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Introduction: The Global Rating Scale (GRS) is a quality assurance program that was developed in England to assess patient-centered care in endoscopy. The aim of the current studywas to evaluate patient experiences of colonoscopy using the GRS in order to compare different departments and to provide benchmarks. The study also evaluated factors associated with patient satisfaction. Methods: A GRS questionnaire was used both before and after the procedure in outpatients undergoing colonoscopy. The questionnaire assessed the processes associated with the colonoscopy, from making the appointment up until discharge. Mean values and ranges of 12 endoscopy departments were calculated together with P values in order to assess heterogeneity. Results: In total, 1904 pre-procedure and 1532 (80 %) post-procedure questionnaires were returned from 12 endoscopy departments. The mean time patients had to wait for their procedure was 4.3 weeks (range 3.1-5.8 weeks), and 54% (range 35-64%; P<0.001) reported being given a choice of appointment dates/times. Discomfort during colonoscopy was reported by 20% (range 8-40%; P<0.001). Recovery room privacywas satisfactory for 76% of patients (range 66-90%; P<0.05). The majority of patients reported being sufficiently informed about what to do in case of problems after discharge (79 %, range 43-98%; P<0.001), and 85% of individuals stated that they would be willing to repeat the colonoscopy procedure (range 72-92%; P<0.001). Factors associatedwith a decreased willingness to return were the burdensome bowel preparation (odds ratio [OR] =0.25; P<0.001), "rushing staff" attitude (OR=0.57; P<0.05), low acceptance of the procedure (OR=0.42; P<0.01), and more discomfort than expected (OR=0.54; P<0.05). Conclusion: Overall patient experiences with colonoscopywere satisfactory, but they also showed considerable variation. This study shows that use of a GRS patient questionnaire is feasible in the Dutch endoscopy setting for the assessment of patient experience. The significant variability between endoscopy units can be used to benchmark services and enable shortcomings to be identified. [ABSTRACT FROM AUTHOR]

Introduction: The Global Rating Scale (GRS) is a quality assurance program that was developed in England to assess patient-centered care in endoscopy. The aim of the current study was to evaluate patient experiences of colonoscopy using the GRS in order to compare different departments and to provide benchmarks. The study also evaluated factors associated with patient satisfaction. Methods: A GRS questionnaire was used both before and after the procedure in outpatients undergoing colonoscopy. The questionnaire assessed the processes associated with the colonoscopy, from making the appointment up until discharge. Mean values and ranges of 12 endoscopy departments were calculated together with P values in order to assess heterogeneity. Results: In total, 1904 pre-procedure and 1532 (80 %) post-procedure questionnaires were returned from 12 endoscopy departments. The mean time patients had to wait for their procedure was 4.3 weeks (range 3.1-5.8 weeks), and 54% (range 35-64%; P<0.001) reported being given a choice of appointment dates/times. Discomfort during colonoscopy was reported by 20% (range 8-40%; P<0.001). Recovery room privacy was satisfactory for 76% of patients (range 66-90%; P<0.05). The majority of patients reported being sufficiently informed about what to do in case of problems after discharge (79 %, range 43-98%; P<0.001), and 85% of individuals stated that they would be willing to repeat the colonoscopy procedure (range 72-92%; P<0.001). Factors associated with a decreased willingness to return were the burdensome bowel preparation (odds ratio [OR] =0.25; P<0.001), "rushing staff" attitude (OR=0.57; P<0.05), low acceptance of the procedure (OR=0.42; P<0.01), and more discomfort than expected (OR=0.54; P<0.05). Conclusion: Overall patient experiences with colonos copy were satisfactory, but they also showed considerable variation. This study shows that use of a GRS patient questionnaire is feasible in the Dutch endoscopy setting for the assessment of patient experience. The significant variability between endoscopy units can be used to benchmark services and enable shortcomings to be identified. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The lusorian artery is a rare anomaly of the right subclavian artery. This artery arises from the aortic arch distal of the left subclavian artery, crossing the midline behind the esophagus. Normally this anomaly causes no symptoms. Sometimes dysphagia first appears above the age of 40 yr. METHODS: In the period of 1992-1997, the diagnosis of an aberrant right subclavian artery was made in five patients with dysphagia who were referred to a small community hospital. A sixth patient had a right-sided aorta with an aberrant left subclavian artery. RESULTS: Endoscopy revealed a pulsating impression in the esophagus of three patients. Four patients had coexisting esophageal abnormalities. Barium contrast examination of the esophagus showed a characteristic diagonal impression at the level of the fourth thoracic vertebra in all patients. Computed tomography and angiography confirmed the diagnosis and excluded aneurysms. Manometric investigation of the esophagus revealed nonspecific abnormalities in five patients. Drug treatment was sufficient in three patients (mean follow up, 6.2 yr). Three patients were operated upon because of persistent dysphagia. Through a cervical approach the artery was ligated near its root and connected with the right carotid artery. Postoperatively two patients became symptom-free, the other patient still has intermittent dysphagia. CONCLUSION: Dysphagia can be caused by a rare anomaly of the subclavian artery. The diagnosis can be overlooked at endoscopy, but barium contrast study of the esophagus will reveal the abnormality. In patients with coexisting esophageal abnormalities the finding may be incidental and specific conservative treatment may be sufficient. Manometry cannot be used to diagnose this condition or to predict surgical outcome. When the symptoms are intractable, surgical correction should be considered even if coexisting esophageal abnormalities are present. [ABSTRACT FROM AUTHOR]

Chronic ingestion of liquorice induces a syndrome with findings similar to those in primary hyperaldosteronism. We describe a patient who, with a plasma K+ of 1.8 mmol/l, showed a paralysis and severe rhabdomyolysis after the habitual consumption of natural liquorice. Liquorice has become widely available as a flavouring agent in foods and drugs. It is important for physicians to keep liquorice consumption in mind as a cause for hypokalaemic paralysis and rhabdomyolysis.

Two female patients, aged 54 and 67 years, respectively, had suffered from watery diarrhoea for several weeks or months without cramps or blood in the stools. The findings upon physical examination, blood and faecal examination and endoscopy were normal, and subsequent histological examination of intestinal biopsies revealed collagenous colitis. After treatment with a high-fibre diet, sulphasalazine and either prednisone or budesonide, the symptoms subsided. Collagenous colitis is a chronic watery diarrhoea disorder with unknown aetiology and pathogenesis. It is characterised by macroscopically normal mucosa, while histopathologically an abnormal thickening of the subepithelial collagenous layer and an increase in the number of intra-epithelial lymphocytes is found. There are various treatment options such as dietary fibre, mesalazine or bismuthsubsalicylate. Recently budesonide has been found to have a favourable effect both clinically and histologically. Complications of the disease are rare.

The frequency of adenocarcinomas at the oesophagocardial junction is increasing and, if symptomatic, the patients chances of cure are bleak. Given the association of Barrett's oesophagus (Barrett's oesophagus; denoting metaplasia of the oesophageal squamous cell lining to gastric-type mucosa) and oesophageal adenocarcinoma, it is plausible that establishing the presence of Barrett's oesophagus will subsequently enable two preventive strategies: primary, i.e. the treatment and eradication of Barrett's oesophagus, and secondary, the early diagnosis of (pre)malignancy during periodic endoscopic follow-up. Given the frequent occurrence of Barrett's oesophagus and the rarity of oesophageal adenocarcinoma there is a clear risk of overdiagnosis and overtreatment. Most studies on the effect of regular follow-up are uncontrolled and barely give any indication of a favourable outcome. Only a minority of patients with Barrett's oesophagus ought to have periodic endoscopic checkups: those with dysplasia or with one or more of the known risk factors (especially male gender, specialised type Barrett's oesophagus and long segment Barrett's oesophagus). Those patients must be healthy enough beforehand to undergo surgical treatment if necessary. The amount of quantity or quality of life that may be gained from this approach has yet to be established.