Abstracts

of small polyps. When we categorized the endoscopists according to a meanwithdrawal time of either less than 6 minutes or 6 minutes or more, the longerwithdrawal time group had a greater polyp detection rates (30.7% vs 18.4%,p!0.001). We also observed a negative correlation between colonoscopic insertiontimes and the withdrawal times among the endoscopists (p!0.001). Conclusion:There is wide range of polyp detection rates among colonoscopists and a strongpositive correlation between the colonoscopic withdrawal times and polypdetection rates. Long enough withdrawal times would be necessary to raise thepolyp detection rates during colonoscopy.

M1399

Lack of Discriminatory Function for Endoscopy Skills On

a Computer-Based SimulatorStephen Kim, Geoffrey Spencer, George Makar, Nuzhat A. Ahmad, DavidL. Jaffe, Gregory G. Ginsberg, Michael L. KochmanBackground: Computer-based endoscopy simulators have been developed toenable trainees to learn and gain technical endoscopic skills before performing onpatients. This study prospectively evaluated the capability of a computer-basedsimulator to discriminate between varying levels of skill and experience inesophagogastroduodenoscopies (EGD) and colonoscopies. Methods: Five first-yeargastroenterology fellows with no prior endoscopic experience performed sixtymentored endoscopy cases on the Simbionix GI Mentor II (Simbionix Ltd. Israel).Six experts, with more than 1000 previous EGDs and colonoscopies, performed sixcases (three EGDs, three colonoscopies) on the simulator that were selected torepresent common clinical scenarios. Performance parameters were collected bythe simulator. Results: Novices and experts were able to complete the tasks in thesimulated cases with no significant overall differences between the two groups. Thecomputer-based simulator was only able to discriminate levels of expertise onparameters related to the time spent on the procedure (total time, time to secondduodenum, time to cecum, and efficiency of screening). No statistically significantdifferences were found for the other nine performance parameters measured bythe simulator. Conclusions: 1. The computer-based endoscopy simulator displaysa lack of discriminatory function between novices and experts for endoscopic skillsbased on measured objective performance parameters.2. Our findings suggest thatthe computer-based simulator lacks fidelity and is not capable of producinga prediction of skill during in vivo endoscopy.

Comparison of Novices and Experts on the Endoscopy Simulator - EGD Cases

Novice (nZ15) Expert (nZ18)

Perforamance Paremeter

AB232 GASTROINTESTINAL EN

mean (median)

DOSCOPY Vo

mean (median)

lume 69, No.

p-value

Total time (seconds)

421.0 (393.0) 265.3 (257.5) 0.002 Percent mucosa examined 84.3 (84.0) 81.5 (81.0) 0.294 Time to second duodenum (seconds) 100.6 (99.5) 55.3 (36.0) 0.006 Percent time with clear view 97.4 (98.0) 96.4 (98.0) 0.624 Percent time patient in pain 0.0 (0.0) 0.0 (0.0) 1.000 Efficiency of screening 70.7 (72.0) 81.8 (84.5) 0.024

Comparison of Novices and Experts on the Endoscopy Simulator - ColonoscopyCases

Novice (nZ15) Expert (nZ18)

Performance Parameter mean (median) mean (median) p-value

Total time (seconds)

880.2 (828.0) 610.1 (572.5) 0.021 Caused excessive local pressure 3.1 (3.0) 2.5 (2.0) 0.327 Lost view of lumen 1.3 (1.0) 0.7 (0.5) 0.067 Excessive loop formed 0.7 (0.0) 1.7 (1.0) 0.107 Percent mucosa examined 84.6 (91.0) 89.9 (93.0) 0.093 Time to cecum (seconds) 391.9 (350.0) 228.6 (219.0) 0.001 Percent time iwth clear view 88.7 (89.0) 88.9 (91.0) 0.280 Percent time patient in pain 2.0 (0.0) 0.1 (0.0) 0.459 Efficiency of screening 66.2 (71.5) 82.8 (89.0) 0.023

M1400

Randomized Study On the Efficacy of Polyethylenglicol and

Sodium Phosphate Alone or Associated with Bisacodyl for Bowel

Cleansing Prior to VideocolonoscopyLisandro Pereyra, Daniel G. Cimmino, Carlos E. Gonzalez Malla,Mariano Laporte, Sandra Lencinas, Carlos Peczan, Nicolas A. Rotholtz,Pablo Luna, Silvia C. Pedreira, Luis A. Boerr, Hugo N. CatalanoIntroduction: An optimal colonic cleansing prior to a videocolonoscopy (VCC)reduces the possible failures in the detection of mucosa lesions and the need torepeat the study. Although a number of papers have been published that assess thesafety and efficacy of Polyethilenglicol (PEG) and Sodium Phosphate (NaP), theydon’t allow us to draw definitive conclusions on which is the best agent. Aim: To

5 : 2009

compare the tolerance and efficacy of NaP and PEG alone and associated withBisacodyl for colonic cleansing. Method. 353 patients, older than 18 years old, wererandomized to receive one of the following preparations: 90 ml of NaP (group A);45 ml of NaP þ 20 mg of Bisacodyl (group B); 4 liters of PEG (group C) or 2 liters ofPEG þ 20 mg of Bisacodyl (group D). The allocation of the randomization wascouncealed. The patients, the doctors who carried out the VCC, the nurses whoconducted surveys on tolerance, the secretary who handed out the boxes to thepatients and the ones in charge of the statistical analysis were blinded to theallocated preparation. The primary outcome was the necessity to repeat the VCCdue to an inadequate preparation. The secondary outcomes were: quality ofpreparation (measured with a validated scale), tolerance to the preparation andadverse effects. Results. From the 353 patients, 3 were excluded post randomizationfor not complying with the inclusion criteria, 7 were unable to finish the study dueto a sigmoid colon stenosis or fixed angulation, and 19 did not undergo the VCC.Information about the primary outcome was obtained from 323 patients (92%). Theprimary outcome (necessity to repeat the study due to an inadequate preparation)was similar in all the groups: A 3.5%, B 4.9%, C 7.1%, D 8.1% (pO0.05). There wereno significant differences regarding the quality of the preparation either. Thecompliance was significantly higher in the NaP preparations (A vs CþD p 0.05, B vsCþD p !0.01) being even higher in the association with Bisacodyl (B vs AþCþDp! 0.01). Patients who received preparations with Bisacodyl presented abdominalpain with more frequency, although this was not a significative observation(pO0.05). The combination of NaP and Bisacodyl was associated with insomnia (p0.039). Conclusion. 90 ml of NaP is more easily completed and equally effective asthe rest of the preparations. The combination with Bisacodyl was associated witha higher number of adverse effects.

M1401

The Risk of Bacterial Contamination to the Endoscopist and

Endoscopy Unit During Routine Esophagogastroduodenoscopy

and ColonoscopyNatasha Chandok, David G. MorganIntroduction: Although personnel in the endoscopy unit are exposed to entericpathogens, documented instances of infectious complications are rare. There areno controlled studies on the risk of bacterial transmission from the patient to theendoscopist or endoscopy unit during routine esophagogastroduodenoscopy(EGD) and colonoscopy. It is common for individual institutions to develop theirown guidelines on preventing infection with little or no supporting evidence. Aim:To determine the risk of bacterial infection to the endoscopist and endoscopy unitduring routine EGD and colonoscopy among outpatients at a university teachinghospital. Methods: 50 random outpatient endoscopic procedures done atMcMaster University from May to July 2008 were examined. Before each procedure,the endoscopist changed into a sterile surgical shirt and scrubbed their hands withantimicrobial soap. Subsequently, the endoscopist wore clean non-latex gloves anda disposable plastic apron. Swabs were taken of the endoscopist’s face andforearms before and after the procedure. Agar plates were placed within 1 meter ofthe procedure to assess for airborne contamination. Results: 21 EGD’s and 29colonoscopies were analyzed. Swabs taken from the forearms before theprocedure were sterile, and swabs taken from the face showed innumerablecolonies with mixed skin flora. After the procedure, right forearm cultures werepositive in 6 of 50 procedures, 5 of these being colonoscopies. The left forearmcultures were positive in 2 colonoscopies. There was no increased growth ofbacteria on the face. Cultures of the endoscopy work-place one meter from theendoscopic procedure grew 1 or 2 colonies of bacteria on average. Conclusion:The endoscopist is at minimal risk for bacterial contamination throughcolonoscopies, and less so with EGD’s. Routine EGD and colonoscopy does notimpose a risk of bacterial contamination of the face, so face shields are notrequired. The most likely place for the endoscopist to become contaminated is theright arm, likely because this is the arm which manipulates the scope and is closestto the patient. There is minimal contamination of the endoscopy work place.Wiping counters with antiseptic cleansers and exercising handwashing betweenpatients should be routine practice.

M1402

Weekend Versus Weekday Management and Prognosis of Upper

GI Bleeding: Results of a Post Hoc Subanalysis of a French

Prospective StudyStephane Nahon, E. Alexandre Pariente, Bernard Denis, Bernard Nalet,Herve Hagege, Bruno Bour, Roger Faroux, Jean-Pierre Arpurt,Jacques Denis, Jean HenrionBackground: Hospital staffing is often lower at weekends than on weekdays.Consequently, it may be difficult to perform endoscopies and if necessary anappropriate endoscopic treatment. The aims of this study were to evaluate thecharacteristics and prognostic factors of upper GI bleeding (UGIB) during

www.giejournal.org