Evaluation of different bowel preparations for small bowel capsule endoscopy: a prospective, randomized, controlled study.

BACKGROUND AND STUDY AIMS: To obtain an adequate view of the whole small intestine during capsule endoscopy (CE) a clear liquid diet and overnight fasting is recommended. However, intestinal content can hamper vision in spite of these measures. Our aim was to evaluate tolerance and degree of intestinal cleanliness during CE following three types of bowel preparation. PATIENTS AND METHODS: This was a prospective, multicenter, randomized, controlled study. Two-hundred ninety-one patients underwent one of the following preparations: 4 L of clear liquids (CL) (group A; 92 patients); 90 mL of aqueous sodium phosphate (group B; 89 patients); or 4 L of a polyethylene glycol electrolyte solution (group C; 92 patients). The degree of cleanliness of the small bowel was classified by blinded examiners according to four categories (excellent, good, fair or poor). The degree of patient satisfaction, gastric and small bowel transit times, and diagnostic yield were measured. RESULTS: The degree of cleanliness did not differ significantly between the groups (P = 0.496). Interobserver concordance was fair (k = 0.38). No significant differences were detected between the diagnostic yields of the CE (P = 0.601). Gastric transit time was 35.7 ± 3.7 min (group A), 46.1 ± 8.6 min (group B) and 34.6 ± 5.0 min (group C) (P = 0.417). Small-intestinal transit time was 276.9 ± 10.7 min (group A), 249.7 ± 13.1 min (group B) and 245.6 ± 11.6 min (group C) (P = 0.120). CL was the best tolerated preparation. Compliance with the bowel preparation regimen was lowest in group C (P = 0.008). CONCLUSIONS: A clear liquid diet and overnight fasting is sufficient to achieve an adequate level of cleanliness and is better tolerated by patients than other forms of preparation.

[Programme of screening for colorrectal cancer in the Valencia community, Spain: results of the first round (2005-2008)]. / Programa de cribado de cáncer colorrectal de la comunidad valenciana: Resultados de la primera ronda: 2005-2008.

BACKGROUND: Several studies evaluating colorectal cancer (CRC) screening with fecal occult blood testing (FOBT) have reported a significant reduction in mortality from this tumor. The study aims to describe the results of the first round of the CRC screening program in medium-risk population of Valencia and assessing their feasibility and acceptability. METHODS: Colorectal cancer screening pilot study using biennial FOBT. All residents (106,000 Inhabitants) between 50 and 69 years old (a subgroup of 70-74 years), from 3 selected health departments (04, 07 and 13) were invited by mail to participate. The individuals with FOBT positive were referred to hospital for colonoscopy. The following rates were calculated as indicators of program quality: the participation rate, positive FOBT rate, acceptance rate of colonoscopy, and detection rate of low and high-risk adenomas and invasive cancers, and positive predictive value of FOBT. RESULTS: The participation was 35,231 individuals (35.70%). The number of FOBT positive was 579 (1.64% of total analyzed test), 548 people agreed colonoscopy (acceptance rate: 94.69%). 61 CRC were detected, 61 and 153 High-Risk and Low-Risk Adenomas (rates of 1.77, 1.77 and 4.46% per 1,000 participants). The positive predictive values for cancer, low-risk and high risk adenomas were 10.95%, 10.95%, and 27.46% respectively. CONCLUSION: The program indicators suggest that a population program of colorectal cancer is feasible in our community as the process indicators obtained are similar to those given in other programs in Spain and Europe.