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CAPtain PREP-A Better colonoscopy prep quality scoring tool

by Vikas Khullar, M.D.

CAPtain(Computer-Assisted program) Prep is a tool that provides you information on your colonoscopy prep to help you determine if you got the best colon-cancer screening possible!

Gainesville, FL Colorectal Cancer

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About this project

The problem we solve:
Colorectal cancer is the third leading cause of cancer death in the United States. Colonoscopy has become the gold-standard for screening and surveillance of colo-rectal cancer given its ability to detect and remove pre-cursor lesions. The effectiveness of the colonoscopy however depends on adequate visualization of the colonic mucosa in order to avoid missing lesions and to determine the appropriate follow-up interval for repeat procedures. Current guidelines recommend early repeat colonoscopy in patients who are deemed to have an inadequate prep defined as the inability to identify lesions >5 mm. However, no tool is currently available on how to determine if the bowel preparation is adequate to identify lesions > 5mm in size and hence the ability of gastroenterologists to recommend repeat colonoscopy intervals in patients without excellent colonoscopy preparation is limited. Often, patients are recommended sooner than appropriate intervals for surveillance.
About our solution:
Currently only a few scoring systems exist for the evaluation of bowel preparation quality however, none of them objectively categorize them as clinically acceptable for colon-cancer prevention. We propose a better colonoscopy prep scoring system that would incorporate technology to determine the most-appropriate follow-up surveillance intervals for colonoscopy. For the purposes of this project, we would require a computer program that would determine the percentage of colonic mucosa visualized during colonoscopy and provide an objective value for the quality of bowel preparation. Using a dichotomy such as adequate or inadequate based on this system, it would immensely help endoscopists determine follow-up colonoscopy surveillance intervals based on type of polyps resected, reduce costs of early-unnecessary colonoscopies, decrease the risk to patients from unnecessarily early procedures and decrease interval cancers between colonoscopies.
Progress to date: Currently, we are in the process of testing a prototype computer algorithm that would objectively identify the percentage of mucosa seen during colonoscopy and also be able to identify polyps using a video of the procedure. We are in the process of filling an IRB for this project and looking for funding sources for the study.

About Our Team


Dr. Vikas Khullar, M.D.
Gastroenterology, Resident
Medical school: St. George's University
Bio: Hello. I am currently a first-year Gastroenterology fellow at the University of Florida in Gainesville. After doing my residency at the same institution for three years, I felt gastroenterology was the field that provided me with the most satisfaction and had a complete mix of pathology and ages of patients I wanted to treat. While I am in my first of three year program, I have a special interest in quality improvement as well as improving accessibility to healthcare for my patients.
Hospital Affiliation: UF Health Shands Hospital - Gainesville
Title: CAPtain PREP: A cost-effective and patient-centered project to help determine appropriate surveillance colonoscopy interval

About Team Members

Brian Weiner
Clinical Associate Professor, Medicine/Gastroenterology, M.D., M.S., F.A.C.P., A.G.A.F.
Biography: Dr. Brian Weiner is responsible for the idea of the project. He is a gastroenterologist at the University of Florida - Division of Gastroenterology and Hepatology in Gainesville. He has interests in prevention of colon cancer and virtual colonoscopy technology. He has addressed national audiences in this area. Dr. Weiner also has patents and patents pending in other areas of medical technology.

About Our Company

CAPtain Prep
Location: Gainesville, Florida
Product stage: idea
Sales: Working on it
Employees: 3-5

How We Help Patients

At this time, patients are recommended repeat colonoscopy based on the risk of colorectal cancer in the average population and assumption that the procedure was adequate or inadequate to detect pre-cancerous polyps. However if the less is less than excellent, most patients are being recommended shorter intervals for surveillance which in turn leads to increased healthcare expenditure as well as exposing patients' to increased risk of procedure and preparation. Our software would not only help identify the adequacy of prep and help with determination of appropriate follow-up intervals, we also plan to improve the algorithm to detect lesions which were missed while doing initial colonoscopy. This may be done in real time or through the means of a second opinion using a video of colonoscopy performed. Identifying patients with missed lesions would help prevent colo-rectal cancer and target patients who need early surveillance colonoscopy the most.

How We Help Education

Our project has the added benefit for transforming physician education in many ways. It can help identify areas of improvement for learners by not only identifying polyps that may have been missed, but also by providing guidance in areas of the colon where it is difficult to maneuver. A video based prep scoring system would be the first of its kind that can also help create basis for many research protocols as it would standardize the way prep is scored. Additionally, a video-recorded system may be used for not only archiving for future needs, but benefits to physician groups of quality assurance and even malpractice defense.

How We Help Physicians

Our project idea has improvement for physician practice as a pivotal outcome. Currently endoscopists have the hard decision based on their assessment of bowel preparation to determine if it was sufficient to have seen pre-cancerous polyps and determine what is the safest surveillance protocol for repeat procedures. When bowel prep is less than excellent, data suggests that most endoscopist recommend shorter intervals. Our project plans to make the decision as simple as possible for endoscopists by ranking bowel prep as adequate vs inadequate which would help them feel comfortable with decision making. We also have plans to incorporate technology to help detect missing polyps which in turn can help physicians identify high risk patients. Additionally, from a medical-legal point-of-view, a video of the procedure can help provide defense and mind-of-ease for physicians who may be sued for poor colonoscopy and missing cancerous lesions.

Challenge Mission

Mission: Our project mission is completely in sync with the mission of AMA and other major medical organizations. Our project has the potential to further improve colon cancer prevention.
Use of funds: At this time, we believe it would be best to use the funds to have a computer engineer refine the process and develop an algorithm for determining adequate colonoscopy preparation with the ability to detect polyps. We plan to use half of the grant for this purpose. The remaining half of the grant would be used for IRB filling and testing the program in real-life colonoscopies at the University of Florida. Some of the funds may be used for patent application.
Intellectual Property Status: At this time, there is a patent pending on our project.
FDA Status: Currently, the project is in its infancy. We plan to first develop a program with the algorithm to successfully accomplish our mentioned goals. We then plan to prove its efficacy at a clinical level at the University of Florida. Once successful, we plan to file for FDA application for evaluation of our methods.
Personal Message: Colo-rectal cancer is the 3rd most common cause of cancer deaths and colonoscopy has been shown to a cost-effective and life-saving diagnostic measure. Yet many people who undergo colonoscopies are found to have colon cancer within a few years of recent evaluation. Our project aims at reducing missed lesions as well as determine an appropriate interval for repeat surveillance to ensure we help patients who undergo colonoscopy get the best evaluation possible. Help us make this possible!

Supporters

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    05/25/2016 Jacques Karcnik - Other

    Liked the project.

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    05/21/2016 Alberto Unzueta - Physician

    Followed the project.

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    05/21/2016 Alberto Unzueta - Physician

    Interested in piloting the project.

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    05/20/2016 Meg Barron - Private

    Liked the project.

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    05/20/2016 Nancy McKnabb - Hospital Staff

    Liked the project.

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    05/19/2016 Ruben Papraniku - Engineer

    Liked the project.

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    05/19/2016 feliks kogan - Physician

    Followed the project.

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    05/19/2016 feliks kogan - Physician

    Liked the project.

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    05/19/2016 feliks kogan - Physician

    Interested in other factor.

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    05/19/2016 feliks kogan - Physician

    Interested in mentorship.

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    05/19/2016 Ruben Papraniku - Engineer

    Followed the project.

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    05/18/2016 Sarah Weiner - Concerned Citizen

    Liked the project.

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    05/18/2016 Brian Weiner - Physician

    Interested in mentorship.

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    05/18/2016 Brian Weiner - Physician

    Interested in trying the project.

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    05/18/2016 David Winchester - Physician

    Liked the project.

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    05/18/2016 Brian Weiner - Physician

    Interested in partnership.

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    05/18/2016 Timothy Guinn - Healthcare Innovator

    Followed the project.

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    05/18/2016 Timothy Guinn - Healthcare Innovator

    Liked the project.

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    05/18/2016 Naueen Chaudhry - Physician

    Liked the project.

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    05/18/2016 Brian Weiner - Physician

    Followed the project.

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    05/18/2016 Brian Weiner - Physician

    Liked the project.

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    05/18/2016 Brian Weiner - Physician

    Interested in piloting the project.

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    05/17/2016 Dr. Vikas Khullar - Resident

    Liked the project.

13

likes

6

Follows

2

Pilots

0

Partners

68

Interest
Score

7

Adoption
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Vikas Khullar, M.D.
Resident
CAPtain PREP: A cost-effective and patient-centered project to help determine appropriate surveillance colonoscopy interval
St. George's University

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