An Intraprocedural Endoscopic Cleansing Device for Achieving Adequate Colon Preparation in Poorly Prepped Patients.

BACKGROUND AND AIMS: An effective bowel preparation is essential for quality colonoscopy. Inadequate preparation results in missed lesions, need for earlier repeat procedures, prolonged colonoscopy duration, an increased likelihood of adverse events, reduced patient satisfaction, and increased costs. The MOTUS GI Pure-Vu System (Tirat Carmel, Israel) is an Food and Drug Administration-cleared device designed to improve visualization in an inadequately prepared colon by facilitating intraprocedural cleaning. We evaluated the efficacy, safety, and usability of the Pure-Vu System in cleansing poorly prepared colons in human subjects. METHODS: In total, 50 patients with poorly prepared colons undergoing colonoscopy were prospectively enrolled to evaluate the Pure-Vu System at 2 clinical sites [Spain (N=41) and Israel (N=9)]. Cleansing quality was measured using the Boston Bowel Preparation Score (BBPS). RESULTS: In total, 50 patients (64% male individuals), mean age 51.9±10.4 years, and mean body mass index of 26.6±3.1 were enrolled. The Pure-Vu System significantly increased the BBPS median score from 5.0 at baseline to 9.0 after the use of Pure-Vu (P<0.0001). Patients with an adequate cleansing level (BBPS≥2 in each colon segment) increased significantly from 31% (15/49) at baseline to 98% (48/49) after use of Pure-Vu (P<0.001). Cecal intubation was achieved in 48/49 (98%) patients. Colonoscopists were satisfied with the Pure-Vu System. No serious adverse events were reported. CONCLUSIONS: The Pure-Vu System was found to be safe, efficacious, and easy to use in cleansing inadequately prepared colons, enabling the colonoscopist to conduct a complete examination.

[Effectiveness of percutaneous drainage in the treatment of abdominal fluid collections in inflammatory pancreatic disease]. / Efectividad del drenaje percutáneo en el tratamiento de las colecciones abdominales asociadas con una enfermedad inflamatoria del páncreas.

AIMS: To assess the effectiveness of ultrasonography-guided percutaneous drainage (UGPD) in the management of fluid collections (FC) in acute and chronic pancreatitis, and to evaluate factors associated with treatment results. METHOD: Seventy-two patients with pancreatic fluid collections ranging from 5 to 20 cm (median 9 cm) were studied. There were 27 type I pseudocysts (PC), 12 type II PC, 13 type III PC, 16 abscesses, and 4 acute fluid collections. Catheters were placed in 60 patients and simple aspiration was performed in 8 patients. UGPD could not be performed in 4 patients. RESULTS: UGPD was curative in 39 patients (54.1%): 44.4% in type I PC, 83% in type II PC, 30.7% in type III PC, 62.5% in abscesses, and 75% in acute FC. Resolution was achieved in 35.7% of patients with pancreatic duct communication and in 71.4% of those with non-communicated FC. No differences in effectiveness were observed according to the etiology of pancreatitis, pancreatic duct obstruction, drainage method, or the number or size of FC. UGPD was effective in 45.8% of the procedures performed before 1993, in 58.3% of those performed between 1993 and 1999, and in 63.6% of those performed after 2000. The complication rate was 37.5% and all complications were mild. CONCLUSIONS: UGPD is an effective treatment for pancreatic FC. The effectiveness of this method depends on appropriate patient selection and careful management of acute pancreatitis. Outcomes were less favorable in patients with type III PC and in those with duct communication.

Dilutional hyponatremia in patients with cirrhosis and ascites.

OBJECTIVES: To analyze the predisposing factors, modifications of vasoactive systems, and prognosis of patients with cirrhosis and hyponatremia. PATIENTS AND METHODS: Fifty-four patients with hyponatremia (serum sodium level of <130 mEq/L after 5 days of hyponatremic diet and no diuretic therapy). Twenty cirrhotic patients served as controls. We measured plasma renin activity and levels of plasma aldosterone, norepinephrine, and antidiuretic hormone. Follow-up identified the development of hepatorenal syndrome and death. RESULTS: A higher percentage of patients with hyponatremia had decreased liver size, higher levels of plasma renin activity, and higher serum concentrations of aldosterone and norepinephrine. Renal insufficiency was detected in 31 of them (57%). Precipitating factors (hemorrhage or infections) were detected in 27 patients (50%). Incidence of hepatorenal syndrome and death were higher in patients with spontaneous development of hyponatremia (n = 23 [85%] and n = 25 [93%], respectively) than in patients with precipitating factors (n = 15 [56%] and n = 12 [44%], respectively) and cirrhotic controls (n = 1 [5%] and n = 5 [25%], respectively) (P<.001). Results of multivariate analysis showed that Child-Pugh index, presence of hepatocarcinoma, and serum concentration of urea were associated with mortality. After excluding those patients with kidney failure at the time of admission, only Child-Pugh index and norepinephrine concentrations were independent predictors of mortality. CONCLUSIONS: Hyponatremia is an alteration in patients with advanced liver disease. Although survival is significantly reduced in patients with spontaneous development of hyponatremia, a reduced sodium concentration cannot be considered as a independent predictor of the risk for death.

Progression of chronic hepatitis C to liver fibrosis and cirrhosis in patients coinfected with hepatitis C virus and human immunodeficiency virus.

To evaluate the factors associated with the evolution of chronic hepatitis C in human immunodeficiency virus (HIV)-infected patients, a cross-sectional analysis of 41 HIV-infected patients with chronic hepatitis C (known as "HIV-HCV [hepatitis C virus]-coinfected patients") and a control group of patients with chronic hepatitis C who did not have HIV infection (known as "non-HIV-infected patients") was performed. The association of histological variables with demographic parameters, HCV load and genotype, HIV load, CD4(+) T cell count, and response to highly active antiretroviral therapy (HAART) was evaluated. HIV-HCV-coinfected patients showed a significantly higher HCV load, more-advanced fibrosis, and a higher liver fibrosis progression rate (FPR) than did non-HIV-infected patients. A high HCV load and a low CD4(+) T cell count were associated with a higher FPR. The immune response induced by HAART did not influence this progression. In conclusion, HIV-HCV-infected patients, mainly such patients with a high HCV load and an immunodepressed state, have a higher FPR. An independent effect of the immune response to HAART was not evident.

Implication of inflammation-related cytokines in the natural history of liver cirrhosis.

BACKGROUND/AIMS: Increased serum concentrations of pro-inflammatory cytokines have been detected in patients with liver cirrhosis. However, their role in the natural history of cirrhosis and portal hypertension, in the absence of infection, and the prognostic significance of inflammation-related cytokines have not been reported. Our objective was the analysis of the prognostic value of inflammation-related cytokines in cirrhotic patients. PATIENTS AND METHODS: Serum concentrations of tumor necrosis factor (TNF-alpha) and its soluble receptors I and II and interleukin 6 (IL-6), as well as mean blood pressure, plasma renin activity, aldosterone, vasopressin and norepinephrine concentrations were determined in 72 cirrhotic patients (Child-Pugh score: A 50%, B 33.3%, C 16.7%), without any evidence of infection, and in 25 healthy controls. Patients were followed up for a median of 35.9 (range 6-60) months. RESULTS: Increased concentrations of soluble TNF receptors were detected in cirrhotic patients when compared with healthy controls. TNF receptors and IL-6 concentrations were both significantly more elevated in advanced phases of cirrhosis (Child-Pugh score C vs B and vs A). Sixteen patients died as a related consequence of liver cirrhosis. Multivariant analysis demonstrated that Child-Pugh score, mean blood pressure and serum levels of TNF receptor I were associated with mortality. CONCLUSIONS: In addition to the classic factors implicated in mortality (Child-Pugh score and hemodynamic parameters), alterations in inflammation-related components are of prognostic significance in cirrhotic patients.