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Prospective analysis of complications 30 days after outpatient colonoscopy

GASTROINTESTINAL ENDOSCOPY 1999年第3期50卷 322-328页

作者： Zubarik, R Fleischer, DE Mastropietro, C Lopez, J Carroll, J Benjamin, S Eisen, G Georgetown Univ Hosp Dept Gastroenterol Washington DC 20007 USA Vet Affairs Med Ctr Gastroenterol Sect Memphis TN USA

Background.. Our objective was to (1) determine whether more complications are reported by patients 30 days after outpatient colonoscopy than are discussed at our monthly morbidity and mortality conferences, (2) identify complications resulting in visits to the emergency department or physician's office or leading to hospitalization, and (3) assess which factors put patients at highest risk. A secondary goal was to determine the rate of work lost after outpatient colonoscopy. Methods: Trained interviewers performed standardized telephone interviews of consecutive outpatients undergoing colonoscopy at Georgetown University Hospital over a 1-year period. Results: One thousand one hundred ninety-six patients were contacted 30 days after outpatient colonoscopy and participated in our study. Twenty patients had complications that required a visit to an emergency department or physician. Ninety percent of these cases (18) were detected at 30 days, but 15% (3) were discussed at morbidity and mortality conferences. All seven complications that necessitated hospitalization were identified at 30 days, but only two were discussed at our morbidity and mortality conference. The most common complications reported by patients were abdominal discomfort (5.4%) and rectal bleeding (2.1%). Conclusion: More complications are detected by means of contacting patients 30 days after outpatient colonoscopy than are discussed at our morbidity and mortality conferences.

关键词：腹痛/流行病学腹痛/病因学缺勤门诊医疗/标准卡方分布队列研究结肠疾病/诊断结肠镜检查/方法结肠镜检查/标准随访研究胃肠出血/流行病学胃肠出血/病因学住院/统计学和数值数据肠穿孔/流行病学肠穿孔/病因学患病率前瞻性研究直肠/损伤成年人老年人女(雌)性人类男(雄)性中年人

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Magnetic resonance colonography versus conventional colonoscopy for the detection of colonic endoluminal lesions

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GASTROENTEROLOGY 2000年第2期119卷 300-304页

作者： Pappalardo, G Polettini, E Frattaroli, FM Casciani, E D'Orta, C D'Amato, M Gualdi, GF Univ Rome La Sapienza Surg Clin 2 Policlin Umberto I Rome Italy Univ Rome La Sapienza Med Clin 1 Policlin Umberto I Rome Italy

Background & Aims: The most effective prophylaxis for colorectal cancer is endoscopic polypectomy. Prompted by the disadvantages of conventional colonoscopy (CC), we assessed the diagnostic ability of a promising alternative technique for detecting endoluminal masses: magnetic resonance colonography (MRC). Methods: Seventy consecutive patients referred for CC underwent preliminary MRC. The diagnostic ability of this technique in detecting colonic endoluminal lesions was determined, compared with that of CC, and related to the findings from histologic examination. Results: In detecting endoluminal lesions, MRC achieved a diagnostic accuracy similar to CC (sensitivity, 96%;specificity, 93%;positive predictive value, 98%;and negative predictive value, 87.5%). Conclusions: MRC could be useful in screening programs of patients at high risk for colon cancer. Patients with MRC-detected endoluminal lesions must undergo CC for histologic diagnosis.

关键词：腺癌/诊断结肠镜检查/标准结直肠肿瘤/诊断置信区间肠息肉/诊断磁共振成像/方法磁共振成像/标准病人满意度试验预期值结果可重复性敏感性与特异性成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Disease-specific outcomes assessment for diagnosis of colorectal neoplasia: From clinical trials to community practice

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Gastrointestinal Endoscopy Clinics of North America 1999年第4期9卷 697-704页

作者： Rex, D.K. Ness, R.M. Department of Medicine Indiana Univ. School of Medicine Indianapolis IN 46202 550 North University Boulevard United States

Maximizing the outcomes of any diagnostic or treatment strategy translated from clinical trials to community practice is a complex process. Certainly, this is true of screening and diagnostic strategies for colorectal cancer and polyps. First, clinicians must identify clinical trials with valid results. Second, questions should be posed regarding whether the population in community practice is similar to that of the study population in the clinical trial, whether the methodology of the trial is or can be reproduced in the community setting, and whether the individuals performing the strategies have comparable training and expertise to those in the clinical trial. Most importantly, monitoring the performance of the strategies in community practice identifies areas of strength and weakness and allows for decision making that optimizes patient outcomes.

关键词：结肠镜检查/标准结直肠肿瘤/诊断结直肠肿瘤/治疗诊断鉴别结果评价(卫生保健)/标准人类

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Colonoscopy versus double-contrast barium enema.

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Gastroenterology 2000年第5期119卷 1402-1403页

作者： Nelson, D.B.

GASTROENTEROLOGY 2000;119:1402-1403

关键词：结肠腺瘤息肉病/诊断结肠腺瘤息肉病/外科学钡结肠镜检查/标准结直肠肿瘤/诊断结直肠肿瘤/外科学灌肠随访研究肿瘤复发局部/诊断人群监测/方法手术后期间前瞻性研究单盲法人类

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Procedure-specific outcomes assessment for colonoscopy

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Gastrointestinal Endoscopy Clinics of North America 1999年第4期9卷 625-637页

作者： Johanson, J.F. Rockford Gastroenterology Associates Rockford IL 61107 401 Roxbury Road United States

When implementing a CQI program in colonoscopy, the above performance measures provide the foundation to assess procedural quality and should be routinely tracked on all patients undergoing colonoscopy. In some cases, this may require only a random sample of patients. For example, patient satisfaction and procedure success might require only a quarterly sample of patients to provide the necessary data. In other areas, such as demographics, indications, and complications, all patients undergoing colonoscopy should be tracked. This is particularly true for complications because they occur so infrequently.

关键词：结肠疾病/诊断结肠疾病/治疗结肠镜检查/标准结果评价(卫生保健)/方法病人满意度人类

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Sigmoidoscopy costs and the limits of altruism

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AMERICAN JOURNAL OF MEDICINE 2000年第6期108卷 515-515页

作者： Volpintesta, EJ Bethel Connecticut USA

The article by Shaheen and Ransohoff (1) demonstrates how managed care has forced physicians to reevaluate the cost effectiveness of the procedures that they perform. However, in my 25 years as a primary care doctor, I have seen many patients with colon cancer in the transverse or ascending colon, well beyond the reach of my flexible sigmoidoscope. This makes me wonder if patients would be better served by having a colonoscopy every 10 years or so, rather than having flexible sigmoidoscopies at more frequent intervals. This issue concerns many primary care doctors who perform sigmoidoscopy routinely.

关键词：结肠镜检查/经济学结肠镜检查/标准结直肠肿瘤/诊断费用效益分析管理医疗规划/组织和管理普查/经济学普查/标准初级卫生保健/方法乙状结肠镜检查/经济学乙状结肠镜检查/标准人类

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