ABSTRACT Colorectal cancer is the second leading cause of cancer-related deaths in the US, claiming about50,000 lives in 2015. Colonoscopy is currently the preferred screening modality for colorectal cancer; intheory colonoscopy should prevent most colorectal cancers. However, recent data suggest that there is asignificant miss-rate associated with colonoscopy for the detection of even large polyps and cancers.Indeed, reports from Canada and Germany fail to show any protection of colonoscopy for right-sided andonly about 70% protection for left-sided colorectal cancer. Reports from the US show that prevention ofcolorectal cancer related death is at best 53-68% in carefully controlled longitudinal studies. Furthermore,patients of endoscopists with the highest rate of detection of premalignant polyps had the lowest rate ofcolorectal cancers in subsequent years. In 2015, the American College of Gastroenterology and the American Society of Gastroenterologyrenewed consensus guidelines defining a good quality colonoscopy but adherence to these guidelinesvaries among endoscopists and there is growing concern that these guidelines do not reflect true quality. We hypothesize that real-time objective feedback during the withdrawal phase of colonoscopywill improve quality of colonoscopy. We have created software that in real-time evaluates the technique of the endoscopist, categorizestechnique into different degrees of quality (similar to software in airplanes that warns pilots againststalling) within milliseconds and via heads-up display technology can inform the endoscopist about thelevel of measured quality. In other words, we have created a system that has the potential to improveendoscopic technique during a procedure in a live patient. Using this system, we propose to address two Specific Aims. First, to determine the optimal methodof real-time feedback for four features of colonoscopy related to the amount of stool in the colon and theeffort of the endoscopist to inspect as much as possible all mucosa of the colon. And second, to testwhether real-time feedback during colonoscopy improves quality of colonoscopy and the adenomadetection rate in three endoscopy centers. Successful evaluation and implementation of the proposed real-time analysis and feedbacksystem has the potential to improve the quality of care of over 14 million US citizens ? theapproximate number of people undergoing colonoscopy ? on an annual basis. In addition, thetechnology lends itself for rapid adaptation to other endoscopic medical procedures such as uppergastrointestinal endoscopy, cystoscopy, arthroscopy and bronchoscopy.
|Effective start/end date||8/1/16 → 5/31/20|
- National Institutes of Health: $739,523.00
Quality of Health Care