RESUMO
OBJECTIVES: Accurate identification of adverse events after colonoscopy is essential for quality assurance in colorectal cancer (CRC) screening. Review of medical records is labour intensive as adverse events are infrequent. The object of this study was to investigate the accuracy of claims data in identifying adverse events after colonoscopy in CRC screening. DESIGN: Cross-sectional, retrospective. SETTING AND PARTICIPANTS: Males and females aged 50-74 years were randomised to once-only sigmoidoscopy or biennial faecal immunochemical test in a CRC screening trial at two screening centres in Norway. Participants in the present study underwent follow-up colonoscopy from 2012 to April 2020 after initial positive screening test. We reviewed medical records for adverse events within 30 days following 11 205 colonoscopies. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome of the study was to assess the sensitivity of claims data from the Norwegian Patient Registry to identify lower gastrointestinal bleeding using emergency contact International Statistical Classification of Diseases and Related Health Problems 10th Revision diagnostic code sets under two definitions: a stringent definition (codes explicitly identifying bleeding) and a broad definition (including suggestive codes). Secondary outcome measures included the sensitivity to identify perforation using a stringent and a broad definition. Additionally, we assessed whether incorporating procedure codes and non-emergency contacts improved accuracy. RESULTS: 87 cases of lower gastrointestinal bleeding and eight perforations were confirmed. Sensitivity for bleeding differed between the centres (p<0.001). At centre 1, sensitivity was 48.6% (95% CI 31.9% to 65.6%) using the stringent and 89.2% (95% CI 74.6% to 97.0%) using the broad definition. At centre 2, sensitivity was 36.0% (95% CI 22.9% to 50.8%) and 50.0% (95% CI 35.5% to 64.5%), respectively. Combined sensitivity for perforation was 37.5% (95% CI 8.5% to 75.5%) using the stringent and 62.5% (95% CI 24.5% to 91.5%) using the broad definition. Adding procedure codes and non-emergency contacts slightly increased sensitivity but increased false positives. CONCLUSIONS: Use of claims data underestimated adverse event rates following colonoscopy. Difference in coding practice across hospitals underscores the need for standardised reporting in screening programmes. TRIAL REGISTRATION NUMBER: NCT01538550.
Assuntos
Colonoscopia , Neoplasias Colorretais , Detecção Precoce de Câncer , Hemorragia Gastrointestinal , Revisão da Utilização de Seguros , Humanos , Estudos Transversais , Noruega/epidemiologia , Masculino , Feminino , Pessoa de Meia-Idade , Colonoscopia/efeitos adversos , Neoplasias Colorretais/diagnóstico , Idoso , Detecção Precoce de Câncer/efeitos adversos , Detecção Precoce de Câncer/métodos , Estudos Retrospectivos , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/epidemiologia , Perfuração Intestinal/etiologia , Perfuração Intestinal/epidemiologia , Sangue OcultoRESUMO
RATIONALE: Colonoscopy is a widely used diagnostic and therapeutic procedure with a low risk of serious adverse events. Acute bilateral lower-limb paralysis following colonoscopy is extremely rare. Acute limb ischemia due to thromboembolism from abdominal aortic aneurysm (AAA) is a vascular emergency that requires prompt diagnosis and intervention. This is the report of a unique case of acute limb ischemia due to thromboembolism associated with infrarenal AAA following colonoscopy. This case report aims to raise clinical awareness of the potential risk of thromboembolic complications after colonoscopy. Further, this case suggests a potential mechanism in which hemodynamic alterations or periprocedural factors, such as dehydration associated with bowel preparation, may have contributed to thrombus dislodgement and subsequent embolization. PATIENT CONCERNS: A 67-year-old man with acute paraplegia was referred to our emergency department following colonoscopy. DIAGNOSES: The patient was diagnosed with acute thromboembolism associated with an infrarenal AAA, resulting in paraplegia following colonoscopy, as confirmed by computed tomography angiography. INTERVENTIONS: The patient underwent emergent aorto-bifemoral bypass, bilateral lower extremity thrombectomy, and left femoral artery-to-distal superficial femoral artery bypass surgery. OUTCOMES: Although revascularization was technically successful, the patient died of massive reperfusion injury. LESSONS: Acute paraplegia caused by thromboembolism from an infrarenal AAA following colonoscopy is extremely rare but potentially fatal. Awareness of this potential adverse event after colonoscopy is critical to avoid severe outcomes and improve patient prognoses.
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Aneurisma da Aorta Abdominal , Colonoscopia , Paraplegia , Tromboembolia , Humanos , Aneurisma da Aorta Abdominal/complicações , Aneurisma da Aorta Abdominal/cirurgia , Masculino , Idoso , Colonoscopia/efeitos adversos , Paraplegia/etiologia , Tromboembolia/etiologia , Tromboembolia/complicações , Tromboembolia/cirurgia , Evolução Fatal , Doença AgudaRESUMO
BACKGROUND: Prophylactic complete closure of mucosal defects after resection of gastrointestinal lesions is key to reducing delayed bleeding, but complete closure for large defects can be challenging with conventional through-the-scope clips (TTSC). The introduction of a TTSC with anchor prongs offers ability to approximate margins of larger defects. OBJECTIVE: The study objective was to evaluate prophylactic complete closure after polypectomy, endoscopic mucosal resection (EMR), or endoscopic submucosal dissection (ESD) in large (≥ 20 mm) nonpedunculated colorectal lesions (LNPCLs). METHODS: We conducted a multicenter, single-arm prospective cohort study of the TTSC with anchor prongs for prophylactic closure after EMR/polypectomy or ESD for LNPCLs. Patients were followed for 30 days after the index procedure. The primary outcome was the rate of complete closure of the defect. Other outcomes were the rate of delayed (postprocedural) bleeding, and rate of serious adverse events (SAEs). RESULTS: One hundred five eligible patients were enrolled. Ninety-nine (94.3%) defects had complete closure, with rates of 93.0% (80/86) for EMR/polypectomy and 100.0% (19/19) for ESD procedures. Delayed bleeding occurred in 2 (1.9%) patients by 30 days after the index procedure. Eight (7.6%) patients had ≥ 1 SAE, including bleeding (2 patients), perforation (1), microperforation (1), aspiration (1), nausea (1), and post-polypectomy syndrome (1). CONCLUSION: Prophylactic use of the TTSC with anchor prongs achieved a 94% rate of complete defect closure after EMR/polypectomy or ESD for LNPCLs. The rate of delayed bleeding after closure in this cohort was 1.9%. A prospective RCT is ongoing to further evaluate the clinical outcomes of a TTSC with anchor prongs used for prophylactic closure. TRIAL REGISTRATION: ClinicalTrials.gov number, NCT05653843.
Assuntos
Pólipos do Colo , Colonoscopia , Neoplasias Colorretais , Ressecção Endoscópica de Mucosa , Hemorragia Pós-Operatória , Instrumentos Cirúrgicos , Técnicas de Fechamento de Feridas , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pólipos do Colo/cirurgia , Pólipos do Colo/patologia , Colonoscopia/efeitos adversos , Colonoscopia/instrumentação , Colonoscopia/métodos , Neoplasias Colorretais/cirurgia , Neoplasias Colorretais/patologia , Ressecção Endoscópica de Mucosa/efeitos adversos , Ressecção Endoscópica de Mucosa/instrumentação , Ressecção Endoscópica de Mucosa/métodos , Hemorragia Pós-Operatória/prevenção & controle , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/epidemiologia , Estudos Prospectivos , Instrumentos Cirúrgicos/efeitos adversos , Resultado do Tratamento , Técnicas de Fechamento de Feridas/instrumentação , Técnicas de Fechamento de Feridas/efeitos adversosRESUMO
BACKGROUND AND AIMS: Partial resection of colon polyps induces submucosal fibrosis, making subsequent resection attempts more difficult. Some consider that partially resected lesions require specialized techniques such as endoscopic submucosal dissection, full-thickness resection, or surgery. We investigated whether traditional endoscopic resection methods were safe and effective. METHODS: We report results of endoscopic resection of previously partially resected colorectal polyps by means of conventional resection methods (snare resection with or without injection and/or avulsion) and compare outcomes with lesions without previous partial resection. This is a retrospectively evaluated assessment of a prospectively collected database at a single tertiary academic center. RESULTS: From August 12, 2019, to May 14, 2024, 1101 referred colorectal lesions underwent conventional resection and at least 1 surveillance colonoscopy. The last follow-up colonoscopy included in the study was performed on July 19, 2024. Out of the 1101 lesions, 220 had previous partial resection by means of snare, hot biopsy forceps, or surgical transanal excision. All of these 220 lesions were successfully resected with the use of conventional methods, and recurrence rates at first follow-up (8.2%) were similar to lesions without previous resection (7.8%; P = .889), as was the perforation rate (0.5% vs 0.3%). Compared with lesions with no previous resection, previously partially resected lesions were more often resected by means of electrocautery (94.1% vs 64.2%; P < .001), and required the cap technique (36.4% v. 17.4%; P < .001) and avulsion (65.5% v 28.8%; P < .001). CONCLUSIONS: While specialized resection techniques are increasingly advocated to manage fibrotic colorectal lesions, we demonstrate conclusively that experts can successfully and safely manage previously partially resected colorectal lesions with the use of conventional techniques.
Assuntos
Pólipos do Colo , Colonoscopia , Neoplasias Colorretais , Ressecção Endoscópica de Mucosa , Humanos , Masculino , Feminino , Pólipos do Colo/cirurgia , Pólipos do Colo/patologia , Estudos Retrospectivos , Pessoa de Meia-Idade , Colonoscopia/métodos , Colonoscopia/efeitos adversos , Centros de Atenção Terciária , Idoso , Ressecção Endoscópica de Mucosa/métodos , Ressecção Endoscópica de Mucosa/efeitos adversos , Neoplasias Colorretais/cirurgia , Neoplasias Colorretais/patologia , Recidiva Local de Neoplasia/epidemiologia , Reoperação , Complicações Pós-Operatórias/epidemiologia , Perfuração Intestinal/epidemiologia , Perfuração Intestinal/etiologia , Resultado do TratamentoRESUMO
INTRODUCTION: Colonoscopy is one of the most commonly performed endoscopic procedures and is generally considered low-risk. However, when adverse events (AEs) occur, they can present significant challenges in clinical practice. The aim of this study was to estimate the global incidence of colonoscopy-related AEs. METHODS: We searched multiple databases for population-based studies reporting the incidence of colonoscopy-related AEs up to December 22, 2024. Meta-analyses were conducted for both gastrointestinal and nongastrointestinal AEs. Subgroup analyses were performed based on factors including World Health Organization region, publication year, sample size, data collection method, and study design. RESULTS: Among the 30,818 records identified, 82 population-based studies from 24 countries were included, involving a total of 38.5 million colonoscopies. The estimated incidence per 10,000 colonoscopies was as follows: gastrointestinal AEs, including perforation (5.15; 95% confidence interval [CI] 4.19-6.34, I2 = 99%), bleeding (18.39; 95% CI 13.53-24.99, I2 = 100%), and splenic injury (0.61; 95% CI 0.43-0.85, I2 = 93%); nongastrointestinal AEs, including cardiovascular events (52.11; 95% CI 18.67-144.59, I2 = 100%), respiratory events (4.26; 95% CI 0.73-24.99, I2 = 100%), and deaths related to colonoscopy (0.18; 95% CI 0.10-0.34, I2 = 74%). Subgroup analyses yielded partially divergent findings. The majority of the included studies exhibited a low to moderate risk of bias. DISCUSSION: This comprehensive meta-analysis provides valuable insights into the global incidence of colonoscopy-related AEs and underscores the imperative need for continuous efforts to enhance the safety of this procedure.
Assuntos
Colonoscopia , Humanos , Colonoscopia/efeitos adversos , IncidênciaRESUMO
Colonoscopy-associated rectal perforation is rare but serious. Although a colostomy or laparotomy is frequently required, primary repair may suffice in selected cases. A 70-year-old woman with prior laparoscopic low anterior resection underwent surveillance colonoscopy and EMR. During retroflexion, a 3 cm perforation was noted 10 cm from the anal verge, which was located 7 cm proximal to the previous anastomosis at 3 cm from the anal verge. Endoscopic clipping failed due to the size and location of the lesion. No intraperitoneal contamination was evident. A transanal endoscopic approach (TAMIS) was employed using an Alexis® wound protector and insufflation. The defect was closed using 3-0 Vicryl under direct intraluminal visualization. Laparoscopic inspection confirmed no leakage. A transanal drain was left in place.The postoperative course was uneventful. Inflammatory marker levels remained stable, and the patient was discharged on postoperative day 9 without complications. Transanal endoscopic repair is a viable, minimally invasive alternative for iatrogenic rectal perforations without gross contamination, potentially avoiding colostomy and improving the postoperative quality of life.
Assuntos
Colonoscopia , Perfuração Intestinal , Reto , Cirurgia Endoscópica Transanal , Humanos , Feminino , Idoso , Colonoscopia/efeitos adversos , Perfuração Intestinal/cirurgia , Perfuração Intestinal/etiologia , Reto/lesões , Reto/cirurgia , Cirurgia Endoscópica Transanal/métodosRESUMO
BACKGROUND AND AIM: Alterations in gut microbiota after colonoscopy have been observed. Moreover, there is limited consensus regarding the impact of the procedure on gut microbiota. We aim to evaluate whether the probiotic can treat gut microbiota and abdominal symptoms disturbance after colonoscopy. METHODS: A total of 301 participants were randomized into probiotic and placebo groups. The probiotic group received live combined Bacillus Subtilis and Enterococcus Faecium-coated capsules (0.5 g thrice daily for 28 days) postcolonoscopy. The placebo group was given placebo in an identical manner. Fecal samples were collected from participants and symptoms were reported. The intestinal microbiota composition was assessed using 16S rRNA sequencing. RESULTS: Notable differences in α (p = 0.011) and ß (p < 0.001) diversity were observed after colonoscopy. Bowel cleansing resulted in the proliferation of Pseudomonas and Klebsiella in the placebo group. However, the probiotic group exhibited a marked enrichment in beneficial probiotics such as Lactobacillales (p = 0.002). Gastrointestinal symptom rating scale (GSRS) showed significant improvements in the probiotic group within the initial week (p = 0.005). Patients in the probiotic group who exhibited symptoms experienced fewer days of abdominal discomfort postcolonoscopy (p = 0.034). Additionally, they exhibited enhanced glucose metabolism (p = 0.040) and a notable increase in Lactobacillales (p = 0.009). In the probiotic group, α and ß diversities differed significantly in patients without GSRS improvements, and the concentration of Bacteroides was significantly elevated (p = 0.004). CONCLUSION: Gut microbiota was altered after colonoscopy, especially the proliferation of potentially pathogenic bacteria. Administering probiotics postcolonoscopy leads to beneficial alterations in gut microbiota and associated metabolic pathways, while abdominal discomfort symptoms were improved early.
Assuntos
Colonoscopia , Microbioma Gastrointestinal , Probióticos , Humanos , Probióticos/administração & dosagem , Colonoscopia/efeitos adversos , Microbioma Gastrointestinal/efeitos dos fármacos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Fezes/microbiologia , Dor Abdominal/prevenção & controle , Dor Abdominal/etiologia , Adulto , Método Duplo-Cego , Enterococcus faecium , Resultado do TratamentoRESUMO
BACKGROUND: Emerging blood tests may improve colorectal cancer (CRC) screening uptake and outcomes but are less sensitive for advanced precancerous lesions than some currently recommended tests. We examine whether these tests meet expectations for the US Preventive Services Task Force (USPSTF) recommendation. METHODS: A decision-analytic model that informed USPSTF was replicated and used to estimate the lifetime benefits (averted CRC cases and deaths, life-years gained [LYG]), burdens (required screening tests and colonoscopies), and harms (colonoscopy-related complications) for annual, biennial, or triennial blood testing through age 45-75 years vs a benchmark of recommended and contemporary stool-based strategies, with colonoscopy screening as the reference. Base-case analyses assumed 100% adherence. Sensitivity analyses evaluated more realistic scenarios. RESULTS: Among benchmark strategies, colonoscopy screening had the most benefit, with an estimated 30 CRC deaths averted, 356 LYG, 4270 colonoscopies required, and 15 complications per 1000 adults; stool-based strategies resulted in 81% to 88% of LYG for colonoscopy, 6829-19â476 screening tests, 1523-1880 colonoscopies, and 9-10 complications. By comparison, annual blood testing resulted in 85% to 87% of LYG for colonoscopy and an intermediate number of screenings, colonoscopies, and complications. Biennial and triennial blood testing provided 57% to 72% of LYG for colonoscopy but resulted in net population benefit under plausible scenarios for increased utilization vs existing strategies. CONCLUSIONS: The estimated benefits, burdens, and harms of annual blood testing are within the range of current CRC screening strategies. Biennial and triennial testing should also be considered for recommendation given the potential for increased utilization and net population benefit.
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Neoplasias Colorretais , Detecção Precoce de Câncer , Programas de Rastreamento , Sangue Oculto , Humanos , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/sangue , Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/prevenção & controle , Pessoa de Meia-Idade , Detecção Precoce de Câncer/métodos , Detecção Precoce de Câncer/efeitos adversos , Idoso , Colonoscopia/efeitos adversos , Feminino , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/efeitos adversos , Técnicas de Apoio para a Decisão , Estados Unidos/epidemiologiaRESUMO
Colonoscopy procedures are common, low-risk, outpatient procedures generally performed under monitored anesthesia care. Air emboli typically occur with patients with larger high-risk surgical procedures at critical points during the case. Asystole events can occur in the operating room for various reasons based on the surgical procedure or patient comorbidities. This case report describes asystole at the end of a colonoscopy that led to the presumptive differential diagnosis of air embolism.
Assuntos
Colonoscopia , Embolia Aérea , Parada Cardíaca , Humanos , Colonoscopia/efeitos adversos , Diagnóstico Diferencial , Embolia Aérea/diagnóstico , Embolia Aérea/etiologia , Parada Cardíaca/etiologia , Parada Cardíaca/diagnóstico , Enfermeiros AnestesistasRESUMO
BACKGROUND: Bacterial contamination during colonoscopy is a significant concern, yet few studies have evaluated bacterial aerosols. This study aimed to determine whether covering the biopsy hole check valve with enzymolysis gauze (refers to sterile gauze soaked in a multi-enzyme cleaning solution) reduces bacterial air pollution in endoscopy rooms. AIM: To evaluate the efficacy of an enzymolysis gauze cover in reducing bacterial aerosols from the biopsy valve. METHODS: This prospective, single-blind trial included 80 patients undergoing elective diagnostic colonoscopy. During the procedure, the biopsy hole check valve was either covered or left uncovered with enzymolysis gauze. Air samples (100 L) were collected at a distance of 30 cm from the biopsy hole check valve and approximately 140 cm above the floor using a percussive air sampling instrument. Gram-positive bacteria were cultured on standard 90 mm colimycin nalidixic agar blood plates. The primary outcome measures were bacterial load and species identification. RESULTS: Covering the biopsy hole check valve with enzymolysis gauze reduced bacterial load near the check valve from 50 colony-forming unit (CFU)/m3 [interquartile range (IQR): 30-80] to 20 CFU/m3 (IQR: 10-20). At the end of the procedure each day, covering the valve also decreased bacterial load in the endoscopy room from 35 CFU/m3 (IQR: 33-85) to 10 CFU/m3 (IQR: 5-10). The predominant bacteria identified were Gram-positive cocci. CONCLUSION: Applying enzymolysis gauze to cover the biopsy hole check valve significantly reduces bacterial aerosol contamination in endoscopy rooms during colonoscopy.
Assuntos
Microbiologia do Ar , Colonoscopia , Contaminação de Equipamentos , Humanos , Estudos Prospectivos , Colonoscopia/instrumentação , Colonoscopia/efeitos adversos , Masculino , Feminino , Pessoa de Meia-Idade , Biópsia/instrumentação , Biópsia/efeitos adversos , Método Simples-Cego , Contaminação de Equipamentos/prevenção & controle , Idoso , Aerossóis , Carga Bacteriana , Adulto , Quartos de PacientesRESUMO
BACKGROUND: Cold snare polypectomy (CSP) is increasingly popular because of its safety and convenience, but it is currently recognized as the best way to remove diminutive polyps (≤ 5 mm). CSP for nonpedunculated polyps ≥ 10 mm in size has not been well examined. We evaluate the safety and efficacy of CSP for benign-looking intermediate nonpedunculated polyps. METHODS: We reviewed intermediate nonpedunculated polyps that resected by CSP from 2021 to 2023. The lesions were carefully observed with high-definition white-light (HD-WL) endoscopy and magnifying endoscopy with narrow-band imaging (ME-NBI) before CSP. We analyzed lesion characteristics, complete resection, cold snare defect protrusion (CSDP), histopathology, adverse events, and recurrence/residual. We compared the differences between lesions 10-14 mm in size and lesions ≥ 15 mm in size. We also analyzed risk factors for recurrence/residual and incomplete resection. RESULTS: We retrospectively analyzed 631 lesions in 482 patients. The average size was 11.1 ± 1.3 mm, of which 3.3% were ≥ 15 mm. The CSDP rate was 34.1%. The rates of post-polypectomy bleeding (PPB), delayed post-polypectomy bleeding (DPPB), post-polypectomy perforation (PPP) and delayed post-polypectomy perforation (DPPP) were 0.3%, 0.2%, 0.0% and 0.0%, respectively. Two lesions were carcinoma in situ (0.3%) and seven lesions were high-grade dysplasia (HGD) (1.1%). The histological complete resection rate (the horizontal margin) was 94.3%. There were significant differences in sex, histological complete resection rate, and CSDP rate between lesions 10-14 mm in size and lesions ≥ 15 mm in size. CSDP was the only risk factor for incomplete resection of the polyps. CONCLUSION: CSP of intermediate nonpedunculated polyps is safe and effective. The recurrence/residual rate and the adverse event rate were low.
Assuntos
Pólipos do Colo , Colonoscopia , Humanos , Pólipos do Colo/cirurgia , Pólipos do Colo/patologia , Masculino , Feminino , Estudos Retrospectivos , Pessoa de Meia-Idade , Colonoscopia/métodos , Colonoscopia/efeitos adversos , Idoso , Resultado do Tratamento , Adulto , Hemorragia Pós-Operatória/epidemiologia , Hemorragia Pós-Operatória/etiologia , Imagem de Banda Estreita , Fatores de Risco , Complicações Pós-Operatórias/epidemiologiaRESUMO
Colonoscopy is a cornerstone of colorectal cancer screening with a low incidence of complications such as bleeding and perforation. Infectious complications such as liver abscesses are exceedingly rare. We report a case of a 72-year-old Sri Lankan man with a background of diabetes mellitus and diverticulosis who developed a pyogenic liver abscess (PLA) following an uncomplicated colonoscopy performed as part of the New Zealand bowel screening programme. The abscess was caused by Klebsiella pneumoniae, a pathogen commonly associated with such infections. He was successfully treated with broad-spectrum antibiotics and ultrasound-guided drainage. This case raises the possibility of a rare association between colonoscopies and pyogenic liver abscesses, even in non-invasive procedures, particularly in high-risk patients, though direct causality cannot be established. We reviewed potential mechanisms and relevant literature in this case report.
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Colonoscopia , Infecções por Klebsiella , Klebsiella pneumoniae , Abscesso Hepático Piogênico , Humanos , Masculino , Idoso , Colonoscopia/efeitos adversos , Infecções por Klebsiella/etiologia , Infecções por Klebsiella/diagnóstico , Infecções por Klebsiella/terapia , Klebsiella pneumoniae/isolamento & purificação , Antibacterianos/uso terapêutico , Abscesso Hepático Piogênico/microbiologia , Abscesso Hepático Piogênico/etiologia , Abscesso Hepático Piogênico/terapia , Abscesso Hepático Piogênico/diagnóstico , Nova Zelândia , DrenagemRESUMO
Colonoscopy is a pivotal technique for screening and diagnosing colorectal diseases, particularly colorectal polyps and cancers. Early detection of lesions enables early diagnosis and treatment, thereby improving patient prognosis. The adequacy of bowel preparation is directly related to the quality and effectiveness of colonoscopy. However, the bowel cleansing process may disrupt the balance of gut microbiota, subsequently affecting the host's health status. Currently, there is a relative scarcity of reports on the specific impacts of different types of laxatives on gut microbiota. Therefore, this paper aims to deeply analyze and summarize the effects of various bowel preparations on gut microbiota and their potential adverse reactions following colonoscopy, providing a more comprehensive reference for the selection of bowel preparations in clinical practice.
Assuntos
Catárticos , Colonoscopia , Microbioma Gastrointestinal , Humanos , Colonoscopia/métodos , Colonoscopia/efeitos adversos , Microbioma Gastrointestinal/efeitos dos fármacos , Catárticos/efeitos adversos , Laxantes/efeitos adversosRESUMO
BACKGROUND: Endoscopic submucosal dissection (ESD) has emerged as an effective technique for the en bloc and curative removal of sizable colorectal tumors. Despite ESD's advantages over traditional surgery, its primary associated complications of perforation and hemorrhage pose significant challenges. Sedation-free ESD allows for real-time reporting of symptoms by patients, improving the identification and management of complications. This study aimed to evaluate the safety of sedation-free ESD. METHODS: A retrospective cohort study included patients undergoing sedation-free ESD for colorectal lesions at a tertiary center in Taiwan from 2018 to 2023. Patient demographics, lesion characteristics, procedure time, and clinical outcomes were collected. The primary outcome was safety as assessed via intraoperative complications (e.g., perforation or hemorrhage) and overall complication rates. Additional analyses included factors associated with perforation and management strategies (i.e., endoclips or surgical intervention) using univariate and multivariable logistic regression analyses. RESULTS: A total of 134 patients were included in the study. The mean patient age was 65.3 years, with an average lesion size of 3.6 ± 1.5 cm. ESD-associated perforation or hemorrhage occurred in 6.7% and 10.4% of cases, respectively, most of which were successfully managed with endoclips. Patients with hemorrhage-compared with those without-had significantly larger lesions (median: 4.7 cm versus 3 cm, p = 0.004). Multivariable analysis revealed no statistically significant associations between lesion characteristics and perforation. No delayed perforations were reported. CONCLUSIONS: Sedation-free ESD is a safe alternative to traditional sedated ESD for colorectal lesions. Real-time symptom reporting by patients enhances management of complications. In addition, precision application of endoclips ensures optimal perforation and hemorrhage control, improving patient outcomes and safety.
Assuntos
Colonoscopia , Neoplasias Colorretais , Ressecção Endoscópica de Mucosa , Complicações Intraoperatórias , Humanos , Estudos Retrospectivos , Feminino , Masculino , Ressecção Endoscópica de Mucosa/efeitos adversos , Ressecção Endoscópica de Mucosa/métodos , Idoso , Pessoa de Meia-Idade , Taiwan , Perfuração Intestinal/etiologia , Perfuração Intestinal/epidemiologia , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/epidemiologia , Resultado do Tratamento , Neoplasias Colorretais/cirurgia , Neoplasias Colorretais/patologia , Colonoscopia/efeitos adversos , Colonoscopia/métodos , Colo/cirurgia , Colo/patologiaRESUMO
BACKGROUND Bezold-Jarisch reflex (BJR) is a physiologic cardioinhibitory reflex, but its occurrence can lead to severe bradycardia and hypotension, or even cardiac arrest. Due to the rarity of its occurrence and the lack of awareness among most anesthesiologists, this clinical presentation may be mistaken for other adverse cardiovascular events, and effective preventive and curative measures may not be taken. CASE REPORT We report a case of cardiac arrest during a routine sedated colonoscopy. Following the arrest, the patient underwent cardiopulmonary resuscitation and received atropine and epinephrine. After 2 minutes of cardiopulmonary resuscitation, the patient's heart rate and blood pressure normalized, and he regained consciousness with no discomfort reported except for fatigue. We excluded organic pathology after a thorough systematic examination, and after discussion with our multidisciplinary team in the context of intraoperative hemodynamic alterations, it was concluded that intraoperative cardiac arrest was caused by BJR in this patient. The patient's clinical course - characterized by initial recurrent bradycardia with hypotension progressing to syncope or cardiac arrest - was more consistent with BJR than with typical vasovagal syncope. Prolonged fasting prior to sedated colonoscopy likely induced hypovolemia, and subsequent sedation further exacerbated peripheral vasodilation, collectively triggering BJR. The patient was discharged on day 5 after cardiac arrest, with no recurrence of syncope noted during a 4-month telephone follow-up. CONCLUSIONS This is the first reported case of BJR-induced cardiac arrest during sedated colonoscopy. It underscores the need for anesthesiologists to consider BJR in the differential diagnosis of recurrent bradycardia and hypotension, and to implement targeted interventions to mitigate the risk of associated severe complications.
Assuntos
Bradicardia , Colonoscopia , Sedação Processual , Parada Cardíaca , Complicações Intraoperatórias , Humanos , Colonoscopia/efeitos adversos , Parada Cardíaca/etiologia , Parada Cardíaca/terapia , Masculino , Bradicardia/etiologia , Complicações Intraoperatórias/etiologia , Sedação Processual/efeitos adversos , Pessoa de Meia-IdadeRESUMO
INTRODUCTION: Colonoscopy is an essential procedure for the early diagnosis of colorectal conditions; however, over 60% of patients undergoing non-sedated colonoscopy report moderate to severe pain. This study aims to investigate the central analgesic mechanisms of transcutaneous electrical nerve stimulation based on wrist-ankle acupuncture theory (TENS-WAA). A multimodal approach combining electroencephalography (EEG) and functional near-infrared spectroscopy (fNIRS) will be employed to assess pain-related brain activity, with artificial intelligence applied to model the relationship between objective neurophysiological signals and subjective pain experience. METHODS: This is a single-centre, randomised, double-blind, controlled trial involving 60 patients undergoing colonoscopy without anaesthesia. Participants will be randomly allocated (1:1) to either an electrical stimulation group receiving TENS-WAA or a sham stimulation group. EEG and fNIRS data will be acquired before, during and after the procedure. The primary outcome is the analysis of EEG-fNIRS signals to characterise cerebral responses associated with pain modulation. Secondary outcomes include patient-reported pain using the Visual Analogue Scale (VAS), total colonoscopy duration and the correlation between EEG-fNIRS indicators and VAS scores. A deep learning framework will be used to enhance pain prediction accuracy. ETHICS AND DISSEMINATION: This study has received ethical approval from the Ethics Committee of Changhai Hospital, Shanghai (approval reference CHEC2025-006), and has been registered at ClinicalTrials.gov. Written informed consent will be obtained from all participants. Findings will be disseminated in peer-reviewed academic journals and at relevant scientific conferences, regardless of outcome, contributing to evidence-based, non-pharmacological pain management strategies. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov, NCT06813703.
Assuntos
Colonoscopia , Eletroencefalografia , Manejo da Dor , Estimulação Elétrica Nervosa Transcutânea , Humanos , Método Duplo-Cego , Colonoscopia/efeitos adversos , Colonoscopia/métodos , Estimulação Elétrica Nervosa Transcutânea/métodos , Espectroscopia de Luz Próxima ao Infravermelho , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição da Dor , Feminino , Masculino , Manejo da Dor/métodos , AdultoRESUMO
This meta-analysis of randomized controlled trials (RCTs) aimed to compare the risk of recurrence and adverse events (AEs) between cold snare polypectomy (CSP) and hot endoscopic mucosal resection (H-EMR) for large nonpedunculated colorectal polyps (LNPCPs).A systematic search of Medline, Embase, and Cochrane Library databases until August 2024 was performed for studies comparing recurrence, bleeding, and perforation rates between CSP and H-EMR for LNPCPs ≥15 mm. A random-effects meta-analysis, with heterogeneity measured with I2, was conducted to generate pooled risk ratios (RRs) with 95%CIs.Four RCTs comprising 1516 LNPCPs (766 CSP and 750 H-EMR) in 1442 patients were included in the quantitative analysis. CSP demonstrated a higher recurrence risk at first surveillance colonoscopy than H-EMR in the pooled analysis (22.6% vs. 10.8%; RR 1.98; 95%CI 1.22-3.21; P = 0.02; moderate certainty evidence), corresponding to a number needed to harm of 9. Regarding AEs, CSP demonstrated a 67% reduced risk of delayed bleeding (1.2% vs. 3.9%; RR 0.33; 95%CI 0.12-0.89; P = 0.03; high certainty evidence), corresponding to a number needed to treat of 37. Although CSP appeared to reduce the risk of intraprocedural bleeding (10.0% vs. 19.8%; RR 0.30, 95%CI 0-52 256, P = 0.42), the wide confidence interval from the random-effects model included 1. There were no intraprocedural or delayed perforations in the CSP group.CSP has nearly double the recurrence risk of H-EMR for LNPCPs; however, its superior safety profile may make it a preferable option for patients where procedural safety is prioritized over radicality, such as those with extensive co-morbidities.
Assuntos
Pólipos do Colo , Colonoscopia , Neoplasias Colorretais , Ressecção Endoscópica de Mucosa , Humanos , Ressecção Endoscópica de Mucosa/métodos , Ressecção Endoscópica de Mucosa/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Pólipos do Colo/cirurgia , Pólipos do Colo/patologia , Colonoscopia/métodos , Colonoscopia/efeitos adversos , Recidiva Local de Neoplasia/epidemiologia , Neoplasias Colorretais/cirurgia , Neoplasias Colorretais/patologia , Hemorragia Pós-Operatória/epidemiologia , Hemorragia Pós-Operatória/etiologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologiaRESUMO
INTRODUCTION: Colonoscopy is often associated with significant patient pain and anxiety. Virtual reality (VR) technology has been widely used to alleviate pain and anxiety in patients undergoing invasive surgeries. However, there is a lack of reliable evidence supporting its effectiveness in reducing pain and anxiety in patients undergoing colonoscopy. We aim to conduct a meta-analysis to investigate the effectiveness of VR in alleviating pain and anxiety in patients undergoing colonoscopy. METHODS AND ANALYSIS: We will search PubMed, EMBASE, Web of Science and the Cochrane Library from inception to August 2024 for randomised controlled trials evaluating VR interventions for patients undergoing colonoscopy, without language restrictions. Two reviewers will independently screen studies, extract data and assess the risk of bias using the Cochrane Risk of Bias tool. The primary outcomes will be patient-reported pain and anxiety. A meta-analysis will be performed using RevMan V.5.4, with subgroup and meta-regression analyses to explore potential heterogeneity. The certainty of the evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach. ETHICS AND DISSEMINATION: This systematic review does not require ethical approval, given that it will not directly utilize information from human participants-instead, the data to be used will be extracted from original studies. Additionally, this systematic review and meta-analysis has been registered with the International Prospective Register of Systematic Reviews (PROSPERO). Following the completion of the systematic review and meta-analysis, we intend to publish the study in an academic journal. PROSPERO REGISTRATION NUMBER: CRD42024580998.
Assuntos
Ansiedade , Colonoscopia , Manejo da Dor , Realidade Virtual , Humanos , Revisões Sistemáticas como Assunto , Ansiedade/terapia , Ansiedade/prevenção & controle , Ansiedade/etiologia , Metanálise como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Colonoscopia/psicologia , Colonoscopia/efeitos adversos , Projetos de Pesquisa , Manejo da Dor/métodosRESUMO
BACKGROUND AND AIMS: The use of glucagon-like peptide-1(GLP-1) receptor agonists has revolutionized the treatment of Type 2 diabetes mellitus and morbid obesity. They are known to slow gastric emptying and potentially increase the risk of pulmonary aspiration perioperatively. We aim to conduct a retrospective study to evaluate the risk of aspiration pneumonia in patients on GLP-1 receptor agonists undergoing colonoscopy. METHODS: A large research network (TriNetX LLC) comprising over 100 million patients was leveraged to obtain data from 2016 to 2024. Patients who underwent colonoscopy during the study period were divided into GLP-1 users and non-users. The primary outcomes were aspiration pneumonia and hospitalization following colonoscopy. The secondary outcomes were respiratory failure and the need for mechanical ventilation within 7 days of colonoscopy. RESULTS: Before propensity score matching, the study included 126 663 patients on GLP-1 agonists and 1 380 652 not on GLP-1 agonists. Propensity score matching resulted in balanced cohorts of 126 663 patients per group. After propensity score matching, the risk ratio for aspiration pneumonia in the GLP-1 agonist group was 0.70 (95% confidence interval, 0.50-0.98), suggesting a trend towards reduced risk and does not suggest increased risk of aspiration pneumonia. Similarly, no significant differences were observed in mechanical ventilation, respiratory failures, or hospitalization rates between the two groups. CONCLUSIONS: This large retrospective study shows no increased risk of aspiration pneumonia with GLP-1 agonist use, in patients undergoing screening colonoscopy. These findings suggest that minimally sedated gastroscopy prior to colonoscopy, routine GLP-1 agonist withholding, and overly restrictive fasting are not required.
Assuntos
Colonoscopia , Agonistas do Receptor do Peptídeo 1 Semelhante ao Glucagon , Pneumonia Aspirativa , Humanos , Masculino , Feminino , Estudos Retrospectivos , Pessoa de Meia-Idade , Colonoscopia/efeitos adversos , Pontuação de Propensão , Pneumonia Aspirativa/etiologia , Pneumonia Aspirativa/epidemiologia , Idoso , Diabetes Mellitus Tipo 2/tratamento farmacológico , Hospitalização/estatística & dados numéricos , Fatores de Risco , Respiração Artificial/estatística & dados numéricosRESUMO
Background: Post-colonoscopy syndrome is an emerging clinical entity characterised by the onset of gastrointestinal symptoms following a colonoscopy. The current management of this syndrome has not yet been established, although probiotics have been proposed. The therapeutic potential of a combination nutraceutical compound based on HBQ-Complex®, butyrate, and probiotics (Lactobacillus acidophilus, Bifidobacterium animalis, and Lactiplantibacillus plantarum) in this setting remains unknown. Methods: A retrospective, multicentre, observational study was conducted in adult patients undergoing colonoscopy in the absence of known gastrointestinal diseases, assessing the onset of upper and lower gastrointestinal symptoms post-colonoscopy immediately after the procedure (T0), at 2 weeks (T1), and 4 weeks (T2) thereafter, using a VAS (0-10). Two groups were analysed, one undergoing nutraceutical supplementation and a control group. Results: A total of 599 patients were included (64.9% receiving nutraceutical supplementation and 35% in the control group). Several variations were observed involving the treated group compared to the control for abdominal pain (59.9% vs. 33.3%), meteorism (64.9% vs. 35.1%), diarrhoea (46.9% vs. 19.5%), and bloating (59.3% vs. 26.7%) (p < 0.001 for all). Logistic regression analysis showed a reduction in constipation (OR: 3.344) and bloating (OR: 3.791) scores. Conclusions: Nutraceutical supplementation based on this combinational compound was associated with a reduction in gastrointestinal symptoms arising after colonoscopy, suggesting potential benefit in this setting. These findings pose a rationale for controlled prospective studies to confirm such evidence in broader clinical settings.