The efficacy of on-demand sedation colonoscopy: a STROBE-compliant retrospective cohort study.

BACKGROUND: Colonoscopy has been routinely performed with sedation. Previous studies showed that on-demand sedation colonoscopy is acceptable in patients. We aim to compare the clinical outcomes of patients undergoing colonoscopy with and without sedation. METHODS: A prospectively collected retrospective matched cohort study was performed. 290 consecutive patients who underwent colonoscopy without sedation were included into the study. Another 290 patients who underwent colonoscopy with sedation were then selected based on matched sex and age group distribution. Data were collected in a prospective database. Age, sex, race, and procedural variables were collected. Outcomes analyzed included adenoma detection rate, Boston bowel preparation scores, time spent in the recovery room, cecal intubation time, and presence of pain during colonoscopy. RESULTS: A total of 580 patients were included in the study. Of the 290 patients who underwent colonoscopy without sedation, 10 patients (3.45%) required sedation to be administered to complete the scope. Intention-to-treat analysis was performed. Multivariate analysis demonstrated that the administration of sedation was a significant predictor of prolonged recovery time (increase in 34.76 min, 95% CI 29.56-39.55, p < 0.001). Comparing the group who underwent colonoscopy without sedation to the group who underwent colonoscopy with sedation, there was no statistically significant difference in mean cecal intubation time (11.28 vs. 10.38 min, p = 0.129), adenoma detection rates (25.1 vs. 35.8%, p = 0.060), percentage of patients who experienced no pain at all during the procedure (93.5 vs. 93.5%, p = 1.000), and Boston bowel preparation scores (2.23 vs. 2.34, p = 0.370). CONCLUSIONS: Our data suggest that on-demand sedation colonoscopy can be performed in patients, with a significant decrease in time spent in the recovery room prior to discharge. Cecal intubation time, adenoma detection rates, and percentage of patients experiencing no pain at all during the procedure were similar in both groups of patients.

Perioperative and oncologic outcomes in young and octogenarian patients with colorectal cancer: a comparison at the extremes.

INTRODUCTION: In colorectal cancer (CRC), surgical outcomes in the young (< 50) and octogenarian populations are believed to be poor due to an aggressive phenotype in the former, and increased frailty in the latter. Given that age-related effects are inversely related between groups, we compared short- and long-term outcomes of young and octogenarian patients with CRC to determine the dominance of one age-related factor over another. METHODS: A prospectively collected database from 2015 to 2020 of all CRC was analyzed. Cases were divided into metastatic and non-metastatic groups. RESULTS: Among non-metastatic cases, there were 34 young and 113 octogenarian patients. Mean CEA was higher among octogenarians (11.2 vs 32.8 units/ml; p = 0.041). Octogenarians suffered from more comorbidities than younger counterparts, with increased rates of postoperative UTI (3.3% vs 10.3%; p = 0.246) and pneumonia (3.1% vs 8.8%; p = 0.331). There was no increased rate of reintervention or Clavien-Dindo scores. We noticed a statistically significant higher proportion of extramural vascular invasion (EMVI) (8.8% vs 32.3%; p = 0.003) among the young. When excluding octogenarians who had declined surgery, Kaplan-Meier analysis showed no difference in disease-free (p = 0.290) or overall survival (p = 0.111). Among metastatic cases, there were 21 young and 19 octogenarian patients. Young patients were treated more aggressively with chemotherapy (55.6% vs 12.5%; p = 0.040). There was however no difference in overall survival between groups (p = 0.610). CONCLUSIONS: Octogenarians may have more comorbidities, but can achieve similar surgical outcomes with younger patients. There is no reason to suspect a more aggressive phenotype in younger patients.

Endovascular treatment of cephalic arch stenosis in brachiocephalic arteriovenous fistulas: A systematic review and meta-analysis.

PURPOSE: The aim of this study is to appraise the current literature on the endovascular management options and their outcomes of cephalic arch stenosis in the setting of a failing brachiocephalic fistula for hemodialysis. METHODS: A systematic search of the literature was performed using PubMed, Embase, and Google Scholar from January 2000 to December 2017 in accordance with the PRISMA guidelines to investigate the outcomes of endovascular management of cephalic arch stenosis. Data from randomized controlled trials and observational studies, published in the English language, were extracted to determine pooled proportion of primary and secondary patency, using a random-effects meta-analysis. Subgroup analyses of stent grafts, bare metal stents, and percutaneous transluminal angioplasty outcomes were performed. RESULTS: Of the 125 total studies, 11 were included for analysis by consensus. Overall, 457 patients were reviewed and analyzed for primary and secondary patency rates at 6 and 12 months post-treatment. There was significantly higher primary patency at both 6 and 12 months in the stent graft group compared to those who received bare metal stents or percutaneous transluminal angioplasty (relative risk = 0.30-0.31, relative risk = 0.34-0.59, respectively; p < 0.01). Higher secondary patency rates were noted in the bare metal stents cohort compared to the percutaneous transluminal angioplasty cohort at 12 months (relative risk = 0.17, 95% confidence interval = 0.07-0.26; p < 0.01). CONCLUSION: This study demonstrated a significant benefit in using stent grafts in cephalic arch stenosis compared to bare metal stents or percutaneous transluminal angioplasty with higher primary and secondary patency rates.