Form:GLNE 007 Colonoscopy v9.0


CDE IDCDE Description
* 421EDRN Participant ID (Go To: 2176)
* 2176Visit code (Go To: 3020)
 
Permissible Values (value):BLN1 (1)
 
 BLN2 (2)
* 3020Colonoscopy date (MM/DD/YYYY): (Go To: 423)
* 423EDRN Protocol ID (Go To: 422)
* 422EDRN Site ID (Go To: 929)
* 929EDRN Staff ID of the person who collected the data: (Go To: 4957)
* 4957Reason(s) for colonoscopy (check all that apply) (Go To: 2986)
 
Permissible Values (value):First time colonoscopy (1)
 
 Surveillance (2) (Go To: 4958)
 
 Routine screening (3) (Go To: 2986)
 
 Repeat colonoscopy due to poor bowel prep (4)
 
 Diagnostic colonoscopy (5) (Go To: 4959)
 
 Other, specify: (97) (Go To: 4960)
 
 Unknown (99)
* 4960Reason for colonoscopy (other, specify) (Go To: 2986)
* 4958Reason for surveillance colonoscopy (Go To: 2986)
 
Permissible Values (value):Colorectal cancer (1)
 
 Adenomas (2)
 
 Family history (3)
 
 Polyps (4)
 
 Unknown (99)
* 4959Reason for diagnostic colonoscopy (Go To: 2986)
 
Permissible Values (value):Flex sig (1)
 
 Fecal Occult Blood Test (FOBT) (2) (Go To: 4967)
 
 Virtual colonoscopy (3)
 
 Barium enema (4)
 
 FIT (5) (Go To: 4967)
 
 Exact Sciences multi-marker panel (6) (Go To: 4967)
 
 Other, specify: (97) (Go To: 4968)
 
 Unknown (99)
* 4968Reason for diagnostic colonoscopy (other, specify) (Go To: 2986)
* 4967Date of test (MM/DD/YYYY) (Go To: 2986)
* 2986Type of preparation (main regimen) used for colonosocpy: (Go To: 3162)
 
Permissible Values (value):Any PEG preparation (1)
 
 Osmoprep (phosphosoda) (2)
 
 Oral Mg Citrate (3)
 
 Dulcolax (4)
 
 Other, specify: (97) (Go To: 4704)
 
 Unknown (99)
* 4704Type of preparation used for colonoscopy (Other, specify): (Go To: 3162)
* 3162Date on which preparation for colonoscopy began (MM/DD/YYYY): (Go To: 2984)
* 2984Quality of the bowel preparation: (Go To: 3159)
 
Permissible Values (value):Excellent (0-4% obscured) (1)
 
 Fair but adequate (5)
 
 Fair but inadequate (6)
 
 Good (5-15% obscured) (2)
 
 Poor (greater than 30% obscured) (4)
* 3159Was the colon completely visualized? (less than 15% obscured, entire colon visualized, and the scope reached the cecum)? (Go To: 2989)
 
Permissible Values (value):No (0) (Go To: 3160)
 
 Yes (1)
* 3160Reason(s) for incompletely visualized colonoscopy: (Check all that apply) (Go To: 2989)
 
Permissible Values (value):Poor sedation (1)
 
 Tortuous colon requiring general anesthesia (2)
 
 Obstructing mass (3)
 
 Other, specify: (97) (Go To: 3161)
* 3161Reason(s) for incompletely visualized colonoscopy: (Other, specify) (Go To: 2989)
* 2989Results of colonoscopy (check all that apply): (Go To: 3146)
 
Permissible Values (value):Normal colon (1)
 
 Cancer (2) (Go To: 3149)
 
 Crohns disease (3)
 
 Ulcerative colitis (4)
 
 Adenoma polyps (6) (Go To: 2996)
 
 Hyperplastic polyps (8) (Go To: 2998)
 
 Other, specify: (97) (Go To: 3010)
* 3010Results of colonoscopy (Other, specify): (Go To: 3146)
* 3149Colorectal adenocarcinoma, quantity: (Go To: 2159)
 
Permissible Values (value):1 (1)
 
 2 (2)
 
 3 (3)
 
 4 (4)
 
 5 (5)
 
 6 (6)
 
 7 (7)
 
 8 (8)
 
 9 (9)
 
 10 (10)
 
 11 (11)
 
 12 (12)
 
 13 (13)
 
 14 (14)
 
 15 (15)
 
 16 (16)
 
 17 (17)
 
 18 (18)
 
 19 (19)
 
 20 (20)
* 2159Specimen line number or identifier (system-generated): (Go To: 3024)
* 3024Location of lesion (colorectal): (Go To: 3008)
 
Permissible Values (value):CE=Cecum (1)
 
 AC=Ascending (2)
 
 HF=Hepatic flexure (3)
 
 TC=Transverse colon (4)
 
 SF=Splenic flexure (5)
 
 DC=Descending colon (6)
 
 SG=Sigmoid colon (7)
 
 RE =Rectum (8)
 
 U=Unobtainable (9)
 
 Unknown (99)
* 3008Colorectal adenocarcinoma, size: (Go To: 3158)
   3158Loop-specific comments: (Go To: 4961)
* 2996Adenoma polyps, quantity: (Go To: 3150)
 
Permissible Values (value):0 (0)
 
 1 (1)
 
 2 (2)
 
 3 (3)
 
 4 (4)
 
 5 (5)
 
 6 (6)
 
 7 (7)
 
 8 (8)
 
 9 (9)
 
 10 (10)
 
 11 (11)
 
 12 (12)
 
 13 (13)
 
 14 (14)
 
 15 (15)
 
 16 (16)
 
 17 (17)
 
 18 (18)
 
 19 (19)
 
 20 (20)
* 3150Specimen line number or identifier 2 (system generated): (Go To: 3175)
* 3175Location of polyp (colorectal): (Go To: 3145)
 
Permissible Values (value):CE=Cecum (1)
 
 AC=Ascending (2)
 
 HF=Hepatic flexure (3)
 
 TC=Transverse colon (4)
 
 SF=Splenic flexure (5)
 
 DC=Descending colon (6)
 
 SG=Sigmoid colon (7)
 
 RE =Rectum (8)
 
 U=Unobtainable (9)
 
 Unknown (99)
* 3145Colon polyp histology or pathology: (Go To: 4705)
 
Permissible Values (value):Adenoma (1)
 
 Carcinoma in situ (2)
 
 High grade dysplasia (3)
 
 Tubulovillous adenoma (5)
 
 Villous adenoma (6)
 
 Sessile serrated adenoma/polyp (7)
 
 Traditional serrated adenoma (8)
 
 Other, specify: (97) (Go To: 3151)
 
 Unknown (99)
* 3151Colon polyp histology or pathology (Other, specify): (Go To: 4705)
* 4705% villous features: (Go To: 3009)
* 3009Adenoma polyp size, cm: (Go To: 3163)
   3163Loop-specific comments 2: (Go To: 4961)
* 2998Hyperplastic polyps, quantity: (Go To: 3011)
* 3011Hyperplastic polyps, size(s), cm: (Go To: 3756)
* 3756Hyperplastic polyps on the right side of the colon (cecum, ascending, hepatic flexure, or transverse)? (Go To: 4706)
 
Permissible Values (value):No (0)
 
 Yes (1)
 
 Unknown (99)
* 4706Pathology notes on hyperplastic polyps: (Go To: 4961)
* 4961Were all lesions removed? (Go To: 3146)
 
Permissible Values (value):No (0)
 
 Yes (1)
 
 Unknown (99)
* 3146Incidental findings, colorectal: (Go To: 1097)
 
Permissible Values (value):Diverticuli (10)
 
 Hemorrhoids (19)
 
 None (44)
 
 Other, specify: (97) (Go To: 3147)
* 3147Incidental findings, colorectal (Other, specify): (Go To: 1097)
   1097Comments (do not include any participant identifiers) (Go To: End of Form)