Conclusion: Our study highlights a signi fi cant increase in performance rates of scheduled screening colonoscopies with a 74% increase after implementation of a DNP and MyChart app utilization. Usefulness of digital applications in improving screening colonoscopy adherence and reducing no show rates, has been well studied in literature with promising results, but implementation on a larger scale is lacking. Especially after COVID-19 pandemic, use of technology to increase adherence to CRC screening and surveillance seems more warranted.

A hiatal hernia is a prolapse of the contents of the abdominal cavity into the mediastinum through the esophageal hiatus. It is a fairly common condition seen in up to half of the individuals older than 50 years of age. Although usually asymptomatic, hiatal hernias typically present as gastroesophageal reflux disease (GERD). Life-threatening cases are extremely rare and those reported are mostly in patients with comorbidities and incarcerated paraesophageal or mixed hiatal hernias. This is a case of a patient with mixed hiatal hernia presenting with chest pain and shortness of breath upon arrival, and later developed shock and lactic acidosis. We describe a case of an 85-year-old woman with a history of hypertension, hyperlipidemia and recently diagnosed GERD. She presented to the emergency room with acute onset shortness of breath, epigastric pain and chest pain. The pain was described as sharp and tearing in nature, 8/10 in intensity, and radiating to her back with severe associated shortness of breath. On physical examination, she was found to be hypotensive, tachycardic and in respiratory distress. Prominent bowel sounds were heard in the thoracic cavity. Initial EKG was not suggestive of ST elevation myocardial infarction. Blood work showed lactic acidosis. She was started on intravenous fluid boluses. An emergent CT angiogram of the chest was done to rule out aortic dissection. The CT scan (Figure 1) revealed her entire stomach herniating into the thoracic cavity, compressing the heart and lungs. She was taken emergently to the operating room and laparoscopic hiatal hernia repair was performed. Post-operatively, she was monitored in the intensive care unit and underwent an uneventful recovery. In the 1970s-80s, hiatal hernia was considered an innocent bystander in regards to GERD, but recent literature suggests the increased significance of hiatal hernia in the pathogenesis of the disease. Our patient was recently diagnosed with GERD, probably due to a hiatal hernia. Earlier recognition and intervention could have prevented this life-threatening complication. A new onset of GERD in an elderly patient should raise suspicions of a hiatal hernia as a contributing factor. This case also highlights the importance of maintaining a high index of suspicion of a hiatal hernia as an uncommon etiology presenting with non-cardiac, life-threatening chest pain or shortness of breath.Figure: CT Scan Images.

Introduction: The adenoma detection rate (ADR), defined as the percentage of screening colonoscopies with one or more histologically confirmed adenoma detected, is recognized as an important quality measure for improved outcomes of screening colonoscopies. Prior studies have identified some patient and technical factors that affect ADRs; however, few studies have evaluated the effect of common comorbid conditions encountered routinely in an outpatient community setting. The aim of this study is to determine if the very common comorbid conditions of diabetes mellitus (DM), hypertension (HTN), and obesity, affected ADR. Methods: This study is a retrospective analysis of all average-risk patients undergoing screening colonoscopy at our outpatient endoscopy centers from July 1, 2016 to December 31, 2016. Demographics, comorbidities and pathology results were recorded for all patients. The effect of DM, HTN, and obesity (defined as BMI >30 kg/m2), as independent variables on ADR was assessed by calculating odds ratio; P values for a 95% confidence interval was calculated using the chi-squared test.Table: Table. Baseline Characteristics of all Patients and Variation of Adenoma Detection Rate with Gender, Diabetes Mellitus, Hypertension, and ObesityResults: A total of 2365 screening colonoscopies were performed during the study period, and 898 colonoscopies identified at least one adenoma yielding an overall ADR of 37.97%. 13.5% (320/2365) of patients had DM, 39.1% (927/2365) had HTN, and 34.1% (927/2364) were obese. It was possible for a patient to have more than one comorbid condition. The mean age of the study population was 59.12 years, and 46.81% were male. The ADR for patients with DM was 43.13% as compared to 37.16% for patients without DM (P<0.05), (OR 1.2820; 95% CI 1.0098 - 1.6277) (Table 2). The ADR for patients with HTN was 39.59% as compared to 36.93% for patients without HTN (P=0.19), (OR 1.1194; 95% CI 0.9447-1.3264) (Table 3). The ADR for obese patients was 41.19% while ADR for non-obese patients was 36.31% (P<0.05), (OR 1.2288; 95% CI 1.0324 - 1.4626) (Table 4).Table: Variation of Adenoma Detection Rate with Diabetes Mellitus and Hypertension.Table: Variation of Adenoma Detection Rate with Obesity.Conclusion: In the community endoscopy suite setting, a physician's ADR can vary depending on their patient population. Our study revealed the ADR is significantly higher in patients with DM and obesity when compared to patients without such comorbidities. Further studies are warranted to better understand the role of patient comorbidities in ADR assessment.

Introduction: The Adenoma Detection Rate (ADR) is the proportion of screening colonoscopies with at least one histologically confirmed adenoma detected. Higher ADR is associated with improved outcomes and is widely accepted as a quality measure to report. Unfortunately, various reporting registries are inconsistent with ADR calculation, in particular, if to include the 10-year follow-up screening examination. Even national experts seem divided over the inclusion of 10-year follow-up screening colonoscopies for ADR calculation. The aim of this study is to determine if there is a difference in ADR for initial screening colonoscopies vs. 10-year follow-up examination after an initial negative screen. Methods: This study is a retrospective analysis involving average-risk patients who underwent a screening colonoscopy in our GI practice in the year 2015. Group 1 comprised of patients undergoing initial screening colonoscopy and Group 2 consisted of patients who underwent a 10-year follow-up study after an initial negative study. We excluded high-risk patients. Patient demographics and comorbidities were assessed, and ADR was calculated for each group. The two groups were compared using the t-test for means and the difference in ADR was calculated using the chi-squared test. Results: A total of 4092 screening colonoscopies were performed on average-risk individuals in 2015. Group 1 comprised of 3052 patients with no prior colonoscopy, and Group 2 consisted of 1040 patients with a negative study ten years earlier. The two groups had similar gender distribution (Group 1: 46.70% males vs. Group 2: 46.33% males; p=0.92), BMI (Group 1: 28.91±5.82 vs. Group 2: 28.67±5.74; p=0.38) and smoking status (Group 1: 19.29% vs. Group 2:18.53%; p=0.66) (Table 1). The initial screening colonoscopy group was younger (54.36±5.60 years old vs. 63.66±5.97 years old; p < 0.00001) and less likely to have DM (10.95% vs. 15.19%; p=0.01) as compared to the 10-year follow-up study group. The ADR for Group 1 was 33.88% vs. 32.5% for Group 2; p=0.56( Figure 1).Figure 1Table 1: Baseline Characteristics and Comorbidities of Patients Included in the Study.Conclusion: Due to lack of supporting data, experts remain divided over whether to include 10-year follow-up screening colonoscopies for ADR calculation. Our study suggests that ADR is same for initial screening colonoscopy and 10-year follow-up screening examination, and hence, both groups should be included in ADR calculation.

We present here a case of 22 years old male who sustained road traffic accident, crushed between two vehicles, suffering complete transaction of the trachea extending from C7-D1 level to D3-4 level. Patient sought immediate medical assistance at the nearest medical centre with complaints of respiratory distress and subcutaneous emphysema; referred to a tertiary care hospital. Fibreoptic bronchoscopy was performed; airway was secured by placing the endotracheal tube tip distal to the distal tracheal disruption site. It was an interesting and challenging case, as patient had only airway trauma and no other injury. Surgical repair was done on 8th day of injury. Patient developed chest infections and septicemia, treated as per sepsis guidelines and using mechanical ventilation. He responded to treatment, recovered and was extubated on 40th day. Tracheal stenosis at the site of repair was observed on Fibreoptic bronchoscopy and CECT (Contrast enhanced computer tomography) chest.