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Poor inpatient colonoscopy preparations can provide multiple challenges to healthcare providers and patients alike. Poor preparations can make the colonoscopy difficult to perform, and can require the procedure to be repeated. This can in turn lead to greater costs, longer length of stays, less patient satisfaction and worse outcomes. The aim of this quality improvement project was to decrease the rate of poor inpatient colonoscopy preparations using the plan-do-study-act approach. Inpatient colonoscopies at our institution from a 3-month span (November 2016 to January 2017) were evaluated, and found to have a 19% rate of poor preparations. A multiphase intervention programme was then conducted to improve the quality of these preparations. This intervention programme was threefold, and involved (1) direct education to physicians and nursing staff on the preparation process and its importance; (2) the implementation of an electronic order set within our electronic medical record (EMR) to standardise and simplify the process of ordering colonoscopy preparations; and (3) patient education in the form of a handout explaining the steps and importance of a good preparation. Through these interventions, we were able to bring down our rate of poor preparations over a 3-month average from 19% to 4%. Specifically, the implementation of an electronic order set within our EMR resulted in the greatest impact. Our interventions can be replicated at other institutions in order to decrease the rate of poor preparations, and thus result in better outcomes for patients, providers and healthcare facilities.

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Background: Multiple devices are available for tissue approximation, and a new through-the-scope suturing (TTSS) device has recently been introduced. However, data on this device’s scope of use and clinical effectiveness are limited. Thus, we aimed to assess the clinical course and effectiveness of this TTSS device. Methods: A retrospective review was performed for consecutive patients who underwent the application of the TTSS. The primary outcomes were the technical and clinical success of the procedure, and the secondary outcome was the adverse event(AE) and long-term clinical success. Results: Fifty-three patients (mean age, 67.8 y; 69.8% females) were included. Technical success was achieved in 96.2% of patients, with a mean defect size of 32.6± 11.9 mm. Clinical success was achieved in 49(92.4%) patients. Two patients (3.8%) had failed fistula closure after technical success. Long-term follow-up(>30 days) was noted in 84.9% of patients, with a mean follow-up of 7.2 months. One patient(1.9%) had AE as self-reported bleeding that did not require further intervention. Conclusions: The use of TTTS is an effective and safe method for the closure of large GI defects and can be utilized for fistula closure and stent fixation. TTSS is a valuable addition to the armamentarium of endoscopic closure devices.

Introduction: Endoscopic ultrasound-guided biliary drainage (EUS-BD) is the procedure of choice for patients who cannot undergo endoscopic retrograde cholangiopancreatography (ERCP). The outcomes of patients undergoing surgery after EUS-BD for malignancy are unknown. Methods:We conducted an international, multicenter retrospective comparative study of patients who underwent hepatobiliary surgery after having undergone EUS-BD or ERCP from 6 tertiary care centers. Patient demographics, procedural data, and follow-up care were collected in a registry.Results: One hundred forty-five patients were included: EUS-BD n = 58 (mean age 66, 45% male), ERCP n = 87 (mean age 68, 53% male). The majority of patients had pancreatic cancer, cholangiocarcinoma, or gallbladder malignancy. In the EUS-BD group, 29 patients had hepaticogastrostomy, 24 had choledochoduodenostomy, and 5 had rendezvous technique done. The most common surgery was Whipple in both groups (n = 41 EUS-BD, n = 56 ERCP) followed by partial hepatectomy (n = 7 EUS-BD, n = 14 ERCP) and cholecystectomy (n = 2 EUS-BD, n = 2 ERCP). Endoscopy clinical success was comparable in both groups (98% EUS-BD, 94% ERCP). Adverse event rates were similar in both groups: EUS-BD (n = 10, 17%) and ERCP (n = 23, 26%). Surgery technical success and clinical success were significantly higher in the EUS-BD group compared with the ERCP group (97% vs. 83%, 97% vs. 75%). Total Hospital stay from surgery to discharge was significantly higher in the ERCP group (19 d vs. 10 d, P = 0.0082).Discussion: Undergoing EUS-BD versus ERCP before hepatobiliary surgery is associated with fewer repeat endoscopic interventions, shorter duration between endoscopy and surgical intervention, higher rates of surgical clinical success, and shorter length of hospital stay after surgery.

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