Colonoscopy cecal intubation rates appear to decline with successive procedures. There also appears to be a trend for insertion times to lengthen. Reassuringly, other quality indicators of colonoscopy (lesion detection and withdrawal time) and EGD duration do not appear to be impacted by repetitive procedures.

Background and AimTransient elastography (TE) and point shear wave elastography (pSWE) are noninvasive methods to diagnose fibrosis stage in patients with chronic liver disease. The aim of this study is to compare the accuracy of the two methods to diagnose fibrosis stage in non‐alcoholic fatty liver disease (NAFLD) and to study the intra‐observer and inter‐observer variability when the examinations were performed by healthcare personnel of different backgrounds.MethodsConsecutive NAFLD patients who underwent liver biopsy were enrolled in this study and had two sets each of pSWE and TE examinations by a nurse and a doctor on the same day of liver biopsy procedure. The medians of the four sets of pSWE and TE were used for evaluation of diagnostic accuracy using area under receiver operating characteristic curve (AUROC). Intra‐observer and inter‐observer variability was analyzed using intraclass correlation coefficients.ResultsData for 100 NAFLD patients (mean age 57.1 ± 10.2 years; male 46.0%) were analyzed. The AUROC of TE for diagnosis of fibrosis stage ≥ F1, ≥ F2, ≥ F3, and F4 was 0.89, 0.83, 0.83, and 0.89, respectively. The corresponding AUROC of pSWE was 0.80, 0.72, 0.69, and 0.79, respectively. TE was significantly better than pSWE for the diagnosis of fibrosis stages ≥ F2 and ≥ F3. The intra‐observer and inter‐observer variability of TE and pSWE measurements by the nurse and doctor was excellent with intraclass correlation coefficient > 0.96.ConclusionTransient elastography was significantly better than pSWE for the diagnosis of fibrosis stage ≥ F2 and ≥ F3. Both TE and pSWE had excellent intra‐observer and inter‐observer variability when performed by healthcare personnel of different backgrounds.

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There is a willingness to embrace CRC screening and to shoulder some of the financial burden that this entails.

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times for procedures. Physician unavailability may contribute to considerable delays in endoscopic procedures. 2 Leighton 3 address the importance of delivering the highest quality care in the most efficient and cost-effective manner. To validate their results, we report herein our annual volume of endoscopies and colonoscopies over the past 3 years. Our findings indicate that the main factor in procedure volume and efficiency in an endoscopy unit is room turnover time, as already demonstrated by Zamir and Rex. 4 This retrospective analysis was conducted at University Hospital Germans Trias, a tertiary-care referral and teaching hospital that provides postgraduate endoscopic training for gastroenterology fellows. Our annual endoscopy volume is approximately 8000 procedures, and our endoscopy unit comprises 4 endoscopy rooms and 1 recovery room. Two rooms are for full-time endoscopy and colonoscopy, and the other 2 are used as needed for EUS and ERCP. One full-time endoscopy nurse works in each room. Procedures are performed by experienced endoscopists (3 staff members) or senior fellows. For colonoscopies, intravenous propofol is routinely administered by an anesthesiologist. The unit is operated 11 hours per day, from 9 AM to 8 PM, with a 1-hour break scheduled for lunch. Between 9 AM and 2 PM, all endoscopists are assigned to a single endoscopy suite. However, from 3 to 8 PM, 1 endoscopist is assigned to 2 rooms. Other strategies to reduce procedure delays are comparable between morning and afternoon: obtaining written consent and intravenous access is performed before the procedure, patients are transported to the endoscopy suite and returned to the recovery room by the hospital porter, and all procedure details are entered into the hospital computerized database located in the endoscopy suite.During the past 3 years, 9787 colonoscopies (3179, 3260, and 3348 each year) and 8134 endoscopies (2759, 2759, and 2616 each year) were performed. Interestingly, we showed that with a 2-rooms-per-endoscopist model, we significantly increased the total number of procedures per endoscopist in the past 3 years (2113 vs 1912, 2283 vs 1868, 2173 vs 1896, respectively; P ! .05). The overall increase in the number of procedures was 11.3%, and we agree with Sipe et al 5 that propofol use increases the recovery rate and shortens the time to discharge. Nevertheless, our findings should be interpreted in light of the strengths and limitations of the study because we realize that involvement of trainees is associated with prolonged procedure duration.The correspondence from Boix et al provides helpful insight into the aspects of endoscopic procedures that influence overall practice efficiency. Their findings underscore the major role that room turnover time plays in procedure efficiency. By using 2 rooms per endoscopist, they found that procedure numbers per endoscopist increased from 5676 to 6569 over 3 years. These results corroborate the findings from our recent study that further illustrate the role of using 2 rooms per endosc...