gender, ASA score and indication. Results: A total of 3,145 patients were included (55% female; mean age 59 16 years). The majority of procedures (87%) were performed in adequately prepared colons, defined as a Boston Bowel Preparation Scale (BBPS)R6. Mean CIR was 94%, ranging from 89% to 99%, and was significantly different between hospitals (p! 0.001). We found no significant differences in CIR between gastroenterologists (94%) fellows (94%) and nurse endoscopists (96%) (pZ0.235). The overall ADR was 32% and was significantly higher in men vs. women (39% vs. 27%; p!0.001). ADR varied between hospitals, ranging from 23% to 43% (p!0.001) and between type of endoscopists, with nurse endoscopists (37%) performing slightly better than gastroenterologists (31%) and fellows (34%; p!0.05). In multivariate analysis, independent predictors for CIR were use of sedation (OR 2.49, 95%CI 1.57 3.94), BBPS R6 (OR 13.0, 95%CI 8.69 19.4) and hospital (p!0.001), with OR’s ranging from 0.81 (95%CI 0.44-1.51) to 4.91 (95%CI 2.01-12.01) (largest hospital as reference). In multivariate analysis, independent predictors for ADR were with BBPSR6 (OR 0.55, 95%CI 0.40 0.74), incomplete colonoscopy (OR 0.615, 95%CI 0.40 0.94) and hospital (p!0.001), with OR’s ranging from 0.59 (95%CI 0.44-0.79) to 1.62 (95%CI 1.00-2.64) (largest hospital as reference). Conclusion: CIR and ADR as quality indicators for colonoscopy are able to detect differences between hospitals. As both CIR and ADR are not dependent on casemix, they objectively provide incentives for quality improvement.

Background: Adherence to therapy is a key factor when analyzing the efficacy of a given treatment in clinical practice. Inflammatory bowel disease (IBD) is associated with high rates of non-compliance to therapy. The aim of our study was to assess the prevalence of non-adherence to treatment among patients with IBD and evaluate which factors could be related. Methods: One hundred consecutive IBD outpatients (60% with Crohn’s disease and 40% with Ulcerative Colitis) filled in an anonymous questionnaire, which included information about demography, duration of the disease, specific therapy for IBD, and data possibly related to extent of non-adherence to treatment. Statistics were performed with SPSS v.18.0. For continuous variables, mean and standard deviation were calculated and for categorical variables percentages were provided. Categorical variables were compared with Fisher’s exact test. A p value

Risk Analyses for Sigmoidoscopy As a Screening Tool Based On the Incidence of Proximal Colorectal Carcinomas in a General Hospital Sanna Mulder, Rob J. Ouwendijk, Monique E. Van Leerdam, Ernst J. Kuipers Introduction: Sigmoidoscopy screening for colorectal cancer (CRC) has been suggested. Colonoscopy may be more effective in CRC prevention, however colonoscopy requires more endoscopy facilities, has a higher risk of complications and is more expensive. Aim: To determine the risk for advanced proximal neoplasia and to identify subgroups in which screening sigmoidoscopy might suffice using retrospective colonoscopy data from a single general hospital. Methods: A database search using the Endobase datasystem was performed on all patients who underwent lower endoscopy between 1997 and October 2005 in a single general hospital. All patients diagnosed with CRC were included. Demographical data were collected as well as data concerning tumor characteristics, i.e. location, stage. Variables including age (!65 or O65 years of age), sex, and distal findings were used for risk analyses. Results: In total, 794 patients were diagnosed with CRC (M/F 416/378, mean age 70 yrs, range 27-95 yr). The CRC was localized in 67% of the patients in the distal colon and in 33% proximal of the descending colon. In 7 patients the location of the CRC was not further specified.In the group under 65 years of age, in total 258 patients were diagnosed with CRC (149 M, 109 F). In 65/ 258 (25%) patients the CRC was localized in the proximal colon, without significant difference between men and women. A synchronous distal neoplasia was found in 21 of these 65 patients (12 M, 9 F). In 17% (44/258) only a proximal CRC was found, which would have been missed by screening sigmoidoscopy. In the group over 65 years of age, 536 patients were diagnosed with CRC (267 M, 269 F). In 198/536 (37%) patients the CRC was localized in the proximal colon, significantly more women had a proximal CRC (75 M, 123 F, p ! 0.01). A synchronous distal neoplasia was found in 44 of these 198 patients (22 M, 22 F). In 29% (154/536) only a proximal CRC was found, which is significantly more compared to those under 65 yrs of age (p ! 0.01). There was a significant difference regarding the overall prevalence of proximal neoplasia between the age-group under and over 65 years (p ! 0.01). Conclusions: The proportion of CRC that is located in the proximal colon changes with age. In elderly, proximal CRC is proportionally more common, and more often occurs without distal marker lesions. In patients above 65 yrs of age significantly more proximally localized CRC would have been missed by screening sigmoidoscopy. When considering CRC screening sigmoidoscopy screening will suffice in the age-group below 65 yrs of age. Given these data, in men and women above 65 yrs of age colonoscopy might be the preferred screening method.

Percutaneous Endoscopic Gastrostomy (PEG) is a relative simple and safe manner to feed patients who are unable to swallow. It is more comfortable and better tolerated than a nasogastric tube for long periods. We report our experience with PEG for the palliative treatment of intestinal tract obstruction. In a 2-year period 47 PEG s were placed in 40 patients. In 12 patients the PEG was placed because of end-stage malignancy. In 5 of these patients additional feeding was the main purpose. Seven patients were given a PEG because of decompression of their malignant intestinal obstruction. All patients had nasogastric draining tubes to relieve nausea and were unable to tolerate oral fluids or feeding. Malignancy was due to ovarian cancer in 2 patients, cervical cancer in 2 patients and colorectal carcinoma in 3 patients. Gastrostomy tube placement was done in the endoscopy room with the use of a short acting benzodiazepine (midazolam). The MIC-PEG catheter (Medicor®) 20 french was placed using the pull technique under direct vision by the endoscopist. In all 7 patients the placement of the PEG catheter occurred without complications. In all 7 patients the nasogastric tubes could be removed and the PEG catheter was used to drain the stomach. All patients experienced symptomatic relief. One patient died 8 days after insertion and had supportive care only. Five patients were able to go home and had parenteral nutrition using a subclavian catheter. One patient remained in hospital and survived 36 days. The mean survival was 43 days (range 8 - 67 days). No major complications occurred during this period. One patient came back for replacement of the catheter.We consider the PEG as a better alternative than the nasogastric tube for long term drainage. It is less invasive than laparotomy and can be performed under local anaesthesia and the use of midazolam. Conclusions Percutaneous endoscopic drainage gastrostomy is a simple technique to relieve small bowel obstruction due to intraperitoneal malignancy. All patients had symptomatic relief and were able to tolerate some oral fluids and feeding. Five out of seven patients were able to go home and had parenteral nutrition for considerable time. All PEG placements occurred without complications and the mean survival was 43 days after insertion of the tube.

Endoscopic report systems are becoming more and more available in the current endoscopic practice. The way reports are composed and data is stored differ considerable between the systems. They all use different kinds of databases and it is only possible to evaluate the endoscopic data of their own system. One problem is that there is no specific code system for endoscopic terminology and findings that is widely used. To be able to compare different ways of report writing we developed a comprehensive code-system suitable to code every used term during gastrointestinal endoscopy. This new extended code system was based on a code-system, already in use throughout the world. The International Classification of Diseases 10thedition (ICD-10) is a comprehensive and widely used codesystem, published by the World Health Organization (WHO) and translated into many different languages. The ICD-10 was originally composed for mortality statistics. However on conditions defined by the WHO this ICD- 10 can be extended for local purposes. Terms that are used during gastrointestinal endoscopy were based on Minimal Standard Terminology (MST). However MST only includes terms that are commonly used. So this list was expanded to be able to describe every possible gastrointestinal endoscopic term. By extending the ICD-10 a complete coding system for endoscopic terminology was created on conditions of the WHO. It is possible to code every indication. In this way, it is also possible to code severity and classification of certain endoscopic findings into generally used grading scores. Abnormalities that can only be endoscopically diagnosed and precise locations were added. The medication given during the examination, the proceeding of the examination, any therapeutic interventions but also complications can be given a specific code. A project was started to evaluate endoscopic examinations in the Netherlands. In this TRANS.IT project, different ways of report writing are used in Endobase III® and a central database is build by collecting the GET-C codes that are linked to these reports. Yet, this new code-system can be implemented in every endoscopic database system. Conclusions Gastrointestinal Endoscopic Terminology Coding (GET-C) is a complete code system that can be used in every endoscopic database program. Each endoscopic term has its own specific code. Using this code-system it is possible to compare different endoscopic databases even internationally.

Hospitals are becoming more and more computerized throughout the world. Also for endoscopy units several systems are available nowadays. Most of these systems have composing a report as main purpose. However the way a report is composed within these systems varies considerably. The report has to be accurate but the time needed to describe the findings in a report has to be as short as possible in the busy practice of most endoscopy units. Besides this the program has to be user-friendly to become fully accepted in the unit. Some systems attempt to work with a structured data-entry for endoscopy reports. Drawbacks of present-day systems with structured data-entry are the low velocity of composing a report, brought out by the many choices to be made, and the risk of getting lost in the structured data-tree. Endobase® III is a system with the possibility of choosing standard reports and text-blocks besides structured data-entry based on Minimal Standard Terminolgy (MST). All standard reports and text-blocks are linked to a specific gastrointestinal endoscopic terminology coding (GET-C). This GET-C is an extension of the International Classification of Diseases 10th edition. In this way it is possible to evaluate different kinds of report writing with each other. After four year experience of working with standard reports in our endoscopy unit, a project is started in the Netherlands to evaluate the use of standard reports and text-blocks for composing endoscopy reports. Before the start of the investigation all the patient characteristics, indication, medication and other exam data are put into the system. Using standard reports you only have to choose once for a diagnosis or a combination of diagnosis to get a full report. This is preferable for frequently detected findings during endoscopy. Different text-blocks are available for every part of the GI-tractus, e.g. esophagus, stomach, bulbus and duodenum. Also procedures, complications and advice can be selected. In this way it is possible to compose quickly a complete and accurate report by combining different text-blocks. We have composed 290 standard reports and 570 text-blocks at this moment.With the use of these reports and text-blocks we are able to compose a report for 80-90 % of all the endoscopies performed. Conclusions The possibility of using standard reports and text-blocks linked to GET-C creates a system that is user-friendly in daily practice and can still be very accessible for extensive statistical analysis.