Background Colonoscopy is the predominant method for colorectal cancer screening in the US. Prior studies have documented variation across physicians in colonoscopy quality as measured by the adenoma detection rate (ADR). ADR is the primary quality measure of colonoscopy exams and an indicator of the likelihood of subsequent patient colorectal cancer. There is interest in mechanisms to improve ADR. In Central Illinois, a local employer and a quality improvement organization partnered to publically report physician colonoscopy quality. Objective To assess whether this initiative was associated with an improvement in ADR. Design This study compares ADR before and after public reporting at a private practice endoscopy center of 11 gastroenterologists in Peoria, Illinois who participated in the initiative. To generate ADR, colonoscopy and pathology reports from exams performed over four years at the endoscopy center were analyzed using previously validated natural language processing software. Setting Central Illinois Endoscopy Center Results The ADR for colonoscopy in the pre-public reporting era was 25.1%, and after public reporting was 36.4% (increase of 11.3%, p<0.001). Detection of advanced adenomas increased from 10.0% to 12.7% (p<0.001). Each physician’s ADR increased (range of 4.3% to 17.4%). Similar increases in ADR were observed when the analysis was restricted to screening colonoscopy. Limitation There was no concurrent control group to assess whether the increased ADR was due to a secular trend. Conclusion A public reporting initiative on colonoscopy quality was associated with a relative forty-five percent increase in ADR and a 25% increase in advanced adenoma detection. Public reporting may be a means to improve colonoscopy quality.

Oral midazolam significantly reduces anxiety and pain during flexible sigmoidoscopy as assessed by both patients and physicians. Oral midazolam is a safe and effective premedication before flexible sigmoidoscopy in patients who require or prefer sedation.

We report a case of gastrointestinal tuberculosis, presenting with both massive upper and lower gastrointestinal bleeding that required two emergency operations. Massive bleeding is rare in gastrointestinal tuberculosis because of associated obliterative endarteritis. Tuberculosis should be considered in the differential diagnosis of massive gastrointestinal bleeding in the appropriate clinical setting even in an immunocompetent patient.

We report a case of gastrointestinal tuberculosis, presenting with both massive upper and lower gastrointestinal bleeding that required two emergency operations. Massive bleeding is rare in gastrointestinal tuberculosis because of associated obliterative endarteritis. Tuberculosis should be considered in the differential diagnosis of massive gastrointestinal bleeding in the appropriate clinical setting even in an immunocompetent patient.

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