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P115 Standardising assessment and documentation of pouchoscopy

V. A. van der Ploeg1, Y. Maeda*1, O. D. Faiz1, A. L. Hart2, S. K. Clark1

1St Mark’s Hospital, Department of Surgery, Harrow, United Kingdom, 2St Mark’s Hospital, Department of Gastroenterology, Harrow, United Kingdom

Background

Systematic endoscopic evaluation of an ileo-anal pouch is important in assessing pouch dysfunction. Endoscopists are often inexperienced in pouchoscopy and tend to report abnormal findings only. However, a systematic approach is important and normal findings may be equally important in the diagnostic or therapeutic process.The aims of this study were to develop a standardised reporting template and review the status of pouchoscopy reports. Secondary aims were to implement this template to standardise pouchoscopy reports and see if the standard of documentation improved as a result.

Methods

A group of ileo-anal pouch experts (n = 4) compiled a list of items that should be documented at pouchoscopy. Reports over a period of 3 months were reviewed for their completeness compared with the template. The template was then introduced for 3 months, and reports obtained during that time were analysed.

Results

In total, 121 reports, generated between March 2015 and June 2015, were reviewed. The anus and peri-anal area was specifically described in 12% of the reports, rectal cuff in 55%, pouch-anal anastomosis in 37%, pouch body in 98%, pouch inlet in 13%, and pre-pouch ileum in 61%. From August 2015 until November 2015, the template was introduced, and 63 reports were obtained. There was a significant improvement in documentation of the anus and peri-anal area (to 51%, p < 0.0001), rectal cuff (to 75%, p = 0.0104), pouch-anal anastomosis (to 67%, p = 0.0002), and pouch inlet (to 41%, p < 0.0001). Overall, there was a significant improvement in documentation 15 out of 22 features.

Sub-analysis to review the improvement of documentation of absence of inflammation, showed a significant improvement in all 3 anatomical sites (rectal cuff p = 0.0012, pouch body p = 0.0004, and pre-pouch ileum p < 0.0001).

In both retrospective and prospective analysis, findings concerning the rectal cuff were reported by endoscopy nurses more often than by consultants (p < 0.0001 and p = 0.0008), and the pouch inlet was documented more often by consultants (p < 0.0087 and p = 0.0003). By introducing the template, documentation by consultants improved for the anus and peri-anal area (p = 0.0333), pouch inlet (p < 0.0001), and pre-pouch ileum (p = 0.0409). Documentation by endoscopy nurses improved for the anus and peri-anal area (p < 0.0001), as well as the pouch-anal anastomosis (p < 0.0001), pouch inlet (p = 0.0046), and pre-pouch ileum (p = 0.0152).

Conclusion

The introduction of the template improved documentation of pouchoscopy significantly, including the documentation of normal findings. The template universally improved documentation across different types of endoscopists.