ABSTRACT
ABSTRACT Background: There is a two-fold higher rate of failed colonoscopy secondary to inadequate bowel preparation among hospitalized versus ambulatory patients. Split-dose bowel preparation is widely used in the outpatient setting but has not been generally adapted for use among the inpatient population. Objective The aim of this study is to evaluate the effectiveness of split versus single dose polyethylene glycol bowel (PEG) preparation for inpatient colonoscopies and determine additional procedural and patient characteristics that drive inpatient colonoscopy quality. Methods: A retrospective cohort study was performed on 189 patients who underwent inpatient colonoscopy and received 4 liters PEG as either split- or straight-dose during a 6-month period in 2017 at an academic medical center. Bowel preparation quality was assessed using Boston Bowel Preparation Score (BBPS), Aronchick Score, and reported adequacy of preparation. Results: Bowel preparation was reported as adequate in 89% of the split-dose group versus 66% in the straight-dose group (P=0.0003). Inadequate bowel preparations were documented in 34.2% of the single-dose group and 10.7% of the split-dose group (P<0.001). Only 40% of patients received split-dose PEG. Mean BBPS was significantly lower in the straight-dose group (Total: 6.32 vs 7.73, P<0.001). Conclusion: Split-dose bowel preparation is superior to straight-dose preparation across reportable quality metrics for non-screening colonoscopies and was readily performed in the inpatient setting. Interventions should be targeted at shifting the culture of gastroenterologist prescribing practices towards use of split-dose bowel preparation for inpatient colonoscopy.
RESUMO Contexto: Há uma taxa duas vezes maior de colonoscopia com falha secundária ao preparo intestinal inadequado entre pacientes hospitalizados versus ambulatoriais. O preparo intestinal em dose dividida é amplamente utilizado em ambulatório, mas geralmente não foi adaptado para uso entre a população hospitalar. Objetivo: O objetivo deste estudo é avaliar a eficácia da preparação do intestino de polietilenoglicol (PEG) em dose única versus doses separadas para colonoscopias hospitalares e determinar características adicionais do procedimento e do paciente que promovam a qualidade da colonoscopia do paciente internado. Métodos Um estudo de coorte retrospectivo foi realizado em 189 pacientes que foram submetidos a colonoscopia hospitalar e receberam 4 litros de PEG como dose dividida ou direta durante um período de 6 meses em 2017 em um centro médico acadêmico. A qualidade do preparo intestinal foi avaliada usando-se o Boston Bowel Preparation Score (BBPS), o Aronchick Score, e relatório sobre a adequação do preparo. Resultados O preparo intestinal foi relatado como adequado em 89% do grupo de dose dividida versus 66% no grupo de dose direta (P=0,0003). Preparações intestinais inadequadas foram documentadas em 34,2% do grupo de dose única e 10,7% do grupo de dose dividida (P<0,001). Apenas 40% dos pacientes receberam PEG em dose fracionada. O BBPS médio foi significativamente menor no grupo de dose direta (total: 6,32 vs 7,73, P<0,001). Conclusão O preparo intestinal em dose dividida é superior ao preparo de dose única em todas as métricas de qualidade relacionadas para colonoscopias sem triagem e foi adequadamente realizado no ambiente de internação. As intervenções devem ser direcionadas para mudar a cultura das práticas de prescrição de gastroenterologistas para o uso de preparação intestinal em dose dividida para colonoscopia hospitalar.
ABSTRACT
Objective:To analyze and interpret the literature on intestinal preparation during colonoscopy in the elderly in China, and explore the research hotspots and development frontiers in this field, so as to provide theoretical reference for relevant institutions and researchers.Methods:Bibliometrics CiteSpace Ⅴ software was used to search CNKI, Wanfang Database, VIP, Chinese biomedical journal database, Chinese biomedical literature database from January 1, 2000 to April 30, 2022, and then statistical analysis was made on the number of published papers, distribution of institutions and regions, authors, journals, funding, and the maps of high-frequency keywords, clustering, and cooperation of authors, institutions and burst words were drawn.Results:A total of 281 literatures were included, and the characteristics of intestinal preparation, the effect of intestinal preparation for colonoscopy and nursing intervention of intestinal preparation for colonoscopy in the elderly were extracted as the research focus.Conclusions:The visualization analysis showed the research hotspots and trend of intestinal preparation during colonoscopy in the elderly. Intestinal preparation and comprehensive nursing intervention are still the focus of future research, and the cooperation among researchers and quality of published literature should be improved based on the research hotspots in the future.
ABSTRACT
Objective:To investigate the effect of applying narrative therapy theory into game on improving the quality of bowel preparation in children, and to provide a basis for selecting nursing intervention methods before bowel preparation.Methods:This study was a quasi experimental study. Totally 62 children who took polyethylene glycol electrolyte dispersion for bowel preparation in Gansu Maternal and Child Health Hospital from January to December 2021 were included in this retrospective study. They were divided into control group with 28 cases and experimental group with 34 cases according to random number table method. The control group was given conventional bowel preparation and medication guidance, and the experimental group was given the intervention during bowel preparation by applying narrative therapy theory implanted games. The bowel preparation adequacy rate, complete medication taking rate and parental satisfaction of the two groups were observed and compared.Results:The bowel preparation adequacy rate and complete medication taking rate in the experimental group were 94.12% (32/34) and 52.94% (18/34), respectively, which were higher than 46.43% (13/28) and 10.71% (3/28) in the control group, and the differences were statistically significant ( χ2 = 15.23, 10.41, both P<0.01). According to the average BBPS score, the experimental group had better intestinal cleanliness compared to the control group (7.65 ± 1.07 vs 6.07 ± 1.41, t = -4.87, P<0.01), the difference was statistically significant. 97.06% (33/34) of the parents in the experimental group expressed satisfaction, which was higher than 64.29% (18/28) in the control group, and the difference was statistically significant ( χ2 = 12.74, P<0.05). Conclusions:By applying the narrative therapy theory implanted games, the complete taking of high-dose bowel cleasing agent can be promoted and the quality of bowel preparation can be improved, which is worth suggesting as a nursing intervention method for bowel preparation.
ABSTRACT
Abstract Background: The accuracy of diagnosis and the safety of treatment in colonoscopy depends largely on the quality of bowel cleansing. This study aimed to compare the efficacy and adverse reactions of Polyethylene Glycol (PEG) combined with lactulose with that of PEG alone in bowel preparation before colonoscopy. Methods: The authors searched a number of databases including EMBASE, MEDLINE, Cochrane Library, and China Academic Journals Full-text Database. The authors screened according to literature inclusion and exclusion criteria, assessed the quality of the included literature, and extracted the data. The meta-analysis of included literature used RevMan 5.3 and Stata 14.0 software. Results: A total of 18 studies, including 2274 patients, were enrolled. The meta-analysis showed that PEG combined with lactulose had a better efficacy (OR = 3.87, 95% CI 3.07‒4.87, p = 0.000, and I2 = 36.2% in the efficiency group; WMD = 0.86, 95% CI 0.69‒1.03, p = 0.032 and I2 = 0% in the BBPS score group) in bowel preparation for patients with or without constipation. Moreover, PEG combined with lactulose had fewer adverse reactions, including abdominal pain (OR = 1.42, 95% CI 0.94‒2.14, p = 0.094), nausea (OR = 1.60, 95% CI 1.13‒2.28, p = 0.009) and vomiting (OR = 1.77, 95% CI 1.14‒2.74, p = 0.011), than PEG alone. No significant reduction in the incidence of abdominal distention was observed. Conclusion: PEG combined with lactulose may be a better choice for bowel preparation before colonoscopy compared with PEG alone.
ABSTRACT
The quality of colonoscopy diagnosis and treatment is closely related to bowel cleansing. At present, polyethylene glycol electrolyte powder is the most widely used bowel cleaning regimen at home and abroad, but its intake is large, which reduces the compliance of patients. In recent years, many reports on the application of new bowel cleansing have emerged abroad. In contrast, the application of bowel cleanser in China is still relatively single, which has large room for improvement. At present, we need to solve the problem of developing a new bowel cleanser suitable for Chinese people to improve patient tolerance and bowel cleaning effect.
ABSTRACT
Objective:To investigate the influencing factors for inadequate bowel preparation of colonoscopy.Methods:A total of 677 patients who underwent colonoscopy at Peking Union Medical College Hospital from December 2021 to January 2023 were recruited, and all patients underwent standardized bowel preparation by using 3 L polyglycol electrolyte powder with fractional dose. The quality of bowel preparation was assessed by Boston bowel preparation scale, and the influencing factors for inadequate bowel preparation were analyzed by logistic regression analysis.Results:The rate of inadequate bowel preparation was 31.5% (213/677). Among the patients with inadequate bowel preparation, 85.4% (182/213) inadequate bowel preparation was only in proximal colon, 14.1% (30/213) was in both proximal and distal colon, and 0.5% (1/213) was only in distal colon. Inadequate bowel preparation in distal colon and total colon were combined into inadequate bowel preparation in distal colon. The results of logistic regression analysis showed that inadequate bowel preparation in proximal colon was more likely to occur in men ( P=0.001, OR=2.253, 95% CI: 1.399-3.629), outpatients ( P<0.001, OR=4.175, 95% CI: 2.410-7.231), those with no family history of colorectal cancer ( P=0.001, OR=2.117, 95% CI: 1.365-3.284), and diagnostic colonoscopy ( P=0.003, OR=1.978, 95% CI: 1.261-3.102). And spinal disease ( P=0.044, OR=7.430, 95% CI: 1.051-52.511), outpatients ( P<0.001, OR=135.577, 95% CI: 29.135-630.883),non-compliance of dietary requirements ( P=0.006, OR=4.772, 95% CI: 1.576-14.453), adverse reaction during bowel preparation ( P=0.015, OR=4.341, 95% CI: 1.329-14.179), no family history of colorectal cancer ( P=0.003, OR=7.110, 95% CI: 1.912-26.438), and poor last stool character ( P=0.001, OR=25.922, 95% CI: 3.779-177.832) were risk factors for inadequate bowel preparation in distal colon. Conclusions:The inadequate bowel preparation of colonoscopy mainly occurs in proximal colon, and the risk factors for the inadequate bowel preparation vary in different colonic segments. Therefore, the specific interventions should be performed according to the character of different colon segments to improve the quality of bowel preparation.
ABSTRACT
Objective:To explore the value of linaclotide combined with compound polyethylene glycol electrolytes powder (PEG) for bowel preparation for colonoscopy.Methods:A randomized and single blind prospective clinical study was conducted in patients who intended to receive colonoscopy at the Department of Gastroenterology in Shenzhen Hospital, Southern Medical University from June 2021 to August 2021. One hundred and fifty-two patients in the experimental group were treated with 580 μg linaclotide + 2 L PEG, and 152 patients in the control group were treated with 3 L PEG. The bowel preparation effects including Boston bowel preparation scale (BBPS) score, bubble score and lesion detection rate, and safety (adverse events) were compared between the two groups.Results:The total BBPS scores were 9 (8, 9) in the experimental group, and 9 (9, 9) in the control group with no significant difference ( Z=0.141, P=0.888). The bubble scores were 1 (1, 2) in the experimental group, and 1 (1, 1) in the control group with no significant difference ( Z=1.788, P=0.074). There was no significant difference in detection rate of lesions between the experimental group and the control group [37.50% (57/152) VS 33.55% (51/152), χ2=0.517, P=0.472]. There was no significant difference in safety including incidence of nausea [7.24% (11/152) VS 13.16% (20/152), χ2=2.910, P=0.088], vomiting [2.63% (4/152) VS 7.24% (11/152), χ2=3.436, P=0.064], abdominal distension [7.89% (12/152) VS 11.84% (18/152), χ2=1.331, P=0.249] and abdominal pain [2.63% (4/152) VS 4.61% (7/152), χ2=0.849, P=0.357] between the experimental group and the control group. Conclusion:Linaclotide combined with PEG for colonoscopic bowel preparation reduces drinking water volume. The cleaning effect and safety are comparable to using 3 L PEG. It can be recommended for bowel preparation for colonoscopy.
ABSTRACT
Objective:To establish a nomogram to evaluate the adequacy of bowel preparation before colonoscopy and to guide clinical decision-making.Methods:A total of 1 023 valid questionnaires from subjects who underwent diagnosis and treatment of colonoscopy at the digestive endoscopy center, Xiangya Hospital, Central South University from September 2020 to March 2021 were finally returned. The contents of the questionnaire mainly included the clinical characteristics, defecation habits, the number of defecation and the time of the last defecation after taking the medicine and the self-assessment results of bowel preparation before colonoscopy. Subjects' bowel preparation was graded with the Boston bowel preparation scale (BBPS) by a designated endoscopist in a single blinded method. Multivariate analyse was used to explore the influencing factors for bowel preparation adequacy, and a nomogram was drawn accordingly.Results:Based on BBPS scores, bowel preparation of 674 subjects were adequate and 349 were inadequate. Multivariate analyse identified the number of defecation per week ( OR=1.649,95% CI:1.233-2.204, P=0.001), the number of defecation after medication ( OR=3.963, 95% CI: 1.851-8.485, P<0.001), the time of the last defecation after medication ( OR=5.151, 95% CI: 1.152-23.037, P=0.032), and self-assessment of bowel preparation before examination ( OR=8.284, 95% CI: 2.042-33.601, P=0.003) were influencing factors for the adequacy of bowel preparation for colonoscopy. The area under the receiver operating characteristic curve of assessment of colonoscopic bowel preparation adequacy with nomogram visualization according to influencing factors was 0.913, optimal cutoff value was 0.824, the sensitivity was 0.746, and the specificity was 0.971 under the internal validation cohort. Conclusion:The nomogram based on the number of defecation per week, the number of defecation after medication, the time of the last defecation after medication, and self-assessment of bowel preparation before examination could evaluate the adequacy of bowel preparation before colonoscopy, which is worthy of application.
ABSTRACT
Objetivo: Evaluar las complicaciones posoperatorias y la evolución clínica en pacientes sometidos a colectomías y anastomosis con dos estrategias preoperatorias, preparación mecánica (PMC) y preparación mecánica con antibióticos orales (PMC+AO). Materiales y Método: Estudio retrospectivo, con un total de 216 pacientes, 149 fueron del grupo PMC y 67 del PMC+AO. Variables estudiadas: características demográficas, intervención quirúrgica, localización anastomótica, fuga anastomótica (FA), infección del sitio operatorio (ISO), tránsito intestinal posoperatorio, infección por Clostridium difficile (CD) y estadía hospitalaria. Para el análisis estadístico se realizaron modelos bivariados y multivariados. Resultados: La FA fue más frecuente en el grupo PMC (7,38% vs. 0%, p = 0,011). En colectomías del lado izquierdo, la diferencia más marcada en las FA de ambos grupos fue en anastomosis del recto medio, sin casos en el grupo PMC+AO (0% vs. 50%, p = 0,019). En colectomías derechas, la FA fue similar para ambos grupos. Hubo más ISO en el grupo PMC (4,7% vs. 0%, p = 0,037). La recuperación del tránsito intestinal fue más rápida para el grupo PMC+AO, determinando menor estadía hospitalaria (3,98 días vs. 6,39 días, p = 0,001). El grupo PMC+AO se asoció a mayor tasa de colitis por CD (4,48% vs. 0,67%, p = 0,008). Discusión y Conclusión: El uso de la preparación intestinal con antibióticos orales podría ayudar a prevenir la FA en las colectomías izquierdas y evitar las ISO, favoreciendo la recuperación del tránsito intestinal, reduciendo la estadía hospitalaria. La asociación a CD debe examinarse en estudios más amplios.
Aim: To evaluate postoperative complications and clinical evolution in patients undergoing colectomies and anastomosis with two preoperative strategies, mechanical bowel preparation alone (MBP) and mechanical bowel preparation with oral antibiotics (MBP+OA). Materials and Method: Retrospective study, with defined inclusion and exclusion criteria. Variables studied: preoperative demographic characteristics, surgical intervention, anastomotic location, anastomotic leakage (AL), surgical site infection (SSI), postoperative intestinal transit, Clostridium difficile (CD) infection and hospital stay. Statistical analysis, bivariate and multivariate models were performed. Results: 216 patients studied, 149 were MBP group and 67 MBP+OA group. The group MBP had higher rates of AL (7.38% vs. 0%, p = 0.011). For left-sided colectomies, AL rate in both groups had a higher difference in the middle rectum, with no cases in the MBP+OA group (0% vs. 50%, p = 0.019). For right colectomies, the AL rates were similar in both groups. SSI was higher in MBP group (4.7% vs. 0%, p = 0.037). The bowel transit recovery was faster for MBP+OA group, determining less hospital stay (3.98 days vs. 6.39 days, p = 0.001). The group MBP+OA had a higher rate of CD colitis, 4.48% (p = 0.008). Discussion and Conclusion: These results suggest that preoperative oral antibiotic with mechanical bowel preparation could help to prevent anastomotic leaks in left-sided colectomies, also avoid surgical site infection, favoring the recovery of postoperative bowel transit, reducing hospital stay. The association to CD should be examined in larger studies.
ABSTRACT
La preparación intestinal se ha utilizado en cirugía de colon y recto por una variedad de razones, se cree que un colon limpio facilita la manipulación del intestino, permite el paso y disparo de engrapadoras quirúrgicas y permite la colonoscopia intraoperatoria, si es necesario. Sin embargo, el aspecto más estudiado y debatido de la preparación intestinal es su papel en la reducción de la morbilidad quirúrgica, es decir, las infecciones del sitio quirúrgico (ISQ). La cirugía de colon y recto tiene una de las tasas más altas de ISQ reportadas para todos los tipos de cirugía electiva, con revisiones recientes que muestran tasas que varían del 5,4% al 23,2%, con una media ponderada del 11,4%. (1). La preparación mecánica del intestino (PMI) se usó como un medio para disminuir la concentración bacteriana intraluminal con la esperanza de reducir las tasas de infección. Eventualmente, se agregaron antibióticos no absorbibles a las preparaciones intestinales para reducir aún más el contenido bacteriano intestinal(AU)
Bowel preparation has been used in colon and rectal surgery for a variety of reasons. A clean colon is thought to facilitate bowel manipulation, enable passage and firing of surgical staplers, and allow for intraoperative colonoscopy, if needed. The most studied and debated aspect of bowel preparation, however, is its role in reducing surgical morbidity, namely surgical site infections(SSIs). Colon and rectal surgery has among the highest rates of SSIs reported for all types of elective surgery, with recent reviews demonstrating rates varying from 5.4% to 23.2%, with a weighted mean of 11.4%(AU)
Subject(s)
Rectum/surgery , Colonoscopy , Colon/surgery , Surgical Wound Infection , Antisepsis , Morbidity , Colitis, IschemicABSTRACT
Objective:To investigate the effect of “Internet+Healthcare” combined with traditional education on the quality of bowel preparation for colonoscopy.Methods:A double-blind randomized parallel controlled trial was conducted. A total of 660 patients who underwent colonoscopy from August 2020 to August 2021 were enrolled. The patients were randomly assigned to receive “Internet+Healthcare” education combined with traditional education (study group, n=330 cases) or the traditional education alone (control group, n=330).The Boston bowel preparation scale, the qualified rate of bowel preparation and the adenoma detection rate of the two groups were compared. The factors affecting bowel preparation were determined by multivariate logistic regression analysis. Results:The Boston bowel preparation scale (6.1±1.1 vs. 5.3±1.2, t=-9.18, P<0.001), the qualified rate of bowel preparation [93.5% (300/321) vs. 75.8% (244/322), χ2=38.58, P<0.001], and the adenoma detection rate [39.3%(126/321) vs. 30.4%(98/322), χ2=5.51, P=0.019] in the study group were significantly higher than those in the control group. The factors related to qualified bowel preparation were female gender ( OR=2.19, 95 %CI:1.33-3.59, P=0.002), no hypertension ( OR=1.91, 95 %CI:1.17-3.12, P=0.010), diarrhea ( OR=4.84, 95 %CI:1.22-19.24, P=0.025), and “Internet+Healthcare” combined with traditional education ( OR=4.79, 95 %CI:2.81-8.16, P<0.001).The factors related to unqualified bowel preparation were no colonoscopy history ( OR=0.34, 95 %CI:0.20-0.56, P<0.001) and no diabetes ( OR=0.44, 95 %CI:0.24-0.80, P=0.008). Conclusions:Compared with traditional education, patients who received “Internet+Healthcare” education combined with traditional education have high quality of bowel preparation and high adenoma detection rate in colonoscopy. To obtain qualified bowel preparation for colonoscopy attention should be paid to factors affecting bowel preparation quality.
ABSTRACT
OBJECTIVES@#To investigate the influencing factors for the quality of bowel preparation before colonoscopy in children and the association of the interval from the last administration of laxative to the start of colonoscopy (shortly referred to as waiting time) with the quality of bowel preparation.@*METHODS@#A retrospective analysis was performed for the children who were admitted to the Department of Gastroenterology, Children's Hospital of Nanjing Medical University, from January to November 2020, and received bowel preparation with polyethylene glycol electrolyte powder combined with diet control before colonoscopy. According to the score of Boston bowel preparation scale, they were divided into two groups: adequate bowel preparation group (n=337) and inadequate bowel preparation group (n=30). Related data were collected from the children in both groups, including general information, possible influencing factors for the quality of bowel preparation, adverse reactions associated with bowel preparation, duration of colonoscopy, and postoperative diagnosis. Univariate and multivariate analyses were used to explore the influencing factors for the quality of bowel preparation.@*RESULTS@#The univariate analysis showed that age, body weight, and waiting time were associated with inadequate bowel preparation (P<0.05). The multivariate analysis showed that older age (OR=2.155, 95%CI: 1.087-4.273, P=0.028) and longer waiting time (OR=1.559, 95% CI: 1.191-2.041, P=0.001) were independent risk factors for inadequate bowel preparation. The receiver operating characteristic (ROC) curve analysis showed that the cut-off value of waiting time was 5.5 hours in determining whether bowel preparation was adequate or not, with a sensitivity of 90.0%, a specificity of 50.7%, and an area under the ROC curve of 0.708. After grouping based on waiting time, it was found that the incidence rate of inadequate bowel preparation in the ≥5.5 hours group was significantly higher than that in the <5.5 hours group [14.0% (27/193) vs 1.7% (3/174), P<0.001].@*CONCLUSIONS@#For children who use polyethylene glycol electrolyte powder combined with diet control for bowel preparation, older age is an independent risk factor for inadequate bowel preparation before colonoscopy, which may be associated with an insufficient dose of polyethylene glycol in older children. Longer waiting time is also an independent risk factor for inadequate bowel preparation, and it is recommended that the waiting time should not exceed 5.5 hours.
Subject(s)
Child , Humans , Cathartics , Colonoscopy , Diet , Electrolytes , Polyethylene Glycols/adverse effects , Powders , Retrospective StudiesABSTRACT
Resumo Objetivo: avaliar o efeito da educação aprimorada realizada por enfermeiros no preparo intestinal adequado e na taxa de intubação cecal. Método: estudo prospetivo, quasi-experimental e comparativo com abordagem quantitativa. Os pacientes no grupo de intervenção (n=150) receberam a educação aprimorada e telefonemas para lembrá-los do procedimento. O grupo de controle (n=156) recebeu as instruções padrão da clínica por escrito. As taxas de preparo intestinal adequado e outros indicadores da qualidade da colonoscopia foram comparadas entre os grupos. Resultados: as pontuações obtidas na Boston Bowel Preparation Scale e a taxa de preparo intestinal adequado foram maiores no grupo de intervenção do que no grupo de controle (6,76±2,1 vs. 5,56±2,4, p=0,000, e 80% vs. 69,2%, p=0,031). A taxa de intubação cecal foi mais alta no grupo de intervenção (80% vs. 67,3%, p=0,012). A taxa de intubação cecal malsucedida devido ao preparo intestinal inadequado foi de 0% no GI, enquanto que o GC obteve uma taxa de 17,6%. Além disso, a taxa de biópsia foi maior no grupo de intervenção (28% vs. 13,3%, p=0,002). Conclusão: a educação do paciente aprimorada e realizada por enfermeiros aumenta as taxas de preparo intestinal adequado e, consequentemente, as taxas de intubação cecal. Para alcançar os padrões de qualidade de colonoscopia recomendados nas diretrizes, recomendamos que a educação do paciente inclua diferentes ferramentas de treinamento e seja realizada por profissionais da saúde.
Abstract Objective: to evaluate the effect of nurse-performed enhanced patient education sessions on adequate bowel preparation and cecal intubation rates. Method: a prospective, quasi-experimental, comparative study with a quantitative approach. The intervention group (n=150) received education enhanced by a visual presentation and reminder calls. The control group (n=156) received the clinic's standard written instructions. Adequate bowel preparation rates and other colonoscopy quality indicators were compared between the groups. Results: Boston Bowel Preparation scale scores and adequate bowel preparation rates were higher in the intervention group than in the control group (respectively, 6.76±2.1 vs. 5.56±2.4, p=0.000, and 80% vs. 69.2%, p=0.031). The cecal intubation rates were higher in the intervention group (80% vs. 67.3%, p=0.012). Due to inadequate bowel preparation, unsuccessful cecal intubation rates were 0% in the intervention group and 17.6% in the control group. Biopsy rates were higher in the intervention group (28% vs. 13.3%, p=0.002). Conclusion: the nurse-performed enhanced patient education sessions increase adequate bowel preparation rates and, in parallel, cecal intubation rates. To reach the colonoscopy quality standards recommended in the guidelines, it is suggested that patient education be supported by different training tools and given by health professionals.
Resumen Objetivo: evaluar el efecto de la educación perfeccionada realizada por enfermeros en la preparación intestinal adecuada y en las tasas de intubación cecal. Método: estudio prospectivo, casi experimental y comparativo, con abordaje cuantitativo. El grupo de intervención (n=150) recibió la educación perfeccionada y llamadas telefónicas recordatorias. El grupo de control (n=156) recibió las instrucciones estándar de la clínica por escrito. Las tasas de preparación intestinal adecuadas y otros indicadores de la calidad de la colonoscopia fueron comparadas entre los grupos. Resultados: las puntuaciones obtenidas en la Boston Bowel Preparation Scale y las tasas de preparación intestinal adecuadas fueron en el grupo de intervención mayores que en el grupo de control (6,76±2,1 vs. 5,56±2,4, p=0,000, y 80% vs. 69,2%, p=0,031, respectivamente). Las tasas de intubación cecal fueron mayores en el grupo de intervención (80% vs. 67,3%, p=0,012). La tasa de intubación cecal fracasada debido a la preparación intestinal inadecuada fue de 0% en el GI, en cuanto que el GC obtuvo una tasa de 17,6%. Además de eso, las tasas de biopsia fueron mayores en el grupo de intervención (28% vs. 13,3%, p=0,002). Conclusión: la educación del paciente perfeccionada y realizada por enfermeros aumenta las tasas de preparación intestinal adecuadas y, consecuentemente, las tasas de intubación cecal. Para alcanzar los estándares de calidad de colonoscopia recomendados en las directrices, recomendamos que la educación del paciente sea apoyada por diferentes herramientas de entrenamiento y realizada por profesionales de la salud.
Subject(s)
Humans , Male , Female , Cathartics , Cecum , Patient Education as Topic , Prospective Studies , Colonoscopy , Education, Nursing, ContinuingABSTRACT
Objective:To explore the influencing factors of bowel preparation quality in hospitalized elderly patients, and to find the appropriate waiting time from the end of bowel preparation to the beginning of colonoscopy.Methods:Baseline and clinical data of elderly patients over 60 years old who underwent colonoscopy in the Tenth People′s Hospital, Tongji University from February 2021 to August 2021 were collected. Multivariate analysis was used to screen the factors that might affect the quality of bowel preparation in hospitalized elderly patients. Patients were grouped according to waiting time before colonoscopy. After eliminating confounding factors using propensity matching analysis, the difference of bowel preparation quality among groups was compared.Results:251 patients were included in the study. Multivariate analysis revealed that, hypertension ( OR=3.530, 95% CI 1.295-9.618), chronic constipation ( OR=3.302,95% CI 1.132-9.632), dietary compliance ( OR=0.161, 95% CI 0.070-0.371), medication and drinking water compliance ( OR=0.167, 95% CI 0.070-0.397), exercise compliance after medication ( OR=2.245, 95% CI 1.040-4.845), The frequency of defecation after medication ( OR=0.446, 95% CI 0.308-0.647) and waiting time ( OR=0.537, 95% CI 0.387-0.745) were important factors affecting the quality of bowel preparation in hospitalized elderly patients ( P<0.05). There were differences in bowel preparation quality between groups of waiting times. The overall quality of bowel preparation in 120-180 min group was significantly better than that in 241-300 min group, 301-360 min group and>360 min group ( P<0.05). The overall quality of bowel preparation in 181-240 min group was better than that in >360 min group ( P<0.05). There were no significant differences among other groups( P>0.05). The scores of cecum and ascending colon were the best in 120-180 min group, and the cleanliness of descending colon, sigmoid colon and rectum was significantly higher in 241-300 min group, 301-360 min group and > 360 min group. The scores of descending colon, sigmoid colon and rectum showed that the intestinal preparation quality of 181-240 min group was better than that of 301-360 min group and > 360 min group. Conclusions:The best examination time for elderly patients is about 180 minutes after bowelpreparation. Medical workers should flexibly guide the medication time to ensure that patients are in the best clean state of intestinal tract during examination.
ABSTRACT
Objective:To compare the efficacy of oral sulfate solution (OSS) and polyethylene glycol (PEG) electrolyte powder for colonoscopy bowel preparation.Methods:A total of 283 randomized patients from 9 centers in China taking OSS ( n=143) or PEG ( n=140) using two-day split bowel preparation regimen received colonoscopy and assessment. The primary index was the bowel preparation success rate [global Boston bowel preparation scale (BBPS)≥ 6 by independent assessment center]. Secondary indices included BBPS global and segmental scores, investigator satisfaction (5-point Likert scale) with the quality of bowel preparation, patient satisfaction assessed by questionnaires, and patient tolerance assessed by Sharma scale. Compliance and safety were compared between the two groups. Results:The bowel preparation success rates were 100.0% for OSS and 99.3% for PEG [adjusted difference 0.7% (95% CI: -5.3% - 6.7%), P<0.001 for non-inferiority]. The BBPS global score in OSS group was significantly higher than that in PEG group (8.1 VS 7.7, P<0.001). The segment BBPS scores were also higher in OSS group than those in PEG group for all 3 segments (right colon: 2.4 VS 2.3, P=0.002; transverse colon: 2.8 VS 2.7, P=0.018; left colon: 2.8 VS 2.7, P=0.007). Investigator Likert score in the OSS group was significantly higher than that in the PEG group (2.6 VS 2.3, P<0.001). There was no significant difference in compliance between OSS and PEG, except for the second dose (90.9% VS 82.6%, P=0.039). There was no significant difference in patient satisfaction, Sharma score or proportion of patients with tolerance-related symptoms between the two groups. Safety was comparable between the two groups, and all adverse events were mild to moderate. Conclusion:OSS has comparable efficacy with PEG, with higher BBPS scores in all segments, better investigator satisfaction, better compliance in split dose, and comparable patient tolerance and safety.
ABSTRACT
Objective:To evaluate the efficacy and safety of lactulose combined with polyethylene glycol for bowel preparation before colonoscopy in patients of different risks.Methods:A total of 208 patients undergoing colonoscopy were enrolled, including 108 high-risk and 100 low-risk patients. The high-risk patients were divided into group A (54 taking lactulose + polyethylene glycol) and group B (54 taking polyethylene glycol), and the low-risk patients were divided into group C (49 taking lactulose + polyethylene glycol) and group D (51 taking polyethylene glycol). The Boston bowel preparation score, cecal intubation time, withdrawal time, the detection rate of colonic polyps and adenoma, and the incidence of adverse reactions were observed.Results:Among the high-risk patients, the Boston bowel preparation score and adenoma detection rate in group A [(6.35±1.15) scores, 46.3%] were significantly higher than those in group B [(5.76±0.89) scores, 22.2%, both P<0.05], and the first defecation interval in group A was significantly shorter than that in group B [(1.20±0.85) h VS (3.29 ± 2.93) h, P<0.05]. There was no significant difference in adequate bowel preparation rate, polyp detection rate, frequency of defecation or incidence of adverse reactions between group A and B. In the low-risk patients, the first defecation interval in group C was significantly shorter than that in group D [(1.65 ± 1.35) h VS (3.42 ± 2.64) h, P<0.05], and the incidence of adverse reactions was significantly lower than that in group D (44.9% VS 64.7%, P<0.05). There was no significant difference in adequate bowel preparation rate, Boston bowel preparation score, adenoma detection rate, polyp detection rate or frequency of defecation between group C and D. Conclusion:For the high-risk patients, the effect of lactulose combined with polyethylene glycol for bowel cleansing is better than that of traditional polyethylene glycol in the improvement of the Boston bowel preparation score, adenoma detection rate, and the first defecation interval. For low-risk patients, lactulose combined with polyethylene glycol regimen has few advantages over traditional polyethylene glycol regimen.
ABSTRACT
Background: Mechanical bowel preparation (MBP) before elective resection of left colon cancer remains controversial. We propose that the protective effect of MBP is dependent on its combination with chemical preparation by oral antibiotics.Methods: Medical data of adult patients with left colon cancer who underwent elective resection at Sohag University Hospital (August 2016-March 2019) were reviewed. Anastomotic leak (AL), surgical site infections (SSI), postoperative morbidity and mortality were compared among patients who preoperatively received MBP followed by chemical preparation with oral antibiotics (MBP and OABx group) versus another group of preoperative MPB alone (MBP group).Results: Forty-two patients with left colon adenocarcinoma were enrolled, 21 per group. Overall, sigmoid colon was the most common site of left sided colon cancer (76%). Malignant lesions were found in proximal sigmoid in 19 (45%), rectosigmoid in 13 (31%), descending colon in 8 (19%) and splenic flexure in 2 (5%) patients. Dukes’ classification was A in 6 (14%), B in 19 (45%) and C in 17 (41%) patients. Compared with MBP, MBP and OABx group showed significantly lower rates of anastomotic leak (3 patients (14%) versus 1 (5%) respectively, p<0.05) and surgical site and intraabdominal infections (7 patients (33%) versus 2 (10%), p<0.05). MBP and OABx group exhibited lesser grades of postoperative complications (p<0.05) and shorter hospital stay (p<0.05). Postoperative mortality occurred only in the MBP group.Conclusions: Combined mechanical-chemical bowel preparation prior to elective resection of left colon cancer confers superior clinical outcome regarding anastomotic leak, surgical site infections and overall postoperative complications.
ABSTRACT
Background: Bowel preparation is important for improving the effectiveness and positivity rate of colonoscopy. At present, all laxative drugs used in clinical medicine have certain shortcomings and limitations. Exploring ideal bowel preparation drug has important clinical value. Aims: To compare the effectiveness of lactulose and polyethylene glycol electrolyte in bowel preparation before colonoscopy. Methods: A total of 150 patients underwent colonoscopy from June 2019 to November 2019 at the Second Affiliated Hospital of Baotou Medical College were enrolled and randomly divided into the lactulose group and the polyethylene glycol electrolyte group, and the laxatives were taken in two stages. The patient's basic information, subjective feelings and adverse reactions during bowel preparation, the stool frequency and the last stool consistency were collected. The score of cleanliness and foam of each segments of intestine were estimated. Results: No significant differences in gender, age, BMI, education level, stool consistency and frequency were found between lactulose group and polyethylene glycol electrolyte group. Stool frequency in Stage 1 and the total stool frequency in lactulose group were significantly higher than those in polyethylene glycol electrolyte group (P<0.05), however, cleanliness score of descending colon was significantly lower (P<0.05). The taste score was significantly lower in lactulose group than in polyethylene glycol electrolyte group (P<0.05), and the incidence of thirst was significantly higher in lactulose group (P<0.05). Correlation analysis showed that cleanliness of descending colon, sigmoid colon were negatively correlated with stool frequency in Stage 1 (P<0.05), cleanliness of rectum was negatively correlated with total stool frequency (P<0.05). Conclusions: Lactulose has good application value in bowel preparation before colonoscopy, and its taste is better than polyethylene glycol electrolyte. Evaluating the stool frequency in Stage 1 and total stool frequency can optimize the quality of bowel preparation and enhance the cleanliness of various segments of intestine.
ABSTRACT
As the gold standard for the diagnosis and treatment of colorectal diseases, colonoscopy plays an important role in the screening of colorectal cancer. The quality of bowel preparation is the prerequisite for the success of colonoscopy. Elderly patients are at increased risk of complications during colonoscopy and bowel preparation. The risk-benefit balance of colonoscopy in elderly patients should be carefully considered. This article reviewed the optimization regimen of bowel preparation for colonoscopy in elderly patients.
ABSTRACT
OBJECTIVES: Our goal was to compare the hydrogen potential (pH) and residual gastric volume (RGV) of patients undergoing colonoscopy after 3 and 6 hours of colon preparation with mannitol. METHODS: We described a prospective randomized trial with a 50:50 allocation rate of two distinct times of colonoscopy after colon preparation with 10% mannitol. We included outpatients aged over 18 years, with no history of gastric surgeries and an American Society of Anesthesiologists (ASA)-rated anesthetic risk below III. Colonoscopy was performed after upper digestive endoscopy at two different times: 3 versus 6-hour after mannitol ingestion. During upper gastrointestinal endoscopy, we measured RGV and evaluated pH with a digital pH meter. Clinical trials.gov: 71123317.9.3001.0065 RESULTS: We randomized a total of 100 participants to the 3 and 6-hour groups, with the patients in the 6-hour group being younger and presenting a higher body mass index (BMI). The intervention did not result in any statistically significant differences between the two groups, neither for the RGV (p=0.98) or the pH (p=0.732). However, the subgroup of patients with diabetes mellitus showed statistically significant higher RGV values in the 3-hour group. CONCLUSION There was no difference between RGV and pH values at 3 versus 6-hour after bowel preparation with mannitol, except for RGV in diabetic patients at 3 hours. As prolonged fasting protocols may result in adverse events such as dehydration and electrolyte imbalance, we can infer that colonic preparation with mannitol in shorter fasting periods, such as 3 hours, can be adopted safely and routinely.